Supplementary Material for: The Efficacy and Safety of Treatment Outcomes for Refractory Benign Esophageal Strictures Using a Novel Combination of Needle-Knife Stricturoplasty, Balloon Dilation, and Steroid Injection (with Video)

Background and Aims: Benign esophageal strictures often present with dysphagia and can significantly impair a patient’s quality of life, especially when refractory to standard endoscopic techniques. When repeat dilations fail to achieve an adequate luminal diameter or resolve dysphagia, further therapy with needle-knife or steroid injections is needed. However, patients can still clinically fail. To manage such strictures, we employed a novel combination of all three techniques. Methods: Single-center case series of adult patients with benign strictures that were refractory to conventional endoscopic therapy and removable self-expanding metal stenting. Primary clinical success was defined as complete resolution in dysphagia. Secondary outcomes included periodic dilation index (frequency of dilations over the follow-up time), esophageal diameter changes, technical success, and complications. Results: Four patients (median age 49.7 years old, interquartile range [IQR] 30–59) underwent endoscopic therapy for complex, benign strictures using our triple therapy technique. Etiologies of the strictures included peptic strictures (n = 3) and an anastomotic stricture (n = 1). There was 100% technical success rate with no associated adverse events. There was a 50% clinical success rate, with 1 additional patient having partial improvement in dysphagia. The median diameter of the esophagus before and after triple therapy was 3.2 mm (IQR 3.5–5.5) and 12.8 mm (IQR 11.7–14.2), respectively. The periodic dilation index was 6.3 before and 1.5 after triple therapy. The median length of follow-up was 362.5 days. Conclusion: Triple combination therapy may be useful in benign strictures that are refractory to standard techniques. Larger studies are needed to validate these findings.

背景与目的：良性食管狭窄（benign esophageal strictures）常以吞咽困难（dysphagia）为主要表现，可显著损害患者生活质量，尤其对于标准内镜治疗难治的患者。若反复食管扩张术未能达到足够管腔直径或缓解吞咽困难，则需采用针形切开刀（needle-knife）或类固醇注射（steroid injections）进行后续治疗，但此类患者仍可能出现临床治疗失败。针对此类狭窄病例，我们采用了三种技术的新型联合方案。
方法：本研究为单中心病例系列研究，纳入对常规内镜治疗及可移除自膨式金属支架（removable self-expanding metal stenting）治疗难治的成年良性食管狭窄患者。主要临床疗效终点定义为吞咽困难完全缓解。次要结局指标包括定期扩张指数（periodic dilation index，即随访期间的扩张频率）、食管直径变化、技术成功率及并发症发生情况。
结果：共4例患者（中位年龄49.7岁，四分位间距[IQR] 30~59岁）接受了基于三联治疗方案的复杂良性食管狭窄内镜治疗。狭窄病因包括消化性狭窄（n=3）及吻合口狭窄（n=1）。本研究技术成功率达100%，未发生相关不良事件。临床成功率为50%，另有1例患者吞咽困难获得部分改善。三联治疗前后食管中位直径分别为3.2 mm（IQR 3.5~5.5）与12.8 mm（IQR 11.7~14.2）。定期扩张指数在治疗前为6.3，治疗后降至1.5。中位随访时长为362.5天。
结论：三联联合疗法或可应用于标准治疗难治性良性食管狭窄。未来需开展更大样本量的研究以验证本研究结果。