Video Tip: Self-dilation of Refractory Esophageal Stricture | May 2023-Self-dilation of Refractory Esophageal Stricture

Video Transcription

This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB.  Esophageal cell dilation is under-recognized and unfortunately under-utilized strategy for these refractory benign esophageal strictures.  This was a case series that we published from the Mayo Clinic. This was a single center review in which 52 patients underwent with refractory benign esophageal stricture.  So this could be radiation-induced, this could be lye-induced, or endotherapy-induced who are treated with self-dilation.  And as you can see, after a successful self-dilation procedure, the median pre-self-dilation EGDs  reduced from 9.5 to 0, and the median intervention-free interval increased to 417 days. So this is a very successful approach if it is utilized, and I would refer you to a very  nice review written by one of our colleagues in Mayo, Arizona, talking about the under-utilization of self-dilation. And of course, this is due to a variety of things.  There is lack of patient and provider awareness, there are lack of structured guidelines, lack of physician training, and of course, a paucity of high-quality research data.  And again, this is a program that one would have to set up, and this would be a multidisciplinary  program where you would have nurses, endoscopists, and the ability to teach patients. And this is a nice review article which we can post on the chat, wherein it goes through  what are the preparations that you would actually require. In this instance, patients would need a minimum diameter of about 13 to 14 millimeters.  They would need a teaching session where the physician would model the technique, and then you would pass a Maloney dilator up to the length at which the stricture is present.  And some of the tips that they mentioned would be to have a minimal luminal diameter of 12 millimeters before you start this education. You would use Maloney dilators.  You would start with dilation at least once a day or more frequently initially, and this would be a team approach where you would have the physician, you would have the nurse and  the patient, and have close follow-up, perhaps weekly initially and then monthly thereafter. And this is just a picture of a patient who has mastered this technique and typically  works very well for more proximal or mid-esophageal strictures, but I have used this very successfully even for distal esophageal strictures.  Thank you for watching. See you next time.

Video Summary

The video discusses the under-utilization of esophageal cell dilation as a treatment for refractory benign esophageal strictures. It highlights a case series from the Mayo Clinic where 52 patients with these strictures underwent self-dilation treatment, resulting in significant improvements. The median number of pre-treatment procedures reduced from 9.5 to 0, and the median time between interventions increased to 417 days. The video also mentions the factors contributing to the under-utilization of self-dilation, such as lack of awareness, guidelines, training, and research data. A multidisciplinary program would be required to implement this approach successfully. The video concludes with tips for the self-dilation technique and emphasizes the need for close follow-up.

Keywords

esophageal cell dilation

refractory benign esophageal strictures

self-dilation treatment

Mayo Clinic case series

under-utilization of self-dilation