Role of endoscopic ultrasonography (EUS) in management of benign esophageal strictures

Abstract

Background: EUS, as it images the full thickness of the GIT wall, could provide more detailed information in benign esophageal strictures.

Objective: To evaluate the role of EUS in predicting the response to endoscopic dilatation in benign esophageal strictures.

Methods: 27 patients with benign strictures (corrosive 14, peptic 10 & post radiation 3) were prospectively studied with radial EUS.

Results: The maximum esophageal wall thickness was significantly more in patients with corrosive and post radiation strictures in comparison to patients with peptic strictures. In patients with peptic stricture, the mucosal thickness involved either the mucosa (2) or submucosa (8) and in none of the patients the muscularis propria was involved. However, muscularis propria was involved in all the 3 patients with post radiation strictures and in 11/14 (78.5%) patients with corrosive strictures. Two patients with peptic stricture with only mucosal thickness required a single session of dilatation whereas patients with involvement of submucosa required 2-4 sessions of dilatation. Patients with corrosive stricture having only involvement of submucosa required significantly lesser number of dilating sessions in comparison to patients having muscularis propria involvement (2.67 ± 0.58 vs. 6.30 ± 1.16 sessions respectively; p=0.0003).

Conclusion: EUS by delineating extent of wall involvement in benign esophageal strcitures predicts the response to endoscopic dilatation.

Key words: corrosive; endoscopic ultrasound; endoscope; computed tomography