Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study
Background and Aims: Endoscopic dilation (ED) is still the mainstay of therapeutic management of benign esophageal strictures (BESs). This study aimed to establish risk factors for refractory BESs and assess long-term clinical outcomes of ED. Methods: We performed a retrospective study in 891 patients who underwent ED from 2003 to 2018 for BESs. We searched electronic medical records in 6 tertiary care centers in the Netherlands for data on clinical outcome of ED. Median follow-up was 39 months. The primary endpoint was risk factors for refractory BESs, defined as factors associated with an increased number of ED sessions during follow-up. Secondary endpoints were time from first to last ED session and adverse events. Results: Dilation up to 13 to 15 mm was associated with a higher number of ED sessions than dilation up to 16 to 18 mm (5.0 vs 4.1; hazard ratio [HR], 1.4; P =.001). Compared with peptic strictures, anastomotic (4.9 vs 3.6; HR, 2.1; P <.001), radiation (5.0 vs 3.6; HR, 3.0; P <.001), caustic (7.2 vs 3.6; HR, 2.7; P <.001), and postendotherapy (3.9 vs 3.6; HR, 1.8; P =.005) strictures were associated with a higher number of ED sessions. After 1 year of follow-up, the proportions of patients who remained free of ED was 75% in anastomotic, 71% in radiation, 70% in peptic, 83% in postendotherapy, and 62% in caustic strictures. Esophageal perforation occurred in 23 ED sessions (.4%) in 22 patients (2.4%). Conclusions: More than 60% of patients with BESs remain free of ED after 1 year of follow-up. Because dilation up to 16 to 18 mm diameter was associated with fewer ED sessions during follow-up, we suggest that clinicians should consider dilation up to at least 16 mm to reduce the number of ED sessions in these patients.
|Organisation||Department of Gastroenterology & Hepatology|
Vermeulen, B.D. (Bram D.), de Zwart, M. (Merle), Sijben, J. (Jasmijn), Soons, E. (Elsa), van der Weerd, L. (Lucie), Arese, D. (Daniele), … Siersema, P.D. (2020). Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study. Gastrointestinal Endoscopy. doi:10.1016/j.gie.2019.12.040