Author ORCID Identifier
Date Available
12-8-2022
Year of Publication
2022
Degree Name
Doctor of Philosophy (PhD)
Document Type
Doctoral Dissertation
College
Medicine
Department/School/Program
Clinical and Translational Science
First Advisor
Terrance A. Barrett, MD
Abstract
Benign esophageal strictures are a frequently encountered problem in clinical practice. The management of benign esophageal strictures have slowly evolved over the decades based on “expert opinion.” Despite vast amounts of data about the efficacy and safety of dilation, unfortunately there is no consensus on a systematic and safe approach that is efficient, limits complications and provides long lasting improvement of dysphagia. Our group designed a progressive approach to endoscopic balloon dilation based on tailoring certain technical aspects of the dilation process.
Most studies in the literature concluded that endoscopic dilation is safe and effective in relieving dysphagia caused by benign esophageal strictures of various etiologies. There have been few studies that investigated the optimal target of endoscopic dilation of benign esophageal strictures.
Our main retrospective secondary study, 27 patients underwent balloon dilation for benign esophageal stricture. Etiology of the esophageal stricture (n=27) included, peptic (n=18, 66.7%), anastomotic (n=4, 14.8%) eosinophilic esophagitis (n=3, 11.1%), post Heller myotomy (n=1, 3.7%) and radiation induced (n=1, 3.7). The diameter of the esophageal stricture ranged from 6mm to 12mm with the most common diameter being 9mm (15%) or 10mm (26%). Most balloon dilations started at 15mm (range 12-15mm, n=26, 59.2%) or > 15mm (n=11, 40.7%) with end dilation of < 15mm > (n=4, 14.8%), 15-< 18mm > (n=7, 25.9%), 18-20mm (n=16, 59.3%). Most patients had 1 to 3 dilations at an interval of every 2-4 weeks to achieve goal diameter of 16-8mm. Many patients with follow up data (77%), all had clinical improvement of their dysphagia.
Our study sheds light on the possibility that our novel progressive approach improves the patient’s dysphagia without causing complications, although further investigation is warranted in the form of a prospective randomized trial. Although endoscopic esophageal dilation is considered the best initial therapeutic approach for benign esophageal strictures, the best technique to perform the procedure remains to be determined.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2022.394
Recommended Citation
Cooper, Chad J., "PROGRESSIVE ENDOSCOPIC APPROACH TO BALLOON DILATION FOR BENIGN ESOPHAGEAL STRICTURES" (2022). Theses and Dissertations--Clinical and Translational Science. 18.
https://uknowledge.uky.edu/cts_etds/18
