Comparison between Savary‐Gilliard and balloon dilatation of benign esophageal strictures

Abstract

The efficiency and safety of the 2 most commonly used endoscopic dilators, Savary-Gilliard and pressure balloons, were compared in 2 groups, each including 30 patients, with benign esophageal strictures. Four additional patients with tight and tortuous cervical esophageal strictures were initially managed by balloon dilatation followed by Savary-Gilliard dilatation. These patients could not be dilated by each of the methods alone. Sixty patients [35 males and 25 females with a mean age of 52 years (range, 4-91)] underwent 165 esophageal dilatations. The etiologies of strictures included reflux esophagitis (65%), caustic damage (18.3%), and postoperative (anastomotic, or post-Nissen operation) in 16.7%. Dysphagia improved in all patients; however, 2 patients (1 from each group) with hard postoperative anastomotic stricture eventually underwent surgical resection of stricture. There were no major complications or mortality related to the dilatations. Both methods were highly effective and well tolerated, yet Savary-Gilliard dilators were slightly more effective and simpler to use than balloons. Nevertheless, tortuous cervical strictures and multiple closely-placed strictures were more effectively managed by initial use of balloon followed by Savary dilators.

Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer

“…This result suggested that the gastroesophageal reflux is associated with anastomotic stenosis. All cases of stenosis required one or two endoscopic dilations and did not show any recurrence [17,18]. However, further clinical observation and prospective controlled studies are needed to elucidate the development of anastomotic stenosis.…”

Radiologically guided balloon dilatation of obstructing gastrointestinal strictures

“…Our "technical failures" had all been surgical or endoscopic "failures" prior to referral for radiological dilatation, and several "failed" surgical and endoscopic dilatations were managed successfully by radiologically guided balloon dilatation. All methods of dilatation of GIT strictures seem to be similar in efficacy [18,19]. Some authors claim that balloon dilatation gives longer lasting symptom relief than bougienage [20], but the real bonus of balloon dilatation is its relative safety, thought to be due to the manner in which the dilating force is exerted radially on the stricture [15].…”

“…Balloon dilatation on the other hand usually requires only one passage of a balloon catheter for radiological dilatation. Some stenoses may require dilatation with an angioplasty balloon at first; however, such fight strictures are unlikely to be amenable to dilatation by any method other than a radiologically guided one [14,19]. Endoscopic balloon dilatation is now being performed increasingly frequently using "through the scope" pneumatic balloons, enabling the procedure to be performed with just one intubation [2,4].…”

Effective diameter of balloon dilation for benign esophagojejunal anastomotic stricture after total gastrectomy

“…Frequency of benign strictures at the esophagojejunostomy site ranges from 1.2% to 7.9% [7][8][9][10][11][12][13]. Although both fixed-diameter/ push-type dilators and balloon dilators give good results [14][15][16], balloon dilators are theoretically safer because push dilators exert longitudinal shearing forces in addition to radial forces [17], and also because the area can be directly visualized endoscopically during balloon dilation.Although balloon dilations are often performed with good results [9,14,15,[18][19][20][21][22][23], outcomes of through-thescope balloon dilation (TTS-BD) are uncertain because benign esophageal strictures have various causes, including reflux and radiation esophagitis [15,20,23], caustic damage [20,21,23], sclerotherapy [21], Schatzki rings [15], and surgical anastomoses [9,[18][19][20][21][22][23]. For the latter, the…”

“…Although balloon dilations are often performed with good results [9,14,15,[18][19][20][21][22][23], outcomes of through-thescope balloon dilation (TTS-BD) are uncertain because benign esophageal strictures have various causes, including reflux and radiation esophagitis [15,20,23], caustic damage [20,21,23], sclerotherapy [21], Schatzki rings [15], and surgical anastomoses [9,[18][19][20][21][22][23]. For the latter, the…”