CORROSIVE ESOPHAGEAL STRICTURES - PREDICTORS OF RESPONSE TO ENDOSCOPIC DILATION

Twenty-one patients with corrosive esophageal strictures underwent con trast-enhanced CT of the chest to determine (1) the esophageal wall th ickness at the stricture site and (2) its correlation with number of s essions required for adequate dilation. Average esophageal wall thickn ess was defined as the mean thickness of all four walls at the site of the stricture, whereas the size of the thickest wall was taken as max imal esophageal wall thickness. Average esophageal wall thickness (8.5 2 +/- 0.61 mm; range, 5.4 to 13.5 mm) and maximal esophageal wall thic kness (11.63 +/- 0.83 mm; range, 5.4 to 20 mm) were significantly high er in patients with corrosive esophageal strictures than normal esopha geal wall thickness (2.70 +/- 0.04 mm, p < .01). These patients requir ed a mean of 5.70 +/- 1.42 sessions for achieving adequate dilation. A ge, sex, grade of dysphagia, and cause and site of the stricture did n ot influence the number of sessions required for adequate dilation. On multivariate analysis, maximal esophageal wall thickness (p < .01) bu t not average esophageal wall thickness or stricture length was indepe ndently associated with the number of sessions required for adequate d ilation. Patients with maximal esophageal wall thickness of 9 mm or mo re required a significantly higher number of sessions for adequate dil ation than did those with wall thickness of less than 9 mm (7.57 +/- 1 .80 versus 1.42 +/- 0.27, p < .05). These observations suggest that (1 ) marked esophageal wall thickening occurs in patients with corrosive esophageal strictures, and (2) maximal esophageal wail thickness can b e helpful in predicting the response to endoscopic dilation.