Endoscopic Dilation of Benign Esophageal Strictures in a Surgical Unit

Abstract

Ninety-five patients were treated by endoscopic dilation without fluoroscopic guidance between 1997 and 2005 for benign esophageal strictures. The etiologies were: anastomotic (38), postfundoplication (13), caustic (14), peptic (11), radiation-induced (10) and others (9). The strictures were classified at every session on a 0 to 4 scale on the basis of the diet and the luminal diameter. Savary-Gillard or Through-the Scope balloon dilators were used depending on the type and the location of the stenosis. A total of 472 dilation sessions were carried out without serious complications. A normal and a semisolid diet were respectively achieved in 75% and 91%. Recurrence of dysphagia was found in 33% and 51% of the patients respectively after 2 months and 1 year. Improvement of dysphagia, the number of sessions, and recurrence were significantly better in the patients with postsurgical stenosis as compared with those affected by caustic, peptic, and radiation-induced strictures.

Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures

“…First, we report one of the largest studies to date on endoscopic therapy of radiation-induced strictures; our study encompasses the largest number of refractory/recurrent strictures in the literature. 33,35,36,37 Second, our selected cohort had comprehensive long-term follow-up data to investigate detailed safety and efficacy factors. Lastly, this is the first study to categorize outcomes of dilation of esophageal stenosis based on standardized definitions for recurrent and refractory strictures and identify risk factors of refractory radiation-related strictures.…”

Dilation of refractory benign esophageal strictures

“…2,15,16 The efficacy and safety of endoscopic dilation without fluoroscopy has been shown in several studies. 7,[17][18][19] Nonetheless, it is generally advocated to use fluoroscopic guidance to enhance safety during dilation of complex strictures. 6 The majority of complex strictures can be endoscopically passed with a guidewire, followed by dilation.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…156 157 Controlled radial expansion balloons are more commonly used for this purpose now. A study of 472 oesophageal dilations included a mixture of bougie and balloon dilatations, and no perforations or haemorrhage were reported, 158 A series of 98 balloon dilations of anastomotic strictures of the cervical oesophagus reported no haemorrhagic complications. 159 A study of the complications arising from 504 balloon dilations in 237 patients with achalasia revealed 4 (1.7%) asymptomatic haematomas, but no clinically significant haemorrhage.…”