良性非腐蚀性食管狭窄内镜治疗失败的预测因素：一项回顾性队列研究
Predictors of endoscopic management failure in benign non-caustic esophageal strictures: a retrospective cohort study.
文献信息
| PMID | 42880126 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ilan David Friedmann |
| 作者单位 | Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: ilan.friedmann@fm.usp.br. |
| 期刊 | Clinics (Sao Paulo, Brazil) |
| SCI 分区 | Q2 |
| IF | 2.4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 良性非腐蚀性食管狭窄（BNES）常需反复内镜下扩张，但相当一部分患者仍难治，最终需要食管切除术。识别内镜治疗失败的预测因素对于风险分层和及时转诊至替代治疗至关重要。本研究旨在确定与BNES患者内镜治疗失败导致食管切除术相关的因素。
方法： 这项回顾性队列研究纳入了2004年1月至2026年3月在一家三级中心接受治疗的51例BNES患者。腐蚀性、恶性或食管切除术后吻合口狭窄的患者被排除。治疗包括球囊或探条扩张。内镜失败定义为尽管接受治疗仍因持续或复发性吞咽困难而需要食管切除术。采用多变量logistic回归分析确定失败的独立预测因素。
结果： 51例患者中，18例（35.3%）需要食管切除术。失败与非GERD病因（p < 0.001）、无食管裂孔疝（p = 0.001）、节段性狭窄（p = 0.016）以及较高的扩张次数（p = 0.026）相关。在多变量分析中，非GERD病因（OR = 7.45，p = 0.034）和无食管裂孔疝（OR = 8.28，p = 0.016）是独立预测因素。在次要模型中，无食管裂孔疝（OR = 17.02，p = 0.011）和扩张次数（每次治疗OR = 1.08，p = 0.028）仍具有显著性。在接受内镜管理的患者中，33.3%存在持续症状。
结论： 三分之一的BNES患者需要食管切除术。非GERD病因、无食管裂孔疝以及扩张负担增加可独立预测内镜失败，可能支持更早考虑手术治疗。
英文摘要
BACKGROUND: Benign Non-caustic Esophageal Strictures (BNES) often require repeated endoscopic dilations, yet a substantial proportion of patients remain refractory and ultimately require esophagectomy. Identifying predictors of endoscopic failure is essential for risk stratification and timely referral to alternative therapies. This study aimed to identify factors associated with endoscopic treatment failure leading to esophagectomy in patients with BNES.
METHODS: This retrospective cohort study included 51 patients with BNES treated at a single tertiary center from January 2004 to March 2026. Patients with caustic, malignant, or post-esophagectomy anastomotic strictures were excluded. Treatment consisted of balloon or bougie dilation. Endoscopic failure was defined as the need for esophagectomy due to persistent or recurrent dysphagia despite treatment. Multivariable logistic regression was performed to identify independent predictors of failure.
RESULTS: Of 51 patients, 18 (35.3%) required esophagectomy. Failure was associated with non-GERD etiology (p < 0.001), absence of hiatal hernia (p = 0.001), segmental strictures (p = 0.016), and a higher number of dilations (p = 0.026). In multivariable analysis, non-GERD etiology (OR = 7.45, p = 0.034) and absence of hiatal hernia (OR = 8.28, p = 0.016) were independent predictors. In a secondary model, absence of hiatal hernia (OR = 17.02, p = 0.011) and number of dilations (OR = 1.08 per session, p = 0.028) remained significant. Among endoscopically managed patients, 33.3% had persistent symptoms.
CONCLUSIONS: One-third of BNES patients required esophagectomy. Non-GERD etiology, absence of hiatal hernia, and increasing dilation burden independently predict endoscopic failure and may support earlier consideration of surgical management.