CUTTING THE DEFIANT LOWER ESOPHAGEAL RING

A symptomatic lower esophageal ring generally responds to standard bou gienage therapy. However, a subset of patients with a lower esophageal ring defy dilation therapy. We have evaluated the efficacy of electro cautery incision of ''defiant'' lower esophageal rings, the data of wh ich forms the basis of this report. Seven of 75 patients with a lower esophageal ring failed to respond to conventional esophageal dilation. All seven patients underwent electrocautery incision of a ''defiant'' lower esophageal ring with alleviation of dysphagia. One patient had recurrence of dysphagia that occurred 6 months after initial electroca utery incision. No major complication occurred, although one patient h ad transient chest pain. Subsequently, all patients have remained with out symptoms at a mean follow-up of 36 months. Electrocautery incision of ''defiant'' lower esophageal ring is efficacious, safe, and result s in long-term relief of dysphagia.