Surgical endoscopy
September 21, 2026 · via Europe PMC
Novel endoscopic treatment to prevent refractory caustic esophageal strictures: a propensity score-matched analysis.
Chobarporn T, Mesiri D, Chennavasin P, Tharavej C.
AI summary — for doctors, generated from the abstract only
Repeated early endoscopic lysis of fibrinous adhesions after severe caustic acid injury was associated with far fewer esophageal strictures than conventional care.
What was studied
A propensity score-matched comparison of 50 patients (25 vs 25) with Zargar grade IIb-IIIa caustic acid esophageal injuries managed with the RIFLE program of repeated endoscopic adhesiolysis versus conventional treatment.
Key findings
- Median four RIFLE sessions; no procedure-related complications
- Esophageal stricture 24% vs 96% at median 9 months follow-up; specific statistic not fully captured in the abstract
- Refractory strictures and esophageal reconstruction were significantly lower with RIFLE; specific statistic not fully captured in the abstract
Clinical relevance
These promising results in a small matched cohort warrant prospective trials before the technique can be considered established.
Who should care
Limitations
Small non-randomized matched study with short follow-up; some results are truncated in the abstract.
Early repeated endoscopic adhesiolysis may help prevent refractory caustic strictures.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Refractory caustic esophageal stricture (RCES) is a highly morbid condition. Prevention, rather than treatment, remains the ultimate goal. During the acute phase of injury, we have observed abundant fibrinous adhesions on the luminal surface of the injured esophagus, leading to luminal obliteration. We hypothesize that maintaining luminal patency during this period using our novel technique-Repeated Endoscopy with Intraluminal Fibrinous adhesioLysis of the Esophagus (RIFLE)-is crucial for successful subsequent esophageal dilation and for reducing the prevalence of RCES.
Methods
Patients with Zargar grade IIb to IIIa caustic acid esophageal injuries were included in the study. Those who underwent the RIFLE program were assigned to the study group. Upper endoscopy with gentle lysis of intraluminal fibrinous adhesions was performed by advancing the endoscopic tip along with normal saline irrigation through the lesions, initially on the second or third day post-ingestion, and then repeated twice weekly during the first two weeks after the injury. Patients who received conventional treatment comprised the control group. Individuals in both groups who developed esophageal strictures underwent a dilation program. One-to-one propensity score matching was conducted.
Results
Fifty patients (25 in the RIFLE group and 25 in the conventional group) met the inclusion criteria. The median number of RIFLE sessions was four, and no endoscopic treatment-related complications occurred in patients undergoing RIFLE. At a median follow-up of 9 months, the rates of esophageal stricture, RCES, and esophageal reconstruction were significantly lower in the RIFLE group compared to the conventional group: 6/25 (24%) vs. 24/25 (96%), p < 0.001; 2/25 (8%) vs. 19/25 (76%), p < 0.001; and 2/25 (8%) vs. 17/25 (68%), p < 0.001, respectively.
Conclusions
Patients with severe caustic acid esophageal injury without transmural necrosis who underwent the RIFLE procedure experienced a reduced prevalence of RCES and subsequent esophageal reconstruction.
DOI
10.1007/s00464-026-13378-0
PMID
42768114
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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