Savary Dilation Is a Safe and Effective Means for Treatment of Symptomatic Cricopharyngeal Bar: A Single Center VA Experience

Abstract

Purpose: To evaluate the efficacy and safety of Savary dilation as a treatment option for symptomatic Cricopharyngeal (CP) Bar. Methods: Retrospective chart review was performed for 327 patients who underwent esophageal dilation with Savary dilators for dysphagia at VA Loma Linda between 2007 and 2011. Out of 327 patients, 27 patients had dysphagia attributed solely to a diagnosis of CP bar confirmed by modified barium swallow and/or barium esophagogram. Details including demographics, symptomatology, other causes of dysphagia, size and number of Savary dilators, complications and pre/post dilation Functional Outcome Swallowing Score (FOSS) were obtained. Results: Over the time period, 48 dilations were performed on 27 patients. Most of the first dilations were performed with 54 Fr Savary dilators. Repeat dilations were performed with 60 Fr dilators. The end point of the follow up was improvement lasting 6 months after dilation as assessed by the pre- and post treatment FOSS. 16 patients reached endpoint after first dilation. 7 patients underwent repeat dilation for recurrence of symptoms within 6 months of first dilation. Median pre dilation FOSS was 3. Median post dilation FOSS was 1. All except 3 patients had significant improvement that lasted for variable time from initial dilation. On follow up from last dilation, 63% patients had statistically significant improvement in FOSS lasting for at least 6 months. No complications were noted. Conclusion: Savary dilation appears to be a safe and effective treatment for symptomatic CP bar patients in our VA population. A significant majority of patients had consistent improvement in symptoms for more than six months.Figure: No Caption available.Figure: [8]