P235 Peptic esophageal strictures: clinical profile and endoscopic management in a North African Center

Abstract

<h3>Introduction</h3> Peptic strictures of the esophagus (PS) are prevalent in hepatogastroenterology, affecting patients‘ quality of life with pronounced dysphagia. Endoscopic dilation (ED) is an effective intervention to restore luminal patency. This study aims to explore the epidemiological, clinical, therapeutic, and progressive aspects of peptic strictures. <h3>Methods</h3> A retrospective 16-year study (2007 to 2023) included all patients treated for PS in our department, diagnosed by esophagogastroduodenoscopy (EGD) after excluding other causes. Patient records provided necessary data, and a stricture was deemed refractory after five closely spaced dilation sessions. Excel and Jamovi were used for data collection and statistical analysis. <h3>Results</h3> Among 247 patients with benign esophageal strictures, n=95 (38%) presented with PS. Consultation occurred after a median of 30 (60; 365) days from symptom onset. Mean age was 47.6 +/- 24.6 years, with a male-to-female ratio of 1.6. In medical history: 40% (n=38) GER, 3.2% (n=3) hiatal hernia surgery, 2.1% (n=2) Nissen Fundoplication for PS, 2.1% (n=2) surgery for bulbar stricture with post-surgical GER, and 1.1% (n=1) paraplegia due to myelomeningocele. Clinically, 97.4% (n=90) reported dysphagia, 28.5% (n=27) weight loss, 10.6% (n=9) vomiting (one case with hypersalivation and cough), and 4.2% stunted growth. Digestive bleeding, odynophagia, dyspeptic syndrome, chest pain, and dysphonia were present in 5.3%, 3.2%, 2.1%, 2.1%, and 1.1%, respectively. <h3>EGD revealed</h3> 51.6% of PS in the lower third, 25.3% in the middle third, and 22.1% in the upper third of the esophagus. All strictures were impassable. Associated pathologies included hiatal hernia in 25.2%, ulcerated bulbar stricture in 3.2%, and Plummer-Vinson ring in 1.1%. Esophageal transit showed narrowing in 37.2%, with 6 cases associated with hiatal hernia and 3 with dilation upstream. This constriction was located in the lower third of the esophagus in 28.4% of cases. ED was performed in 93.7%. 96.9% using Savary dilators (25.3% with 11/12/13 mm diameters, and 71.6% with 12/13/14 mm diameters). Balloon dilatation was used in 3.2% with no post-procedure complications. Short-term evolution was satisfactory in 89.5%. The follow up was for a median of 5 (2;15) months. Recurrence occurred in 43% after a median duration of 3 (2; 5.75) months. 16.8% required 2 dilations, 15.8% needed 3 dilations, 4.2% required 4 dilations, while 6.2% were considered failures and underwent surgical treatment, and 1.1% underwent duodenal diversion. In simple logistic regression, the location of the stricture was not associated with the dilation’s failure or success (OR=1.04, 95% CI: 0.17–6.14), and this association was not statistically significant (p=0.96). <h3>Conclusions</h3> The study highlights the predominance of lower esophageal strictures, demonstrating effective endoscopic dilation but emphasizing the need for ongoing multidisciplinary management. The location of the stricture is not associated with the dilation’s results.