Background and Aims: Benign esophageal strictures often present with dysphagia and can significantly impair a patient’s quality of life, especially when refractory to standard endoscopic techniques. When repeat dilations fail to achieve an adequate luminal diameter or resolve dysphagia, further therapy with needle-knife or steroid injections is needed. However, patients can still clinically fail. To manage such strictures, we employed a novel combination of all three techniques. Methods: Single-center case series of adult patients with benign strictures that were refractory to conventional endoscopic therapy and removable self-expanding metal stenting. Primary clinical success was defined as complete resolution in dysphagia. Secondary outcomes included periodic dilation index (frequency of dilations over the follow-up time), esophageal diameter changes, technical success, and complications. Results: Four patients (median age 49.7 years old, interquartile range [IQR] 30–59) underwent endoscopic therapy for complex, benign strictures using our triple therapy technique. Etiologies of the strictures included peptic strictures (n = 3) and an anastomotic stricture (n = 1). There was 100% technical success rate with no associated adverse events. There was a 50% clinical success rate, with 1 additional patient having partial improvement in dysphagia. The median diameter of the esophagus before and after triple therapy was 3.2 mm (IQR 3.5–5.5) and 12.8 mm (IQR 11.7–14.2), respectively. The periodic dilation index was 6.3 before and 1.5 after triple therapy. The median length of follow-up was 362.5 days. Conclusion: Triple combination therapy may be useful in benign strictures that are refractory to standard techniques. Larger studies are needed to validate these findings.
GE Port J Gastroenterol

中文翻译：

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使用针刀狭窄成形术、球囊扩张和类固醇注射的新型组合治疗难治性良性食管狭窄的疗效和安全性（带视频）

背景和目的：良性食管狭窄常伴有吞咽困难，可显着影响患者的生活质量，尤其是当标准内窥镜技术难以治愈时。当重复扩张不能达到足够的管腔直径或解决吞咽困难时，需要用针刀或类固醇注射进一步治疗。然而，患者仍然可能在临床上失败。为了管理此类限制，我们采用了所有三种技术的新颖组合。方法：对常规内窥镜治疗和可拆卸自膨胀金属支架置入难以治疗的良性狭窄成年患者的单中心病例系列。初步临床成功被定义为吞咽困难的完全解决。次要结果包括周期性扩张指数（随访时间内扩张的频率）、食管直径变化、技术成功和并发症。结果：四名患者（中位年龄 49.7 岁，四分位距 [IQR] 30-59）使用我们的三联疗法技术接受了复杂良性狭窄的内镜治疗。狭窄的病因包括消化性狭窄（n = 3）和吻合口狭窄（n= 1). 有 100% 的技术成功率，没有相关的不良事件。临床成功率为 50%，另外 1 名患者的吞咽困难得到部分改善。三联疗法前后食管的中位直径分别为 3.2 毫米（IQR 3.5-5.5）和 12.8 毫米（IQR 11.7-14.2）。周期性扩张指数在三联疗法前为 6.3，在三联疗法后为 1.5。中位随访时间为 362.5 天。结论：三联疗法可能对标准技术难以治愈的良性狭窄有用。需要更大规模的研究来验证这些发现。
GE Port J 胃肠醇