Management of Acid- and Alkali-Induced Esophageal Strictures in 79 Adults by Endoscopic Dilation: 8-Years’ Experience in New Delhi

Abstract

Experience with endoscopic dilation of acid- and alkali-induced strictures of the esophagus using Savary-Gilliard (SG) and balloon dilators is limited, especially in adults. The aim of this study was to determine the safety and efficacy of endoscopic dilation in the management of corrosive esophageal strictures and to compare results with regard to acid- vs. alkali-induced strictures. The records of 230 patients who were treated by endoscopic dilation between 1997 and 2005 at our center were reviewed. This study included all the patients who had corrosive-induced esophageal strictures. SG dilators were used in most of our patients [67/79 (85%)], while only a few patients [12/79 (15%)] were treated with balloon dilators. Dilation was found to be successful after an initial course of dilation (not requiring further dilations) in 28/37 (75.67%) cases in the SG dilator group and in 9/12 (75%) in the balloon group. Strictures caused by acids required a greater mean number of dilations for initial relief of dysphagia compared with that for alkalis. Some of these patients responded to a second course of dilation, leading to final combined SG dilator and balloon dilator success rates of 24/28 (86%) in the acid group and 17/21 (81%) in the alkali group. A total of 359 sessions of dilations were performed with a complication rate of 2/359 (0.56%). Endoscopic dilation using Savary-Gilliard and balloon dilators is safe and effective in managing corrosive esophageal strictures, but it is operator-dependent and the final outcome depends largely on the technical expertise and appropriate selection of patients.

The effects of endoscopic-guided balloon dilations in esophageal and gastric strictures caused by corrosive injuries

“…However, there is no good evidence in the literature to suggest the best timing to perform endoscopic balloon dilation. EBD can be performed effectively and safely from four to six weeks after corrosive injury and is the treatment of choice for most of these injuries [5,11-13]. In patients with ES, esophagectomy followed by reconstruction operation can be performed, but such invasive procedure is grueling for both the patients and their surgeons.…”

Predicting the Progress of Caustic Injury to Complicated Gastric Outlet Obstruction and Esophageal Stricture, Using Modified Endoscopic Mucosal Injury Grading Scale

“…However it is known that EBD can be performed effectively and safely 4–6 weeks after corrosive injury and is the treatment of choice for most of these injuries [21, 22]. Surgery is carried out only in cases with severe complications, when EBD fails or when patients are unable to tolerate EBD procedures.…”

Surgical management of benign strictures of the oesophagus: 18 years of experience

“…Conservative techniques include oesophageal dilatation, which may be via rigid dilators or via flexible endoscopy with balloon dilatation. Relief of dysphagia is reported in 43% to 75% of patients [4]. Unfortunately, in those patients who do not experience lasting relief recurrent dilatation yields little benefit.…”

“…Many different therapies have been recommended. Repeated dilatation to maintain adequate lumen diameter has been recommended for chronic benign strictures [1,2,3,4]. In view of the ineffectiveness of dilatation as well as the complications caused by such procedures surgery may be required.…”