Outcome of radiation related esophageal stricture from endoscopic dilation.

Abstract

387 Background: Esophageal strictures present a significant challenge, particularly in cases of radiation-induced strictures. Esophageal dilation is a commonly used intervention aimed at improving swallowing function and nutritional status. However, radiation-induced strictures are amongst the most refractory to dilation. Understanding the success and limitations of this procedure is crucial for optimizing patient outcomes in the cancer population. Methods: This was a single-center retrospective chart review of 736 patients who received radiation as well as an EGD between 2014 and 2024. Patients without a radiation-induced stricture that was dilated were excluded. All continuous data are summarized as medians with interquartile ranges (IQR). Independent t-test was used for comparison among different groups. Results: 192 were eligible for this study. Our population was mostly male (58%) with a median age of 66 (IQR 67-74). The leading cancer diagnosis were esophageal (37%), head and neck (30.2%), and lung (17.1%). Radiation targets were head and neck (50.5%), lung (45.3%), both (1.6%), or other (1.6%). Patients were receiving active chemotherapy in 9.9% of cases. Mortality by the end of the study period was 51%. The median radiation dose was 5040 cGy (IQR 5040-6600) in a median of 28 fractions (IQR 26-33). Common indications for dilation were dysphagia (91.1%), weight loss (21.9%), and tube feed dependency (17.2%). Strictures were most often dilated 2 to 4 times (39.6%) to a median dilation size of 14 mm (IQR 12-15). Of note, 18.2% of patients needed 8 or more dilations. Dilation was associated with weight gain in 46.4% of patients, PEG tube removal in 3.1%, both forms of improvement in 9.9%, and no change in 40.6%. Complications included perforation (3.6%), aspiration pneumonia (3.6%), chest pain (0.5%), and hospitalization (0.5%). No significant differences were found in maximum dilation size, number of dilations, initial luminal diameter of the stricture, and initial length of the stricture between those who had clinical improvement as compared to those who did not. Conclusions: Our study reported 59.4% clinical improvement from esophageal dilation for radiation-induced strictures with nearly 20% of patients needing 8 or more dilations. The stricture dilation parameters did not appear to affect the success rate. This is the largest known single study of esophageal dilation for radiation-induced strictures.