Therapy of esophageal stricture: A review of 84 patients

The course of patients with stricture of the esophagus is variable. Operation is effective, but preoperative trials of dilatation are often inadequate. We reviewed the records of 84 patients with esophageal stricture of various causes to assess efficacy of operative and nonoperative management. Sixty-five percent of patients were successfully treated with serial bouginage alone and 35% required operation, with an overall mean follow-up of 59.6 months. Sixty-eight percent of 37 patients with reflux-induced stricture were successfully treated with bouginage, whereas 32% required operation. Eighty-five percent of patients with stricture from nasogastric tubes or esophageal surgery were successfully treated with dilatation, but 67% of those with corrosive stricture needed operation. Although surgical therapy is effective and generally safe in the management of esophageal stricture, we estimate that two-thirds of patients with stricture can be treated satisfactorily with nonoperative dilatation. Bouginage should be tried as the initial therapy in patients with reflux-induced, postoperative, or tube-related stricture of the esophagus.