Non surgical treatment of high risk elderly patient due to reflux induced oesophageal stricture

The reflux induced oesophageal stricture can be treated by non surgical interventions.

Patient: 23 patients over 70 year old age has been treated in case of inability of swallow between 2001–2003 of years (15 male, 8 female). On all patients 4^th grade of Savary-Miller type of stricture was proved. Hovewer, they never report any kind of symptoms related to reflux.

Methods: All patient past endoscopy while 19 of 23 had histology finding as well.

Under radiograph swallow control we pushed through a guide wire into the stomach and on 8 cases a duodenal tube with open tip was extended into the stomach both for dilation and feeding purposes.

One week after the radiographic check up showed a substantially improved passage therefore we took the tube out. On the other 15 patients with the help of the guide wire we performed a dilation by the Savary-Gillard tubes as from 7 Ch till 11 Ch. We never used over 11 Ch tube to avoid any disruption on the oesophagus. Additionally we introduced proton pump inhibitor drug to.

Results: Upon the dilation at all patient reported improved swallow passage and the radiographic check up showed the same effect. On two patient only one dilation was performed and effective while on an other patient 10 dilation were necessary to get the same result duration of one year.

On the rest of 21 patients we should have performed more than one dilation.-All patient vent through radiographic check up on every third month and whenever it was necessary we repeated the dilation procedure.

Summary: On the high risk elderly patient we recommend to select non surgical methods to get an appropriate result regarding reflux induced oesophageal stricture.