PTU-161 Endoscopic Bougie Dilatation is Effective and Safe for Oes Ophageal and Pharyngeal Strictures: Outcomes of a Large Case Series

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Abstract

Introduction

Endoscopic bougie dilatation is a traditional technique for managing oesophageal strictures. There are some safety concerns with this technique, but no corroborative evidence of this in controlled or uncontrolled studies to date.

Methods

We evaluated the outcomes and safety of endoscopic bougie dilatation at our centre, using the endoscopy database to identify all dilatations done by a single operator. Bougies were the preferred option for all dilatations. All cases from January 2007 to March 2013 were then reviewed by case note analysis.

Results

146 patients were identified, who underwent a total of 346 bougie dilatations. Median age was 67 yrs (range 27–91). Indications for dilatation were: peptic stricture 80 (55%), malignant stricture 20 (14%), post-surgical stricture 12 (8%), pharyngeal pathology 25 (17%) and other 9 (6%). Pharyngeal pathology was predominantly post-radiotherapy strictures (64%) and neurological (20%).

Results

In cases of peptic stricture, 78/80 (98%) had a good symptomatic response to an initial course of dilatation (requiring 1 procedure only in 82%). Median end dilatation diameter was 17 mm (range 12–18). Recurrence requiring further dilatation occurred in 27 (34%), after a median of 8 months (range 3–47). In the remainder, median observed remission was 24 months (range 1–63). For pharyngeal pathology patients underwent a median of 2 dilatations (range 1–12). After initial dilatation, 12 (48%) achieved lasting benefit, 5 (20%) had no benefit and 8 (32%) benefited from periodic scheduled dilatations.

Results

Overall median follow up was 22 months (IQR 7- 48). Among the whole case series there were 6 (4%) unscheduled admissions, all self-limiting (dysphagia 2, food bolus 2, stent-related bleed 1, pain 1). There were no perforations.

Conclusion

This large case series supports the role of bougie dilatation as a safe and effective therapy for benign peptic strictures. With careful case selection it also appears a valuable, appropriate and safe option for a range of similar oesophageal and pharyngeal pathologies.

Disclosure of Interest

None Declared.

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