Benign Tight Esophageal Strictures Can Be Managed With Weekly Dilations
Prateek Sharma, MD, FASGE, reviewing Palam S, et al. Surg Endosc 2022 Apr 27.
For patients with complex benign esophageal strictures, including tight, long, or tortuous strictures, endoscopic dilation is usually performed at 2- to 4-week intervals. The success rate with such an approach is moderate, 60% to 65%, at best.
In this single-center report, a cohort of 57 patients was divided into 2 groups: patients who had failed to achieve success with esophageal dilations performed at ≥2-week intervals (group A=21) and those with newly diagnosed complex esophageal strictures without prior treatment (group B=36). Both groups had comparable characteristics: mean age of 65 years (group A) versus 61 years (group B), as well as baseline esophageal lumen of <5 mm and dysphagia grade of 3 or 4 (48% vs 53%) or baseline luminal diameter between 5 and 10 mm and dysphagia grade of 2 or 3 (48% vs 47%).
Weekly esophageal dilations were initiated for both groups, with success defined as a luminal diameter of ≥14 mm and dysphagia-free, with minimal additional intervention. During a median follow-up of 4 years, 52 patients (92%) had reached a luminal diameter of ≥14 mm with an overall success rate of 74% (strictures recurred in 10 patients). Patients in group B achieved a higher long-term success rate than group A (83% vs 58%; P=.033) through weekly dilations. Adverse events included bleeding (n=1), chest pain (n=2), and 1 patient death (0.2%) related to esophageal dilation (perforation).
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Palam S, Mohorek M, Rizvi S, Dua K. Clinical outcomes on weekly endoscopic dilations as the initial approach to manage patients with complex benign esophageal strictures: report on 488 dilations. Surg Endosc 2022 Apr 27. (Epub ahead of print) (https://doi.org/10.1007/s00464-022-09248-0)