Self-bougienage in the Treatment of Benign Esophageal Stricture

Jl, Grobe; Ra, Kozarek; Ra, Sanowski

doi:10.1097/00004836-198404000-00002

Cited by 34 publications

(18 citation statements)

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“…No major complications occurred with an estimated 4600 home dilatations in this group of patients. 6 Recently, Davis et al reported self-dilatation in 158 patients with anastomotic strictures after esophagectomy. 7 The median duration of self-dilatation in this series was 10 years; the majority of patients were satisfied with their ability to eat, and all would do it again under similar circumstances.…”

Section: Discussionmentioning

confidence: 99%

Home self-dilatation for esophageal strictures

et al. 2013

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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.

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Section: Discussionmentioning

confidence: 99%

Home self-dilatation for esophageal strictures

et al. 2013

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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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“…There have been a few published studies on the topic of esophageal self dilation. In the mid 1980s and early 1990s two studies showed substantial improvement in patient's dysphagia symptoms with the use of a Maloney dilator [5,7]. In addition, two other case reports have shown short-term relief of dysphagia in a few patients [6,12].…”

Section: Discussionmentioning

confidence: 99%

“…In such patients, esophageal dilation should be considered as an option. Several studies reported excellent results and symptom relief with this treatment alternative [5][6][7].…”

Section: Introductionmentioning

confidence: 94%