Submucosal injection of bleomycin combined with endoscopic dilation for the treatment of benign esopha-geal stricture
Objective To explore the therapeutic effect of submucosal injection of bleomycin combined with endoscopic dila-tion on benign esophageal stricture(ES).Methods A retrospec-tive analysis was conducted on 120 patients with benign ES who un-derwent submucosal injection of bleomycin combined with endoscopic dilation(bleomycin group)at the Department of Digestive Endoscopy,Jiangsu Province Hospital from January 2012 to December 2021.A comparison group of 120 patients with ES who underwent only endo-scopic dilation during the same period(expansion group)were includ-ed at a 1∶1 ratio.General information,short-term(3 months)and long-term(1 year)recurrence rates,periods without dysphagia,num-ber of dilations,dysphagia scores,and other indicators were analyzed.Subgroup analysis was conducted for patients with different etiologies of ES and for those with refractory esophageal stricture(RBES).Final-ly,logistic regression was used to explore the influencing factors of recurrence in the bleomycin group.Results Compared with the expansion group,the bleomycin group showed significant improvements in short-term(34.2％vs 55.0％,P=0.001)and long-term(71.7％vs 85.8％,P=0.008)recurrence rates.Among different etiologies of benign ES,bleomycin significantly benefited patients with postoperative anastomotic stricture(short-term:26.3％vs 46.1％,P=0.011;long-term:64.5％vs 81.3％,P=0.020)and stricture after endoscopic submucosal dissention(ESD)(short-term:61.1％vs 94.4％,P=0.016).The duration without dysphagia in the bleomycin group was significantly longer than that in the expansion group(2.8±2.2 months vs 1.6±1.5 months,P=0.044).Further multivariate lo-gistic regression analysis indicated that the number of dilations before treatment(OR=0.157,P＜0.001),total number of dilations(OR=4.970,P＜0.001),and pre-treatment dysphagia severity(OR=3.053,P=0.007)were influencing factors for recurrence in the bleomycin group.Conclusion Submucosal injection of bleomycin combined with endoscopic dilation is significantly more effective than single endoscopic dilation for the treatment of patients with ES.
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