P1.089. Outcomes of Continued Endoscopic Dilatation Without Surgery in Caustic Esophageal Strictures

Abstract

Esophageal Cancer: Caustic Ingestion of the Esophagus Endoscopic dilatation is the standard initial treatment for caustic esophageal strictures. Although repeated dilatation is often considered treatment failure prompting surgical reconstruction, some patients continue endoscopic therapy without proceeding to surgery. The clinical outcomes and treatment burden of this approach remain incompletely described. Adult patients with caustic esophageal strictures managed with continued endoscopic dilatation without surgery between February 2014 and January 2026 were retrospectively analyzed. Treatment burden and clinical outcomes were evaluated. Outcomes included the total number of dilatation sessions, tolerance of solid diet, and durable luminal patency. Factors associated with a higher number of dilatation sessions were also examined. Twenty-one adult patients were included (median age 46 years; 61.9% male). Acid ingestion was the predominant etiology (85.7%), and long-segment strictures were present in 44.4%. The median number of dilatation sessions was 8 (interquartile range 6-21). Patients with long-segment strictures required more dilatation sessions than those with short-segment disease (median 17.5 vs 8 sessions, p = 0.040). Patients achieving durable luminal patency without repeat dilatation for at least six months also required more sessions than those needing earlier re-intervention (median 17 vs 7 sessions, p = 0.019). There was no statistically significant difference in the interval between sessions among the analyzed groups. Steroid injection was not associated with dilatation burden (p = 0.197). Patients who ultimately tolerated a solid diet (71.4%) underwent more dilatation sessions than those who did not (median 10 vs 4.5, p = 0.016). One procedure-related complication (4.8%) occurred. In adult patients with caustic esophageal strictures managed without surgery, continued endoscopic dilatation achieved functional swallowing and durable luminal patency despite repeated sessions. Long-segment strictures were associated with greater treatment burden but were not inevitably associated with failure of endoscopic therapy. When surgery is not pursued, continued endoscopic dilatation may represent a feasible definitive option in selected patients.