Increased risk of esophageal perforation with dilation in patients with multiple esophageal webs (feline esophagus). A case control study

Background: Feline esophagus or multiple esophageal webs is an uncommon and poorly characterised endoscopic finding. Patients usually present with chronic dysphagia. Management is by gentle dilation. Method: During a 4 year period we identified 10 patients with multiple esophageal webs on endoscopy. There were 8 men and 2 women. The mean age was 35.8yr.(range 16-57 yr). All of them presented with chronic dysphagia (duration 6 months -17 yrs). The patients underwent a total of 19 upper endoscopies (EGD) and 16 dilations. In 3 procedures dilation was deferred. Each patient underwent between 1-5 EGDs (mean 1.9) and between 0-4 dilations (mean 1.5). The dilations performed were by Savary in 12 procedures and by TTS balloon in 4. The Savary size ranged from 27F-54F (mean 36.8F), and each procedure entailed the use of 3 dilators on average. The TTS balloon sizes were 15mm and 18mm (2 were unspecified). We compared these patients with 2 controls per case, matched for gender, symptoms, indication for EGD, method of dilation and size of dilator. The mean dilator size used for the controls was larger than the cases. Results: The patients' dysphagia responded favorably to dilation although some patients required repeat dilations. Five of the 16 dilations resulted in a free perforation (2) or a deep tear (3) despite use of small caliber dilators. None of the controls had a perforation. Cases Controls p value Dilations 16 30 Perforation/tear 5(31.2%) 0 0.005 Conclusion: There is a significantly increased risk of esophageal perforation/tear with dilation in patients with multiple esophageal webs. Dilation in such patients is effective but should be attempted with caution and with small sized dilators.