Schatzki's Ring: To Cut or Break an Unresolved Problem

Abstract

Symptom assessment has been proven to be less reliable than barium pill testing for success of dilation of peptic strictures. Schatzki's ring also has a high recurrence rate. Our aim here was to compare the efficacy of single dilatation with a 54-F Savary dilator and electrosurgical ring incision for symptomatic Schatzki's rings. Schatzki's ring patients who failed to pass a 12.7-mm barium pill were randomized to dilatation with a 54-F Savary dilator or four quadrant incisions with a needle knife. All received lansoprazole (30 mg) for 30 days posttreatment. Follow-up at 1, 3, 6, and 12 months used the pill test and a dysphagia score. Eleven patients (mean age, 62; median, 64) were randomized and received therapy, six with dilatation and five with incision. The ring diameter pretherapy was 9.8 +/- 1.3 mm. One patient with dilatation had a procedure-related esophageal perforation. The dysphagia score decreased (from 2.7 +/- 1.1 predilatation and 3.0 +/- 0.4 preincision) to 0 after treatment, suggesting that both therapies were equally successful. In contrast, using objective measurements with the barium pill showed that the pill failed to pass the ring in 60% at 1 month after therapy. The failure rate by 1 year was 100%. Use of an objective measure of effectiveness of treatment of symptomatic Schatzki's rings showed that neither single large-dilator dilatation nor four quadrant ring incision was a reliable and effective therapy. In the future studies, repeated dilatation may be needed to define success before long-term outcome can be accurately assessed.

Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique

“…Moreover, patients do not have to enter dilatation programs following this procedure. This supports the eYcacy of a single dilatation for treatment of these lesions, which, however, tend to form again with time [14].…”

A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures

“…Perforation has never been reported. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] After esophageal dilation with bougies or balloons, perforation and/or hemorrhage is reported to occur in 0.1% to 0.4% of patients. 1,2,[7][8][9]39 This may be a true difference; however, SB is judged by many to be a more straightforward procedure than EI and may therefore be performed by less experienced endoscopists.…”

“…5,7,[11][12][13][14][15][16] Electrocautery incision (EI) therapy of GI strictures has been reported in a small series of patients with a Schatzki ring and has also been used for the management of circular anastomotic strictures after GI surgery. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In our series of 20 patients with gastroesophageal anastomotic strictures refractory to SB, EI with a needle-knife proved to be safe and effective. 21 Based on these results, we designed a prospective, randomized, controlled study.…”

Aluminum Phosphide-induced Esophageal Strictures

“…A similar technique has been described in strictures owing to some other causes. [22][23][24][25][26] This study has the disadvantage of being retrospective in nature. However, we observed that the strictures induced by AP were not confined to a particular segment of the esophagus and were seen in all parts of the esophagus.…”