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Digestive Diseases and Sciences

, Volume 58, Issue 11, pp 3218–3223 | Cite as

Self-Dilation as a Treatment for Resistant, Benign Esophageal Strictures

  • Ivana DzeletovicEmail author
  • David E. Fleischer
  • Michael D. Crowell
  • Rahul Pannala
  • Lucinda A. Harris
  • Francisco C. Ramirez
  • George E. Burdick
  • Lauri A. Rentz
  • Robert V. SpratleyJr.
  • Susan D. Helling
  • Jeffrey A. Alexander
Original Article

Abstract

Goals and Background

Simple benign strictures may be relieved with one to three dilation sessions. Resistant benign strictures are anatomically complex and resistant to therapy. We sought to determine the efficacy and safety of esophageal self-dilation with bougie dilators in the largest series to date.

Study

A retrospective chart review was performed to identify patients who underwent esophageal self-dilation at two tertiary referral centers (Mayo Clinic, Scottsdale, Arizona and Mayo Clinic Rochester, Minnesota) between January 1, 2003 and June 30, 2012. Demographic details and clinical information regarding relief of dysphagia, complications, and frequency of endoscopic and self-dilation were abstracted.

Results

Of the 32 patients who began self-dilation for nonmalignant strictures, 30 [22 men; median (range) age, 62 years (22–86 years)] were included in the study. Median (range) follow-up was 37 months (14–281 months). Stricture etiology included radiation therapy (n = 8), anastomotic stricture (n = 9), eosinophilic esophagitis (n = 4), caustic ingestion (n = 3), photodynamic therapy (n = 2), granulation tissue (n = 2), peptic stricture (n = 1) and one patient had radiation therapy and peptic stricture. The average number (range) of physician performed dilations before self-dilation was 12 (4–55). Esophageal self-dilation was successful in treating 90 % of patients. Dysphagia score (2 vs. 1; P < 0.001), stricture diameter (median; 5 vs. 12 mm; P < 0.001) and weight (median; 73 vs. 77 kg; P < 0.001) were significantly different between EDG dilation versus self-dilation.

Conclusions

Esophageal self-dilation is a safe, effective treatment for resistant, benign esophageal strictures. This management strategy should be strongly considered in this patient population.

Keywords

Resistant benign esophageal strictures Esophageal self-dilation Dysphagia Endoscopic dilation 

Notes

Conflict of interests

None.

References

  1. 1.
    Spechler SJ. Aga technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999;117:233–254.PubMedCrossRefGoogle Scholar
  2. 2.
    Siersema PD, de Wijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endosc. 2009;70:1000–1012.PubMedCrossRefGoogle Scholar
  3. 3.
    Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002;35:117–126.PubMedCrossRefGoogle Scholar
  4. 4.
    Ramage JI Jr, Rumalla A, Baron TH, et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol. 2005;100:2419–2425.PubMedCrossRefGoogle Scholar
  5. 5.
    Hordijk ML, Siersema PD, Tilanus HW, Kuipers EJ. Electrocautery therapy for refractory anastomotic strictures of the esophagus. Gastrointest Endosc. 2006;63:157–163.PubMedCrossRefGoogle Scholar
  6. 6.
    Eloubeidi MA, Lopes TL. Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans. Am J Gastroenterol. 2009;104:1374–1381.PubMedCrossRefGoogle Scholar
  7. 7.
    Repici A, Hassan C, Sharma P, Conio M, Siersema P. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther. 2010;31:1268–1275.PubMedCrossRefGoogle Scholar
  8. 8.
    Repici A, Vleggaar FP, Hassan C, et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the best (biodegradable esophageal stent) study. Gastrointest Endosc. 2010;72:927–934.PubMedCrossRefGoogle Scholar
  9. 9.
    Dzeletovic I, Fleischer DE. Self-dilation for resistant, benign esophageal strictures. Am J Gastroenterol. 2010;105:2142–2143.PubMedCrossRefGoogle Scholar
  10. 10.
    Dzeletovic I, Fleischer DE, Crowell MD, et al. Self dilation as a treatment for resistant benign esophageal strictures: outcome, technique, and quality of life assessment. Dig Dis Sci. 2011;56:435–440.PubMedCrossRefGoogle Scholar
  11. 11.
    Kim CH, Groskreutz JL, Gehrking SJ. Recurrent benign esophageal strictures treated with self-bougienage: report of seven cases. Mayo Clin Proc. 1990;65:799–803.PubMedCrossRefGoogle Scholar
  12. 12.
    Grobe JL, Kozarek RA, Sanowski RA. Self-bougienage in the treatment of benign esophageal stricture. J Clin Gastroenterol. 1984;6:109–112.PubMedCrossRefGoogle Scholar
  13. 13.
    Shad SK, Gupta S, Chattopadhyay TK. Self-dilatation of cervical oesophagogastric anastomotic stricture: a simple and effective technique. Br J Surg. 1991;78:1254–1255.PubMedCrossRefGoogle Scholar
  14. 14.
    Dzeletovic I, Fleischer DE. Esophageal Self Dilation: A Teaching Guide for Physicians. ASGE Endoscopic Learning Library; 2011.Google Scholar
  15. 15.
    Sullivan S, Corke M, Watson W. Self dilation of esophageal strictures. Can J Gastroenterol. 1991;5:49–50.Google Scholar
  16. 16.
    Moody GA, Mayberry JF, Probert CS. Mercury bougie self-dilation of the esophagus in the 1990s. J Clin Gastroenterol. 1992;15:264.PubMedCrossRefGoogle Scholar
  17. 17.
    Gilmore IT, Sheers R. Oesophageal self-bougienage. Lancet. 1982;1:620–621.PubMedCrossRefGoogle Scholar
  18. 18.
    Manjunath S, Ramachandra C, Veerendra Kumar KV, Prabhakaran PS. Simple dilatation of anastomotic strictures following oesophagectomy in unsedated patients. Eur J Surg Oncol. 2006;32:1015–1017.PubMedCrossRefGoogle Scholar
  19. 19.
    Deng Y, Wang H, Li Z, et al. Application of portable esophageal dilator in treatment of esophageal stenosis at home. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2006;20:457–459.PubMedGoogle Scholar
  20. 20.
    Bapat RD, Bakhshi GD, Kantharia CV, Shirodkar SS, Iyer AP, Ranka S. Self-bougienage: long-term relief of corrosive esophageal strictures. Indian J Gastroenterol. 2001;20:180–182.PubMedGoogle Scholar
  21. 21.
    Palmer E. The requirement for esophageal bougienage. GP. 1966;33:97–101.PubMedGoogle Scholar
  22. 22.
    Noppen MM, Corne L, Peters O, Smekens L, Musch W, Vincken W. Pneumomediastinum after self-dilation of the esophagus. Chest. 1987;92:757–758.PubMedCrossRefGoogle Scholar
  23. 23.
    Luo SD, Hsu RF. A rare but life-threatening complication of self-bougienage: iatrogenic esophageal foreign body. Endoscopy. 2008;40:E17–E18.PubMedCrossRefGoogle Scholar
  24. 24.
    Kashima ML, Eisele DW. Complication of esophageal self-dilation for radiation-induced hypopharyngeal stenosis. Dysphagia. 2003;18:92–95.PubMedCrossRefGoogle Scholar
  25. 25.
    Bakken JC, Wong Kee Song LM, de Groen PC, Baron TH. Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases. Gastrointest Endosc. 2010;72:712–720.PubMedCrossRefGoogle Scholar
  26. 26.
    Sharma P, Kozarek R. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105:258–273; quiz 274.Google Scholar
  27. 27.
    van Boeckel PG, Vleggaar FP, Siersema PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol. 2011;9:653–659.PubMedCrossRefGoogle Scholar
  28. 28.
    Bick BL, Wong Kee Song LM, Buttar NS, et al. Stent-associated esophagorespiratory fistulas: incidence and risk factors. Gastrointest Endosc. 2013;77:181–189.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ivana Dzeletovic
    • 1
    Email author
  • David E. Fleischer
    • 1
  • Michael D. Crowell
    • 1
  • Rahul Pannala
    • 1
  • Lucinda A. Harris
    • 1
  • Francisco C. Ramirez
    • 1
  • George E. Burdick
    • 1
  • Lauri A. Rentz
    • 1
  • Robert V. SpratleyJr.
    • 1
  • Susan D. Helling
    • 2
  • Jeffrey A. Alexander
    • 2
  1. 1.Division of GastroenterologyMayo ClinicScottsdaleUSA
  2. 2.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

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