Self Dilation as a Treatment for Resistant Benign Esophageal Strictures: Outcome, Technique and Quality of Life Assessment

Abstract

Purpose: Resistant benign esophageal strictures can have significant and deleterious effects on patients' quality of life (QoL). A portion of these patients require frequent endoscopic dilations at medical facilities, leading to numerous interactions with their attendant inconvenience, risk, cost and sense of dependence. Few published articles discuss self dilation as a treatment for resistant benign esophageal strictures. This study demonstrates the efficacy, safety and effect on QoL of this under utilized technique. Methods: A retrospective chart review was performed for all patients undergoing esophageal self dilation at our institution between January of 2003 and November of 2008. Demographic and clinical information regarding relief of dysphagia, complications and frequency of endoscopic and self dilation respectively were abstracted. The impact on QoL was evaluated using a telephone questionnaire specifically designed to explore emotional, social and financial impacts. Results: Of the 11 patients who initially began self dilation for non-malignant strictures, 9 are included in this study. Two patients failed attempts at self dilation due to anxiety. Mean age was 62 years (range 34-86 yrs). Etiologies of the strictures were: radiation therapy (n=3), fibrosis at anastomotic site (n=2), eosinophilic esophagitis (n=l), lye ingestion (n=2) and one patient had both radiation induced and peptic stricture. The average number of physician performed endoscopic dilations from the time of diagnosis to the time of initiation of self dilation were 23 (range 6-44). Median follow-up was 35.4 months (range 6-156). No significant complications such as bleeding or perforation were reported. Six patients required endoscopic dilations after the initiation of self dilation. When asked to compare self dilation with endoscopic dilation, 75% (6/8) of patients reported financial benefits, 75% (6/8) reported feeling less anxious and 62.5% (5/8) reported being more socially active. Overall QoL improvement was reported by 75% of the participants in the study. Global scores for dysphagia and overall QoL were significantly improved under conditions of self dilation versus EGD dilation (p=0.008 and p=0.016, respectively). Conclusion: Our results suggest that esophageal self dilation can be a safe and effective treatment modality in motivated patients with benign resistant esophageal strictures. Esophageal self dilation has a positive impact on emotional, social, and financial aspects of patient's life. Improvements in overall health and QoL are substantial. Self dilation should be considered as a treatment option in all patients with benign resistant esophageal strictures.