Endoscopic Dilation of Benign Esophageal Strictures in a Surgical Unit A Report on 95 Cases Lino Polese, MD, Imerio Angriman, MD, Elisa Bonello, MD, Francesca Erroi, MD, Marco Scarpa, MD, Mauro Frego, MD, Davide F. D’Amico, MD, and Lorenzo Norberto, MD Abstract: Ninety-five patients were treated by endoscopic dilation without fluoroscopic guidance between 1997 and 2005 for benign esophageal strictures. The etiologies were: anasto- motic (38), postfundoplication (13), caustic (14), peptic (11), radiation-induced (10) and others (9). The strictures were classified at every session on a 0 to 4 scale on the basis of the diet and the luminal diameter. Savary-Gillard or Through-the Scope balloon dilators were used depending on the type and the location of the stenosis. A total of 472 dilation sessions were carried out without serious complications. A normal and a semisolid diet were respectively achieved in 75% and 91%. Recurrence of dysphagia was found in 33% and 51% of the patients respectively after 2 months and 1 year. Improvement of dysphagia, the number of sessions, and recurrence were significantly better in the patients with postsurgical stenosis as compared with those affected by caustic, peptic, and radiation- induced strictures. Key Words: esophagus, strictures, dilation, anastomosis (Surg Laparosc Endosc Percutan Tech 2007;17:477–481) B enign esophageal strictures have different etiologies: the most frequent are peptic, caustical, radiation- induced, postsurgical, or congenital stenosis. 1 Regardless of the etiology, dysphagia is the principal symptom and endoscopic dilation is the treatment of choice. 2,3 Savary or pneumatic endoscopic dilation is a generally feasible, well-known technique, with a low risk of complications achieving remission of dysphagia in most stenotic patients. 4–8 The defect of this treatment modality is the high rate of recurrence, but repeating dilation sessions has been found to be effective. In this study, conducted in a Surgical Endoscopic Unit, our attention was focalized on the results of endoscopic dilation for postsurgical esophageal strictures, in comparison with other types of benign strictures. PATIENTS AND METHODS Patients A total of 110 patients with benign esophageal and cardial stenosis consecutively treated between January 1997 and December 2005 in our Endoscopic Unit were considered for this retrospective analysis of a prospec- tively collected computerized database. All patients, whose strictures were confirmed by means of endoscopy and esophagogram, presented with dysphagia of varying degrees. As previously described by Wang et al, 9 all of the strictures were prospectively classified both according to the endoscopical estimation of the diameter and to the tolerated diet on a 0 to 4 scale during dilation sessions. The postdilation scores were derived in the same way during the endoscopic follow-up.  Score 0 indicated that the patient was able to manage a normal solid diet, that a 12-mm video-esophago- gastroduodenoscope (EGD) GIF-2T160 (Olympus Corp, Tokyo, Japan) could be passed, and the luminal diameter was >12 mm.  Score 1 indicated that the patient was able to swallow some solid foods, the video-EGD GIF-Q145 (Olympus) can pass, and the luminal diameter was between 9 and 12 mm.  Score 2 indicated that the patient was able to swallow only a semiliquid diet, the video-pediatric EGD GIF- XP160 (Olympus) could pass, the luminal diameter was between 6 and 9 mm.  Score 3 indicated that the patient was able to swallow only a liquid diet, a fiberoptic pediatric EGD GIF-N30 (Olympus) could be passed, the luminal diameter was between 5 and 6 mm.  Score 4 indicated that the patient was on a water diet or with complete dysphagia, only the guide wire could pass, and the luminal diameter was <5 mm. All the dilation sessions and the dysphagia grade were prospectively recorded. The stricture length was endoscopically measured and reported. The technical feasibility, the treatment-related complications, the symp- tom relief, the improvement of the stricture scale, the Copyright r 2007 by Lippincott Williams & Wilkins Received for publication December 27, 2006; accepted June 8, 2007. From the Gastroenterological and Surgical Department, First Surgical Clinic, Padua University, Italy. Reprints: Dr Lino Polese, MD, Clinica Chirurgica 1, Policlinico Universitario, Via Giustiniani 2, 35128 Padova, Italy (e-mail: linopolese@hotmail.com). ORIGINAL ARTICLE Surg Laparosc Endosc Percutan Tech  Volume 17, Number 6, December 2007 477