Corrosive esophageal strictures: long-term effectiveness of balloon dilation in 117 patients.
OBJECTIVE
To retrospectively evaluate the long-term results of balloon dilation in the treatment of corrosive esophageal strictures and to identify prognostic factors associated with clinical outcome.


METHODS
From January 1987 to June 2006, balloon dilation was undertaken in 117 patients with corrosive esophageal strictures. Information on recurrence and complications was obtained. Recurrence rates and factors predicting recurrences were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis. Tested variables were age, sex, corrosive agent, stricture length, stricture number, severity of stricture as judged by the resistance to dilation, and stage (early chronic [3 weeks to 6 months] vs late chronic [>6 months]).


RESULTS
The mean follow-up period was 51 months (range, 1-174 months). Thirty patients (26%) had no recurrence after initial balloon dilation. Twenty-three patients (20%) experienced no recurrence after one or two additional balloon dilation procedures. Forty-five of 117 patients (38%) experienced esophageal rupture (mostly intramural rupture). Early chronic stage (P=.003) and resistance to balloon dilation in the late chronic stage (P=.034) were significantly associated with recurrence after balloon dilation.


CONCLUSIONS
Balloon dilation is associated with minimal complications and is valuable as an initial therapy in patients with corrosive esophageal stricture. However, the recurrence rate after balloon dilation is rather high, with early chronic stage and resistance to dilation in the late chronic stage associated with poor clinical outcome. An algorithm combining balloon dilation with temporary stent placement is proposed for the subsets of patients prone to stricture recurrence.
Kim
Jin Hyoung
JH
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul National University Hospital, Seoul, Korea.
Song
Ho-Young
HY
Kim
Hyo-Cheol
HC
Shin
Ji Hoon
JH
Kim
Kyung Rae
KR
Park
Sang Woo
SW
Jung
Hwoon-Yong
HY
Lee
Gin Hyug
GH
Park
Seung-Il
SI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002424:Caustics / Q000009:adverse effects*; D003287:Contrast Media / Q000008:administration & dosage; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D002424:Caustics; D003287:Contrast Media