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Corrosive Esophageal Strictures: From Dilatation to Replacement: A Retrospective Cohort Study

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Abstract

Endoscopic dilatation is the recommended primary therapy for chronic corrosive esophageal strictures (ES), and surgery is reserved for failed dilatation. Through this study, we intend to analyze the efficacy and long-term outcomes of both endoscopic and surgical interventions in corrosive ES. A retrospective cohort analysis of patients with chronic corrosive ES, managed with endoscopic or surgical procedures at a tertiary teaching institute in North India from December 2009 to December 2016, was performed from a prospectively maintained database. The primary outcome measure was the absence of dysphagia following dilatation or surgery. During the study period, 64 patients with ES underwent surgical or endoscopic treatment. Associated gastric strictures and pharyngeal strictures were present in 39 (60%) and 22 patients (28.9%), respectively. The mean age was 28.8 years and mean BMI was 14.2 kg/m2. Acid was the most common corrosive substance. Endoscopic dilatation using Savary-Gilliard (SG) dilators was successful in achieving persistent symptom relief in 46 patients (71.8%) after a total of 358 sessions (mean number of dilatations were 5.2 ± 1.2) of dilatations over 2 years. The dilatation therapy failed in 18 patients (28.1%) including technical failures (15.6%), perforations (3.1%), refractory stricture (1.5%) and recurrent strictures (7.8%). Increasing stricture length (more than 6 cm) was associated with poor outcome of endoscopic dilatation (p < 0.001). Only eleven patients (17%) required esophageal replacement (resection: 0, bypass: 11) for failed dilatations including seven gastric pull-ups and four pharyngo-coloplasty. The stricture rate after surgery was 36.3% (4/11). The median follows up was 32 months. Endoscopic dilatation of corrosive ES is safe and effective therapy and should be the first-line therapy for these patients and surgery should be considered only in patients who have unsuccessful outcome following dilatation therapy.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, King George’s Medical University, Lucknow, Uttar Pradesh, 226003, India

    Pradeep Joshi, Rakesh Yadav, Amit Dangi, Pavan Kumar, Saket Kumar, Vishal Gupta & Abhijit Chandra

  2. Department of Human Organ Transplant, King George’s Medical University, Lucknow, Uttar Pradesh, 226003, India

    Vivek Gupta

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  1. Pradeep Joshi
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Correspondence to Abhijit Chandra.

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“Pradeep Joshi, Rakesh Yadav, Pavan Kumar, Amit Dangi, Saket Kumar, Vivek Gupta, Vishal Gupta, and Abhijit Chandra have no conflicts of interest or financial ties to disclose.”

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The study was approved by the ethical board of the King George Medical University.

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Joshi, P., Yadav, R., Dangi, A. et al. Corrosive Esophageal Strictures: From Dilatation to Replacement: A Retrospective Cohort Study. Dysphagia 35, 558–567 (2020). https://doi.org/10.1007/s00455-019-10058-1

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