title: Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video).
abstract: BACKGROUND
  There is no effective treatment for gastroesophageal anastomotic strictures that are refractory to repeated endoscopic balloon dilation (EBD). However, EBD is still selected worldwide to manage such refractory strictures. To relieve the symptoms of dysphagia and keep a wide lumen, we developed a new incisional treatment, radial incision and cutting (RIC).
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of the RIC method for the treatment of refractory anastomotic strictures.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  National Cancer Center and University Hospital.
  
  
  METHODS
  This study involved 54 consecutive patients with refractory anastomotic stricture after esophagogastric surgery.
  
  
  METHODS
  RIC.
  
  
  METHODS
  The safety and clinical success of RIC and the long-term patency after RIC compared with those of continued EBD.
  
  
  RESULTS
  The median procedure time of RIC was 14 minutes (range, 4-40 minutes). No serious adverse events associated with RIC were observed. Immediately after RIC, 81.3% (26/32) of patients were able to eat solid food without symptoms of dysphagia. As a short-term effect, the dysphagia improved after RIC in 93.8% (30/32) of the patients. As a long-term effect, 63% (17/27) and 62% (13/21) of patients were able to eat solid food 6 and 12 months after RIC, respectively. The 6-month and 12-month patency rates were significantly different between the RIC group and the continued EBD group (65.3% vs 19.8%, P < .005; 61.5% vs 19.8%, P < .005).
  
  
  CONCLUSIONS
  Nonrandomized retrospective study.
  
  
  CONCLUSIONS
  RIC is an effective and safe method. The demonstration of the validity of this method may place RIC as a new medical treatment for patients with refractory stricture after surgical resection for esophagogastric diseases.
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Muto
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Ezoe
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Ikuo
authors.initials: I
authors.lastname: Aoyama
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoda
authors.forename: Keiko
authors.initials: K
authors.lastname: Minashi
authors.forename: Shuko
authors.initials: S
authors.lastname: Morita
authors.forename: Takahiro
authors.initials: T
authors.lastname: Horimatsu
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ohtsu
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D004435:Eating; D004940:Esophageal Stenosis / Q000150:complications / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D017211:Treatment Failure