PEPTIC OESOPHAGEAL STENOSIS: ABOUT 209 CASES MOROCCAN EXPERIENCE

Aims:

We report our own experience on the endoscopic dilation of oesophageal stenosis of peptic origin.

Methods:

This is a descriptive retrospective study spanning a period of 27 years, from 1990 to 2017. All patients with peptic oesophageal stenosis were included. All our patients underwent gastroesophageal endoscopy. endoscopic dilatation was performed by Savary-Gillard candles with diameters ranging from 12 to 15 mm.

Results:

Of 577 oesophageal strictures, 209 cases with peptic oesophageal stenosis were collected with a prevalence of 36.22%, there were 132 men and 77 women with sex ratio H/F of 1.71. The average age was 49.4 years with extremes (1 – 99 years).75 patients had a history of GERD (35.8%) Clinically all patients had dysphagia, associated with odynophagia in 11 cases, and upper gastrointestinal bleeding in 6 cases. Weight loss has been reported in 43 patients. The average time to onset of dysphagia was 1.5 years. FOGD had shown an insurmountable stenosis in all patients. The stenosis sat at the level of the 1/3 lower in 130 cases (62.2%), 1/3 medium in 49 cases (23.4%),1/3 higher in 19 cases (9%), 2/3 lower in 5 case (2.3%), 2/3 higher in 5 cases (2.3%), and all the esophagus in 1 case. TOGD was initially performed in 78 patients, and showed narrowing of the esophageal lumen in all patients, and hiatal hernia in 14 cases. All patients benefited from endoscopic dilatation with Savary-Gillard candles with a success rate of around 96%. The mean follow-up was 49.36 months. Recurrence was reported in 82 patients or 39.23%, with a mean recurrence of 1.37 months for an average recurrence of 2.4. The use of surgery was reported in 13 patients who benefited from the introduction of antireflux system in 11 patients, a feeding gastrostomy with anti reflux system in two patients. The progression to EBO was reported in 10 patients (4.7%) and there was degeneration of the stenosis to squamous cell carcinoma in one patient.

Conclusions:

Endoscopic dilatation represents the treatment of choice for peptic oesophageal stenosis, with very good efficacy and a low complication rate, monitoring is still needed to detect EBO and malignant degeneration.