Icahn School of Medicine at Mount Sinai Hacienda Heights, CA
Introduction: Esophagogastroduodenosopy (EGD) is used in the evaluation of esophageal disease to assess the lumen and mucosa, sample tissue, and perform therapeutic maneuvers. Standard upper endoscopes, with a diameter of approximately 9-10 mm, may not be able to traverse the entire organ when luminal narrowing exists. An ultra-thin endoscope (UTE), with a diameter closer to 6 mm, allows endoscopists to complete the evaluation and optimize a treatment plan in many of these patients. The aim of this study was to explore UTE patterns of use and evaluate for connections between UTE findings and successful resolution of luminal narrowing with intervention.
Methods: All patients undergoing EGD with UTE at a single high-volume teaching hospital between 9/2018 and 5/2022 were included. Successful dilation was defined as either balloon or Savary dilation to a luminal diameter of at least 13 mm. Stricture locations were defined as upper third (< 24 cm from incisors), middle third (24-32 cm) and lower third ( >32 cm). Demographic and endoscopic data were aggregated and deidentified prior to analysis.
Results: A total of 205 EGDs with UTE were performed, with 103 of those procedures including dilation. Within this cohort, there were 31 patients with luminal narrowing not due to malignancy who underwent a 47 total dilations. Successful dilation was achieved in 14 patients, with an average of 2.35 dilations (vs. 1.19 in the unsuccessful group). There was no significant difference with respect to age or gender when comparing these two group. An ANOVA model showed a statistically significant difference between success rates for dilation of upper, middle, and lower third narrowings (p = 0.01027), with the best results for proximal lesions.
Discussion: The use of UTE to traverse luminal narrowings has been studied, but rarely have therapeutic outcomes been examined with regards to location of narrowings. This study shows that proximal esophageal locations are associated with a greater likelihood of successful dilation. One potential explanation is that the etiologies of more proximal narrowings include congenital webs and radiation-induced strictures, where the causative insult is not active during dilation. This contrasts with reflux-induced distal lesions, where ongoing inflammation and scarring may impede successful dilation. This cohort also has a relatively small number of dilations per patient, leaving open the possibility that more attempts at distal dilation could even out the success rate between groups.
