resident Bridgeport Hospital, Yale University School of Medicine Bridgeport, CT
Ankit Chhoda, MD1, Deepanshu Jain, MD2, Chetanya Malik, MD3, Suresh Kumar, MD3, Premashis Kar, MD, PhD, FACG, FRCP3; 1Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT; 2Advent Health, Orlando, FL; 3Maulana Azad Medical College, New Delhi, Delhi, India
Introduction: The strictures secondary to caustic ingestion is a debilitating condition causing long-term nutritional challenges. This retrospective study investigates the outcomes of endoscopic dilation in patients with benign esophageal strictures secondary to corrosive ingestion. Methods: A retrospective study that included patients with esophageal strictures due to caustic injury under follow-up was performed at a tertiary care center. These patients at the centre underwent endoscopic dilation by both Endoscopic Balloon Dilation (EBD) and Gilliard Savary (GS) dilators based on endoscopist comfort(P.K.). Symptomatic relief within 2 months of intervention was considered a successful response. Results: The study included 39 patients including 31 patients with acid ingestion and 8 with alkali ingestion (Figure 1). Of patients with acid ingestion, 32.3% (10/31) underwent EBD and 67.7% (21/39) underwent GSD with only 50% (5/10) and 38.1% (8/21) respectively having symptom relief. Of patients with alkali ingestion, 50% (4/8) underwent EBD and 50% (4/8) underwent GSD with 75% (3/4) and 50% (2/4) respectively having symptom relief. Irrespective of caustic etiology, the composite success for EBD and GSD sub-groups were 61.5% and 38.5% respectively. Short stricture length was associated with successful outcomes among patients with acid ingestion (p= 0.003) but not among patients with alkali ingestion. Patients with failed outcomes had higher percentages of grade 2B and 3 mucosal injury at time of initial caustic exposure and warranted repeated endoscopic dilations for symptom management. This however did not reach significance in patients with either alkali (p= .19) or acid ingestion (likelihood ratio; p= .14). In the study population, seven patients had concomitant stomach involvement with three (7.7%) developing gastric outlet obstruction (GOO), all of whom underwent surgical intervention. Other than GOO, no other sequelae like achlorhydria, mucosal metaplasia, carcinoma or protein losing enteropathy were diagnosed during follow up. Discussion: Overall success of endoscopic dilation for caustic esophageal stricture is limited and newer modalities like stent placement or endoscopic incision therapy may play a role in management of refractory strictures. Primary prevention of such injuries should be the preferred approach in managing this public health issue.
Figure 1: Flow diagram describing the endoscopic dilations among the patients with benign strictures.
Disclosures: Ankit Chhoda indicated no relevant financial relationships. Deepanshu Jain indicated no relevant financial relationships. Chetanya Malik indicated no relevant financial relationships. Suresh Kumar indicated no relevant financial relationships. Premashis Kar indicated no relevant financial relationships.