Fluoroscopically guided dilation of esophageal strictures in patients with dystrophic epidermolysis bullosa: long-term results.
OBJECTIVE
The purpose of this study was to investigate the immediate and long-term outcomes after fluoroscopically guided balloon dilation of esophageal strictures in a series of patients with dystrophic epidermolysis bullosa (DEB).


METHODS
Between 2005 and 2011, the medical records of all patients with DEB treated with fluoroscopically guided balloon dilation of esophageal strictures were included in the study and retrospectively analyzed. The indication for treatment was dysphagia attributed to at least one radiologically verified esophageal stricture. The primary endpoints of the study included procedural technical success, clinical improvement assessed with a 0-4 dysphagia score, and major complication rate. Secondary endpoints were patient survival and reintervention rates.


RESULTS
Nineteen consecutively registered patients with DEB (age range, 10-51 years; mean, 30 ± 12.2 years) and dysphagia due to esophageal strictures were treated with fluoroscopically guided balloon dilation. In total, 90 procedures and 121 dilations were performed to manage 28 lesions. Balloon diameter ranged from 8 to 18 mm. The mean follow-up time was 47.51 ± 16.64 months (range, 17-73 months). The technical success rate was 96.7% (87/90). There were no major complications. The mean reintervention rate was 1.19 dilations per patient per year, and the postprocedural dysphagia score (0.72 [95% CI, 0.56-0.87]) was significantly lower than baseline (2.50 [95% CI 2.35-2.65]) (p < 0.001).


CONCLUSIONS
Repeated fluoroscopically guided balloon dilation is safe and effective for the management of dysphagia caused by esophageal strictures in DEB. Use of this technique was associated with marked clinical improvement in dysphagia and satisfactory long-term reintervention rates with no major complications.
Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Lambeth Wing, 1st fl, Westminster Bridge Rd, London SE1 7EH, UK. stavspiliop@upatras.gr
Stavros
S
Spiliopoulos
Tarun
T
Sabharwal
Miltiadis
M
Krokidis
Panagiotis
P
Gkoutzios
Jemima
J
Mellerio
Renato
R
Dourado
Andreas
A
Adam
D000293:Adolescent; D000328:Adult; D001037:Aphasia / Q000209:etiology / Q000517:prevention & control; D002404:Catheterization; D002648:Child; D016108:Epidermolysis Bullosa Dystrophica / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult