Predictive factors for the success of endoscopic dilation of esophageal caustic stricture: the experience of a French tertiary reference center.

Abstract

BACKGROUND:

Predictors of the efficacy of endoscopic dilation for caustic esophageal stricture have been poorly studied.

METHODS:

All patients undergoing an endoscopic dilation for an esophageal caustic stricture between 1990 and 2015 in a French national reference center were included. Success of dilation was defined by self-food autonomy without the need for reconstructive esophageal surgery.

RESULTS:

During the study period, 894 patients were admitted after caustic ingestion. Among them, 101 patients developed esophageal stricture and 92 patients were eligible for analysis (missing data in 8 cases, 1 patient died before endoscopic dilation). In this cohort (median age 42 years, women 53%, strong alkali 74%, suicide attempt 77%, hydrostatic balloon use 93%), the overall success rate of dilation was 57% with a median number of 3 dilation sessions (274 sessions, range 1-17). Factors predicting the success of the procedure were: non-inflammatory stricture or non-inflammatory intercalated mucosa between stricture (88% vs 47%, p = 0.001), a single stricture versus 2 or more strictures (69% vs 47% vs 33%, respectively, p = 0.04), a stricture of less than 5 cm (70% vs 27%, p < 0.001) and the existence of mild/ moderately tight or very tight stricture (70% vs 21% of success, p < 0.001). Perforation rate was 6.5% (18/274) requiring emergency surgery in 2 cases.

CONCLUSION:

Several characteristics of caustic esophageal strictures are significantly associated with the success rate of endoscopic dilation. Our data may be useful for customizing treatment strategies in patients with a caustic stricture.

• Authors: Nassim Hammoudi, Audrey Giaoui, Jérôme Lambert, Marion Dhooge, Hélène Corte, My-Linh Tran-Minh, Pierre Cattan, Jean-Marc Gornet
• Journal: Surgical endoscopy (Surg Endosc) Vol. 36 Issue 8 Pg. 5660-5668 (08 2022) ISSN: 1432-2218 [Electronic] Germany
• PMID: 35790591 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Caustics

Topics

• Adult
• Caustics (toxicity)
• Constriction, Pathologic
• Dilatation (methods)
• Esophageal Stenosis (chemically induced, surgery)
• Female
• Humans
• Retrospective Studies
• Treatment Outcome