LAUSR

BACKGROUND AND AIMS Endoscopic dilation (ED) is still the mainstay of therapeutic management of benign esophageal strictures (BES). This study aimed to establish risk factors for refractory BES and assess long-term clinical outcomes of ED. METHODS We performed a retrospective study in 891 patients who underwent ED from 2003 to 2018 for BES. We searched electronic medical records in 6 tertiary care centers in the Netherlands for data on clinical outcome of ED. Median follow-up was 39 months. The primary endpoint was risk factors for refractory BES, defined as factors associated with an increased number of ED sessions during follow-up. Secondary endpoints included time from first to last ED session and adverse events. RESULTS Dilation up to 13-15 mm was associated with a higher number of ED sessions than 16-18 mm (5.0 vs 4.1; hazard rate [HR]=1.4; p=0.001). Compared with peptic strictures, anastomotic (4.9 vs 3.6; HR=2.1; p<0.001), radiation (5.0 vs 3.6; HR=3.0; p<0.001), caustic (7.2 vs 3.6; HR=2.7; p<0.001) and postendotherapy (3.9 vs 3.6; HR=1.8; p=0.005) strictures were associated with a higher number of ED sessions. After 1 year of follow-up, the proportions of patients who remained free of ED was 75% in anastomotic, 71% in radiation, 70% in peptic, 83% in postendotherapy and 62% in caustic strictures. Esophageal perforation occurred in 23 (0.4%) ED sessions, in 22 (2.4%) patients. CONCLUSIONS More than 60% of patients with BES remain free of ED after 1 year of follow-up. Because dilation up to 16 to 18 mm diameter was associated with fewer ED sessions during follow-up, we suggest that clinicians should consider dilation up to at least 16 mm to reduce the number of ED sessions in these patients.