Risk Factor Analysis Of Esophageal Anastomotic Restenosis After Dilation

Objective:In order tothe explore influence factor of restenosis after esophageal anastomotic stenosis dilation, we convert related risk factors of the quantitative data into qualitative data to define the boundary value of clinical operation, which provide theory support for the clinical operation with esophageal dilatation and evidence-based medical evidence. Through meta-analysis comparing bougie dilation and balloon dilation in the treatment of esophageal anastomotic stenosis, we evaluatewhether there is significant difference for the long-term incidence of restenosis between the two dilations.Methods:1.By reviewing the cases post esophagectomy from thethoracic department of the 307 hospital, whichaffiliated of Military Academy Of Medical Science, 83 cases of anastomotic stricture of esophagus with complete data were filteredand retrospectively analyzed. According to whether the patients got restenosis after esophageal dilation(Restenosis is defined as symptoms of dysphagia again within a year, and the degree of difficulty swallowing achieve level 3 above), they divided into no restenosis group and restenosis group. Information of patients’ age, sex, body mass index and grade of difficulty swallowing, the diameter of esophageal stenosis, site of esophageal stricture, he time when the stricture occurred after esophagectomy, times of dilation, the average time of interval after dilationand diameter after dilation.Data is uniformly entering SPSS19.0 statistics software to carry on the analysis, the quantitative data of normal distribution was indicated with mean±standard deviation(x±S). Non-normal distribution of quantitative data are indicated with median and interquartile range. Conduct Logistic single factor regression analysis, statistic significance test was alpha = 0.05; Variables which were statistically significant(P < 0.05) were included in multiple factors Logistic regression analysis, the stepwise regression method is Backward stepwise.2.Search the Pub Med、EMBASE database for articles about the dilation of benign esophageal stricture. Retrieve the related articles in the reference list. According to the principle of “PICOS”, the terms include “Esophageal Stenosis”、“bougie*”、“Savary-Gilliard”、“Probe Dilation”、“Savary Dilation”、“Rigid Dilation”、“Balloon dilat*”�'�“Balloon Catheter”. Inclusion criteria includes: have symptom of dysphasia, be confirmed of benign esophageal stricture by endoscopy, duration of follow-up is above 6 months, offer the incidence rate,study type,balloon dilation(the way, the type), bougie dilation(the way, the type), the amount of patients who need redilation after 6 months or 1year in each group. Evaluate the quality of the article,manage the data by the STATA12.0 software and examine the bias of publication by Egger’s test.Results:1. We retrospectively analysed 83 cases of patients with esophageal anastomoic stricture after esophageal cancer operation patients. 35 patients(42.2%)experienced restenosis in the following year and 48 patients didn’t. The single factor Logistic regression indicates that the difference between dilation type 、 the time when anastonomic stricture appears after operation、the mean interval between dilation、the diameters of stricture after operation are statistically signicant. The odds ratio and 95% confident interval are 27.1(95%CI:7.1-103.4)、5.0(95%CI:1.1-21.2)、5.3(95%CI: 1.4-20.3),respectively.2.Through four randomized controlled studies and one retrospective study, a total of 457 patients include 203 cases in bougie group and 254 cases in balloon group were conducted Meta analysis. The time of publication is from 1990 to 2007. The volume of each study range from 32 to 242. According to the CASP( Critical Appraisal Skills Programme),the scores are all reach or exceed passing score and the average score is 18.The result of Meta-analysis indicates that the discrepancy between bougie and balloon dilation in the incidence of restenosis after dilation is statistically significant(OR,0.559;95% CI,0.342-0.913;P=0.02).Egger’s test indicates that the bias is very small(P=0.883>|t|).Conclusion:1.the time when the stricture occurs, the diameter of stricture, the mean interval between dilation have significant effect on the patients with esophageal anastonomic stricture in whether they will get restenosis after dilation.Restenosis appearing in 3 months, the interval between two subsequent sessions of more than 4 weeks at each esophagus dilatation, the stricture diameter of less than 12mm(milimeter) after dilation are the independent risk factors for restenosis in esophageal anastomotic stricture. But age、gender、BMI、scale of dysphasia、the site of esophageal stricture、the diameter of esophageal stricture before dilation have little effect on restenosis. Notably,the types of dilation seems to show no statistical difference on restenosis in the study of regression analysis in our single center.2.Four randomized controlled trials and one retrospective study totaling 457 patients were included. The results of meta-analysis were as follows: statistically significant difference was found in the incidence rate of the redilations after the initial dilations in the following six months to one year(OR=0.559,95%CI:0.342-0.913).3.The conclusions above can be refered to in the procedure of clinical operation. The patients who get anastonomic stricture in 3 months after esophagectomy should keep intimate follow-up. People who need several dilations should better shorten the interval in 4 weeks and the target should better reach or surpass 12 mm.When come up with the question which types would be choosen. It’s better to choose bougie dilation if balloon dilation is invalid after several dilations. But in fact, we will take much more factors into consideration besides restenosis,so the best strategy is formulated on each patients’ features.