Role of computed tomography in management of benign esophageal strictures

Objectives: The objective of the study is (1) to measure the length of esophageal strictures and wall thickness at the level of stricture on pre-treatment computed tomography (CT) scans, (2) to compare pre and post-treatment CT scan to evaluate the treatment response in the form of changes in stricture length and wall thickness, and (3) to evaluate the effect of intralesional mitomycin and triamcinolone in treatment of benign esophageal strictures. We have studied the role of CT scan in the management of benign esophageal stricture in 29 conservatively managed patients by determining the length of stricture and wall thickness of stricture in pre-management CT scan and in post-management CT scan. Material and Methods: Patients underwent multiple dilatation sessions with or without intralesional mitomycin or triamcinolone. Treatment response was assessed clinically (dysphagia grading) and radiologically (stricture length reduction or wall-thickness decrease on CT). Results: It was observed that the number of dilatations required is more in patients with wall thickness value more than 9 mm in comparison with patients with wall thickness <9 mm with P = 0.001. Furthermore, percentage of patients achieving reduction in esophageal wall thickness more than 25% is high inpatient group managed by dilatations and intralesional triamcinolone, followed by the group of patients managed by dilatations and intralesional mitomycin, followed by patient group managed by dilatations alone. Conclusion: Hence, CT helps in predicting the number of dilatations required in benign esophageal strictures and guides management.