title: Endoscopic dilation of benign esophageal anastomotic strictures over 16 mm has a longer lasting effect.
abstract: The optimal target of endoscopic dilation of postsurgical esophageal strictures is unknown. Our aim was to compare the dilation-free period of patients who underwent dilation up to 16 mm with patients who were dilated up to 17 or 18 mm.
  
  
  
  We retrospectively analyzed adult patients who received bougie/balloon dilation for a benign anastomotic stricture after esophagectomy. An anastomotic stricture was defined as dysphagia in combination with a luminal diameter of ≤13 mm at endoscopy. We analyzed the dilation-free period using Kaplan-Meier and multivariable Cox regression analysis.
  
  
  
  Eighty-eight patients were dilated up to a maximum diameter of 16 mm and 91 patients to a diameter >16 mm. The stricture recurrence rate was 79.5 % in the 16 mm group and 68.1 % in the >16 mm group (p = 0.083). The overall dilation-free period had a median of 41.5 (range 8-3233) days and 92 (range 17-1745) days, respectively (p < 0.001). For patients who developed a stricture recurrence, the median dilation-free period was 28 (range 8-487) days and 63 (range 17-1013) days, respectively (p = 0.001). Cox regression analysis showed a reduced risk of stricture recurrence for patients who were dilated up to >16 mm: crude hazard ratio (HR) 0.57 (95 % confidence interval (CI) 0.41-0.81) and adjusted HR 0.48 (95 % CI 0.33-0.70).
  
  
  
  Endoscopic dilation over 16 mm resulted in a significant prolongation of the dilation-free period in comparison with dilation up to 16 mm in patients with benign anastomotic strictures after esophagectomy.
authors: Department of Gastroenterology and Hepatology, C2-116, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Emo E
authors: EE
authors: van Halsema
authors: Department of Gastroenterology and Hepatology, C2-116, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Irma C
authors: IC
authors: Noordzij
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: Mark I
authors: MI
authors: van Berge Henegouwen
authors: Department of Gastroenterology and Hepatology, C2-116, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Paul
authors: P
authors: Fockens
authors: Department of Gastroenterology and Hepatology, C2-116, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors: Jacques J
authors: JJ
authors: Bergman
authors: Department of Gastroenterology and Hepatology, C2-116, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.e.vanhooft@amc.uva.nl.
authors: Jeanin E
authors: JE
authors: van Hooft
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004106:Dilatation / Q000379:methods*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Benign esophageal strictures; Endoscopic dilation; Esophageal stenosis; Esophagectomy; Esophagoscopy; Surgical anastomosis