A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures

Hordijk, M. L.; Hooft, Jeanin E. van; Hansen, Bettina E.; Fockens, Paul; Kuipers, Ernst J.

doi:10.1016/j.gie.2009.02.023

Cited by 104 publications

(47 citation statements)

References 38 publications

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“…After 3 months of treatment, stricture recurrences were observed in 96.7% patients of SB group. These results are consistent with others studies [21,22,23]. …”

Section: Discussionsupporting

confidence: 94%

“…Unfortunately, the higher recurrence rates of stricture within a short period of time after treatment have been reported [21,22,23]. In our study, 100% CR was observed after 1 week of SB treatment, but after 1 month, CR was dramatically reduced to 3.3%.…”

Section: Discussioncontrasting

confidence: 51%

“…It is noteworthy that the combination of the multiple techniques was able to show improvement in outcome with respect to the relapse rate for dysphagia. For example, the dilation therapy of electrocautery incision in combination with Savary bougienage, and APC with diathermy are superior in prolonging the dysphagia-free period and decreasing the need for re-treatment [23,24,25]. It is unclear if APC combined with SB on postoperative anastomotic-stenosis after esophageal resection would be superior to other techniques, which is the objective of this study.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Combined Argon Plasma Coagulation and Savary Bougienage for the Relief of Anastomotic-Stenosis after Esophageal Squamous Cancer Surgery

Jia

Guo²,

Lv³

et al. 2014

Dig Surg

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Background: Several endoscopic dilation techniques have been reported for treatment of anastomotic-stenosis of esophageal cancer, but the high incidence of dysphagia has remained unchanged. The aim of this study was to compare the effect of Argon Plasma Coagulation (APC) combined with Savary Bougienage (SB) compared to APC alone or SB alone for anastomotic-stenosis after radical operation for squamous cell carcinoma of the esophagus. Methods: Patients with anastomotic-stenosis that was diagnosed for the first time following esophageal squamous cell carcinoma resection surgery were randomly assigned to undergo APC combined with SB, APC alone, or SB alone. Primary endpoints were the dysphagia-free survival (DFS defined as the time from first dilatation of effectively relieved dysphagia to dysphagia relapse expressed in days) after 6 months of follow up. Results: A total of 90 patients from the Cancer Institute, First Affiliated Hospital of Henan University of Science and Technology were entered into the study (APC group, n = 30, SB group, n = 30, combination group [APC combined with SB], n = 30). Primary endpoints: 6 months after treatment, DFS of combination group (115.63 days; 95% CI, 105.31-125.95) was significantly longer than the APC alone group (39.53 days; 95% CI, 35.95-43.11, p = 0.000) and the SB alone group (16.93 days; 95% CI, 15.01-18.84, p = 0.000). No severe complications occurred within the three treatment groups. Conclusions: APC combined with SB was a safe and well-tolerated method for relieving dysphagia of esophageal squamous cell cancer patients with anastomotic-stenosis. (Registered with randomized controlled trials, ChiCRT, registration number ChiCTR-TRC-13003757.)

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“…After 3 months of treatment, stricture recurrences were observed in 96.7% patients of SB group. These results are consistent with others studies [21,22,23]. …”

Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Combined Argon Plasma Coagulation and Savary Bougienage for the Relief of Anastomotic-Stenosis after Esophageal Squamous Cancer Surgery

Jia

Guo²,

Lv³

et al. 2014

Dig Surg

View full text Add to dashboard Cite

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“…According to current knowledge, if this approach is not sufficient, a next step should be discussed with the patient as few options are available in order to maintain oral feeding: incisional therapy may be tried for anastomotic strictures [8,29,30] or stents may be placed [31][32][33][34]. If still recurrent/refractory, self-bougienage can be proposed to selected patients with benign PES [8,35], as it has been proven that this is a very safe and effective therapy [36,37].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

Martins

Pires

Pimentel‐Nunes

et al. 2018

GE Port J Gastroenterol

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Background/Aims: Dysphagia due to benign pharyngoesophageal strictures (PES) often requires repeated dilations; however, a uniform definition for the therapeutic efficacy of this technique has not been yet established. We aimed to assess the overall efficacy of endoscopic dilation of pharyngoesophageal anastomotic or post-radiotherapy (post-RT) strictures. Methods: The data of 48 patients with post-RT (n = 29) or anastomotic PES (n = 19) submitted to endoscopic dilation during a 3-year period were retrospectively assessed. The Kochman criteria were used to determine refractoriness and recurrence. Patients were asked to answer a questionnaire determining prospectively the dilation program efficacy as (a) dysphagia improvement, (b) dysphagia resolution, (c) need for further dilations, or (d) percutaneous endoscopic gastrostomy (PEG) during the previous 6 months. Need for additional therapy was considered an inefficacy criterion. Results: The median number of dilations per patient was 4 (total of 296 dilations) with a median follow-up of 29 months. The mean predilation dysphagia Mellow-Pinkas score was 3 and the initial stenosis diameter was 7 mm. Fifteen and 29% of patients presented with the Kochman criteria for refractory and recurrent strictures, respectively. Moreover, 96 and 60% showed dysphagia improvement and resolution, respectively. Seventy-five-percent did not require dilations during 6 months, and 89% did not require PEG. From the patients' perspective, overall efficacy was achieved in 58% of cases. Nine additional therapies were required. Number of dilations (OR 0.7), stricture diameter (OR 2.2), and nonrecurrence criteria (OR 14.2) appeared as significant predictors of overall efficacy, whereas refractory stenosis criteria did not. Conclusions: Endoscopic dilation seems to be effective for patients with dysphagia after RT or surgery, especially when assessed as patient perception of improvement. Narrow strictures, recurrent ones, and strictures requiring a higher number of dilations may predict worse outcomes. Key Message: Health professionals should establish well-defined efficacy criteria for dilations and base their decision beyond exclusively objective measurements. Dilatação Endoscópica de Estenoses FaringoEsofágicas: Mais Dimensões do que Diâmetros Palavras Chave Estenoses esofágicas benignas · Endoscopia · Dilatação · Satisfação pessoal · Resultado do tratamentoResumo Introdução e objetivo: A disfagia devido a estenoses faringo-esofágicas benignas requer frequentemente dilatações repetidas, não existindo, contudo, uma definição estabelecida para a eficácia desta terapêutica. Pretendemos avaliar a eficácia-global de dilatações endoscópicas de estenoses rádicas e anastomóticas faringo-esofágicas. Métodos: 48 doentes com estenoses pós-radioterapia (n = 29) e estenoses anastomóticas (n = 19) submetidos a dilatação endoscópica durante um período de 3 anos foram avaliados retrospetivamente. Os critérios de Kochman foram utilizados para determinar refratariedade e recorrência. Os doentes fora...

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“…No serious complications were observed in these patients despite the highest dilatation sessions performed on these patients. SGD is the primary therapy of anastomotic strictures and can be performed safely and effectively 17 . Dilation with SGD was performed on 11 patients with strictures secondary to surgical anastomosis safely and effectively.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Esophageal Strictures with Savary-Guilliard Bougies

Ölmez¹,

Sarıtaş²,

Sayar³

et al. 2017

Dicle Tıp Dergisi

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Objective: Esophageal strictures may be caused by benign or malign disorders. Benign strictures are peptic stricture, Schatzki's ring, esophageal web, and caustic ingestion, post-radiotherapy or post-surgical strictures. Dilatation with Savary-Guilliard bougies (SGD) is the most common endoscopic treatment of choice. In this study, we aimed to investigate the effectiveness of dilatation with Savary-Guilliard Bougies (SGB). Methods: We retrospectively analyzed the cases treated with SGD in Ankara Numune Education and Research Hospital between October 2005 and June 2011. All the demographic and clinical datas were recorded as well as endoscopic dilatation count and complications. Results: 73 patients (33(45.2%) males and 40 (54.8%) females) involved in the study. Mean age was 55,6±15,7(18-90) years old. A total of 536 dilatations of 73 patients performed in 169 sessions. Mean sessions of SGD 2,3±2.9(1-21) and dilatation counts were 7.4±9.4(1-65). The most seen etiologies were esophageal web (n=14, 19.2%), postradiotherapy (n=14, 19.2%), anastomotic strictures (n=11, 15.1%) ingestion of corrosive substances (n=9, 12.3%) and malign strictures (n=8, 11%). The most seen benign causes and session counts were compared. Strictures secondary to radiotherapy and ingestion of caustic substances were the most common conditions treated with SGD. A single session was sufficient in strictures caused by esophageal web. No major complications such as perforation, major bleeding or sepsis were observed. Conclusion: SGD for the treatment of esophageal benign strictures is a safe, cheap, easily performed method without need for fluoroscopy. While treatment of esophageal web is usually treated with a single session, repeated endoscopic dilation sessions are required for the strictures caused by radiotherapy and corrosive ingestion. 6±15,7(18-90) idi. 73 hastaya 169 seansta 536 dilatasyon uygulandı. Ortalama seans sayısı 2,3±2.9(1-21) ve dilatasyon sayısı da 7.4±9.4(1-65) idi. En sık görülen etiyoloji web (n=14, %19,2), radyoterapi sonrası (n=14, %19,2), anastomoz darlığı (n=11,%15,1), kostik madde alımı (n=9,%12,3) ve malign darlıklar(n=8,%11) idi. En sık görülen nedenler ve seans sayıları karşılaştırıldı. Radyoterapiyi sekonder ve kostik madde alımına sekonder darlıklar en sık görülen nedenlerdi. . Özofagus web tedavisinde tek seans yeterliydi. Perforasyon, major kanama veya sepsis gibi major komplikasyon görülmedi. Sonuç; SGB ile özofagus benign darlıklarının tedavisi güvenli, ucuz ve kolayca ve floroskopi olmaksızın uygulanabilen bir yöntemdir. Özofagus webi tek seansta tedavi edilebilmesine rağmen, radyoterapi ve kostik madde alımına bağlı gelişen darlıklarda tekrarlayan dilatasyon işlemlerine gereksinim vardır.

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A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures

Cited by 104 publications

References 38 publications

Evaluation of Combined Argon Plasma Coagulation and Savary Bougienage for the Relief of Anastomotic-Stenosis after Esophageal Squamous Cancer Surgery

Evaluation of Combined Argon Plasma Coagulation and Savary Bougienage for the Relief of Anastomotic-Stenosis after Esophageal Squamous Cancer Surgery

Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

Treatment of Esophageal Strictures with Savary-Guilliard Bougies

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