Benign Tight Esophageal Strictures Can Be Managed With Weekly Dilations

For patients with complex benign esophageal strictures, including tight, long, or tortuous strictures, endoscopic dilation is usually performed at 2- to 4-week intervals. The success rate with such an approach is moderate, 60% to 65%, at best.  

In this single-center report, a cohort of 57 patients was divided into 2 groups: patients who had failed to achieve success with esophageal dilations performed at ≥2-week intervals (group A=21) and those with newly diagnosed complex esophageal strictures without prior treatment (group B=36). Both groups had comparable characteristics: mean age of 65 years (group A) versus 61 years (group B), as well as baseline esophageal lumen of <5 mm and dysphagia grade of 3 or 4 (48% vs 53%) or baseline luminal diameter between 5 and 10 mm and dysphagia grade of 2 or 3 (48% vs 47%). 

Weekly esophageal dilations were initiated for both groups, with success defined as a luminal diameter of ≥14 mm and dysphagia-free, with minimal additional intervention. During a median follow-up of 4 years, 52 patients (92%) had reached a luminal diameter of ≥14 mm with an overall success rate of 74% (strictures recurred in 10 patients). Patients in group B achieved a higher long-term success rate than group A (83% vs 58%; P=.033) through weekly dilations. Adverse events included bleeding (n=1), chest pain (n=2), and 1 patient death (0.2%) related to esophageal dilation (perforation).