The management of peptic oesophageal stricture

Eighty-three adult patients with peptic oesophageal stricture are reviewed with regard to diagnosis and treatment. Sliding hiatus hernia was present in 94 per cent of cases. The strictures were graded according to the degree of stenosis encountered at initial oesophagoscopy, but several other factors influenced the management of each case. Bouginage should always be attempted before proceeding to surgery. Thirty-eight patients were treated by bouginage alone, with 21 (55 per cent) good results and 3 deaths. Forty-five patients came to surgery, with 32 (71 per cent) good results and 3 deaths. Six patients sustained instrumental perforation of the oesophagus with 1 fatality. There was in addition 1 case of silent perforation following self-bouginage, which is believed to be unique. Hiatal herniorrhaphy combined with simple bouginage is recommended where reflux oesophagitis dominates the clinical picture. Local plastic repair (oesophagoplasty) has proved a simple and effective method of treating low annular strictures. Oesophagogastrostomy was carried out in 12 patients without operative loss and with good results in 8 cases; the addition of a pyloroplasty is believed to lessen postoperative reflux.