Selective management of benign esophageal strictures

Thirty-eight consecutive patients were treated for benign stricture of the esophagus secondary to reflux esophagitis. All patients were evaluated endoscopically. Mild strictures allowed passage of the adult fiberoptic endoscope with some resistance. Moderate strictures would only allow passage of the pediatric scope and severe strictures failed to allow passage of the pediatric endoscope. Two treatment groups were designed. Group I (20 patients) underwent dilatation and antireflex surgery. Group II (18 patients) consisted of high risk patients who underwent dilatation plus medical management. Sixteen patients were followed in each group for a mean of 2 yr. Good to excellent results occurred in 80% of group I. The only treatment failures occurred in patients with complex pathology. Two patients had Barrett's esophagus and one a concomitant motor disorder. Results in group II showed only one frank treatment failure but three unsatisfactory results. Symptomatic improvement is obtainable in 80% of patients with peptic stricture by dilatation and medical management. Columnar epithelium did not seem to regress after antireflux surgery in three patients.