Endoscopic dilation of benign esophageal strictures: Report on 1043 procedures

OBJECTIVE: Endoscopic dilation is considered the best treatment for most ca ses of benign esophageal stricture, although the best dilation technique an d the kind of stricture is the most amenable to treatment is still controve rsial. We report on our experience on a large series of patients treated by dilation without the aid of fluoroscopy and compare the results of this th erapy among patients with strictures from different causes. METHODS: Between 1992 and 1997, we performed 1033 dilation sessions on 153 patients. Treatment was considered adequate if the esophageal lumen could b e dilated up to the size of a 42F catheter. If the stricture recurred after initial successful treatment, the stricture was dilated again up to a 42F catheter. RESULTS: One hundred forty patients (96 men, 44 women; mean age, 54.1 yr) w ere followed-up for a mean of 20.5 months (4 to 62 months). Stricture's eti ology was postsurgical in 80 patients, peptic in 37, caustic in 12, and fro m other causes in 11 patients. Adequate dilation was achieved in 93.5% of t he patients (131 of 140). Patients with peptic strictures needed a median o f three sessions to be adequately dilated during follow-up in comparison to five sessions among patients with postsurgical or caustic strictures (p = 0.07). There were four perforations, with one death (2.8% and 0.7% per pati ent and 0.4% and 0.1% per session, respectively). CONCLUSIONS: Endoscopic dilation without the aid of fluoroscopy is safe and effective in relieving dysphagia caused by benign strictures of different causes, although repeated sessions are necessary because of stricture recur rence. (Am J Gastroenterol 1999;94:1497-1501. (C) 1999 by Am. Coll. of Gast roenterology).