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55% of patients with symptomatic Schatzki ring require more than one dilation

Clinical Question:
How often do patients with a symptomatic lower esophageal ring require more than one dilation for symptom relief?

Bottom Line:
More than half of patients (55%) with symptomatic lower esophageal (Schatzki) ring require more than one dilation for symptom relief. The risk of repeat dilation is not significantly associated with reflux esophagitis, associated webs, sex, or age. (LOE = 1b)

Reference:
Muller M, Gockel I, König J, Kuhr K, Eckardt VF. Long-term recurrence rates following dilation of symptomatic Schatzki rings. Dig Dis Sci 2011;56(5):1432-1437.  [PMID:20976623]

Study Design:
Cohort (prospective)

Funding:
Unknown/not stated

Setting:
Outpatient (specialty)

Synopsis:
Stricture or web formation at the Schatzki ring is a common cause of dysphagia and food impaction. These investigators identified 133 newly diagnosed adults (mean age = 57 years) with symptomatic Schatzki rings undergoing a single dilation with a large-sized bougie dilator without the aid of fluoroscopy. The diagnosis of symptomatic Schatzki ring was ascertained using standard criteria based on the results of radiographic and/or endoscopic evaluation. All patients underwent initial follow-up at 4 weeks. Following this, time to recurrence was defined as the time elapsed to the recurrence of symptoms severe enough to require repeat dilation. At 4 weeks, 129 patients (97%) reported complete symptom relief. Four patients (3%) with continued symptoms required repeat dilation and all were symptom-free at an additional 4-week follow-up. Complete follow-up occurred for 126 patients (94.7%) for a mean duration of 58.3 months. Of these, 73 (54.9%) reported recurrent symptoms severe enough to require additional dilation. Of those requiring an additional dilation, 39 (53.4%) underwent dilation more than twice. Overall remission rates were 63.8% (95% CI, 55.6% - 72.0%) after 2 years, 44.3% (35.4% - 53.4%) after 5 years, and 39.9% (30.5% - 49.3%) after 10 years. There was no significant association with reflux esophagitis, additional webs, sex, or age with symptomatic remission rates

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