Abstract
Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients' dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non-reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended.
Highlights
Benign strictures of the esophagus can be treated with balloon dilatation under endoscopic and/or fluoroscopic control
Of 15 patients with dysphagia two (13%), had no narrowing but severe esophageal dysmotility
By a careful interview and using a customtailed algorithm for the assessment of dysphagia a correct diagnosis can be revealed in 85% of patients with dysphagia
Summary
Benign strictures of the esophagus can be treated with balloon dilatation under endoscopic and/or fluoroscopic control. Immediate relief of obstructive symptoms is reported in 70-90%, while 60% of the patients are asymptomatic three months after the procedure. -7 The patients’ symptoms may not readily correlate with the diameter of the stricture. Dysphagia including a feeling of obstruction may be due to esophageal dysmotility which might coincide with any esophageal stricture, especially in patients with gastroesophageal reflux disease. Any evaluation of stricture dimensions is difficult during endoscopy. We hypothesized that a careful radiologic exami-. Address for correspondence: Olle Ekberg, MD, Department of Diagnostic Radiology, University of Lund, Maim[6] General Hospital, S214 01 MALMr, Sweden. To that effect we adopted a dedicated radiologic technique including swallowing of a solid tablet for assessment of esophageal strictures
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