Full Text Available
Note: Clicking the button above will open the full text document at the original institutional repository in a new window.
A retrospective review of risk factors for recalcitrant peptic structures
Introduction: Peptic strictures (PS) are a common benign cause of dysphagia, but a scarcity of local data is available as regards identifying risk factors associated with recalcitrancy. Methods: Single centre retrospective audit of PS undergoing endoscopic management between 1st March 2018 and 1st M...
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English English |
| Published: |
Division of General Surgery
2026
|
| Subjects: | |
| Tags: |
No Tags, Be the first to tag this record!
|
| _version_ | 1867613249254457344 |
|---|---|
| access_status_str | Open Access |
| author | Ndlebe, Babalwa |
| author2 | Chinnery, Galya |
| author_browse | Chinnery, Galya Ndlebe, Babalwa |
| author_facet | Chinnery, Galya Ndlebe, Babalwa |
| author_sort | Ndlebe, Babalwa |
| collection | Thesis |
| description | Introduction: Peptic strictures (PS) are a common benign cause of dysphagia, but a scarcity of local data is available as regards identifying risk factors associated with recalcitrancy. Methods: Single centre retrospective audit of PS undergoing endoscopic management between 1st March 2018 and 1st March 2022, aiming to identify recalcitrancy risk factors. Results: Of 69 patients (37 male, 53.4%) with PS, 27 (39.1%) were diagnosed with recalcitrant strictures. Most strictures were positioned distally (53; 76.8%) with an associated hiatus hernia in 52 (75.4%). While comorbidities were not associated with recalcitrancy, younger age was a risk factor (recalcitrant stricture group median age 51 (IQR 38.5-61.0 years) versus non-recalcitrant group median age 62.5 (IQR 48.5-70.8 years); p=0.044). Although HIV status did not affect recalcitrancy risk, taking oral antiretrovirals (ARVs) was significantly associated with PS recalcitrancy (p=0.032; OR 4.55). Presenting degree of dysphagia (p<0.001; OR 16), requiring more than 3 dilatations (p<0.001), and smaller index residual oesophageal lumen (p<0.001) were all significantly associated with stricture recalcitrancy. Fourteen patients were temporarily stented (having a total of 24 stents placed). Thirteen patients had post endoscopic complications with most of these complications occurring amongst the recalcitrant group (n=11). Four complications occurred during endoscopy, two partial thickness tears managed endoscopically, a gastric perforation requiring an over-the-scope-clip closure and one sedation related hypoxia requiring a short period of bag-mask-valve ventilation and sedation-reversal. Two deaths occurred in the cohort; one from a suspected aspiration pneumonia five days after last dilatation and one from a suspected missed oesophageal perforation (2.3% immediate endoscopic intervention complication rate for 265 dilatations performed). Conclusion: Locally pill oesophagitis related to ARVs has been identified as a potential cause of recalcitrancy; identifying at-risk patients early may allow for management adjustments to improve outcomes. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42562 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:33:08.525Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42562 A retrospective review of risk factors for recalcitrant peptic structures Ndlebe, Babalwa Chinnery, Galya Scriba, Thomas Peptic strictures dysphagia Introduction: Peptic strictures (PS) are a common benign cause of dysphagia, but a scarcity of local data is available as regards identifying risk factors associated with recalcitrancy. Methods: Single centre retrospective audit of PS undergoing endoscopic management between 1st March 2018 and 1st March 2022, aiming to identify recalcitrancy risk factors. Results: Of 69 patients (37 male, 53.4%) with PS, 27 (39.1%) were diagnosed with recalcitrant strictures. Most strictures were positioned distally (53; 76.8%) with an associated hiatus hernia in 52 (75.4%). While comorbidities were not associated with recalcitrancy, younger age was a risk factor (recalcitrant stricture group median age 51 (IQR 38.5-61.0 years) versus non-recalcitrant group median age 62.5 (IQR 48.5-70.8 years); p=0.044). Although HIV status did not affect recalcitrancy risk, taking oral antiretrovirals (ARVs) was significantly associated with PS recalcitrancy (p=0.032; OR 4.55). Presenting degree of dysphagia (p<0.001; OR 16), requiring more than 3 dilatations (p<0.001), and smaller index residual oesophageal lumen (p<0.001) were all significantly associated with stricture recalcitrancy. Fourteen patients were temporarily stented (having a total of 24 stents placed). Thirteen patients had post endoscopic complications with most of these complications occurring amongst the recalcitrant group (n=11). Four complications occurred during endoscopy, two partial thickness tears managed endoscopically, a gastric perforation requiring an over-the-scope-clip closure and one sedation related hypoxia requiring a short period of bag-mask-valve ventilation and sedation-reversal. Two deaths occurred in the cohort; one from a suspected aspiration pneumonia five days after last dilatation and one from a suspected missed oesophageal perforation (2.3% immediate endoscopic intervention complication rate for 265 dilatations performed). Conclusion: Locally pill oesophagitis related to ARVs has been identified as a potential cause of recalcitrancy; identifying at-risk patients early may allow for management adjustments to improve outcomes. 2026-01-13T13:12:36Z 2026-01-13T13:12:36Z 2025 2026-01-13T07:43:16Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/42562 en eng application/pdf Division of General Surgery Faculty of Health Sciences University of Cape Town |
| spellingShingle | Peptic strictures dysphagia Ndlebe, Babalwa A retrospective review of risk factors for recalcitrant peptic structures |
| thesis_degree_str | Master's |
| title | A retrospective review of risk factors for recalcitrant peptic structures |
| title_full | A retrospective review of risk factors for recalcitrant peptic structures |
| title_fullStr | A retrospective review of risk factors for recalcitrant peptic structures |
| title_full_unstemmed | A retrospective review of risk factors for recalcitrant peptic structures |
| title_short | A retrospective review of risk factors for recalcitrant peptic structures |
| title_sort | retrospective review of risk factors for recalcitrant peptic structures |
| topic | Peptic strictures dysphagia |
| url | http://hdl.handle.net/11427/42562 |
| work_keys_str_mv | AT ndlebebabalwa aretrospectivereviewofriskfactorsforrecalcitrantpepticstructures AT ndlebebabalwa retrospectivereviewofriskfactorsforrecalcitrantpepticstructures |