High-frequency miniprobe endoscopic ultrasonography in the management of benign esophageal strictures

BACKGROUND: Endoscopic ultrasonography (EUS) can predict the response to endoscopic dilatation by delineating the extent of esophageal wall involvement in benign strictures. In contrast to conventional echoendoscopes, the EUS miniprobe can be negotiated across the stricture and thus provide more information. This study retrospectively evaluated the role of miniprobe EUS in predicting the response to endoscopic dilatation in benign esophageal strictures. METHODS: We analyzed the records of 24 patients (mean age: 48.1±17.9 years) with benign esophageal strictures (corrosive 11, peptic 5, post-radiation 3, anastomotic 2, and others 3) who underwent miniprobe EUS prior to endoscopic dilatation. RESULTS: The stricture was located in the upper, middle and lower esophagus in 2, 9 and 13 patients, respectively. The mean length of the stricture was 3.4±1.9 cm. Miniprobe EUS was able to examine the stricture completely in all patients. The mucosa was involved in 6, mucosa and submucosa in 4, and mucosa, submucosa and muscularis propria in 14 patients. The mean maximum wall thickness of esophageal wall on EUS at the level of the stricture was 8.2±2.8 mm. The mean number of sessions required to achieve adequate dilation was 4.7±2.6. Patients with mucosal involvement required significantly fewer endoscopic sessions for adequate dilatation as compared to patients with muscularis propria involvement (1.8 vs. 6.2 sessions, respectively; P=0.0002). Patients with greater esophageal wall thickness required more endoscopic sessions (r=0.737) (P=0.00004). CONCLUSION: Miniprobe EUS, by delineating the extent of wall involvement as well as measuring wall thickness in benign esophageal strictures, can predict the response to endoscopic dilatation.