Clinical course of esophageal stricture managed by bougienage

Abstract

To define the clinical course of patients with benign esophageal stricture treated with bougienage, we reviewed the records of 76 patients undergoing dilatation. Patients with the diagnosis of scleroderma and those with previous hiatal hernia repair or gastric surgery were excluded. Initial evaluation included contrast study, esophagoscopy, and biopsy. Patients underwent a series of dilatations until a 44-Fr or larger bougie was passed. Patients were then instructed to return for recurrence of dysphagia. In this group, mean duration of follow-up from the first dilatation was 21.1 months. A total of 569 dilatations were performed with one major complication and no mortality. Benign esophageal stricture recurred in 65% of patients. After two or more recurrences, the likelihood of requiring an additional dilatation was 86–94% after each recurrence. The interval between required dilatations was variable; however, after 8 dilatations, it approximated once monthly. The shorter mean follow-up time of patients requiring a single dilatation (9.7 months) compared to those requiring multiple dilatations (28.8 months) suggests that the recurrence rates noted in this study are underestimations. In spite of high recurrence rates and short recurrence intervals, the low morbidity and absent mortality over long-term follow-up suggests that repeated bougienage is, an effective modality for the management of benign esophageal stricture.