Endoscopic incision for treatment of benign gastrointestinal strictures

ABSTRACT

Introduction

Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn’s disease or endoscopic treatments, etc.). Patients usually present with stricture-related symptoms such as vomiting, dysphagia, dyschezia, abdominal pain, which impair their quality of life. Endoscopic balloon dilation (EBD) is the first-line treatment for most of the benign strictures; however, long-term efficacy is suboptimal, and the recurrence rate can be up to 38%. Endoscopic incision (EI) was firstly reported for treatment of congenital membranous stricture, and then applied to other benign gastrointestinal strictures.

Area covered

In the present review, we provided a comprehensive review of EI for the treatment of benign gastrointestinal strictures, mainly focus on the technical details, indication, safety, and efficacy of EI. The present review is expected to provide tips for operators who are going to perform EI.

Expert opinion

EI can serve as an alternative method for treatment of gastrointestinal strictures, the best indications are congenital membranous stricture and short-segmental (<1 cm) anastomotic strictures refractory to EBD. EI may also be attempted for strictures induced by other reasons. Combination with other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.

KEYWORDS:

• Endoscopic incision
• benign gastrointestinal stricture
• esophageal stricture
• colorectal stricture
• refractory gastrointestinal stricture

Article highlights

• EI is an effective and safe method for treatment of benign gastrointestinal stricture.

• Congenital membranous stenosis and short-segmental (<1 cm) anastomotic strictures refractory to EBD are recommended indications for EI.

• EI can be an alternative for other benign gastrointestinal strictures failed EBD.

• Stricture with a length of >1 cm may be a predictor of re-stenosis after EI.

• Combination of EI and other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.