A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki's) rings.

Abstract

BACKGROUND:

Lower esophageal (Schatzki's) rings are a common cause of solid food dysphagia. Standard treatment involves passage of a single large bougie to disrupt the ring, but symptoms recur in the majority of patients. Electrosurgical incision of the ring may provide a longer duration of symptom improvement. There are no data on the treatment of Schatzki's rings in the presence of acid suppression treatment.

OBJECTIVE:

Our purpose was to compare the efficacy of bougie dilation with electrosurgical incision of symptomatic Schatzki's rings at 1-year follow-up in the presence of rabeprazole treatment.

DESIGN:

Randomized, prospective trial.

SETTING:

University of Utah Health Sciences Center and the Veterans Affairs Salt Lake.

PATIENTS:

Fifty patients referred for endoscopic evaluation of dysphagia between January 2002 and March 2005.

MAIN OUTCOME MEASUREMENTS:

Symptom-free survival time (in months), dysphagia, and GERD scores.

RESULTS:

Twenty-five patients each underwent bougie dilation and electrical incision and were followed up for 12 months. Symptom-free survival times were significantly longer in the incision group (7.99 months) compared with the bougie dilation group (5.86 months) (P = .03). Dysphagia and GERD scores significantly improved in each group comparing baseline with each time interval. The incision group had greater relief of dysphagia at 1 month (P = .05) compared with the bougie group. There was no difference between GERD scores in both groups.

LIMITATIONS:

Dysphagia and GERD symptoms were self-reported.

CONCLUSIONS:

Electrosurgical incision of Schatzki's rings is safe and offers longer symptom-free survival compared with bougie dilation. The addition of rabeprazole offered significant improvement in GERD scores in both groups.

• Authors: Jason C Wills, Kristen Hilden, James A Disario, John C Fang
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 67 Issue 6 Pg. 808-13 (May 2008) ISSN: 0016-5107 [Print] United States
• PMID: 18313671 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• 2-Pyridinylmethylsulfinylbenzimidazoles
• Enzyme Inhibitors
• Rabeprazole

Topics

• 2-Pyridinylmethylsulfinylbenzimidazoles (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Deglutition Disorders (etiology, pathology, therapy)
• Dilatation (methods)
• Electrosurgery (methods)
• Enzyme Inhibitors (therapeutic use)
• Esophageal Stenosis (complications, pathology, therapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Rabeprazole
• Severity of Illness Index
• Stereoisomerism
• Time Factors
• Treatment Outcome