Retrograde endoscopic dilatation for difficult caustic esophageal strictures: Feasibility and effectiveness.

Abstract

BACKGROUND\nDifficult caustic esophageal strictures may need a more sophisticated dilatation technique before referring for esophageal replacement surgery.\n\n\nPATIENTS & METHOD\nRetrospective review of caustic esophageal strictures managed at our center between January 2010 and June 2018 was done. Twenty two patients labeled as undilatable strictures were enrolled. These patients had another trial for endoscopic dilatation using retrograde approach.\n\n\nRESULTS\nAmong these 22 patients, 5 patients could be dilated by antegrade approach. Seventeen patients had a trial of retrograde dilatation after failed antegrade endoscopy. Retrograde dilatation was successful in 14 patients (82%). Nasogastric tube was left following dilatation in 4 patients to facilitate next sessions. Collectively, 19 out of the 22 patients could have their esophagus dilated in the first instance (86%). Among retrograde dilated patients; eight patients succeeded to retain their native esophagus (57%), two patients are still on dilatation with marked improvement (14%), and three patients underwent colon interposition owing to refractory stricture despite frequent dilatations.\n\n\nCONCLUSION\nEvery attempt should be tried to preserve the native esophagus. Retrograde endoscopic dilatation is a valuable alternative for undilatable stricture before referring the patient for replacement surgery.\n\n\nLEVEL OF EVIDENCE\nThis is a case series with no comparison group (level IV).