{"id":{"repo_id":"cape-town","oai_identifier":"oai:open.uct.ac.za:11427/42562"},"canonical_url":"https://search.dev.ndltd.org/etd/cape-town/oai:open.uct.ac.za:11427/42562","repository":{"repo_id":"cape-town","name":"University of Cape Town","base_url":"https://open.uct.ac.za/oai/request"},"display":{"title":"A retrospective review of risk factors for recalcitrant peptic structures","abstract":"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.","abstract_html":"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&lt;0.001; OR 16), requiring more than 3 dilatations (p&lt;0.001), and smaller index residual oesophageal lumen (p&lt;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.","abstract_has_math":false,"creators":["Ndlebe, Babalwa"],"institution":"Division of General Surgery","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Chinnery, Galya","Scriba, Thomas"],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025","date_published":"2025","updated_at":"2026-07-22T22:23:06Z","subjects":["Peptic strictures","dysphagia"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/11427/42562","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Chinnery, Galya","Scriba, Thomas"]},{"key":"dc:creator","label":"Author","values":["Ndlebe, Babalwa"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2026-01-13T13:12:36Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2026-01-13T13:12:36Z"]},{"key":"dc:date.issued","label":"Date","values":["2025"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Division of General Surgery"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Cape Town"]},{"key":"dc:type","label":"Dc Type","values":["Thesis / Dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Masters","MMed"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Peptic strictures","dysphagia"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/11427/42562"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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."]},{"key":"dc:title","label":"Title","values":["A retrospective review of risk factors for recalcitrant peptic structures"]}]}],"canonical_facts":{"dc:contributor.advisor":["Chinnery, Galya","Scriba, Thomas"],"dc:creator":["Ndlebe, Babalwa"],"dc:date.accessioned":["2026-01-13T13:12:36Z"],"dc:date.available":["2026-01-13T13:12:36Z"],"dc:date.issued":["2025"],"dc:description.abstract":["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."],"dc:identifier.uri":["http://hdl.handle.net/11427/42562"],"dc:language.iso":["en"],"dc:publisher.department":["Division of General Surgery"],"dc:publisher.institution":["University of Cape Town"],"dc:subject":["Peptic strictures","dysphagia"],"dc:title":["A retrospective review of risk factors for recalcitrant peptic structures"],"dc:type":["Thesis / Dissertation"],"dc:type.qualificationlevel":["Masters","MMed"]},"updated_at":"2026-07-22T22:23:06Z"}