OESOPHAGEAL DILATION FOR STRICTURES: A PROSPECTIVE OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL OF PAKISTAN
Keywords:
esophageal stricture, dilatation, dysphagia, caustic injury, gastroesophageal refluxAbstract
Background: Oesophageal strictures pose a significant clinical challenge, requiring effective management to alleviate symptoms and improve the patient's quality of life. This study aimed to determine the effects of oesophageal dilation on patients with oesophageal stricture in terms of clinical improvement of dysphagia. Methods: This was a prospective, single-arm observational cohort study. Consecutive patients diagnosed with oesophageal stricture at Pak-Emirates Military Hospital, Rawalpindi, between 1 August 2022 and 31 July 2023 were enrolled and followed through up to five dilatation sessions. Data on demographics, causes, types of dilators used, and clinical results were collected. Patients underwent multiple sessions of dilations through the wire guided push dilators (Savary-Gilliard) or through the scope (TTS) balloon dilators, depending on the type of strictures and need of sessions. The procedure was considered successful if there was an improvement in dysphagia. Results: Among the 82 patients diagnosed with oesophageal stricture, 45 (54.9%) were men and 37 (45.1%) were women with a mean age of 46.17±14.75 years. The most prevalent causes of ES were gastro-oesophageal reflux disease (peptic) and caustic injury with a frequency of 25 (30.5%) each, followed by Schatzki’s ring (n=13; 15.9%). Eighty patients (97.6%) showed improvement in dysphagia following dilatation, while 2 (2.4%) were referred to thoracic surgery. Simple strictures predominated in men (40/45, 88.9%) and complex strictures in women (28/37, 75.7%). Bleeding was the only complication recorded; it was more frequent in women and rose from 7.3% at the first session to 42.9% at the fifth. Conclusions: Up to five endoscopic sessions were performed at one- to two-week intervals using three dilator types. Most strictures were dilated to 15 mm or more. Only two patients, both with complex strictures, had persistent dysphagia after five sessions and required referral for surgical assessment.
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