Endoscopic dilatation in cases of benign oesophageal stricture: experience at Nishtar Hospital, Multan

ABSTRACT

Endoscopic dilatation is most widely practiced mode of management in cases of benign oesophageal strictures. It is relatively simple and effective in most cases. Moreover, the procedure carries few complications in experienced hands. The objectives of this study were to establish the safety of Endoscopic dilatation in cases of benign oesophageal strictures in local setup and to evaluate the improvement of dysphagia score following the procedure. It was a prospective/Cohort-hospital based study, conducted from December 2006 to January 2008 at Surgical Unit-1, Nishtar Hospital, Multan. A total of 55 patients with the provisional diagnosis of benign oesophageal stricture were included in the study. Five patients were found to have malignant strictures and were subsequently excluded. Oesophagoscopy was done with rigid oesophagoscope while dilatation was performed with Maloney bougies in most patients. However, in some patients with difficult strictures, dilatation was done "under fluoroscope over the guide wire", using Savary Gillard's dilator system. The data was analyzed with SPSS version 10.0 to formulate the results. The male to female ratio was 1.51. Mean age of the sample was 34.50 +/- 4.75 years. The most common [64%] cause of benign stricture was corrosive intake. All the patients presented to us with history of dysphagia and patients with GORD [14%] had previous history of heart bums of long duration. More than half, 29 [58%] strictures were seen in upper 1/3[rd] of oesophagus. Most of the strictures [86%] were either less than 1cm [42%] or 1-3cm [44%]. All biopsy reports shown benign nature of the stricture. After dilatation therapy, average improvement in the dysphagia score was 2/5 to 3.4/5. Dilatation interval also increased with regular dilatations. Our patients required repeat dilatation after a mean of 16 weeks. Postoperative chest pain was observed in 20 [40%] patients and it was mild in intensity and relieved within six hours. Two patients [4%] developed haematemesis post-operatively. Patients with stricture due to GORD were put on proton pump inhibitors. Endoscopic dilatation is effective and safe procedure in cases of benign oesophageal stricture. It substantially improves dysphagia score postoperatively. Difficult strictures can be safely managed with dilatation under fluoroscopic control