Outcome of long benign esophageal strictures undergoing endoscopictherapy: A tertiary center experience

Complex benign esophageal strictures are defined by length (≥2 cm), small diameter, and stricture angulation or tortuosity. The long-term course of complex esophageal strictures based on length is currently unclear. We suspect that the esophageal stricture length might impact the effectiveness of endoscopic dilation therapy. We performed a retrospective study of all benign esophageal strictures of 2 cm or longer treated at a single center between July 1, 2010, and May 31, 2014. Primary outcomes were changed in dysphagia score at the end of follow-up compared to first dilation at our facility and the need for gastrostomy placement or esophagectomy during follow-up. Data were stratified into four subgroups according to stricture length: 20-29, 30-49, 50-99, and 100 mm or longer. Eighty-seven patients (mean age: 66 years, 54% women) were followed over a median of 40 months. Patients underwent a median of 6 dilations, averaging 0.3 dilations per month. Median dysphagia score remained unchanged at 2; 37 (43%) patients reported resolution or improved dysphagia and 50 (57%) patients reported no improvement or worsened dysphagia. Gastrostomy placement or esophagectomy was needed for 23 (26%) and 3 (3%) patients, respectively. Median degree of dysphagia at the end of follow-up did not differ between the four stricture length subgroups, yet no patient had improvement in the 100 mm or longer subgroup. More than half of patients with long benign esophageal strictures had unchanged dysphagia or developed worse dysphagia during follow-up. Long-term outcomes did not differ between different stricture lengths.