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

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 retr...

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Bibliographic Details
Published in:Dysphagia 2020-08, Vol.35 (4), p.558-567
Main Authors: Joshi, Pradeep, Yadav, Rakesh, Dangi, Amit, Kumar, Pavan, Kumar, Saket, Gupta, Vivek, Gupta, Vishal, Chandra, Abhijit
Format: Article
Language:English
Subjects:
Care and treatment
Cohort analysis
Deglutition disorders
Dysphagia
Endoscopy
Esophagus
Evidence-based medicine
Gastric bypass
Gastroenterology
Hepatology
Homeopathy
Imaging
Materia medica and therapeutics
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Original Article
Otorhinolaryngology
Patients
Pharynx
Radiology
Stricture
Surgery
Therapeutics
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Summary: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/m 2 . 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  
ISSN:0179-051X
1432-0460
DOI:10.1007/s00455-019-10058-1