Comparison of endoscopic radial incision and Savary-Gilliard's bougie dilation in efficacy on refractory esophagogastric anastomosis strictures

Background: Among patients with a benign stricture in the upper gastrointestinal tract, those with esophagogastric anastomosis stricture (EAS) due to complications after esophagectomy for esophageal carcinoma comprise the majority. Dilation is the primary surgical treatment for EAS, but its short-term effect is not remarkable and its long-term effect is worse. Methods: We compared endoscopic radial incision (ERI) and Savary-Gilliard's bougie dilation (SGBD) for patients with refractory EAS, and evaluated overall efficacy and complications. Stooler's scale was used to grade the patients' dysphagia before surgery. The two groups were compared for the number of dilations or incisions, the degree of dilation of the EAS after surgery and postoperative complications, such as intraoperative bleeding (arteriopalmus bleeding requiring endoscopic intervention), postoperative bleeding (hematemesis, bloody stool or black stool), postoperative perforation (fistula formation confirmed by gastrointestinal radiography), and postoperative infection (including postoperative fever). Results: The Exp group had 15 markedly effectively treated patients, 7 effectively treated patients, and 3 ineffectively treated patients, while the numbers of these patients in the Obs group were 5, 6, and 10, respectively. Thus, the Exp group had a significantly higher total effective rate than the Obs group (88.0% vs. 52.4%, P<0.05). Patients treated by ERI had higher overall therapeutic effect, better swallowing symptom grade, and lower incidence of complications. Conclusions: Thus, ERI is superior to SGBD in efficacy and safety for treating refractory EAS.