Home self-dilatation for esophageal strictures

Abstract

Esophageal strictures secondary to caustic ingestion, head and neck radiation and at the anastomosis post-esophagectomy tend to be refractory to one or several dilatations. One option for these strictures is home self-dilatation. The aim of this study was to assess the efficacy and safety of home self-dilatation for a refractory esophageal stricture. A retrospective chart review was performed of all patients from 1997 to 2009 that performed home self-dilatation for an esophageal stricture. Patients with proximal strictures without tortuosity or a shelf proximal to the stricture were selected for self-dilatation. The patients were taught self-dilatation by the surgeon and an experienced nurse, and an appropriate sized Maloney dilator was provided to the patient and returned when no longer needed. There were 16 patients (11 male and 5 female) with a median age of 60 years (range 38-78). The stricture was related to the anastomosis after esophagectomy in 12 patients, caustic injury in 3 patients and cervical chemoradiotherapy in 1 patient. Prior to initiation of self-dilatation patients had a median of four endoscopic dilatations. Self-dilatation was done with a Maloney dilator ranging in size from 45 to 60 French. The median duration of self-dilatation was 16 weeks. No patient had a perforation or complication related to self-dilatation. No patient required stenting or repetitive endoscopic dilatations because of failure of self-dilatation. Strictures recurred in two patients after cessation of self-dilatation and both responded to endoscopic dilatation followed by additional self-dilatation. Self-dilatation effectively resolves refractory esophageal strictures. It was well tolerated, and there were no complications in this series. Home self-dilatation should be considered the treatment of choice in appropriate patients with refractory esophageal strictures in the cervical esophagus.

Outcomes of oesophageal self‐dilation for patients with refractory benign oesophageal strictures

“…Therefore, our study provides a common unit of measure for comparing the effectiveness of self‐dilation with conventional therapy for refractory strictures, as well as an informative tool for the provider when discussing chances of needing an endoscopy in 6 months with the patient. Compared to prior, smaller studies of self‐dilation, our clinical success rate was slightly lower (88% vs 90% and 100%). We suspect this is in part due to our very strict definition of clinical success, incorporating not only symptoms of dysphagia, but also an intervention free interval of >6 months.…”

“…Oesophageal self‐dilation therapy, where the patient learns to pass a polyvinyl dilator orally on a routine basis, has been in practice since at least the 1970s. The largest study on self‐dilation retrospectively studied 30 patients, and all the prior studies combined included less than 50 patients in total . In these retrospective, observational studies, self‐dilation appears to be effective for refractory strictures, reducing the number of endoscopic dilations from an average of 21.7 in the 12 months prior to self‐dilation, to an average of one in the 12 months following self‐dilation .…”

UK guidelines on oesophageal dilatation in clinical practice

“…Self-dilatation is safe and effective for short, proximal strictures. 268–270 For appropriate, well-trained patients willing to undertake this, it appears to be well tolerated, can prevent surgery and the burden of repeated hospital visits. 268–270 Consider teaching selected, self-motivated patients, with short proximal strictures to self-bougienage 268–270 (GRADE of evidence: very low; strength of recommendation: weak).…”

Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats

“…This procedure is typically performed adjunctively with traditional physician‐performed dilatations. Several studies have shown self‐dilatation to be a safe and effective treatment modality in motivated human patients, resulting in positive emotional, social, and financial impacts assessed by quality of life scores …”

“…Several studies have shown self-dilatation to be a safe and effective treatment modality in motivated human patients, resulting in positive emotional, social, and financial impacts assessed by quality of life scores. [15][16][17] The purpose of our study was to determine if the B-Tube technique could be easily performed, well tolerated by the animals, and effective in maintaining dilatation of a BES after removal of the device.…”