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Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case–control study

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Abstract

Introduction

In patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures.

Methods

Patients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year.

Results

39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS).

Conclusion

Overall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration.

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Authors and Affiliations

  1. Endoscopy Unit, CHU Saint Eloi, Université de Montpellier, 80 avenue Gaston Fliche, 34090, Montpellier, France

    Antoine Debourdeau

  2. Centre Hospitalier d’Avignon, Avignon, France

    Alban Benezech

  3. Gastroenterology Unit, North Universitary Hospital, AP-HM, Marseille, France

    Véronique Vitton

  4. Digestive Endoscopy Unit, North Universitary Hospital, Marseille, France

    Marc Barthet & Jean-Michel Gonzalez

Authors
  1. Antoine Debourdeau
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  2. Marc Barthet
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  3. Alban Benezech
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  4. Véronique Vitton
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  5. Jean-Michel Gonzalez
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Correspondence to Antoine Debourdeau.

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Dr. Marc Barthet, Véronique Vitton, Jean-Michel Gonzalez, MD. Véronique Vitton, and Antoine Debourdeau declare that they have no conflicts of interest or financial ties to disclose.

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Debourdeau, A., Barthet, M., Benezech, A. et al. Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case–control study. Surg Endosc 36, 1098–1105 (2022). https://doi.org/10.1007/s00464-021-08376-3

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  • DOI: https://doi.org/10.1007/s00464-021-08376-3

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