ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Sharma

Sharma_Complex Esophageal Strictures

Pdf Summary

Dr. Prateek Sharma, based in Kansas City, USA, provides tips for managing esophageal strictures in his document. He begins by identifying the etiology of strictures, which can include peptic injury, caustic injury, iatrogenic causes, anastomotic issues, radiation, and post-resection complications.<br /><br />To achieve success in managing esophageal strictures, Dr. Sharma suggests assessing the stricture by considering its etiology, duration, location, diameter, length, complexity, and characteristics. He emphasizes the importance of fluoroscopy and the ability to traverse the stricture with a scope.<br /><br />The document also discusses different methods of dilation, such as bougie dilators and balloon dilators, and notes that there is insufficient evidence to indicate that one method is superior to the other. Personal preference and tactile sensation may play a role in choosing the method of dilation.<br /><br />For refractory strictures, Dr. Sharma defines them as anatomic restrictions causing dysphagia without endoscopic evidence of inflammation. He suggests injecting steroids, such as triamcinolone acetate, as a potential treatment option, though results are inconsistent.<br /><br />The document also mentions the use of stents for managing strictures. Both fully covered self-expandable metal stents (FCSEMS) and biodegradable stents are discussed. Meta-analyses have shown a success rate of 40% in using stents for refractory benign esophageal strictures.<br /><br />The optimal duration of stent placement depends on the length of the stricture and its etiology. Stents may be left in place until inflammation is resolved, typically for at least 4-8 weeks.<br /><br />Complications associated with stent placement include pain, bleeding, perforation, migration, fistula, tumor ingrowth, and tumor overgrowth.<br /><br />The document provides tips for managing anastomotic and post-laryngectomy strictures, as well as Eosinophilic Esophagitis (EoE) strictures. Patient preparation, such as discontinuing anticoagulants, is recommended before dilation procedures.<br /><br />Dr. Sharma addresses the safety of dilation in EoE, stating that hemorrhage, post-procedure chest pain, and perforation are potential risks, but they occur relatively infrequently.<br /><br />Overall, Dr. Sharma's document offers valuable insights and recommendations for managing esophageal strictures, aiming to achieve successful treatment outcomes while minimizing complications.

Keywords

esophageal strictures

etiology

dilation methods

refractory strictures

steroid injection

stents

complications

anastomotic strictures

Eosinophilic Esophagitis

successful treatment outcomes