Incision of recurrent distal esophageal (Schatzki) ring after dilation

Background: Distal esophageal (Schatzki) ring is a frequent cause of dysphagia. Bougienage is generally effective but relapse is common. Outcomes for patients treated by endoscopic incision of distal esophageal rings after symptomatic relapses after bougienage are described. Methods: Eleven patients (2 women, 9 men; median age 61 years; range 24 to 81 years) with recurrent dysphagia after bougienage with large caliber bougies underwent 17 sessions of endoscopic incision of the rings. Follow-up was by standardized interview at a median of 55 months (range, 7 to 84 months) after the initial incision procedure. Results: A median of 3 dilation sessions (range, 1 to >25) were performed prior to incision. All patients noted complete resolution of dysphagia immediately thereafter. Seven required subsequent incision or dilation and 4 did not. The mean dysphagia score was significantly improved from that before incision to that during follow-up. There was a significant increase in the mean duration of improvement in dysphagia after the initial incision compared with that after preincision dilation (respectively, 17 months [range, 2 to 72 months] vs. 5 months [range, 0.5 to 28 months]; p = 0.034). Conclusions: Endoscopic incision of distal esophageal rings that cause recurrent dysphagia after bougienage improves dysphagia and provides a longer dysphagia-free interval compared with repeated bougienage.