BACKGROUND AND AIMS Endoscopic dilation (ED) is still the mainstay of therapeutic management of benign esophageal strictures (BESs). This study aimed to establish risk factors for refractory BESs and assess long-term clinical outcomes of ED. METHODS We performed a retrospective study in 891 patients who underwent ED from 2003 to 2018 for BESs. We searched electronic medical records in 6 tertiary care centers in the Netherlands for data on clinical outcome of ED. Median follow-up was 39 months. The primary endpoint was risk factors for refractory BESs, defined as factors associated with an increased number of ED sessions during follow-up. Secondary endpoints were time from first to last ED session and adverse events. RESULTS Dilation up to 13 to 15 mm was associated with a higher number of ED sessions than dilation up to 16 to 18 mm (5.0 vs 4.1; hazard ratio [HR], 1.4; P = .001). Compared with peptic strictures, anastomotic (4.9 vs 3.6; HR, 2.1; P < .001), radiation (5.0 vs 3.6; HR, 3.0; P < .001), caustic (7.2 vs 3.6; HR, 2.7; P < .001), and postendotherapy (3.9 vs 3.6; HR, 1.8; P = .005) strictures were associated with a higher number of ED sessions. After 1 year of follow-up, the proportions of patients who remained free of ED was 75% in anastomotic, 71% in radiation, 70% in peptic, 83% in postendotherapy, and 62% in caustic strictures. Esophageal perforation occurred in 23 ED sessions (.4%) in 22 patients (2.4%). CONCLUSIONS More than 60% of patients with BESs remain free of ED after 1 year of follow-up. Because dilation up to 16 to 18 mm diameter was associated with fewer ED sessions during follow-up, we suggest that clinicians should consider dilation up to at least 16 mm to reduce the number of ED sessions in these patients.

中文翻译：

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良性食管狭窄内镜扩张的危险因素和临床结果：一项长期随访研究。

背景和目的内镜扩张（ED）仍然是良性食管狭窄（BES）治疗管理的主要手段。本研究旨在确定难治性 BES 的危险因素并评估 ED 的长期临床结果。方法 我们对 2003 年至 2018 年因 BES 接受 ED 的 891 名患者进行了一项回顾性研究。我们检索了荷兰 6 个三级医疗中心的电子病历，以获取 ED 临床结果的数据。中位随访时间为 39 个月。主要终点是难治性 BES 的风险因素，定义为与随访期间 ED 会话数量增加相关的因素。次要终点是从第一次到最后一次 ED 会话和不良事件的时间。结果 与扩张至 16 至 18 毫米相比，扩张至 13 至 15 毫米与更多的 ED 会话相关（5.0 对 4.1；风险比 [HR], 1.4; P = .001)。与消化道狭窄相比，吻合（4.9 vs 3.6；HR，2.1；P < .001）、放射（5.0 vs 3.6；HR，3.0；P < .001）、腐蚀性（7.2 vs 3.6；HR，2.7；P < .001） 001）和治疗后（3.9 vs 3.6；HR，1.8；P = .005）狭窄与更多的 ED 会话相关。随访 1 年后，吻合口 75%、放疗 71%、消化性 70%、内治疗后 83% 和腐蚀性狭窄 62% 的患者比例保持无 ED。22 名患者 (2.4%) 在 23 次急诊科 (0.4%) 中发生食管穿孔。结论 超过 60% 的 BES 患者在随访 1 年后仍然没有出现 ED。因为扩张至 16 至 18 毫米直径与随访期间更少的 ED 会话相关，