Combined Treatment of Cicatricial Strictures of the Esophagus: the Experience of One Center

Cicatricial esophageal strictures remain one of the most challenging and clinically significant problems in modern esophageal surgery. The disease is accompanied by progressive dysphagia, impaired nutritional status, and a marked decrease in patients’ quality of life. Despite the widespread implementation of endoscopic technologies, the effectiveness of minimally invasive treatment methods largely depends on the length, density, and anatomical localization of the cicatricial process. In patients with long and recurrent strictures, the rate of restenosis remains high, necessitating the search for an optimal therapeutic strategy. To evaluate the effectiveness of combined treatment of cicatricial esophageal strictures using endoscopic techniques and thoraco-laparoscopic esophagectomy. The study included 16 patients with cicatricial esophageal strictures treated at a single surgical center. At the first stage, all patients underwent endoscopic treatment, including bougienage and balloon dilation, and in selected cases, placement of a self-expanding endoscopic stent. In the absence of a sustained clinical effect, recurrence of dysphagia, or failure of endoscopic interventions, total thoraco-laparoscopic esophagectomy with gastric reconstruction was performed. In patients with cicatricial strictures longer than 3 cm, endoscopic treatment provided only temporary improvement in esophageal patency and was associated with a high rate of dysphagia recurrence. In this group of patients, radical surgical treatment resulted in satisfactory functional outcomes with no postoperative mortality. Cicatricial esophageal strictures longer than 3 cm should be considered prognostically unfavorable with regard to the effectiveness of endoscopic treatment and regarded as an indication for thoraco-laparoscopic esophagectomy with gastric graft replacement an indication for thoraco-laparoscopic esophagectomy with gastric graft replacement.