Predictors of endoscopic management failure in benign non-caustic esophageal strictures: a retrospective cohort study.
- 1Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: [email protected].
- 2Universidade de São Paulo, São Paulo, SP, Brazil.
Abstract
Background
Benign Non-caustic Esophageal Strictures (BNES) often require repeated endoscopic dilations, yet a substantial proportion of patients remain refractory and ultimately require esophagectomy. Identifying predictors of endoscopic failure is essential for risk stratification and timely referral to alternative therapies. This study aimed to identify factors associated with endoscopic treatment failure leading to esophagectomy in patients with BNES.Methods
This retrospective cohort study included 51 patients with BNES treated at a single tertiary center from January 2004 to March 2026. Patients with caustic, malignant, or post-esophagectomy anastomotic strictures were excluded. Treatment consisted of balloon or bougie dilation. Endoscopic failure was defined as the need for esophagectomy due to persistent or recurrent dysphagia despite treatment. Multivariable logistic regression was performed to identify independent predictors of failure.Results
Of 51 patients, 18 (35.3%) required esophagectomy. Failure was associated with non-GERD etiology (p < 0.001), absence of hiatal hernia (p = 0.001), segmental strictures (p = 0.016), and a higher number of dilations (p = 0.026). In multivariable analysis, non-GERD etiology (OR = 7.45, p = 0.034) and absence of hiatal hernia (OR = 8.28, p = 0.016) were independent predictors. In a secondary model, absence of hiatal hernia (OR = 17.02, p = 0.011) and number of dilations (OR = 1.08 per session, p = 0.028) remained significant. Among endoscopically managed patients, 33.3% had persistent symptoms.Conclusions
One-third of BNES patients required esophagectomy. Non-GERD etiology, absence of hiatal hernia, and increasing dilation burden independently predict endoscopic failure and may support earlier consideration of surgical management.
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BibTeX
@article{friedmann2026predictors,
title = {{Predictors of endoscopic management failure in benign non-caustic esophageal strictures: a retrospective cohort study.}},
author = {Ilan David Friedmann and Sergio Szachnowicz and André Fonseca Duarte and Fauze Maluf-Filho and Rubens Sallum and Ulysses Ribeiro and Paulo Herman},
journal = {Clinics (Sao Paulo, Brazil)},
year = {2026},
month = oct,
doi = {10.1016/j.clinsp.2026.101174},
url = {https://europepmc.org/article/MED/42880126},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predictors of endoscopic management failure in benign non-caustic esophageal strictures: a retrospective cohort study.
AU - Ilan David Friedmann
AU - Sergio Szachnowicz
AU - André Fonseca Duarte
AU - Fauze Maluf-Filho
AU - Rubens Sallum
AU - Ulysses Ribeiro
AU - Paulo Herman
PY - 2026
DA - 2026/10/15
JO - Clinics (Sao Paulo, Brazil)
DO - 10.1016/j.clinsp.2026.101174
UR - https://europepmc.org/article/MED/42880126
AB - Background Benign Non-caustic Esophageal Strictures (BNES) often require repeated endoscopic dilations, yet a substantial proportion of patients remain refractory and ultimately require esophagectomy. Identifying predictors of endoscopic failure is essential for risk stratification and timely referral to alternative therapies. This study aimed to identify factors associated with endoscopic treatment failure leading to esophagectomy in patients with BNES.Methods This retrospective cohort study included 51 patients with BNES treated at a single tertiary center from January 2004 to March 2026. Patients with caustic, malignant, or post-esophagectomy anastomotic strictures were excluded. Treatment consisted of balloon or bougie dilation. Endoscopic failure was defined as the need for esophagectomy due to persistent or recurrent dysphagia despite treatment. Multivariable logistic regression was performed to identify independent predictors of failure.Results Of 51 patients, 18 (35.3%) required esophagectomy. Failure was associated with non-GERD etiology (p < 0.001), absence of hiatal hernia (p = 0.001), segmental strictures (p = 0.016), and a higher number of dilations (p = 0.026). In multivariable analysis, non-GERD etiology (OR = 7.45, p = 0.034) and absence of hiatal hernia (OR = 8.28, p = 0.016) were independent predictors. In a secondary model, absence of hiatal hernia (OR = 17.02, p = 0.011) and number of dilations (OR = 1.08 per session, p = 0.028) remained significant. Among endoscopically managed patients, 33.3% had persistent symptoms.Conclusions One-third of BNES patients required esophagectomy. Non-GERD etiology, absence of hiatal hernia, and increasing dilation burden independently predict endoscopic failure and may support earlier consideration of surgical management.
SN - 1807-5932
SN - 1980-5322
ER -