Management of acid-peptic esophageal strictures

Eighty-nine patients with benign acid-peptic strictures of the esophagus were evaluated. Of these, 56 patients were treated by dilatation and medical therapy, whereas 33 underwent operative therapy because medical therapy failed. Three patients, all psychotic and having post-emetic strictures, required resection of the stricture and a colon interposition. Twenty-nine patients underwent a Belsey or Nissen fundoplication combined with esophageal dilatation. Fourteen of 29 had an associated vagotomy and 15 did not. Two patients of this 29 had a poor result, one of whom had a post-emetic stricture. Although the patients having a concurrent vagotomy and pyloroplasty had the more severe disease,there was no significant difference between the results in the two groups. It is concluded that most patients with such esophageal strictures may be adequately treated without resecting the stricture and that the routine addition of a vagotomy and drainage procedure is probably not indicated.