Single-session, graded esophageal dilation without fluoroscopy in outpatients with lower esophageal (Schatzki's) rings: a prospective, long-term follow-up study.
BACKGROUND
Distal esophageal (Schatzki's) ring is a frequent cause of dysphagia. Bougienage is generally effective but relapses are common. The aim of this study was to evaluate the safety and long-term efficacy of single-session graded esophageal dilation with Savary dilators, without fluoroscopic guidance, in outpatients who presented with Schatzki's ring.


METHODS
The study was performed on 44 consecutive patients with symptomatic Schatzki's ring, detected endoscopically and/or radiologically. Graded esophageal dilation was performed as an outpatient procedure in a single session with Savary dilators, without fluoroscopic guidance. After appropriate assessment with esophageal manometry and 24 h ambulatory pHmetry, patients with documented gastroesophageal reflux disease (GERD) were treated with omeprazole continuously. All results, including clinical follow up and technical aspects of bougienage, were recorded prospectively. The necessity for re-dilation after documentation of the ring with endoscopy and/or radiology was considered as a relapse of the ring.


RESULTS
In four (9%) patients a second session was necessary to ensure complete symptom relief. Two (4.5%) patients developed post-dilation bacteremia and were managed with antibiotics as outpatients. Patients with (n = 14) or without (n = 30) GERD were comparable with respect to sex, age, body mass index, smoke and ethanol consumption, diameter of the esophageal lumen at the level of the ring, resting lower esophageal sphincter pressure, duration of dysphagia, need for taking antacids during the follow-up period, and duration of follow-up. There was no recurrence of the ring in patients with GERD during a mean follow-up period of 43.8 +/- 9.3 months (range 27-62 months); however, in patients without GERD, during a mean follow-up period of 40.6 +/- 12.2 months (range 10-58 months), 32% of patients relapsed after a mean 19.9 +/- 10.6 months (P = 0.04).


CONCLUSIONS
Single-session graded esophageal dilation with large caliber Savary dilators without fluoroscopic guidance can be safely used for the symptomatic relief in patients with lower esophageal (Schatzki's) rings. GERD should be treated if present in order to prevent a symptomatic recurrence of the ring.
Sgouros
Spiros N
SN
Department of Gastroenterology, Athens Naval and Veterans Hospital, Athens, Greece. spisgon@otenet.gr
Vassiliadis
Konstantinos
K
Bergele
Christina
C
Vlachogiannakos
Jiannis
J
Stefanidis
Gerasimos
G
Mantides
Apostolos
A
D000368:Aged; D000553:Ambulatory Care; D003680:Deglutition Disorders / Q000209:etiology*; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004940:Esophageal Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000378:metabolism; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D009853:Omeprazole