7145 Endoscopic changes following esophageal dilation in patients with peptic stricture, non-obstructive dysphagia or achalasia.

Abstract

Esophageal bougie dilation is a technique that is used as an effective strategy to relieve symptomatic peptic strictures and non-obstructive dysphagia. Pneumatic dilation is a primary mode of therapy for patients with achalasia. The goals of this study were as follows: First, to assess the endoscopic changes that occur in the esophageal mucosa following dilation; and second to correlate these changes with clinical efficacy and long-term relief of dysphagia in patients with peptic stricture, non-obstructive dysphagia and achalasia. Methods: Included in the study were patients who received bougie dilation for peptic stricture and non-obstructive dysphagia; and pneumatic dilation for achalasia. Upper endoscopy was initially performed to assess the esophagus and for placement of a Savary guide wire. The bougie esophageal dilations were performed over a Savary guide wire with American dilators. The pneumatic dilations were performed over a Savary guide wire with Microvasive balloons. Following the dilations the esophagogastroduodenoscope was reinserted and advanced to the site of dilation for photodocumentation. Patients were then followed by telephone consultation at two weeks, four weeks and six weeks with the frequency of symptoms recorded. Results: Thirty-one subjects were included in the study during the period of 7/98 to 11/99. There were fourteen women and seventeen men with a mean age of 55.5 (range 19 to 89). The diagnoses were as follows: 11 with peptic stricture, 7 with B-ring, 6 with achalasia, 4 with nonobstructive dysphagia, 1 with mid esophageal web, 1 with anastomotic stricture and 1 was post-Nissen. The mucosal changes following dilation included the following: 8 with increased diameter, 17 with tear, 7 with submucosal hemorrhage, and 12 with blood observed on the dilator. At two, four and six weeks following esophageal dilation, there was improvement in dysphagia (p