Radiation-induced esophageal strictures treated with fluoroscopic balloon dilation: clinical outcomes and factors influencing recurrence in 62 patients

Abstract

Background Balloon dilation is safe and effective for the treatment of radiation-induced esophageal stricture (RIES), with favorable short-term and mid-term outcomes; however, few reports of long-term outcomes exist. Few studies have evaluated factors associated with recurrence after balloon dilation. Purpose To evaluate the long-term outcome of balloon dilation in patients with RIES and to identify factors associated with stricture recurrence. Material and Methods The medical records of 62 consecutive patients who had undergone fluoroscopic balloon dilation for RIES at our institution between December 1998 and June 2016 were reviewed. Results One hundred and twenty balloon dilation sessions were performed in 62 patients (mean = 1.9 sessions per patient). Clinical success was achieved in 53 (86%) patients after single (n = 37) or multiple (n = 16) dilation sessions. Complications occurred in 27% of the dilation sessions. The primary patency rates at one, two, three, and five years were 60%, 56%, 52%, and 52%, respectively. Secondary patency rates at one, two, three, and five years were 87%, 85%, 85%, and 80%, respectively. Multivariate logistic regression analysis identified an interval from radiation therapy (RT) to stricture of ≥6 months (hazard ratio [HR] = 0.205; P < 0.001), strictures located at the cervical esophagus (HR = 5.846; P < 0.001), and stricture length of ≥2 cm (HR = 2.923; P = 0.006) as significant predictors of recurrence. Conclusion Despite the high incidence of ruptures and recurrences, fluoroscopic balloon dilation is valuable as an initial therapeutic option for patients with RIES.

Factors predicting successful endoscopic balloon dilatation of esophageal strictures in children - a retrospective study

“…Early EBD was related to fewer EBD sessions. This finding is similar to the previous reports of different series in which time to diagnosis or onset of stricture is the most important factor affecting recurrence after dilation (25,26).…”

Severe esophageal stenosis in a patient with metastatic colon cancer following palliative radiotherapy, ramucirumab, and chemotherapy

“…Radiation‐induced esophageal stenosis is considered to be due to chronic inflammation and fibrosis caused by RT, which can be safely and effectively treated with balloon dilation . The incidence of esophageal stenosis is reportedly 6% in patients with lung cancer who have received concurrent chemoradiotherapy .…”

Pharyngoplasty effectively relieves dysphagia from radiation-induced upper gastrointestinal tract strictures: A report of two cases

“…The development of hypopharyngeal and esophageal stricture is caused by progressive obliterative endarteritis leading to ischemia of the esophageal wall [1]. The estimated risk of developing radiation-induced stricture is less than 2% in patients treated with a dose of 50Gy or less but rises to 15% in those treated with a dose of 60Gy [2,3]. Pharyngeal and esophageal strictures following external beam radiation impacts significantly on patients' quality of life.…”