Minimally invasive in managing

Esophageal Stricture, Esophageal

Stenting, Baloon Dilatation

Anung Noto Nugroho

Bedah Digestif RS Dr Oen Surakarta
 Laparoscopy from 2013-recent

Appendicitis

4
Perforated app
12 15 25
14 19
Cholecysholithiasis
185
22
Empyema gall bladder
30
LCBDE

LAR

159 Hemicolectomy
42

Miles

Hernia

Gastric perforation

Diagnostic

N: 527
 ESSENTIAL DEFINITIONS FOR
STRICTURE and STENOSIS DIAGNOSIS
STENOSIS : NARROWING OR STRICTURE OF DUCT OR CANAL

STRICTURE : DECREASE IN THE CALIBER OF A CANAL, DUCT OR OTHER PASSAGE AS A RESULT

OF FIBROTIC CONTRACTION OR THE DEPOSITION OF ABNORMAL TISSUE
DORLANDS MEDICAL
DICTIONARY
Type stricture

Simple strictures :
short(< 2 cm) and focal, straight, and can be
traversed with an adult endoscope prior to
dilatation

Complex strictures :
long (> 2 cm), irregular, angulated or difficult
to traverse with an endoscope
 Treatment for esophageal strictures

Non surgical and surgical options

depends on :
the etiology: maligna or benign

complexity of the stricture and the response

to prior treatment.
 Treatment of Benign Esophageal
Strictures
All benign esophageal strictures is transmural cellular
injury.
The inflammation that ensues leads to collagen
deposition and fibrosis and ultimately causes a
cicatricial narrowing of the lumen.
 Endoscopic dilation
First-line therapy for esophageal strictures is
endoscopic dilation, with serial intervention
often required.
Baloon
Bougie
Baloon
Only radial force
Bougie
Longitudinal and radial force
Maloney, Savory Gilliard
 Dysphagia after dilation
a repeat endoscopy and dilation in 2 weeks to allow
the mucosal tear sufficient time to heal
patients (especially those with anastomotic or
caustic strictures) require an aggressive schedule of
multiple repeat dilatations at 2-week intervals.
 Esophageal stenting

maintain patency of the esophageal lumen by exerting

radial force on the stricture
Self expanding plastic stent( SEPS): middle and distal
stricture
Self expanding metalic stent (SEMS)
 Variety of esophageal stents

Plastic
Self Expanding Metalic
Uncovered,
Partially
Fully covered
Biodegradable
Plastic stent
Stent Metal
Antirefluks
Biodegradable stent
 Rendez-Vous Procedure
complete loss of the patency of the esophageal
lumen from a variety of benign and malignant
disorders.

combined antegrade and retrograde dilatation (a

rendez-vous procedure) is a safe, useful technique
that restores patency of the lumen in 80100 % of
patients .
Groth et all, 2015
Malignant Esophageal Strictures
Endoscopic Treatment
Dilatation
external beam radiation therapy with or without
chemotherapy is planned.
Stent Placement: unresectable
 Rapid relief of dysphagia and is the most
commonly used modality to palliate dsyphagia
secondary to malignant esophageal strictures

Do not use uncovered metal stents due to the

risk of tumor and granulation tissue in-growth,
which results in a partial obstruction and
recurrent dysphagia.
Vakil N , Morris AI , Marcon N et al. A prospective, randomized, controlled trial of covered
expandable metal stents in the palliation of malignant esophageal obstruction at the
gastroesophageal junction . Am J Gastroenterol 2001 ; 96 : 1791 6 .
 Side effect esophageal stent
Pain (10-15%)
Mild reflux (20-30%)
Stuck (3-10%)
Migrate (10-12%)
Case
Mr S, 57 yo with dysphagia and BW decreased
EGD: biopsy: Adeno CA
CT Scan : Mass in esophageal distal infiltration to
adjancent structure and metastatic liver

Dx : Unresectable esophageal distal CA

Tx : Paliatif - Stent esophageal
 Conclusion
Esophageal balloon dilation and stent placement are
safe, minimally invasive, effective treatments for
esophageal strictures.

Metallic stents are generally reserved for palliation of

malignant diseases, whereas balloon dilation is
usually indicated in benign strictures
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