Late results in patients with Schatzki ring treated by endoscopic electrosurgical incision of the ring

doi:10.1016/S0016-5107(87)71518-1

Gastrointestinal Endoscopy

Volume 33, Issue 2, April 1987, Pages 96-98

https://doi.org/10.1016/S0016-5107(87)71518-1 Get rights and content

In 17 ambulatory patients with severe intermittent dysphagia an endoscopic electrosurgical radial incision of a Schatzki ring was made with a modified straight retractable sphincterotome. The incision was successfully accomplished with immediate relief of dysphagia in all patients. Fourteen patients remain asymptomatic with a mean follow-up of 46 months after the first treatment. Three patients required a second incision and they have been asymptomatic for more than 24 months. There was one mild bleeding episode. Endoscopic electrosurgical incision of the Schatzki ring is an effective therapeutic modality in selected patients.

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Cited by (29)

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Citation Excerpt :
Dilation with a single, large (16 mm to 20 mm) dilator leads to rupture of the Schatzki ring, and symptomatic relief in almost all patients.56,57 Adjunctive methods that have been used with dilation are electrocautery incision with a needle-knife papillotome58,59 and 4-quadrant biopsies of the ring.60 Several studies have reported an association between EoE and Schatzki ring; biopsies of the esophagus should be considered if there is a clinical suspicion of EoE.61,62
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A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki's) rings
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We believe that multiple, more precise and complete disruptions of the SR offers better results than the random disruption that occurs with bougie dilation without increased risk. In 4 previous series, a total of 36 patients undergoing incision of SR reported significant improvement in dysphagia symptoms without any significant complications when followed up for 6.5 to 45 months.7-9 This study, comprising 50 patients, is the largest study to date comparing traditional bougie dilation with electrosurgical incision of symptomatic SR in a prospective randomized fashion.
Lower esophageal (Schatzki's) rings are a common cause of solid food dysphagia. Standard treatment involves passage of a single large bougie to disrupt the ring, but symptoms recur in the majority of patients. Electrosurgical incision of the ring may provide a longer duration of symptom improvement. There are no data on the treatment of Schatzki's rings in the presence of acid suppression treatment.
Our purpose was to compare the efficacy of bougie dilation with electrosurgical incision of symptomatic Schatzki's rings at 1-year follow-up in the presence of rabeprazole treatment.
Randomized, prospective trial.
University of Utah Health Sciences Center and the Veterans Affairs Salt Lake.
Fifty patients referred for endoscopic evaluation of dysphagia between January 2002 and March 2005.
Symptom-free survival time (in months), dysphagia, and GERD scores.
Twenty-five patients each underwent bougie dilation and electrical incision and were followed up for 12 months. Symptom-free survival times were significantly longer in the incision group (7.99 months) compared with the bougie dilation group (5.86 months) (P = .03). Dysphagia and GERD scores significantly improved in each group comparing baseline with each time interval. The incision group had greater relief of dysphagia at 1 month (P = .05) compared with the bougie group. There was no difference between GERD scores in both groups.
Dysphagia and GERD symptoms were self-reported.
Electrosurgical incision of Schatzki's rings is safe and offers longer symptom-free survival compared with bougie dilation. The addition of rabeprazole offered significant improvement in GERD scores in both groups.

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Late results in patients with Schatzki ring treated by endoscopic electrosurgical incision of the ring

Gastroenterology

Gastroenterology

Am J Surg

Dysphagia due to a diaphragm-like localized narrowing in the lower esophagus (“lower esophageal ring”)

Am J Roentgenol

Dysphagia produced hy a contractile ring in the lower esophagus

Gastroenterology

The nature and location of lower esophageal rings

N Engl J Med

The esophagogastric junction in patients with asymptomatic lower esophageal mucosal ring

Gastroenterology

The lower esophageal ring: long term follow-up of symptomatic and asymptomatic rings

Am J Roentgenol