[Conservative treatment of peptic esophageal stenoses. Results of a prospective long-term study]

In a prospective long-term study the feasibility of conservative management of peptic oesophageal stenosis was investigated. Admission criteria were: endoscopic-bioptic evidence of peptic stricture of the oesophagus, acid gastro-oesophageal reflux on pH-metry, high operative risk or previous unsuccessful antireflux operation. Therapy consisted of two components: 1. bouginage of the stricture up to 38 to 45 French; 2. inhibition of gastric secretion by 4 X 400 mg daily cimetidine. A total of 33 patients were entered into the study; 28 were followed up for more than 6 months, the mean follow-up period being 15 months. Out of the 28 patients 16 were clinically free of symptoms, 5 had evident symptoms, 3 needed rebouginage and the remaining 4 were clear failures and had to be operated on because of persistent severe pain or rapid restenosis. Considerable improvement in reflux oesophagitis was obtained in 61.5% of cases; indeed, complete healing was noted in 46% of patients at follow-up. Both the clinical and endoscopic outcome were influenced by compliance. Irregular taking of cimetidine impaired results significantly (p less than 0.001 X2-test) and raised the frequency of rebouginage. These results show that 86% of cases with the most severe form of reflux oesophagitis were managed successfully by conservative therapy and that only the remaining few cases needed surgery.