Self-dilation as a treatment for resistant, benign esophageal strictures.
OBJECTIVE
Simple benign strictures may be relieved with one to three dilation sessions. Resistant benign strictures are anatomically complex and resistant to therapy. We sought to determine the efficacy and safety of esophageal self-dilation with bougie dilators in the largest series to date.


METHODS
A retrospective chart review was performed to identify patients who underwent esophageal self-dilation at two tertiary referral centers (Mayo Clinic, Scottsdale, Arizona and Mayo Clinic Rochester, Minnesota) between January 1, 2003 and June 30, 2012. Demographic details and clinical information regarding relief of dysphagia, complications, and frequency of endoscopic and self-dilation were abstracted.


RESULTS
Of the 32 patients who began self-dilation for nonmalignant strictures, 30 [22 men; median (range) age, 62 years (22-86 years)] were included in the study. Median (range) follow-up was 37 months (14-281 months). Stricture etiology included radiation therapy (n = 8), anastomotic stricture (n = 9), eosinophilic esophagitis (n = 4), caustic ingestion (n = 3), photodynamic therapy (n = 2), granulation tissue (n = 2), peptic stricture (n = 1) and one patient had radiation therapy and peptic stricture. The average number (range) of physician performed dilations before self-dilation was 12 (4-55). Esophageal self-dilation was successful in treating 90 % of patients. Dysphagia score (2 vs. 1; P < 0.001), stricture diameter (median; 5 vs. 12 mm; P < 0.001) and weight (median; 73 vs. 77 kg; P < 0.001) were significantly different between EDG dilation versus self-dilation.


CONCLUSIONS
Esophageal self-dilation is a safe, effective treatment for resistant, benign esophageal strictures. This management strategy should be strongly considered in this patient population.
Division of Gastroenterology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA, ivana.dzeletovic@gmail.com.
Ivana
I
Dzeletovic
David E
DE
Fleischer
Michael D
MD
Crowell
Rahul
R
Pannala
Lucinda A
LA
Harris
Francisco C
FC
Ramirez
George E
GE
Burdick
Lauri A
LA
Rentz
Robert V
RV
Spratley
Susan D
SD
Helling
Jeffrey A
JA
Alexander
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation / Q000295:instrumentation* / Q000379:methods*; D004940:Esophageal Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult