Resource utilization success of treatment in patients with tight, benign esophageal strictures

Contrary to tight, malignant strictures, few studies address the outcomes of patients with tight, benign strictures (TBS). Since these patients have longer life expectancy, the long-term management may be more important. AIM: To review our experience in patients with TBS. METHODS: 52 patients had esophageal stricture that would not allow passage of the standard 9.8 mm endoscope. GERD was treated with aggressive medical therapy. Patients were gradually dilated to 45-48 F during repeated dilation sessions. Once achieving this goal, dilations were performed on a PRN basis. Patients not responding to initial dilation sessions received intralesional steroid injection. Data regarding the dilation sessions (ie. size, number of dilations) was obtained on all patients. Pre and Post dilation dysphagia scores were obtained in 35 patients and compared to a group of patients with GERD strictures after mean follow-up of 20.6 months. The dysphagia score was obtained by adding the dysphagia frequency (never=0, intermittently=1, weekly=2, daily=3) to the diet score (no problems=0, problems with selected solids=1, all solids=2, liquids=3). Comparisons were made with a control group of patients with reflux strictures. RESULTS: Cause of the strictures in the TBS group included GERD 25, post-op 8, other 16. All patients in both groups improved. Table 1 displays mean dysphagia scores. TBS GERD p # of dilation sessions 6.1 2.6 .001 Pre-dilation 4.6 4.0 NS Post-dilation 1.8 1.4 NS TBS patients required more dilation sessions to reach maximum size (2.9 v 1.3, p<.001)and more dilation sessions after reaching that size to remain dysphagia free (3.1 v 1.4, p<0.01). More TBS patients required intralesional steroid injections (14 v 1, p <.01). One TBS patient developed a late perforation. There were no procedure related mortalities in either group. CONCLUSIONS: 1) TBS patients respond equally well to long term dilation therapy. 2) TBS patients require far greater resources to accomplish this.