PEPTIC ESOPHAGEAL STRICTURE - IS SURGERY STILL NECESSARY

Gastroesophageal reflux disease is frequently complicated by peptic es ophageal stricture formation. Treatment of choice over the past 25 yea rs has changed from resection of the stenotic esophagus towards fundop lication, or conservative treatment combined with dilatation. Reports on the long-term results of the clinical course of such patients are s till rare. Between 1965 and 1990 200 patients were treated for peptic esophageal stricture by surgery or bougienage with antisecretory medic ation. Retrospective analysis of the clinical outcome according to the primary therapeutic strategy was performed after a follow-up period o f 1.5 to 267 months. 139 patients (group A) primarily received bougien age and medical treatment. After 71 months 36% of the patients were sy mptom-free, 52% had received further dilatation and 11% had undergone surgery. One fatal complication occurred. 61 patients (group B) underw ent primary surgical treatment. Fundoplication was performed in 72% of the cases, resection in 18% and other procedures in 10%. After a medi an period of 84 months following standard fundoplication (n = 43) 44% were free of symptoms, 39% had received further dilatations and 12% ha d to be reoperated. Fatal complications occurred in 2 patients (5%). T he risk of undergoing surgery after primary dilatation was 16% after 2 years, remaining on this level throughout follow-up time. We conclude that resection of peptic strictures of the esophagus is rarely indica ted any more. Treatment of choice consists of primary bougienage combi ned with antisecretory medication. If conservative treatment fails or patient compliance is low we recommend funcoplication with intraoperat ive dilatation within the first 2 years after diagnosis of symptomatic stricture.