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Open Access 01-07-2018

Self-dilation for therapy-resistant benign esophageal strictures: towards a systematic approach

Authors: Emo E. van Halsema, Chantal A. ’t Hoen, Patricia S. de Koning, Wilda D. Rosmolen, Jeanin E. van Hooft, Jacques J. Bergman

Published in: Surgical Endoscopy | Issue 7/2018

Abstract

Background

Patients with therapy-resistant benign esophageal strictures (TRBES) suffer from chronic dysphagia and generally require repeated endoscopic dilations. For selected patients, esophageal self-dilation may improve patient’s autonomy and reduce the number of endoscopic dilations. We evaluated the clinical course and outcomes of patients who started esophageal self-dilation at our institution.

Methods

This study was a retrospective case series of patients with TRBES who started esophageal self-dilation between 2012 and 2016 at the Academic Medical Center Amsterdam. To learn self-dilation using Savary-Gilliard bougie dilators, patients visited the outpatient clinic on a weekly basis where they were trained by a dedicated nurse. Endoscopic dilation was continued until patients were able to perform self-bougienage adequately. The primary outcome was the number of endoscopic dilation procedures before and after initiation of self-dilation. Secondary outcomes were technical success, final bougie size, dysphagia scores, and adverse events.

Results

Seventeen patients started with esophageal self-dilation mainly because of therapy-resistant post-surgical (41%) and caustic (35%) strictures. The technical success rate of learning self-bougienage was 94% (16/17). The median number of endoscopic dilation procedures dropped from 17 [interquartile range (IQR) 11–27] procedures during a median period of 9 (IQR 6–36) months to 1.5 (IQR 0–3) procedures after the start of self-dilation (p < 0.001). The median follow-up after initiation of self-dilation was 17.6 (IQR 11.5–33.3) months. The final bougie size achieved with self-bougienage had a median diameter of 14 (IQR 13–15) mm. All patients could tolerate solid foods (Ogilvie dysphagia score ≤ 1), making the clinical success rate 94% (16/17). One patient (6%) developed a single episode of hematemesis related to self-bougienage.

Conclusions

In this small case series, esophageal self-dilation was found to be successful 94% of patients when conducted under strict guidance. All patients performing self-bougienage achieved a stable situation where they could tolerate solid foods without the need for endoscopic dilation.

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Title: Self-dilation for therapy-resistant benign esophageal strictures: towards a systematic approach
Authors: Emo E. van Halsema
Chantal A. ’t Hoen
Patricia S. de Koning
Wilda D. Rosmolen
Jeanin E. van Hooft
Jacques J. Bergman
Publication date: 01-07-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6037-z

At a glance: The STEP trials

Springer Medicine

Self-dilation for therapy-resistant benign esophageal strictures: towards a systematic approach

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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