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World J Gastrointest Endosc. Dec 25, 2015; 7(19): 1318-1326
Published online Dec 25, 2015. doi: 10.4253/wjge.v7.i19.1318
Endoscopic incisional therapy for benign esophageal strictures: Technique and results
Jayanta Samanta, Narendra Dhaka, Saroj Kant Sinha, Rakesh Kochhar
Jayanta Samanta, Narendra Dhaka, Saroj Kant Sinha, Rakesh Kochhar, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Samanta J and Dhaka N contributed to literature search, first draft and final approval of the manuscript; Sinha SK contributed to conception, literature search, critical revision of manuscript and final approval of the manuscript; Kochhar R contributed to conception, literature search, critical revision of manuscript and final approval of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rakesh Kochhar, Professor of Gastroenterology, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh 160012, India. dr_kochhar@hotmail.com
Telephone: +91-981-5699565 Fax: +91-172-2744401
Received: June 29, 2015
Peer-review started: July 1, 2015
First decision: August 25, 2015
Revised: September 20, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: December 25, 2015
Abstract

Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy (EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki’s rings (SR) and anastomotic strictures (AS). Short segment strictures (< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment naïve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis (< 1 cm) with good safety profile and acceptable long term patency.

Keywords: Endoscopic incisional therapy, Esophageal strictures, Anastomotic strictures, Needle knife, Radial incision and cutting

Core tip: Benign esophageal strictures refractory to conventional balloon or bougie dilatation can be subjected to endoscopic incisional therapy. The technique entails the use of needle knife or scissors for radial incision and cutting off of the stenotic rim. Adjunctive therapies with balloon dilatation or intralesional steroids may be needed for prevention of re-stenosis. Current evidence suggests use of incisional therapy for refractory short segment (< 1 cm) anastomotic strictures and Schatzki’s rings with good safety profile and acceptable long term patency.