Synchronous polyps predict metachronous colorectal lesions after curative resection of colorectal cancer.

BACKGROUND: The principal aim of endoscopic follow-up programs after curative resection of colorectal cancer (CRC) is to improve survival and identify local recurrence and metachronous CRC. The aim of our study was to identify the possible predictors of metachronous colorectal lesions. METHODS: The records of 348 consecutive patients with CRC and who completed at least 1 year of endoscopic follow-up after surgery were analyzed. In this group, 336 patients underwent surgery for primitive CRC and 12 for metachronous cancer. Patients' characteristics, operative details, and endoscopical follow-up findings were retrieved. Multivariate survival analyses were used to identify patient categories at risk of metachronous colonic lesions. RESULTS: 128 patients presented a metachronous lesion: 118 adenomas and 10 adenocarcinomas. At multivariate analysis, active smoke (HR = 1.84, p = 0.03), neoadjuvant therapy (HR = 0.24, p = 0.01), and presence of synchronous polyps (HR = 1.55, p = 0.04) resulted independent predictors of metachronous adenoma after CRC removal while neoadjuvant therapy (HR = 0.25, p = 0.02), active smoke (HR = 1.54, p = 0.04), and presence of synchronous polyps (HR = 1.86, p = 0.02) resulted independent predictors of metachronous lesions after CRC removal. CONCLUSIONS: This study demonstrated a high rate of metachronous lesions in the early follow-up after curative CRC resection. The negative effects of synchronous polyps should be carefully evaluated when planning patients' follow-up.

Roux-en-Y gastrojejunal bypass using a hybrid NOTES-12 mm trocar technique in a porcine model.

AIMS: To evaluate the feasibility and safety of Roux-en-Y gastrojejunal bypass procedure using a hybrid NOTES-12 mm trocar technique in a survival porcine model. MATERIAL AND METHODS: The procedure was carried out on ten pigs. Two gastroscopes were introduced through the mouth and through a 12 mm trocar, respectively. A mechanical circular gastro-jejunal anastomosis was created by introducing a stapler after the trocar incision was enlarged. A 21 mm EEA OrVil circular stapler was utilized in the first six pigs and a 25 mm one was used in the other four. All pigs were fed beginning 24 hours after the procedure and were euthanized three weeks later. RESULTS: The procedure was successfully completed in all ten animals. The mean length of the skin incision was 2.5 cm. All pigs survived without complications. Endoscopic inspection detected anastomotic strictures in 5/6 of the 21 mm-stapler and in 0/4 of the 25 mm-stapler anastomoses (p < 0.05). CONCLUSION: Roux-en-Y gastrojejunal bypass using a hybrid NOTES-single 12 mm trocar access technique is a simple and safe procedure in a survival porcine model. Functional results need to be evaluated by further studies.

Palliative therapy for esophageal cancer: laser therapy alone is associated with a better functional outcome.

The aim of our study was to compare functional outcome and survival in patients who underwent laser therapy (LT) or laser therapy and esophageal stenting (LTES) to palliate inoperable esophageal cancer. Two hundred and twenty-seven consecutive patients who had endoscopic palliation for esophageal cancer were enrolled in this retrospective study. One hundred and sixty-four underwent LT alone and 63 had LTES. A dysphagia score was adopted (0: absolute dysphagia; 1: liquid diet; 2: semisolid diet; 3: free diet). Survival analysis and non parametric statistics were performed. Patients in the LTES group reported a significantly worse dysphagia score than LT patients (p < 0.01). LTES patients more frequently reported difficulty swallowing than LT patients (p < 0.01). No difference between LTES and LT groups was observed in terms of overall survival. Only radiotherapy resulted in a significant predictor of better survival (p = 0.007). Despite a similar survival, LTES is a predictor of a worse functional palliation than LT alone. Radiotherapy was associated with better survival in patients treated with LT. Therefore, these data seem to suggest that a combination of endoscopic LT and external radiotherapy may yield the best results in palliative care of advanced esophageal cancer.

On the suitability of Thiel cadavers for natural orifice transluminal endoscopic surgery (NOTES): surgical training, feasibility studies, and anatomical education.

BACKGROUND: Surgical training in virtual, animal and cadaver models is essential for minimally invasive surgery. Thiel cadavers are suitable for laparoscopy, but there are few data about the use of embalmed (Tutsch method) and slightly embalmed (Thiel method) cadavers in procedures of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which are usually developed and learned on swine models and fresh frozen cadavers. The aim of this study was thus to assess the use of these cadavers for NOTES approaches. METHODS: The following surgical procedures were evaluated: transanal total mesorectal excision (four cadavers: one Tutsch, two Thiel, one fresh frozen), transanal ileorectal bypass (five cadavers: one Tutsch, three Thiel, one fresh frozen), and transvaginal appendectomy (two Tutsch cadaver). RESULTS: The Thiel method ensured tissue flexibility and consistency suitable for performing the above surgical procedures with good results and without complications, with only a small increase in rigidity with respect to fresh specimens. Cadavers embalmed with higher formalin concentrations (Tutsch method) were more difficult to use, due to high tissue rigidity and resistance of the abdominal wall to pneumoperitoneum, although NOTES accesses were possible. CONCLUSIONS: Thiel cadavers are suitable for transanal/transrectal and transvaginal NOTES approaches, for training surgical residents/specialists and also for surgical research. In minimally invasive surgery (and particularly in NOTES), integration between cadaver (fresh frozen and/or Thiel) and animal models would represent the gold standard, allowing guaranteed knowledge of and respect for human surgical anatomy and correct management of surgery on living subjects. NOTES approaches to human cadavers may also be proposed for the anatomical education of medical students.

Barrett's esophagus and adenocarcinoma risk: the experience of the North-Eastern Italian Registry (EBRA).

OBJECTIVE: To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. BACKGROUND: BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. METHODS: In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression. RESULTS: HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. CONCLUSIONS: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.

Totally stapled gastrojejunal anastomosis using hybrid NOTES: single 12-mm trocar approach in a porcine model.

BACKGROUND: The aim of this study was to evaluate the feasibility of a totally stapled gastrojejunal anastomosis performed using one transabdominal 12-mm trocar and a gastroscope in a porcine model. METHODS: The procedure was carried out on six domestic pigs weighing 45 kg using a hybrid technique with a gastroscope and a 12-mm Hasson trocar, positioned in the left hypochondrium. At the end of the procedure a mechanical circular 21-mm gastrojejunal anastomosis was performed by inserting the stapler through a small gastrotomy after enlarging the trocar incision. RESULTS: In all six cases the procedure was completed through a single 3 cm abdominal incision and without complications. The mean operating time was 2 h, and endoscopic investigation showed that the anastomoses were intact, patent, and airtight. CONCLUSIONS: Totally stapled gastrojejunal anastomosis using a hybrid NOTES-single 12-mm trocar approach is a feasible procedure in the porcine model. Further survival studies are warranted, particularly to evaluate the functional results of this procedure.

B1a lymphocytes in the rectal mucosa of ulcerative colitis patients.

AIM: To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls. METHODS: Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls. CD5(+) B cells were analysed by three colour flow cytometry from rectal mucosal samples after mechanical disaggregation by Medimachine(®). Immunohistochemical analysis of B and T lymphocytes was also performed. Correlations between, on the one hand, rectal B1a cell concentrations and, on the other, erythrocyte sedimentation rate and C-reactive protein levels and clinical, endoscopic and histological disease activity indices were evaluated. RESULTS: Rectal B-lymphocyte (CD19(+)/CD45(+)) rate and concentration were higher in UC patients compared with those in healthy controls (47.85% ± 3.12% vs 26.10% ± 3.40%, P = 0.001 and 501 ± 91 cells/mm(2) vs 117 ± 18 cells/mm(2), P < 0.001); Rectal B1a cell density (CD5(+)CD19(+)) was higher in UC patients than in healthy controls (85 ± 15 cells/mm(2) vs 31 ± 6.7 cells/mm(2), P = 0.009). Rectal B1a cell (CD5/CD19(+)) rate correlated inversely with endoscopic classification (Rs = -0.637, P < 0.05). CONCLUSION: B1a lymphocytes seem to be involved in the pathogenesis of UC, however, the role they play in its early phases and in disease activity, have yet to be defined.

Usefulness of chromogranin A, neuron-specific enolase and 5-hydroxyindolacetic acid measurements in patients with malignant carcinoids.

BACKGROUND: Neuroendocrine tumors (NETs) of the gastro-entero-pancreatic (GEP) system are a heterogeneous group of cancers more common in the small intestine. In patients with malignant NETs, especially carcinoids, a number of prognostic parameters have been considered, such as age, clinical symptoms related to the neoplasm, TNM staging and histological grade, as well as urinary 5-hydroxyindolacetic acid (5-HIAA), chromogranin A (CgA) and neuron-specific enolase (NSE) serum levels. PATIENTS AND METHODS: The data from a series of 14 patients (median age 56 years, range 33-72 years) with gastric (N=8), ileal (N=1), colorectal (N=4) or appendiceal (N=1) malignant carcinoids were retrospectively reviewed. RESULTS: The specificity of CgA, NSE, and 5-HIAA was 86%, 86% and 93%, while the sensitivity was 64%, 36%, and 36%, respectively. There was no relationship between survival and or urinary 5-HIAA (R=0.12, p=0.45), CgA (R=0.22, p=0.21) nor serum NSE (R=0.12, p=0.76) levels. CONCLUSION: The sensitivity of tumor markers is generally low in patients with malignant carcinoids, and both 5-HIAA and CgA levels are independent of survival.

Colonic carcinogenesis in IBD: molecular events.

Patients with ulcerative colitis (UC) and Crohn's disease (CD) are at increased risk of developing intestinal cancers via mechanisms that remain incompletely understood. Several evidences suggest a causal link between chronic inflammation and the development of cancer in the gastrointestinal tract. In fact, patients with UC are exposed to repeated episodes of inflammation that predispose to various tumorigenic events and the sequence of these events are different from those that contribute to develop a sporadic colorectal cancer. In UC carcinogenesis the early events are represented by DNA methylation that produce an inhibition of onco-suppressor genes, mutation of p53, aneuploidy and microsatellite instability. Hypermethylation of tumor suppressors and DNA mismatch repair gene promoter regions, is an epigenetic mechanism of gene silencing that contributes to tumorigenesis and might represent the first step in inflammatory carcinogenesis. P53 is frequently mutated in the early stages of UC-associated cancer, in 33-67% of patients with dysplasia and in 83-95% of UC related cancer patients. Moreover, aneuploidy is an independent risk factor for forthcoming carcinogenesis in UC Finally, the inconsistency between the high cumulative rate of dysplasia in UC and the relatively lower incidence of invasive cancer raises the question about the mechanisms of immunosurveillance that may prevent malignant progression of neoplasm in the colon in most cases. Co-stimulatory molecule CD80 up-regulation in colonic mucosa in UC dysplasia may be one of these mechanism.

Helicobacter pylori and gastroesophageal reflux disease: a cross sectional study.

UNLABELLED: BACKGROUND\ AIMS: Helicobacter Pylori (H. Pylori) is a key pathogenetic factor in gastritis, peptic ulcer disease, gastric carcinoma and lymphoma but its relationship with gastroesophageal reflux disease (GERD) is controversial. The aim of the study is to estimate the possible association between the presence of H. pylori and GERD. METHODOLOGY: In this retrospective study we examined the endoscopy and pathology reports of all the 638 consecutive patients who had upper gastrointestinal endoscopy and adequate mucosal sampling in 2005 in our department at the University of Padova. Yates corrected chi2 test was used to compare the H. Pylori frequency in the different histological groups. Multinomial logistic regression was used to identify possible predictors of H. Pylori infection. RESULTS: In this selected population 133 patients were affected by H. Pylori infection (20.8%) and 107 were affected by GERD according to Montreal definition. No significant relation between H. Pylori infection and GERD or NERD (non erosive reflux disease) was evidenced. As expected histological gastritis at the examination confirmed to be the strongest predictor of infection with a odds ratio of 39.4 (95% CI 5.4-287.4, p < 0.01). Upper abdominal pain showed to be the only clinical independent predictors for the presence of H. Pylori infection with a odds ratio of 1.5 (95% CI 1.0-2.3, p = 0.04). CONCLUSIONS: Our study showed that in north eastern Italy there is no association between H. Pylori infection and GERD. On the contrary presence of histological gastritis and upper abdominal pain were confirmed to be significant predictors of H. Pylori infection. No endoscopic characteristic is significantly related to the presence of H. Pylori.

Ileorectal bypass performed entirely through a transanal route in a porcine model.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES), a new frontier of minimally invasive surgery, uses the body's natural orifices to create an access for surgical procedures. This study aimed to verify the technical feasibility of ileorectal bypass performed entirely through a transanal access. METHODS: The procedure was performed on 10 domestic pigs, after which they were killed. A transanal endoscopic microsurgery (TEM) device and endoscopic and laparoscopic instruments were used. RESULTS: The findings demonstrated that an ileorectal bypass through a transanal access is feasible. The principal steps of a standardized transanal procedure are as follows: confirm a rectal perforation above the peritoneal reflection, perform peritoneoscopy using a standard gastroscope, grasp the small bowel with retrieval forceps and pull it through the rectal hole, suture the ileum and the rectum together using a TEM device, open the ileal loop, and perform endoscopic exploration. Satisfactory anastomosis and no signs of procedure-related complications were confirmed by a post procedure laparotomy. CONCLUSIONS: Ileorectal bypass through a transanal access is technically feasible in a porcine model, and although still at an experimental stage, it could become a surgical option for treating some types of colonic strictures.

Axillary node sampling in conjunction with sentinel node biopsy in patients with breast cancer. A prospective preliminary study.

In patients with breast cancer (BC), axillary lymph node sampling (ALNS) is a reliable procedure with low morbidity, alternative or complementary to sentinel lymph node biopsy (SLNB), which may improve the detection rate of axillary node metastases as compared to SLNB alone in staging the axilla. The aim of this study was to assess the usefulness of ALNS in conjunction with SLNB in improving the sensitivity of SLNB alone at frozen section examination. One hundred and twelve women (median age 56 years, range 29-71 years) with BC underwent SLNB using a combined radioisotope and isosulfan blue dye technique. Two groups of age- and tumor size-matched patients were prospectively randomized: Group A (SLNB alone, 55 women) and group B (SLNB plus ALNS, 57 women). Intraoperative examination showed SN involvement in 32 (28.6%) patients: group A = 14 (25.5%), group B = 18 (31.6%), whilst the final pathology showed axillary node involvement in 7 further cases (group A = 5, group B = 2). The sensitivity and accuracy were 73.7% vs. 90.0% (p = 0.23) and 90.9% vs. 94.7% (p = 0.49), group A vs. B, respectively. Multivariate analysis showed that age >65 years and body mass index independently correlated with the amount of axillary drainage in both groups, which was 47.5 ± 11.3 and 49.6 ± 12.2 ml (A vs. B, p = NS), respectively. In conclusion, in our preliminary study, ALNS in conjunction with SLNB is a low-risk procedure, useful to reduce the false-negative rate of SLNB and to improve the accuracy of intraoperative evaluation of the axillary nodes in patients with BC.

Diode laser treatment of Barrett's esophagus: long-term results.

Different ablation techniques have been utilized in the treatment of Barrett's esophagus (BE) to reduce the risk of degeneration. Treatment complications, risk of recurrence, and buried intestinal metaplasia (IM) are all major concerns. The effect of diode laser treatment on BE, studied in a group of patients over a long-term period, is presented here. All patients with histology of IM or low-grade dysplasia (LGD) treated with diode laser therapy for BE and followed for at least 24 months were included in the study. Treatment sessions were carried out every 3 months and bioptic follow-up examinations were done yearly. Patients without antireflux surgery received proton pump inhibitors. A total of 20 patients with IM, four of them with LGD, were treated with 161 laser sessions (in mean eight per patient) without complications. Complete, sustained endoscopic and histologic remission was obtained in 13 patients (11/12 with BE ≤ 3 cm and 2/8 with BE >3 cm, p < 0.01) and a mean of 83 ± 27% of the metaplasic tissue was removed in all the patients. All four cases of LGD healed to squamous tissue. No buried metaplasia, recurrences, or disease progressions were reported after a mean follow-up of 6 years and 2 months. Diode laser ablation is a safe and effective method in most cases of short BE, while it is less effective in the long form, requiring a large number of sessions. Long-term results show that the risk of recurrence and of buried intestinal metaplasia underneath neosquamous epithelium is negligible.

Hormone receptor rate, MIB-1 score and serum tumour markers CEA and CA 15-3 relationship in elderly women with pT1-2 breast cancer.

The aim of this study was to analyse whether preoperative serum levels of CEA and CA 15-3 correlate with oestrogen (ER) and progesterone (PR) receptor rate and MIB-1 score in elderly (>65 years) women with breast cancer (BC). Data from a series of 349 women (median age 61 years, range 26-89) with pT1-2 BC who underwent curative surgery were reviewed. Patients were divided into two groups: Group A, 237 (60.2%) women <65 years, and Group B, 157 (39.8%) women >64 years. Size of the tumour, ER, PR, CEA and CA 15-3 preoperative serum levels were higher in older patients, while the MIB-1 rate was lower. In both groups, a significant (p<0.05) inverse correlation between ER and MIB-1 was found, while there was a relationship between MIB-1 and both PG and CA 15-3 only in younger patients. These data suggest that only MIB-1 index should be considered an effective parameter for assessing tumour proliferation.

Gastrointestinal stromal tumors: report of an audit and review of the literature.

Gastrointestinal stromal tumors (GISTs), tumors characterized by c-KIT mutations, are the most frequent mesenchymal tumors of the digestive tract. The stomach is the most commonly involved site. Localization, size and mitotic rate are reliable predictors of survival and the two milestones of GISTs treatment are surgery and imatinib. This article is aimed to report the data of an audit, carried out on the morphological and clinical aspects of the disease and to review the present knowledge on GISTs. A total of 172 patients with GISTs (M : F=1 : 1; mean age 65 years) were recruited. The stomach was the most frequently involved site. In 50% of the cases the tumor was smaller than 5 cm, whereas major symptoms were observed in 43% of the cases. Predictors of progressive disease were present only in a small percentage of cases but the disease was in the metastatic phase in over 25% of the cases at diagnosis. Familial aggregation was rare but a consistent share of the patients (21%) had other synchronous or metachronous cancers. The most frequent mutations were in-frame deletions and point mutations of c-KIT exon 11. This report confirms in part the available data on GIST in a consecutive series of patients recruited in Italy and shows that only large collaborative multicenter studies provide data sound enough to enable making reasonable clinical and therapeutic choices, and suggests that, as a measure of secondary prevention, a diagnostic definition should be obtained in all submucosal lesions of the GI tract and that GIST patients should be screened for second tumors.

CHIT1 and AMCase expression in human gastric mucosa: correlation with inflammation and Helicobacter pylori infection.

OBJECTIVES: In this study, we analysed the expression of chitotriosidase (CHIT1) and acidic mammalian chitinase (AMCase) genes in human gastric mucosa biopsies to establish the function of the corresponding enzymes in patients with gastritis associated or not with Helicobacter pylori infection. METHODS: All 27 patients who took part in this study suffered from dyspeptic symptoms and postprandial pain, and sought to undergo gastroscopy. Antral and corpus biopsy specimens were taken to analyse stomach inflammation and detect H. pylori. RNA was extracted from antral gastric biopsies and expression of genes for CHIT1 and AMCase was analysed by quantitative real-time PCR. RESULTS: In human inflamed gastric mucosa, CHIT1 and AMCase genes were expressed on average at a very low level (approximately 10 pg), and a correlation was shown among expression of CHIT1 gene and both positivity to the H. pylori test (P = 0.016) and gastric mucosa inflammation (P = 0.026). No correlation was found among AMCase gene expression and presence of H. pylori and inflammation. CONCLUSION: In this study, we showed the presence of CHIT1 and AMCase mRNA in gastric mucosa and the correlation with the presence of H. pylori was significant only for CHIT1 but not for AMCase expression. This study has shown for the first time that CHIT1 mRNA is present in gastric mucosa and confirms the participation of such an enzyme in the human immune response to inflammation in general, and to H. pylori infection in particular.

Minimally invasive surgery for colorectal cancer: quality of life, body image, cosmesis, and functional results.

BACKGROUND: The aims of this cross-sectional study were to assess the long-term quality of life, the body image, and the cosmetic and functional results in patients who had laparoscopic-assisted for colorectal cancer. METHODS: Forty-two patients were enrolled in this study: 21 consecutive patients who had undergone laparoscopic-assisted colonic resection and 21 patients who had open colonic resection, selected according to stage, gender, age, cancer site, and type of resection. The patients answered four questionnaires about their quality of life, body image, functional, and cosmetic results. Nonparametric tests were used for statistical analysis. RESULTS: Postoperative hospital stay was shorter in patients who had laparoscopic-assisted resection. The cosmetic score was significantly better in the laparoscopic-assisted group than in the open group (p < 0.01). In spite of similar overall body image score, patients who had a laparoscopic-assisted resection reported a significantly better satisfaction with their own body (p = 0.05). Quality-of-life and functional results were similar in both groups. CONCLUSIONS: The cosmetic results and the consequent satisfaction with the body were significantly better after laparoscopic assisted resection compared to equivalent open procedure. These effects seemed to be temporary but they could help patients to accept the burden of surgery.

Double contrast small-bowel radiography in the preoperative assessment of Crohn's disease: is it still useful?

PURPOSE: To evaluate the usefulness of double contrast small-bowel radiography (SBR) in the preoperative assessment of patients with Crohn's disease (CD). METHODS: Thirty-nine consecutive patients who underwent surgery for CD between 2000 and 2004, preceded by a preoperative small-bowel series evaluation, were enrolled in our study. The radiologic findings were compared with the intraoperative findings. RESULTS: Small-bowel radiography was associated with good specificity and sensitivity for the detection of stenosis. Although its main limitation was a remarkable overestimation of stenosis, the main indications for surgery were always confirmed. Sensitivity and specificity were lower for the detection of internal fistulas and the correlation was significant only for SBR performed within 3 months of the operation; however, the concordance between radiological and operative findings was greater. No correlation was observed for the detection of an abdominal mass. CONCLUSIONS: Small-bowel radiography is still reliable for evaluating stenoses and internal fistulas. However, magnetic resonance imaging or computed tomography is mandatory to evaluate an abdominal mass.

Endoscopic dilation of benign esophageal strictures in a surgical unit: a report on 95 cases.

Ninety-five patients were treated by endoscopic dilation without fluoroscopic guidance between 1997 and 2005 for benign esophageal strictures. The etiologies were: anastomotic (38), postfundoplication (13), caustic (14), peptic (11), radiation-induced (10) and others (9). The strictures were classified at every session on a 0 to 4 scale on the basis of the diet and the luminal diameter. Savary-Gillard or Through-the Scope balloon dilators were used depending on the type and the location of the stenosis. A total of 472 dilation sessions were carried out without serious complications. A normal and a semisolid diet were respectively achieved in 75% and 91%. Recurrence of dysphagia was found in 33% and 51% of the patients respectively after 2 months and 1 year. Improvement of dysphagia, the number of sessions, and recurrence were significantly better in the patients with postsurgical stenosis as compared with those affected by caustic, peptic, and radiation-induced strictures.