ENDOSCOPIC DILATATION OF OESOPHAGEAL PEPTIC STRICTURES: PREDICTING FACTORS OF REFRACTORY STRICTURES ESOPHAGEAL

Aims The aim of the work is to evaluate the factors predicting the occurrence of refractory oesophageal strictures.

Methods This is a 16-year retrospective study between January 2002 and March 2019, including all patients with clinical, endoscopic and/or radiological aspects in favor of peptic strictures of the esophagus. The dilatation was carried out by Savary-Gilliard bougie’s with progressive diameters or hydrostatic balloons with variable diameter. Refractory strictures were requiring more than five sessions with short recurrence intervals.

Results Of the 123 patients who underwent endoscopic dilatation for peptic strictures of the esophagus, 13% had refractory strictures. The mean age was 53.5 years with predominance of male. The mean number of dilations was 6.25 [5; 11]. In all these patients we noted: chronic gastro esophageal reflux with a mean duration of evolution of 6.75 years [1; 17], regurgitations in 75% and pyrosis in 18.7%. The dysphagia was total in 25%. Endoscopy revealed peptic stritures associated with oesophagitis in 6.25%, hiatal hernia in 37, 5% and barret’s esophageal in 6.25%. ¾ of our patients were dilated by bougie with progressive diameters. After 5 endoscopic dilations: Only 37.5% underwent surgery, one patient had benefited from esophageal prosthesis and the rest continued the endoscopic management. Refractory strictures was significantly associated with the duration of gastro esophageal reflux (p = 0.01) and poor compliance of proton pump inhibitors

(P = 0.005).

Conclusions Refractory peptic strictures of the esophageal were present in 13% in our series. The duration of gastro esophageal reflux and the poor compliance of proton pump inhibitors are strongly associated with the occurrence of refractory peptic strictures of the esophageal.