One-third of patients with benign esophageal stricture (BES) were able to achieve a normal diet with bougie dilation alone, according to a study published in the Scandinavian Journal of Gastroenterology.
The retrospective study identified 232 patients who were treated for benign esophageal stricture at 3 hospitals in South Korea from 2001 to 2020. Electronic records were used to obtain patients’ demographic data, treatment history, symptom severity, and symptom duration. The primary outcome was the possibility of a normal diet for 2 months after bougie dilation.
A total of 121 patients (median age, 61 [range, 1-91] years; men, 59.5%) were enrolled in the study. The median follow-up was 13.8 months (range, 1-171). Postoperative stricture was the most common cause of esophageal stricture (n=55), followed by corrosive injuries (n=40) and radiation therapy (n=10).
Among the cohort, 35.5% of patients achieved clinical success with bougie dilation alone. Of this group, 97.7% achieved clinical success within the first 3 sessions or fewer. The number of bougie dilations ranged from 1 to 12 until clinical success.
Patients with corrosive injury had the lowest success rate (22.5%), followed by individuals with peptic stricture (25.0%), postradiation (40.0%), and postoperation (41.8%).
The success rate was 51.3% when the dysphagia score was 1 or 2 and 4.9% when the dysphagia score was 3 or 4 (P <.001). No significant difference was observed in the success rate of bougie expansion based on the patient’s symptom duration or the presence or absence of previous endoscopic procedures.
The clinical success rate was 47.2% for strictures with a length less than 2 cm, 31.6% for strictures 2 to 5 cm, and 20.0% for strictures greater than 5 cm (P =.011). The treatment success rate increased as the diameter of the bougie dilator became larger: 17.8% when the dilator diameter was less than 13 mm vs 46.1% when the dilator diameter was at least 13 mm (P =.002).
In multivariate analysis, a dysphagia score of less than 2 was the only significant factor (odds ratio [OR], 0.08; 95% CI, 0.02-0.39; P =.001).
In subgroup analysis, the rate of corrosive stricture was higher in the group with a dysphagia score of 3 or 4 compared with 1 or 2 (27.5% vs 43.9%, P =.039).
The initial dysphagia score (OR, 3.90; 95% CI, 1.46-10.43; P =.007), the maximum diameter of dilation (OR, 4.77; 95% CI, 1.80-12.65; P =.002), and the number of treatments (OR, 6.26; 95% CI, 1.40-28.02; P =.016) were associated with significant results, according to multivariate analysis.
Study limitations include the retrospective design, which entailed patient enrollment over a 20-year period; a large quantity of patients without follow-up; and an inability to enroll enough patients due to a low prevalence of benign esophageal stricture.
“Bougie dilatation can achieve … symptom improvement for patient[s] with BES [benign esophageal stricture] within 4 sessions, especially with mild to moderate dysphagia, noncorrosive cause, short length of stricture and dilatation of 13 mm or more,” the study authors noted. “In patients with severe dysphagia, symptoms can be improved, but repetition of bougie [dilation] for a normal diet should be avoided.”
Park JY, Park JM, Shin G-Y, et al. Efficacy of bougie dilation for normal diet in benign esophageal stricture. Scand J Gastroenterol. Published online August 23, 2022. doi:10.1080/00365521.2022.2111227