内镜下放射状切开联合食管支架置入治疗食管良性狭窄的疗效研究

Efficacy of endoscopic radial incision with esophageal stent placement for the treatment of benign esophageal stenosis

摘要:

目的 比较内镜下探条或球囊扩张术（EBD）、内镜下放射状切开术（ERI）和ERI联合食管支架置入术（ESP）治疗食管良性狭窄的疗效，评估ERI联合ESP治疗食管良性狭窄的可行性和安全性。方法 回顾性分析2019年1月－2023年1月于该院就诊的48例食管良性狭窄患者的临床资料，根据内镜下治疗方案不同，分为EBD组（n = 24）、ERI组（n = 17）和ERI+ESP组（n = 7）。比较3组患者手术成功率、术后再狭窄率和手术并发症发生率。结果 ERI+ESP组既往内镜治疗次数多于EBD组和ERI组，差异均有统计学意义（P < 0.05）。EBD组技术成功23例，临床缓解23例，ERI组技术成功16例，临床缓解15例，ERI+ESP组技术成功7例，临床缓解7例，3组患者技术成功率和临床缓解率比较，差异均无统计学意义（P > 0.05）。随访3个月时，EBD组、ERI组和ERI+ESP组分别有15、9和1例出现食管再狭窄，3组患者食管再狭窄率比较，差异无统计学意义（P > 0.05）；随访6个月时，EBD组、ERI组和ERI+ESP组分别有20、13和1例出现食管再狭窄，ERI+ESP组再狭窄率低于EBD组和ERI组，差异均有统计学意义（P < 0.05），但EBD组和ERI组再狭窄率比较，差异无统计学意义（P > 0.05）。EBD组术后首次再狭窄时间为74.00（48.75，159.00）d，ERI组为84.00（54.50，195.00）d，ERI+ESP组为250.00（206.00，289.00）d，ERI+ESP组再狭窄时间长于EBD组和ERI组，差异均有统计学意义（P < 0.05），但EBD组和ERI组再狭窄时间比较，差异无统计学意义（P > 0.05）。EBD组、ERI组和ERI+ESP组分别有5、5和3例出现并发症，3组患者并发症发生率比较，差异无统计学意义（P > 0.05）。结论 ERI联合ESP治疗食管良性狭窄，在技术成功率和短期临床缓解率方面，与EBD和ERI相当，且不增加并发症发生率，长期再狭窄率明显低于EBD和ERI，再狭窄时间明显长于EBD和ERI。

Abstract:

Objective To compare the efficacy of endoscopic bougie/balloon dilation (EBD), endoscopic radial incision (ERI), and ERI combined with esophageal stent placement (ESP) for the treatment of benign esophageal stenosis, and evaluate the feasibility and safety of ERI combined with ESP for the treatment of benign esophageal stenosis.Methods 48 Patients with benign esophageal stenosis from January 2019 to January 2023 were recruited, and divided into EBD group (n = 24), ERI group (n = 17) and ERI + ESP group (n = 7). The differences in operating success, restenosis and complications among the three groups were compared.Results The number of previous endoscopic treatment in ERI + ESP group was more than that in EBD group and ERI group, and the differences were statistically significant (P < 0.05). Technical success was achieved in 23 cases and clinical remission in 23 cases in EBD group, technical success in 16 cases and clinical remission in 15 cases in ERI group, technical success in 7 cases and clinical remission in 7 cases in ERI + ESP group. There was no significant difference in technical success rate and clinical remission rate among the three groups (P > 0.05). After 3 months of follow-up, there were 15, 9 and 1 cases of esophageal restenosis in the EBD group, ERI group and ERI + ESP group, respectively. There was no significant difference in the rate of esophageal restenosis among the 3 groups (P > 0.05). After 6 months of follow-up, there were 20 cases of esophageal restenosis in the EBD group, 13 cases in the ERI group and 1 case in the ERI + ESP group. The rate of esophageal restenosis in the ERI + ESP group was significantly lower than that in the EBD group and the ERI group (P < 0.05). However, there was no statistically significant difference in the esophageal restenosis rate between the EBD group and the ERI group (P > 0.05). The time to the first postoperative restenosis was 74.00 (48.75, 159.00) days in the EBD group, 84.00 (54.50, 195.00) days in the ERI group, and 250.00 (206.00, 289.00) days in the ERI + ESP group. The time to the first postoperative restenosis was longer in the ERI + ESP group than that in the EBD and ERI groups. The differences were statistically significant (P < 0.05), but there was no significant difference in restenosis time between EBD group and ERI group (P > 0.05). There were 5, 5 and 3 cases of complications in the EBD group, ERI group and ERI + ESP group, respectively, and there was no significant difference in the incidence of complications among the three groups (P > 0.05).Conclusion ERI+ESP is comparable to EBD and ERI in terms of technical success and short-term clinical remission rate for the treatment of benign esophageal stenosis, and is superior to EBD and ERI in terms of long-term restenosis rate and restenosis time, with no influence on the occurrence of complications.