Endoscopic Dilation of Benign Oesophageal Strictures: a Large Multicentre Evaluation of Real-World Practice
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2025
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Introduction: Although overall prevalence of benign oesophageal strictures (BOSs) is low, a rising prevalence of associated risk factors, such as increased life expectancy, gastro-oesophageal reflux disease and eosinophilic oesophagitis is predicted to contribute to an increased incidence and evolving aetiology. Endoscopic dilation (ED) currently remains the primary treatment modality. Aims and Methods: This study aimed to evaluate the current most common aetiologies for BOSs, alongside evaluating the success of ED. Between January 2021 and December 2023, 1994 upper GI endoscopies (UGIEs) with endoscopic dilatation of a BOS were identified using electronic patient records across 11 UK centres. Details of procedures were then collected in a retrospective observational fashion at each site before central pooling of pseudo-anonymised data for analysis. For both individual UGIEs with dilatation and given sessions of dilatations (defined as consecutive UGIEs separated by =14mm (confirmed on a check procedure >4 weeks after, and/ or not requiring further dilatation to maintain diameter within a 6-month period). Result(s): Eight hundred and eighteen patients (328[40%] female; mean age 64.3[SD 15.52]) were followed-up for a mean of 20.5 (range 4-62) months, from time of initial stricture diagnosis. The most common aetiology of BOS were peptic in 38% (313/818), post-op anastomotic in 13%(105/818), post-radiotherapy in 6% (48/818), post-operative (non-anastomotic) in 6% (47/818), Schatzki rings in 6% (46/818), and eosinophilic oesophagitis in 5% (37/818). Less common aetiologies seen included: post-endoscopic mucosal resection (EMR), post-radiofrequency ablation (RFA), post-caustic injury, webs, lichen planus, and connective tissue disease. (see Table 1) Successful dilatation for a single UGIE procedure with ED was achieved in 875/1994 (43.9%) of procedures. With respect to 'sessions' of consecutive dilatations, success was achieved within three months in 44.2% (388/878) of patients, and within six months in 60.6% (530/878) of patents. For successful sessions, mean number of dilatations required was 2.2 (SD 2.4), and median number of weeks to successful dilatation was 15 (IQR 7-30). Stricture Aetiology Number of patients n Percentage of patients n/N (%) Conclusion(s): Peptic strictures remain the most common aetiology of BOS. A significant proportion of patients (39.4%) with BOS failed to achieve success following ED. This may reflect both the inherent limitations of ED and suboptimal adherence to guidelines, particularly regarding the recommended frequency of dilations until treatment success is achieved Further analysis of data from this study will look to explore relative effectiveness of endoscopic dilatation in the context of differing aetiology, additional patient (as well as procedural) factors influencing success, as well as complication rates. It will also explore whether greater compliance with established guidelines may help to more accurately define the true therapeutic potential of ED in the management of BOS.
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United.Eur.Gastroenterol.J.