GASTROENTEROLOGY ARTICLE OF THE WEEK
January 21, 2010
Siersema PD, de Wijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endosc 2009;70:1000-1012.
1. General recommendations in the management of benign esophageal strictures include
a. Dilation to a diameter of 20mm during the first session is recommended
b. Sequential dilation sessions to achieve desired diameter should be done every 4-6 weeks.
c. If repeated dilations fail, the next step is to try intralesional steroid injection
d. Totally covered plastic stents are not recommended for strictures in the proximal or distal esophagus due to migration risk
e. Stents placed for benign strictures should be removed in 4-8 weeks in most instances.
f. If a non-covered stent is used, repeat endoscopy is recommended at 4 week
intervals to assess for tissue overgrowth
True or False
2. Major complications from the placement of metal stents to treat benign esophageal strictures occur in 17% of patients
3. Balloon dilators are usually considered to be more effective than Savary dilators when dilating benign esophageal strictures
4. Stents have FDA approval for their use in the treatment of benign strictures
5. Intralesional injection of steroids is a technique that may reduce the frequency of dilations but requires further study.
6. Recurrence of stricture after removal of SEPs is as high as 90%
7. When using SEMs to treat benign strictures, a covered stent should be used to reduce the risk of migration
8. By convention, the initial dilation session should dilate the stricture to no more than 39F to 45F (13 to 15mm)
9. SEPs have less problem with tissue overgrowth, but more problems with stent migration