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ENDOSCOPIC DILATION OF BENIGN OESOPHAGEAL STRICTURES: A LARGE MULTICENTRE EVALUATION OF REAL-WORLD PRACTICE

Benjamin Zare 1, Eathar Shakweh 1, Krishna Shah 2, Nikolaos Pantzaris 3, Prabhsimran Singh 4, Amy Hicks 5, Katrina Pekarska 6, Jennifer Murray 1, Yaa Danso 7, Stephanie Poo 7, Rawen Kader 8

Affiliations

1 St Mark's Hospital & Academic Institute, London, United Kingdom|||Imperial College London, London, United Kingdom

2 Barts Health NHS Trust, London, United Kingdom

3 York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom

4 York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom|||Hull York Medical School, York, United Kingdom

5 Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom

6 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

7 Imperial College London, London, United Kingdom|||St Mark's Hospital & Academic Institute, London, United Kingdom

8 University College London, London, United Kingdom|||St Mark's Hospital & Academic Institute, London, United Kingdom

Summary

AI Generated

A retrospective 11-centre UK study of 818 patients with benign oesophageal strictures found peptic aetiology most common (38%) and endoscopic dilation achieved success in 60.6% of patients within six months.

Single-procedure success rate for endoscopic dilation was 43.9% (875/1994 procedures), while 60.6% of patients achieved success within six months of consecutive dilation sessions.
Peptic strictures accounted for 38% of cases, followed by post-operative anastomotic (13%), post-radiotherapy (6%), post-operative non-anastomotic (6%), Schatzki rings (6%), and eosinophilic oesophagitis (5%).
For successful dilation sessions, a mean of 2.2 dilations over a median of 15 weeks were required to achieve a lumen diameter of at least 14mm.
The 39.4% failure rate may reflect inherent limitations of endoscopic dilation and suboptimal adherence to guidelines regarding dilation frequency, according to the authors.
This material is relevant for gastroenterologists managing benign oesophageal strictures and those interested in contemporary UK practice patterns for endoscopic dilation.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Although overall prevalence of benign oesophageal strictures (BOSs) is low, a rising prevalence of associated risk factors, such as increased life expectancy, gastro-oesophageal reflux disease and eosinophilic oesophagitis is predicted to contribute to an increased incidence and evolving aetiology. Endoscopic dilation (ED) currently remains the primary treatment modality.

Aims & Methods

This study aimed to evaluate the current most common aetiologies for BOSs, alongside evaluating the success of ED.
Between January 2021 and December 2023, 1994 upper GI endoscopies (UGIEs) with endoscopic dilatation of a BOS were identified using electronic patient records across 11 UK centres. Details of procedures were then collected in a retrospective observational fashion at each site before central pooling of pseudo-anonymised data for analysis.
For both individual UGIEs with dilatation and given “sessions” of dilatations (defined as consecutive UGIEs separated by ≤6 months), treatment was deemed successful if the lumen was confirmed to be dilated to a diameter of ≥14mm (confirmed on a check procedure >4 weeks after, and/or not requiring further dilatation to maintain diameter within a 6-month period).

Results

Eight hundred and eighteen patients (328[40%] female; mean age 64.3[SD 15.52]) were followed-up for a mean of 20.5 (range 4–62) months, from time of initial stricture diagnosis. The most common aetiology of BOS were peptic in 38% (313/818), post-op anastomotic in 13%(105/818), post-radiotherapy in 6% (48/818), post-operative (non-anastomotic) in 6% (47/818), Schatzki rings in 6% (46/818), and eosinophilic oesophagitis in 5% (37/818). Less common aetiologies seen included: post-endoscopic mucosal resection (EMR), post-radiofrequency ablation (RFA), post-caustic injury, webs, lichen planus, and connective tissue disease.
(see Table 1)
Successful dilatation for a single UGIE procedure with ED was achieved in 875/1994 (43.9%) of procedures. With respect to ‘sessions’ of consecutive dilatations, success was achieved within three months in 44.2% (388/878) of patients, and within six months in 60.6% (530/878) of patents. For successful sessions, mean number of dilatations required was 2.2 (SD 2.4), and median number of weeks to successful dilatation was 15 (IQR 7–30).

Table 1 – Most common aetiology of benign oesophageal strictures for patients (N = 818).

Stricture Aetiology	Number of patients n	Percentage of patients n/N (%)
Peptic	313	38
Post-operative (anastomotic)	105	13
Post-radiotherapy	48	6
Post-operative (non-anastomotic)	47	6
Schatzki ring	46	6
Eosinophilic oesophagitis	37	5
Other*	222	26
* ‘Other’ includes (in order of frequency, though all representing <5%) cases of: unidentifiable aetiology, post-endoscopic mucosal resection (EMR), post-radiofrequency ablation (RFA), post-caustic injury, webs, lichen planus, connective tissue disease, and miscellaneous

Conclusion

Peptic strictures remain the most common aetiology of BOS. A significant proportion of patients (39.4%) with BOS failed to achieve success following ED. This may reflect both the inherent limitations of ED and suboptimal adherence to guidelines, particularly regarding the recommended frequency of dilations until treatment success is achieved
Further analysis of data from this study will look to explore relative effectiveness of endoscopic dilatation in the context of differing aetiology, additional patient (as well as procedural) factors influencing success, as well as complication rates. It will also explore whether greater compliance with established guidelines may help to more accurately define the true therapeutic potential of ED in the management of BOS.

References

Richter JE, Rubenstein JH. PresentaAon and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology. 2018 Jan;154(2):267-276. doi: 10.1053/j.gastro.2017.07.045. Epub 2017 Aug 3. PMID: 28780072; PMCID: PMC5797499.
Pereira-Lima JC, Ramires RP, Zamin I Jr, Cassal AP, Marroni CA, Mapos AA. Endoscopic dilatation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol. 1999 Jun;94(6):1497-501. doi: 10.1111/j.1572-0241.1999.01061.x. PMID: 10364013.
Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005 Sep;62(3):474-5. doi: 10.1016/j.gie.2005.04.050. PMID: 16111985.
Sami SS, Haboubi HN, Ang Y, Boger P, Bhandari P, de Caestecker J, Griffiths H, Haidry R,Laasch HU, Patel P, Paterson S, Ragunath K, Watson P, Siersema PD, Apwood SE. UK guidelines on oesophageal dilatation in clinical practice. Gut. 2018 Jun;67(6):1000-1023. doi: 10.1136/gutjnl-2017-315414. Epub 2018 Feb 24. PMID: 29478034; PMCID: PMC5969363.
Vermeulen BD, de Zwart M, Sijben J, Soons E, van der Weerd L, Arese D, von den Hoff DW, Craviopo V, Tan ACITL, Groenen MJM, Bogte A, Repici A, Spaander MCW, Siersema PD. Risk factors and clinical outcomes of endoscopic dilaAon in benign esophageal strictures: a longterm follow-up study. Gastrointest Endosc. 2020 May;91(5):1058-1066. doi: 10.1016/j.gie.2019.12.040. Epub 2020 Jan 7. PMID: 31917167.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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