Modification of the classification of benign cicatricial strictures of the esophagus and esophageal anastomoses and the scale for assessing the immediate results of endoscopic treatment

Introduction. The article summarizes the results of a long period of practical and analytical work of the endoscopic department of the Petrovsky National Research Centre of Surgery in treating patients with benign cicatricial strictures of the esophagus and esophageal anastomoses. Aim: to adjust the scale for assessing the immediate results of endoscopic treatment of benign cicatricial strictures of the esophagus and esophageal anastomoses and to supplement the classification of benign stenoses with a definition of the concept of “complex stricture”. Main part. Based on the analysis of many years of experience in endoscopic treatment of more than 1,500 patients in this category, the prerequisites for the need to revise the criteria for assessing immediate results are considered due to changes in the quality and arsenal of tools that allow for safe achievement of a larger lumen in the stenosis zone, including in patients with resistant stenoses. The results of endoscopic treatment of 82 patients with complex strictures using intramural steroid injections are demonstrated in comparison with 27 patients with complex strictures who underwent a standard treatment protocol. Two appendices provide a step-by-step comparison of the previous and updated assessment scales and a modified classification of benign cicatricial strictures of the esophagus and esophageal anastomoses (2025) with criteria for complex strictures and forms of stricture resistance to the treatment. Conclusion. The modified classification of strictures with criteria for the multiple concept of “complex stricture” will draw attention to an extremely complicated, but small group of patients who require a non-standard personalized approach and treatment in expert institutions engaged in both endoscopic and surgical treatment of esophageal diseases. The refined scale for assessing immediate treatment results has become even more rigorous in defining excellent and good results, taking into account both the changed arsenal of tools for dilating strictures and safety assessment of achieving such results in a large group of patients. This allows us to recommend it for wide clinical use.

esophageal strictures, strictures of the esophageal anastomoses, endoscopic bougienage, assessment scale, modified classification, complex esophageal strictures, intramural steroid injections, Kenalog

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