Comparison of esophageal stent placement versus endoscopic incision method for treatment of refractory esophageal anastomotic stricture

Background: Refractory esophageal anastomotic strictures are difficult to treat. Current treatments include esophageal stent placement (ESP) and the endoscopic incision method (EIM). This study was conducted to determine which treatment is better for patients with refractory esophageal anastomotic stricture. Methods: This study retrospectively collected data of patients with refractory esophageal anastomotic stricture who underwent ESP or PAM between January 2012 and June 2018. Dysphagia scores before and after the procedure were recorded in both groups. The duration of relief during the follow-up period was recorded. Results: Fifty patients were enrolled in this study, including 32 patients who underwent ESP and 18 who underwent EIM. Patients in the ESP group had a markedly larger diameter of dilatation than those in the EIM group (19.9 +/- 1.8 versus 11.0 +/- 1.9 mm, respectively; P<0.001). However, the dysphagia score improved by 1.0 +/- 0.0 point in the ESP group and by 1.4 +/- 0.5 points in the ELM group (P<0.001). Nearly 70% of patients in the ESP group maintained lumen patency at 12 months. In contrast, only 50% of patients in the EIM group had persistent relief of stricture symptoms at 6 months and only 20% had relief at 12 months. Five patients had slight bleeding; none required blood transfusion. Thirteen patients in the ESP group had slight chest pain; seven of these required administration of a painkiller. Conclusions: EIM can rapidly relieve the symptoms of esophageal anastomotic stricture but ESP provides longer duration of relief. Both procedures are safe for patients with refractory esophageal anastomotic stricture.