Endoscopic incisional therapy for benign esophageal strictures: Technique and results

Table 1 Endoscopic options of esophageal stricture management

Dilatation

Balloon

Bougie

Dilatation with injection therapy

Intralesional triamcinolone

Topical mitomycin C

Incisional therapy

Stent placement

SEMS

SEPS

Biodegradable stents

Rendezvous procedure

SEMS: Self expanding metal stents; SEPS: Self expanding plastic stents.

Table 2 Instruments for incisional therapy

	Distal tip outer diameter (Fr)	Knife length (mm)	Knife diameter (mm)	Min. channel size (mm)	Working length (cm)
Needle knives
Olympus (Tokyo, Japan)
Triple lumen needle knife	5	5	0.2	2.8	195
Hook knife	Hook length 1.3 mm	4.5	0.4	2.8	165/230
Needle knife (require handle)
KD-10Q-1.B	NA	3	0.4	2.0	195
KD-11Q-1.B	NA	3	0.7 (flat)	2.0	195
IT-Knife-L	Ceramic tip with diameter 2.2 mm	4	0.4	2.6
Boston scientific (Natick, Mass)
RX needle knife	5.5	5			200
MicroknifeTMXL triple lumen knife	7-5.5				200
Cook medical (Winston Salem, NC)
Fusion needle knife	6	4		4.2	200
Zimmon needle	5	7		2.0	200/320
Scissors
Surgical scissors FS-3L-1 (Olympus): Min. channel size - 2.8 mm Working length - 165 cm
Heiss-Device flexible endoscopic scissors (Telemed Systems, Hudson, Mass): 1.7 mm blade diameter × 2.5 mm blade length 1.7 mm shaft diameter 180 cm shaft length Single-action blade
SB knife Jr (Sumitomo Bakelite Co., Tokyo, Japan): Width 4.4 mm × Length 3.5 mm Rotatable monopolar scissors

Fr: French; NA: Not applicable; IT knife: Insulated tip knife.

Table 3 Various studies of incisional therapy in esophageal anastomotic stricture

Ref.	Type of stricture	No. of patients	Length of stricture	No. of pre-procedure dilatations1	Follow-up duration (mo)	Outcome of single session
Schubert et al[31], 2003	Treatment naive	15	6.1 mm	NA	23	No recurrence - 14/15 (93%)
			(3-10 mm)
Simmons et al[23], 2006	Refractory	9	--	6	3-14	No dysphagia - 4/9 (44.4%)
						No response - 1/9 (11%)
Hordijk et al[42], 2006	Refractory	20	< 1 cm - 12 cm	8	12	No dysphagia - 12/20 (60%)
			> 1 cm - 8 cm			Recurrence - 8/20 (40%)
						Treatment failure - 2/20 (10%)
2Hordijk et al[30], 2009	Treatment naive	EIT arm - 31	EIT arm - 1.35 cm	N/A	6	No difference in the success rate (80.6% vs 67.7%)
		SB arm - 31	SB arm - 0.55 cm (mean)			Treatment failure- EIT arm - 1; SB arm - 5
Lee et al[24], 2009	Treatment naive	24	< 1 cm - 21 cm	N/A	24	No recurrence - 21/24 (87.5%)
			> 1 cm - 3 cm			Restricture - 3/24 (12.5%)
Muto et al[25], 2012	Refractory	EIT - 32	≤ 5 mm - 49 mm	10	EIT - 14.8	Short term - 93.8% improvement
		EBD - 22	> 5 mm - 5 mm		EBD - 17.2	Long term - EIT better than EBD

¹Mean number of dilatations;

²Randomized prospective study. Treatment naïve: No previous dilatation; EIT: Endoscopic incisional therapy; SB: Savary bougienage; EBD: Endoscopic balloon dilatation; NA: Not applicable.