Outcomes of oesophageal self-dilation for patients with
refractory benign oesophageal strictures
D. B. Sunjaya
D. A. Katzka
J. A. Alexander
Division of Gastroenterology and
Hepatology, Mayo Clinic, Rochester, MN,
Dr. M Halland, Division of Gastroenterology
and Hepatology, Mayo Clinic, Rochester,
Background: Current management of refractory benign oesophageal strictures with
endoscopic dilations and stenting leads to resolution of dysphagia in only 30% of
patients. Oesophageal self-dilation may be an alternative.
Aim: To evaluate the efficacy and safety of oesophageal self-dilation at a tertiary
Methods: We conducted a retrospective review of patients with refractory benign
oesophageal strictures who participated in oesophageal self-dilation at Mayo Clinic
(Rochester, MN, USA) between 2003 and 2017. Clinical data including stricture
characteristics, Dakkak and Bennett Dysphagia Score, number and dates of endo-
scopies, and complications were collected. A two-tailed paired Student’s t test was
used to compare the measures of efficacy, with differences considered significant at
a 5% probability level.
Results: We identified 52 patients with refractory strictures treated with self-
dilation. The median number of endoscopic interventions was reduced from 9.5
(range 5-30) to 0 (range 0-3) within 12 months before and after self-dilation, respec-
tively (P < 0.0001). A median intervention-free interval of 417 days (IQR 256-
756 days) was observed. The mean dysphagia score at baseline was 2.5 (95% CI
2.2-2.8) and 0.33 (95% CI 0.11-0.53) after self-dilation. 23 of 27 (85%) patients who
received enteral nutrition prior to self-dilation had their feeding tubes removed.
Conclusions: Oesophageal self-dilation is an effective way of maintaining oesopha-
geal patency in refractory benign oesophageal strictures, with safety comparable to
current standard of care. Prospective studies are needed to further validate the role
of self-dilation in treatment of refractory benign oesophageal strictures.
The Handling Editor for this article was Dr. Colin Howden, and it was accepted for
publication after full peer-review.
Received: 28 March 2018
First decision: 4 April 2018
Accepted: 24 April 2018
Aliment Pharmacol Ther. 2018;48:87–94. wileyonlinelibrary.com/journal/apt © 2018 John Wiley & Sons Ltd