Self-dilation as a treatment for resistant, benign esophageal strictures

Ivana Dzeletovic, David E. Fleischer, Michael D. Crowell, Rahul Pannala, Lucinda A. Harris, Francisco C. Ramirez, George E. Burdick, Lauri A. Rentz, Robert V. Spratley, Susan D. Helling, Jeffrey A. Alexander

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Goals and Background: Simple benign strictures may be relieved with one to three dilation sessions. Resistant benign strictures are anatomically complex and resistant to therapy. We sought to determine the efficacy and safety of esophageal self-dilation with bougie dilators in the largest series to date. Study: A retrospective chart review was performed to identify patients who underwent esophageal self-dilation at two tertiary referral centers (Mayo Clinic, Scottsdale, Arizona and Mayo Clinic Rochester, Minnesota) between January 1, 2003 and June 30, 2012. Demographic details and clinical information regarding relief of dysphagia, complications, and frequency of endoscopic and self-dilation were abstracted. Results: Of the 32 patients who began self-dilation for nonmalignant strictures, 30 [22 men; median (range) age, 62 years (22-86 years)] were included in the study. Median (range) follow-up was 37 months (14-281 months). Stricture etiology included radiation therapy (n = 8), anastomotic stricture (n = 9), eosinophilic esophagitis (n = 4), caustic ingestion (n = 3), photodynamic therapy (n = 2), granulation tissue (n = 2), peptic stricture (n = 1) and one patient had radiation therapy and peptic stricture. The average number (range) of physician performed dilations before self-dilation was 12 (4-55). Esophageal self-dilation was successful in treating 90 % of patients. Dysphagia score (2 vs. 1; P < 0.001), stricture diameter (median; 5 vs. 12 mm; P < 0.001) and weight (median; 73 vs. 77 kg; P < 0.001) were significantly different between EDG dilation versus self-dilation. Conclusions: Esophageal self-dilation is a safe, effective treatment for resistant, benign esophageal strictures. This management strategy should be strongly considered in this patient population.

Original languageEnglish (US)
Pages (from-to)3218-3223
Number of pages6
JournalDigestive diseases and sciences
Volume58
Issue number11
DOIs
StatePublished - Nov 1 2013

Keywords

  • Dysphagia
  • Endoscopic dilation
  • Esophageal self-dilation
  • Resistant benign esophageal strictures

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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