Experience of Endoscopic Dilatation of Esophageal Strictures in a Tertiary Care Hospital: A Study From Central India.

Background Endoscopic dilatation is the cornerstone therapy for esophageal strictures. The primary indication for dilatation is to provide immediate and durable symptomatic relief from dysphagia. Following esophageal dilatation, the two most common major consequences are bleeding and perforation, both of which are quite rare. Post-radiation and caustic strictures continue to be a common source of recurrent and refractory strictures that require multiple dilatations, despite a variety of therapeutic techniques. There is a lack of studies dealing with the efficacy and safety of the procedure. Therefore, this study was conducted to explore the effectiveness and application of the Savary-Gilliard dilatation of strictures, as well as the factors influencing the outcome. Methods We recruited patients of dysphagia of various grades having esophageal strictures of various etiologies. The dilatation sessions were done as an outpatient procedure in the majority of patients. In all patients, preprocedural workups, such as routine investigations and esophagogastroduodenoscopy, were done. Contrast-enhanced computed tomography scans of the abdomen and barium swallow examination were done in selected patients. Results of dilatation using wire-guided dilators were reported as the number of dilatations per stricture according to their location and the mean number of sessions required to achieve the target diameter (15 mm). Evaluating clinical efficacy and adverse events were the main goals. Results A total of 250 dilatations were carried out in 112 patients, of whom 67 were females and 45 were males. The mean age of the study population was 50.38 ± 15.4 years. Post-radiation stricture was the commonest. Strictures of upper esophageal origin required the highest number of sessions (2.21 ± 0.78) for adequate dilatation compared to the middle (2.14 ± 0.83) and lower locations (1.7 ± 0.78) with a p-value of 0.004. Post-corrosive upper esophageal stricture required a greater number of sessions for adequate dilatation as compared to post-radiation strictures (3.0 ± 0 vs. 2.6 ± 0.63) with a p-value of 0.005. Conclusion Esophageal dilation for strictures produces a good outcome with minimal adverse effects or major complications. Post-radiation, post-surgical, and post-corrosive strictures are more likely to require repeated sessions for symptomatic relief.