Recognition of refractory benign esophageal strictures at index endoscopy: creation of a predictive model

Refractory benign esophageal strictures (RBESs) are defined by an inadequate response to dilation. Early recognition of RBESs allows for earlier initiation of aggressive therapy, potentially leading to less morbidity and cost. We sought to establish a predictive model for RBESs.

Patients who underwent EGD with esophageal dilation at Mayo Clinic Rochester were identified. In addition, a cohort of patients from a clinical database of patients with RBESs managed with self-dilation was identified. Malignant strictures, Schatzki's rings, and previously treated strictures were excluded. RBES was defined by the inability to maintain a diameter ≥14 mm over 5 dilation sessions. Multivariable logistic regression models were built to predict RBESs.

Of 128 identified patients with an index EGD and esophageal dilation, 25 met the RBES criteria. An additional 63 RBES patients were identified from the self-dilation cohort for a total of 88 RBES and 103 non-RBES patients. Multivariable analysis yielded a strong predictive model, with a c-statistic of .85, identifying stricture length ≥2 cm, diameter ≤7 mm, and proximal or diffuse stricture location as associated with a higher risk for RBESs. Patients without any of these risk factors had a 2% risk of RBESs, whereas those with all 3 risk factors had a risk of 73% for RBESs.

Risk of RBESs can be predicted at the index EGD based on stricture features. A predictive model for RBESs was created based on readily available risk factors, which may guide an individualized therapeutic approach to patients with benign esophageal strictures, potentially reducing morbidity and cost.