Aims
To determine esophageal diameter(D), distensibility index(DI), and pressure(P) before and after dilation, and to assess whether these parameters correlate with the number of dilation sessions required or the need for repeat dilation after initial improvement.
Methods
This single-center prospective study included patients undergoing esophageal stricture dilation between July 2022 and July 2024. FLIP measurements were obtained at various balloon volumes, with comparisons based on the hightest volume achieved. Clinical data were collected before and after dilation using validated questionnaires and the electronic medical record.
Results
Twenty-two strictures in 20 patients were analyzed. The mean age was 57.4 years (SD 15.6); 31.8% were female. Etiologies included peptic strictures (10, 45.5%), EoE (3, 13.6%), prior esophageal surgery (4, 18.2%), lichen planus (1, 4.6%), caustic injury (3, 13.6%), and a Schatzki ring (1, 4.6%). All underwent their first dilation except those with caustic injury. Five lesions (22.7%) were considered clinically chronic. ES and BEDQ scores improved significantly (p < 0.00001), with no significant change in GERD-Q.
The initial endoscopic diameter estimate was 10.5 mm (IQR 8–13 mm), increasing to 15 mm (IQR 15–16 mm) after dilation. FLIP-measured diameters were 9.4 mm (IQR 7–12.6 mm) pre-dilation and 13.2 mm (IQR 12–15 mm) post-dilation, with a significant pre–post difference (p = 0.0003). Pre-dilation endoscopic and FLIP diameters were similar (10.0 mm vs 9.95 mm), but post-dilation endoscopic diameters were significantly larger than FLIP measurements (15.6 mm vs 13.6 mm; p = 0.0001).
DI increased from 0.8 (IQR 0.5–2.4) to 1.8 (IQR 1–2.7) (p = 0.0290). Pressure decreased from 92 (IQR 75–105) to 76 (IQR 61–100) (p = 0.0005) after dilation.
Five patients required repeat dilation within one year. Etiologies were caustic injury(3), peptic stricture(1), and lichen planus(1). Compared with patients who did not require re-dilation, these cases had lower initial and final diameters and DI values, with a significantly lower initial DI (0.3 [IQR 0.2–0.5] vs 1.2 [IQR 0.5–3.1]).
No significant differences in pre- or post-dilation D, DI, or P were observed based on the total number of dilation sessions. No major adverse events occurred. In one case, the FLIP catheter could not be advanced through the stricture.
|
Median pre and post-dilatation diameters measured by endoscopy and FLIP |
|||
|
|
Pre dilatación |
Post dilatación |
p |
|
D Endoscopy mm (IQR) |
10.5 (8-13) |
15 (15-16) |
<0,0001 |
|
D FLIP mm (IQR) |
9.4 (7-12,6) |
13.2 (12-15) |
0.0003 |
|
DI mm2/mmHg (IQR) |
0.8 (0,5-2,4) |
1.8 (1-2,7) |
0.0290 |
|
Pressure mmHg (IQR) |
92 (75-105) |
76 (61-100) |
0.0005 |
Conclusions
FLIP measurements of diameter, distensibility, and pressure improve after dilation. Endoscopic and FLIP diameters are similar before dilation, but endoscopy tend to overestimate post-dilation diameter relative to FLP. Patients requiring repeat dilation had lower initial distensibility. FLIP may be useful in selected cases to help predict treatment failure and to direct dilation diameter in complex cases.