CLINICAL OUTCOMES AFTER ENDOSCOPIC DILATATION OF EOSOPHAGEAL PEPTIC STRICTURE

Aims Esophageal peptic sticture (EPS) is the endstage result of chronic gastroesophageal reflux disease. Treatment usually include endoscopic dilation combined with medical therapy. We aimed to determine the procedural outcomes and recurrence rates after endoscopic dilation of EPS.

Methods Patients who underwent endoscopic dilation of an EPS in a university Hospital (2002- 2017) were retrospectively reviewed. We studied the endoscopic and therapeutic parameters. Procedure dilation was performed with Wire-guided dilators (Savary-Gilliard) or Polyethylene balloon dilators. Technical success was defined as resolved dysphagia.

Results Thirty-eight patients were enrolled (66% male ; mean age 61.2±4 years). All patients had dysphagia at the time of diagnosis. Stricture was located in the lower third of the esophagus in 37 cases. Its average extent is 34.24 mm. A hiatus hernia was associated in 22 cases. Brachyesophagus was observed in 7 cases. Clinical success of first endoscopic dilation associated with proton pump inhibitors (PPI) therapy was attempted in 80% of cases. Two dilation sessions (1 – 5) were needed, on average, to achieve remission. No serious complications were reported. Surgery was indicated in 7 cases after failure of endoscopic dilations. The failure of endoscopic dilation was significantly associated with an age<50 years (p=0.006). Brachyesophagus was more frequent in operated patients (p=0.07). Gender, smoking, and hiatus hernia were not associated with endoscopic dilation failure.

Conclusions Based on our experience, endoscopic dilation associated with PPI therapy is safe and effective for the management of EPS. Young patient and brachyesophagus seem to be associated with the failure of this technique.

Publication History

Article published online:
14 April 2022