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1 . 2022

Combined endoscopic treatment of restenosis of esophagus and anastomoses using steroids and autolipoaspirate

Abstract

Aim - to retrospectively analyze our own experience of intramural injections of steroids (dexamethasone and triamcinolone), as well as autolipoaspirate during endoscopic bougienage of recurrent, refractory or very dense benign cicatricial strictures of the esophagus and esophageal anastomoses.

Material and methods. From 2013 to September 2021, endoscopic treatment was undertaken in 47 patients (29 men, 18 women) aged 16 to 82 years with refractory and recurrent strictures of the esophagus (62%) and anastomoses (38%). The bougienage courses were supplemented with intramural injections of steroids (dexamethasone and triamcinolone) and, in one case, autolipoaspirate. In 41 patients, only dexamethasone was administered, in 3 - dexamethasone and triamcinolone, in 2 - only triamcinolone according to the developed scheme. In 1 patient, after an ineffective course of dexamethasone injections, autolipoaspirate was injected three times intramurally with a three-month interval between procedures.

Results. An excellent result was obtained in 23.5% (11/47), good - in 50% (23/47), satisfactory -in 23.5% (11/47) observations, which is 97%. An unsatisfactory result was noted in 1 (3%) patient. After intramural injections of dexamethasone (41), the lumen was expanded to 8-18 mm, after a combination of injections of dexamethasone and triamcinolone (2) - up to 11-13 mm. In the group with triamcinolone injections (3), the lumen stabilized at the level of 12-14 mm. In one patient, when using autolipoaspirate injections, the lumen is maintained at a level of 6-8 mm, which is currently regarded as a lack of positive dynamics. In the group of patients with dexamethasone injections, 97.6% (40/41) showed a good recurrence-free result in the period from 1 to 7 years. 

Conclusion. For recurrent or refractory strictures resistant to standard endoscopic treatment, it is recommended to add intramural injections of steroids, preferably triamcinolone, to the bougienage to achieve good long-term results. If a satisfactory result is not achieved, the use of autolipoaspirate can be considered as an alternative, a short-term stent placement is possible, and the final stage is surgical treatment.

Keywords:esophageal stricture; stricture of anastomosis; endoscopic bougienage; intramural injections; steroids; dexamethasone; triamcinolone; autolipoaspirate

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Godzhello E.A., Khrustaleva M.V., Bulganina N.A., Belisova T.V., Dekhtyar M.A., Vasilyev V.S. Combined endoscopic treatment of restenosis of esophagus and anastomoses using steroids and autolipoaspirate. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (1): 53-64. DOI: https://doi.org/10.33029/2308-1198-2022-10-1-53-64 (in Russian) 

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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