LONG-TERM RESULTS OF ENDOSCOPIC DILATATION FOR CORROSIVE ESOPHAGEAL STRICTURES

Although dilatation is the treatment of choice for most patients with benign oesophageal strictures, there is little information on its effi cacy and safety in corrosive oesophageal strictures. Of 123 adults wit h benign oesophageal strictures treated by endoscopic dilatation, 52 ( 42-3%) had strictures after corrosive ingestion and 39 (31.7%) had pep tic strictures. Treatment was considered adequate if the oesophageal l umen could be dilated to 15 mm and there was complete relief of dyspha gia. If dysphagia recurred after adequate initial dilatation, the stri cture was dilated again up to 15 mm. Initial dilatation was adequate i n 93.6% of patients with corrosive strictures and this success rate wa s comparable with that of the peptic stricture group (100%, p>0.05). L ong term success after adequate initial dilatation was studied in 36 p atients with corrosive strictures (mean follow up 32.36 (17.12) months , range 6.60) and 33 patients with peptic strictures (mean follow up 3 6-32 (17.9) months, range 6.60). The mean (SEM) number of symptomatic recurrences per patient month during the total follow up period in the corrosive group was significantly higher than that in the peptic grou p (0.27 (0.04) v 0.07 (0.02), p<0.001). The recurrence rate in the cor rosive group, however, decreased over time, and after 12 months it was significantly (p<0.001) lower than the recurrence rate in the first s ix months. After 36 months, the difference in the recurrence rate in t he two groups was not significant (p>0.05). Only nine oesophageal perf orations occurred during a total of 1373 dilatation treatments (proced ure related incidence 0.66%), and eight of these were in the corrosive stricture group. These patients were managed conservatively and subse quently strictures were dilated adequately in all. Endoscopic dilatati on is safe and effective for short and long term relief of dysphagia i n patients with corrosive oesophageal strictures.