A comparison of three kinds of balloon dilatations for patients with benign esophageal strictures

Benign esophageal strictures (BES) have been usually treated with balloon dilatation with occasionally drug-coated balloon (DCB) or large balloon dilatation. We compared the clinical outcomes of 3 types of dilatations: small balloon dilatation, DCB dilatation, and large balloon dilatation for the treatment of BES. This retrospective study evaluated 3 groups of 82 consecutive patients with BES who underwent dilatation of either small balloon (Group S, n = 25), DCB (Group D, n = 22) or large balloon (Group L, n = 35). Technical success, dysphagia score, safety and recurrence of stricture were collected and evaluated. Technical success rates of dilatation procedure were 88.7%, 87.1% and 89.7% in Group S, Group D and Group L, respectively (P = 0.9291). Rupture occurred in 8 dilatations: two (2.8%) in the Group S, one (3.2%) in the Group D and 5 (7.4%) in the Group L (P = 0.4109). The final scores in Group L (0.4 ± 0.9) was significantly lower than that in Group S (1.3 ± 1.5) or Group D (1.3 ± 1.4; P < 0.01). A total of 44/82 patients (53.7%) were cured with no dysphagia after the end of follow-up: 10 (40.0%) in the Group S, 9 (40.9%) in the Group D and 25 (71.4%) in the Group L. Group L showed the best clinical effectiveness among the three groups (P = 0.0272). Longer hospitalization was required in the Group D (median 21.0, interquartile range [IQR] 10.0-49.5) than in the Group S (median 14.0, IQR 9.0-24.0) or the Group L (median 12.0, IQR 8.0-24.0, P = 0.0112). More hospitalization cost was required in the Group D (median 6.9 months, IQR 3.7-11.2 months) than in the Group S (median 4.0 months, IQR 2.6-6.8 months) or the Group L (median 3.1, IQR 2.1-6.3, P = 0.0006). In conclusion, large balloon dilatation is a safe and effective treatment for BES, with higher clinical effectiveness, shorter hospitalization and lower hospitalization cost. The use of DCB seems least preferable, as they are associated with more hospitalization cost and few cases of clinical improvement.