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Outcome of dilatation and predictors of failed dilatation in patients with acid-induced corrosive esophageal strictures

Surgical Endoscopy volume 32, pages 900–907 (2018)Cite this article

Abstract

Outcome of endoscopic dilatation in acid-induced corrosive esophageal stricture is less known. This study aims to determine the outcome of dilatation and predictors of failed dilatation in patients with acid-induced corrosive esophageal stricture. Patients diagnosed of corrosive esophageal strictures were included. Endoscopic dilatation with graded Savary-Gilliard dilator was performed as the first line treatment. Outcome of dilatation was considered favorable when patients were able to swallow solid without intervention at least six months after successful dilatation. Failure of dilatation was defined as one of the following; complete luminal stenosis, inability to perform safe dilatation, perforation, and inability to maintain adequate luminal patency. Surgery or repeated dilatation was indicated in failed dilatations. There were 55 patients with corrosive esophageal strictures. Of 55 patients, 41 (75%) had failed dilatation (38 having esophageal replacement procedure, two continue repeated dilatation and one unfit for surgery). Of 323 sessions of dilatations, eight out of 55 patients (14.5%) had perforations. There was no dilatation-related mortality. Patients with concomitant pharyngeal stricture (p = 0.0001), long (≥ 10 cm) stricture length (p < 0.0001), number of dilatation >6 sessions per year (p = 0.01) and refractory stricture (inability to pass a larger than 11 mm dilator within three sessions) (p = 0.01) were more likely to have failed dilatation. Thirty-two of 38 patients with surgery had good swallow outcome with one operative mortality (2.6%). At the median follow-up of 61 months, overall favorable outcome was 84% after surgery and 25% for dilatation (p < 0.0001). Majority of patients with acid-induced corrosive esophageal stricture were refractory to dilatation. Esophageal dilatations were ultimately failed in three-fourth of the patients. Concomitant cricopharyngeal stricture, long stricture length, requiring frequent dilatation, and refractory to >11 mm dilatation were factors associated with failed dilatation.

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Notes

  1. The inability to properly place a guidewire for safe dilatation was defined when a loop of the distal end of the guidewire was unable to be formed within the stomach before dilatation was initiated.

  2. Complete luminal stricture was defined when there was an inability to identify a luminal orifice to negotiate a guidewire.

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Affiliations

  1. Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Chadin Tharavej, Suppa-ut Pungpapong & Pakkavuth Chanswangphuvana

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  1. Chadin Tharavej
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  2. Suppa-ut Pungpapong
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Correspondence to Chadin Tharavej.

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Drs. Tharavej, Pungpapong, Chansawangphuvana have no conflicts of interest or financial ties to disclose.

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Tharavej, C., Pungpapong, Su. & Chanswangphuvana, P. Outcome of dilatation and predictors of failed dilatation in patients with acid-induced corrosive esophageal strictures. Surg Endosc 32, 900–907 (2018). https://doi.org/10.1007/s00464-017-5764-x

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Keywords

  • Corrosive esophageal stricture
  • Endoscopic esophageal dilatation
  • Refractory benign esophageal stricture