Gastrointest Endosc. 2024 Oct 25:S0016-5107(24)03635-6. doi: 10.1016/j.gie.2024.10.036. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Refractory benign esophageal strictures (RBES) are defined by inadequate response to dilation. Early recognition of RBES allows for earlier initiation of aggressive therapy potentially leading to less morbidity and cost. We sought to establish a predictive model for RBES.
METHODS: Patients who underwent esophagogastroduodenoscopy (EGD) with esophageal dilation at Mayo Clinic Rochester were identified. In addition, a cohort of patients from a clinical database of patients with RBES managed with self-dilation was identified. Malignant strictures, Schatzki rings, and previously treated strictures were excluded. RBES was defined by inability to maintain a diameter ≥14mm over 5 dilation sessions. Multivariable logistic regression models were built to predict RBES.
RESULTS: 128 patients with index EGD and esophageal dilation were identified, with 25 meeting RBES criteria. An additional 63 RBES patients were identified from the self-dilation cohort for a total of 88 RBES and 103 non-RBES patients. Multivariable analysis yielded a strong predictive model, with a c-statistic of 0.85, identifying stricture length ≥ 2cm, diameter ≤ 7mm and proximal/diffuse stricture location as associated with a higher risk for RBES. Patients without any of these risk factors had a 2% risk of RBES while those with all 3 risk factors had a risk of 73% for RBES.
CONCLUSIONS: Risk of RBES can be predicted at index EGD based on stricture features. A predictive model for RBES was created based on readily available risk factors, which may guide an individualized therapeutic approach to patients with benign esophageal stricture, potentially reducing morbidity and cost.
PMID:39490691 | DOI:10.1016/j.gie.2024.10.036
