Extensive Dataset for Esophageal Dilation Shows Very Low Rates of Complications, Mortality

What are the rates of postoperative complications and mortality following esophageal dilation, and what factors are associated with adverse outcomes?

BOTTOM LINE

Evidence from a national insurance claim database suggests that esophageal dilation is a safe procedure with a very low rate of serious complications and mortality.

BACKGROUND: Esophageal stricture can result from traumatic or caustic insults and from disease processes. Esophageal dilation is a common treatment for esophageal stricture, with thousands performed in the U.S. annually. Although this procedure has been proven safe and effective, it carries a small risk of serious complications, such as esophageal perforation.

STUDY DESIGN: Observational, retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Kentucky, Lexington, Ky.

SYNOPSIS: Researchers queried a national database of insurance for Current Procedural Terminology codes representing esophageal dilation performed between 2011 and 2017. They identified 202,528 procedures, representing 160,218 unique patients. Patients who underwent percutaneous endoscopic gastrostomy were not included in the primary analysis and were analyzed separately. Data analysis focused only on each patient’s first recorded dilation. The investigators collected data regarding specific comorbidities of concern, including malignancies, esophageal varices, and Barrett’s esophagus. Complications were assessed via codes representing the following diagnoses: esophageal perforation, esophageal hemorrhage, pneumothorax, sepsis (severe and postprocedural), and mediastinitis. Postoperative mortality for all patients was tracked for 30, 60, and 90 days. Data demonstrated a low risk of serious complications, with a perforation rate of 0.92% for patients with and 0.079% for patients without a comorbid malignancy. Mortality rates were also very low at 7.5 per 100,000 dilations after 30 days. Male sex was associated with higher complication and mortality rates, as was advanced age. Authors noted that the clinical significance of these risk factors may be limited, given the extremely low rate of complications in general. Study limitations included lack of access to patient charts.

CITATION: Mullen MB, Witt MA, Stromberg AJ, et al. National database outcomes of esophageal dilations. Laryngoscope. 2021;131:2436-2440.