The treatment of benign esophageal strictures typically involves dilation combined with acid suppressive therapy. Advances in endoscopic equipment and dilators have improved the safety of esophageal dilation , but esophageal dilation may lead to complications even in the most experienced hands. Awareness of the complications associated with dilation permits early recognition and reduces morbidity and mortality.
This topic will review the major complications associated with esophageal stricture dilation. The techniques used for the dilation of benign esophageal strictures, the approach to patients with non-iatrogenic esophageal perforations, and the complications associated with upper endoscopy in general are discussed separately. (See "Management of benign esophageal strictures" and "Boerhaave's syndrome: Effort rupture of the esophagus" and "Management of non-iatrogenic traumatic esophageal perforations" and "Overview of upper gastrointestinal endoscopy (esophagogastroduodenoscopy)", section on 'Complications'.)
The major complication of esophageal dilation is esophageal perforation, which is associated with a mortality rate of approximately 20 percent . The incidence of perforation is influenced by the etiology of the stricture, the experience of the endoscopist, and the techniques and equipment used. In general, perforation rates associated with esophageal stricture dilation are low, unlike procedures such as pneumatic dilation for achalasia, where perforations are estimated to complicate three to five percent of procedures. (See "Pneumatic dilation and botulinum toxin injection for achalasia", section on 'Esophageal perforation'.)
Studies suggest that the perforation rate associated with the dilation of benign strictures is between 0.1 and 0.3 percent [3-8]:
- The perforation rate was 0.1 percent per session in a report from 1999 that looked at 1043 dilation sessions using Eder-Puestow or Savary dilators in 153 patients (over half of whom had peptic strictures) .
- A similar perforation rate was found in a report in which 1071 benign strictures were dilated . The overall complication rate for patients with benign strictures was 0.18 percent, with a perforation rate of 0.09 percent.