Clinical Trials Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2019; 7(13): 1623-1633
Published online Jul 6, 2019. doi: 10.12998/wjcc.v7.i13.1623
Development and validation of a model to determine risk of refractory benign esophageal strictures
Qing Lu, Tian-Tian Lei, Yi-Lan Wang, Hai-Lin Yan, Bo Lin, Lin-Lin Zhu, Hong-Sheng Ma, Jin-Lin Yang
Qing Lu, Yi-Lan Wang, Hai-Lin Yan, Bo Lin, Lin-Lin Zhu, Jin-Lin Yang, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Tian-Tian Lei, Hong-Sheng Ma, Department of Day Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Lu Q and Lei TT contributed equally to this work; Yang JL and Ma HS designed the research; Lu Q, Yan HL, Wang YL, Lei TT, and Zhu LL performed the research; Lu Q, Wang YL, and Lei TT performed the follow-ups; Lu Q analyzed the data and wrote the paper; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the West China Hospital of Sichuan University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Lin Yang, MD, MHSc, PhD, Chief Doctor, Doctor, Lecturer, MHSc, Professor, Department of Gastroenterology, West China Hospital of Sichuan University, No. 37, Guoxue Road, Chengdu 610000, Sichuan Province, China. mouse-577@163.com
Telephone: +86-18-980602058 Fax: +86-28-85423387
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: March 27, 2019
Revised: April 17, 2019
Accepted: May 2, 2019
Article in press: May 3, 2019
Published online: July 6, 2019
Processing time: 129 Days and 19.2 Hours
Abstract
BACKGROUND

Current research has identified several risk factors for refractory benign esophageal strictures (RBES), but research is scarce on the prediction of RBES in benign esophageal strictures patients. Meanwhile, the long-term outcomes of RBES remain unclear. The aim of this study was to develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures. And we also explored the long-term outcomes and safety in patients with RBES.

AIM

To develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures, based on the demographic data and endoscopic findings.

METHODS

A total of 507 benign esophageal stricture patients treated by dilation alone or in combination with stenting were retrospectively enrolled between January 2009 and February 2018. The primary outcome was to establish a risk-scoring model predicting RBES in benign esophageal strictures. The secondary outcome was to explore the clinical effectiveness and adverse events in patients with RBES.

RESULTS

In the study, age, etiology, and number and length of strictures were the independent risk factors for the refractory performance of benign esophageal strictures. According to risk factors of benign esophageal strictures, a risk-scoring model for predicting RBES in benign esophageal strictures was established: The risk score ranged from 0 to 8 points, and the risk scores were divided into low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-8 points). The proportions of RBES in the corresponding risk categories were 1.0%, 12.2%, and 76.0%, respectively. Among 507 patients, 57 had RBES (39 males; median age, 60 years). The success rate of dilation treatment (51.2%, 21/41) was higher than that of stent placement (37.5%, 6/16).

CONCLUSION

In this study, 11.3% (57/507) patients had RBES at our hospital. The risk-scoring model predicting RBES in benign esophageal strictures could predict the long-term outcome of patients with strictures ahead.

Keywords: Refractory benign esophageal strictures; Esophageal dilation; Esophageal stents; Long-term outcomes; Retrospective analysis

Core tip: We developed and validated a model to determine the progression of refractory benign esophageal strictures in patients with benign esophageal strictures. The risk-scoring model could predict the long-term outcome of patients with strictures ahead. The endoscopic therapy was the standard treatment for all benign stenosis patients. Our findings may have an impact on daily practice. The presence of a bad score may means surgical indication and refractoriness to endoscopic therapy.