Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video)

Background: There is no effective treatment for gastroesophageal anastomotic strictures that are refractory to repeated endoscopic balloon dilation (EBD). However, EBD is still selected worldwide to manage such refractory strictures. To relieve the symptoms of dysphagia and keep a wide lumen, we developed a new incisional treatment, radial incision and cutting (RIC). Objective: To evaluate the efficacy and safety of the RIG method for the treatment of refractory anastomotic strictures. Design: Retrospective cohort study. Setting: National Cancer Center and University Hospital. Patients: This study involved 54 consecutive patients with refractory anastomotic stricture after esophagogastric surgery. Intervention: RIC. Main Outcome Measurements: The safety and clinical success of RIC and the long-term patency after RIC compared with those of continued EBD. Results: The median procedure time of RIC was 14 minutes (range, 4-40 minutes). No serious adverse events associated with RIG were observed. Immediately after RIG, 81.3% (26/32) of patients were able to eat solid food without symptoms of dysphagia. As a short-term effect, the dysphagia improved after RIG in 93.8% (30/32) of the patients. As a long-term effect, 63% (17/27) and 62% (13/21) of patients were able to eat solid food 6 and 12 months after RIG, respectively. The 6-month and 12-month patency rates were significantly different between the RIC group and the continued EBD group (65.3% vs 19.8%, P < .005; 61.5% vs 19.8%, P < .005). Limitations: Nonrandomized retrospective study. Conclusions: RIG is an effective and safe method. The demonstration of the validity of this method may place RIG as a new medical treatment for patients with refractory stricture after surgical resection for esophagogastric diseases. (Gastrointest Endosc 2012;75:965-72.)