ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-18-Yang

18-Yang_ASGE 2024 Esophageal Stricture

Pdf Summary

The document discusses the management of post-resection strictures, primarily focusing on esophageal strictures following wide-field endoscopic resections. Dr. Dennis Yang, an expert in Third Space Endoscopy, highlights the high incidence of esophageal strictures due to extensive mucosal defects and outlines various prophylactic methodologies.<br /><br />The pathophysiology of strictures involves inflammatory cell invasion, angiogenesis, collagen hyperplasia, and eventual fibrosis of the muscularis propria. Several strategies to prevent strictures have been explored, with mixed results. Steroid prophylaxis is one approach, applied in local or oral formulations, aiming to reduce the inflammatory response and collagen fiber formation. However, results vary significantly, with some studies reporting persistent high stricture rates, and others showing modest reductions.<br /><br />Esophageal stenting involves using Fully Covered Self-Expandable Metal Stents (FCSEMS) to maintain esophageal patency during healing. While potentially effective, this method is limited by patient discomfort, migration, occlusion, and serious complications.<br /><br />Other therapies include novel approaches like self-assembling peptide gels, which form a 3-D scaffold to promote tissue healing. Despite some promise, significant variability in results and lack of large-scale studies hinder definitive conclusions.<br /><br />Risk factors for esophageal strictures include patient age, location, resection circumference, and muscle injury. The document stresses the importance of avoiding circumferential resection when possible and highlights the need for prospective studies to refine prophylactic strategies.<br /><br />Dr. Dennis Yang’s approach includes applying self-assembling peptide gels, local steroids, and scheduled endoscopic procedures for strictures. The document concludes that although esophageal strictures are challenging and often unavoidable post-resection, more high-quality data is needed to improve prophylactic interventions.

Keywords

esophageal strictures

endoscopic resection

stricture management

Dr. Dennis Yang

Third Space Endoscopy

steroid prophylaxis

esophageal stenting

self-assembling peptide gels

risk factors

prophylactic strategies