AN OBJECTIVE END-POINT FOR DILATION IMPROVES OUTCOME OF PEPTIC ESOPHAGEAL STRICTURES - A PROSPECTIVE RANDOMIZED TRIAL

Background: The usual end point for defining success of dilation is su bjective (relief of dysphagia). In most patents thus managed stricture s recur. We asked whether an objective end point would improve outcome . Methods: After dilation to 15 mm, patients were randomized into subj ective and objective groups. In subjective group patients, end point f or dilation was alleviation of dysphagia; in objective group patients, passing the 12 mm barium pill test. Objective group patients who fail ed underwent redilation until they passed the pill or failed three tim es. During Part 1 of the study, patients received ranitidine, during P art 2 they received omeprazole. Results: In part 1, dysphagia was alle viated in 7 of 8 subjective group patients. Only 2 of 10 objective gro up patients passed the pill test and no additional patients passed aft er 3 sessions, although most had no dysphagiaIn Part 2, 19 subjective group and 15 objective group patients were studied. End point was not achieved in 3 objective group patients. Over long-term follow-up, obje ctive group patients had less recurrent dysphagia (p = 0.02) and requi red fewer redilation sessions (p < 0.05). Overall, the pill test corre lated with the presence or absence of dysphagia (p < 0.001). Predictiv e value of passing the pill 1 week after dilation for the absence of d ysphagia was 100%, but of failing the pill test and the presence of dy sphagia was only 18%. Conclusions: Achieving an objective end point re duces stricture recurrence and the need for subsequent dilation. Initi al subjective improvement does not predict long-term success.