Intro: Most guidelines on esophageal dilation deal with performance of the procedure. There is limited information regarding principles of long-term management (i.e. dilation interval, long-term goals, etc). This may be troublesome for patients with persistent or severe strictures. Aim: To review our experience with patients who have tight, benign strictures. Methods: Tight esophageal strictures were defined as those obstructing the passage of a 9.8 mm endoscope. 37 such patients were referred to our institution from January 1992 to November 1995. During each session, the final dilator passed was 6-10 Fr beyond the initial size meeting resistance. Subsequent sessions were performed frequently (q 1-3 weeks) until an adequate size was reached (approx. 45F), and then the interval was increased as tolerated. Wire-guided Savary-type dilators were used for tight, tortuous strictures. Maloney dilators were used in 14 patients when a 36 Fr dilator could be easily passed at the beginning of the session. All GERD patients were treated with high-dose H2 blockers or omeprazole. 10 patients received intra-lesional steroid injection when no progress was made with the initial sessions. Comparisons were made with the students t-test. Results: 16 patients had GERD, 11 had post-surgical or anastomotic strictures and 10 had other etiologies including Schatzki's ring, pill-induced, radiation injury and caustic ingestion. The 37 pts had 300 sessions (mean 8.1, range 1-33). The mean follow-up was 13 months (range 1-46 months). Table 1 displays mean dilator size (Fr) at the initial and final session, and the mean time between first 3 and last 3 dilation sessions (weeks). TABLE 1: Initial Size Final Size Initial Interval Final Interval All patients* 26.5 45.3 5.9 26.0 GERD pts* 28.3 45.5 7.3 35.9 Post-op pts* 23.7 46.1 4.7 24.1 * p < 0.0001 comparing initial vs final dilation size, and initial vs final dilation interval. There were no significant differences between groups. 3 patients had anti-reflux surgery after dysphagia resolved (one required post-op dilation). 3 patients with anastomotic strictures had surger, 2 for refractory dysphagia (both of whom continue to require dilations) and 1 for suspected (but unproven) perforation. Conclusions: Most patients with tight, benign esophageal strictures have excellent long-term results following techniques outlined above.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging