The role of antireflux surgery combined with fiberoptic endoscopic dilatation in peptic esophageal stricture.

A clinical study of a personal series of 120 patients with peptic esophageal stricture has been conducted. All of the patients were managed by intermittent fiberoptic dilatation performed with diazepam sedation and antireflux measures. Reflux control was attempted pharmacologically early in the study in all patients and subsequently by antireflux surgery in younger patients. Dilatation was performed in all patients as frequently as necessary to maintain satisfactory swallowing. In the 42 surgically treated patients, an effective antireflux operation was achieved, principally by an abdominal approach, without mortality. A single dilatation was sufficient in 71 percent of these patients, the mean number of dilatations required to maintain adequate swallowing being 1.6 during a mean follow-up period of 3.3 years. In the medically treated group, a single dilatation sufficed in 41 percent of the patients, the mean number of dilatations required being 3.1 in a similar follow-up period. In three patients in the latter group esophageal carcinoma superimposed on their peptic stricture while they were under surveillance. Although not randomized, this study suggests that antireflux surgery is beneficial in younger patients for reducing the need for subsequent dilatations and prolonged medication, which may be relevant in the context of the incidence of carcinoma in preexisting peptic strictures in this series and in series reported by others. The conclusions that thought to justify the controlled clinical trial currently in progress to further elevate this impression.