Schatzki's ring: to cut or break an unresolved problem

Dig Dis Sci. 2004 Mar;49(3):379-83. doi: 10.1023/b:ddas.0000020489.96582.cd.

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Aged
  • Deglutition Disorders / etiology
  • Deglutition Disorders / surgery
  • Deglutition Disorders / therapy*
  • Dilatation* / methods
  • Electrosurgery*
  • Enzyme Inhibitors / therapeutic use
  • Esophageal Stenosis / surgery
  • Esophageal Stenosis / therapy*
  • Humans
  • Lansoprazole
  • Middle Aged
  • Omeprazole / analogs & derivatives*
  • Omeprazole / therapeutic use
  • Proton Pump Inhibitors
  • Treatment Outcome

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Enzyme Inhibitors
  • Proton Pump Inhibitors
  • Lansoprazole
  • Omeprazole