Treatment of Esophageal Strictures with Savary-Guilliard Bougies

Yıl 2017, Cilt: 44 Sayı: 2, 145 - 150, 07.06.2017

Sehmus Olmez , Bünyamin Sarıtaş , Süleyman Sayar Banu Kara Burçak Kayhan Ersan Özaslan Hasan Tankut Köseoğlu Emin Altıparmak

https://doi.org/10.5798/dicletip.319796

Öz

Objective: Esophageal strictures may be caused by benign or malign disorders. Benign strictures are peptic stricture, Schatzki’s ring, esophageal web, and caustic ingestion, post-radiotherapy or post-surgical strictures. Dilatation with Savary-Guilliard bougies (SGD) is the most common endoscopic treatment of choice. In this study, we aimed to investigate the effectiveness of dilatation with Savary-Guilliard Bougies (SGB).
Methods: We retrospectively analyzed the cases treated with SGD in Ankara Numune Education and Research Hospital between October 2005 and June 2011. All the demographic and clinical datas were recorded as well as endoscopic dilatation count and complications.
Results: 73 patients (33(45.2%) males and 40 (54.8%) females) involved in the study. Mean age was 55,6±15,7(18-90) years old. A total of 536 dilatations of 73 patients performed in 169 sessions. Mean sessions of SGD 2,3±2.9(1-21) and dilatation counts were 7.4±9.4(1-65). The most seen etiologies were esophageal web (n=14, 19.2%), post-radiotherapy (n=14, 19.2%), anastomotic strictures (n=11, 15.1%) ingestion of corrosive substances (n=9, 12.3%) and malign strictures (n=8, 11%). The most seen benign causes and session counts were compared. Strictures secondary to radiotherapy and ingestion of caustic substances were the most common conditions treated with SGD. A single session was sufficient in strictures caused by esophageal web. No major complications such as perforation, major bleeding or sepsis were observed.
Conclusion: SGD for the treatment of esophageal benign strictures is a safe, cheap, easily performed method without need for fluoroscopy. While treatment of esophageal web is usually treated with a single session, repeated endoscopic dilation sessions are required for the strictures caused by radiotherapy and corrosive ingestion.

Anahtar Kelimeler

Esophageal Strictures, Dilatation

Kaynakça

• 1. Siersema PD. Treatment options for esophageal strictures. Nat Clin Pract Gastroenterol Hepatol. 2008; 5: 142-52.
• 2. Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002; 35: 117-26.
• 3. Wang YG, Tio TL, Soehendra N. Endoscopic dilation of esophageal stricture without fluoroscopy is safe and effective. World J Gastroenterol. 2002; 8: 766-8.
• 4. Canena JM, Liberato MJ, Rio-Tinto RA, et al. A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study. BMC Gastroenterol. 2012; 12 :70.
• 5. Novais P, Lemme E, Equi C, et al. [Benign strictures of the esophagus: endoscopic approach with Savary-Gilliard bougies]. Arq Gastroenterol. 2008; 45: 290-4.
• 6. van Boeckel PG, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treat Options Gastroenterol. 2015; 13: 47-58.
• 7. Hernandez LV, Jacobson JW, Harris MS. Comparison among the perforation rates of Maloney, balloon, and savary dilation of esophageal strictures. Gastrointest Endosc. 2000; 51: 460-462.
• 8. Pereira-Lima JC, Ramires RP, Zamin I, Jr., et al. Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol. 1999; 94: 1497-501.
• 9. Eisen GM, Baron TH, Dominitz JA, et al. Complications of upper GI endoscopy. Gastrointest Endosc. 2002; 55: 784-793.
• 10. Altıntaş E TB, Kaçar S, Sezgin O, et al. Benign özofagus darlıklarının etyolojisine göre Savary-Gilliard buji dilatasyonunun etkinliği. Akademik Gastroenteroloji Dergisi. 2003; 2: 15-9.
• 11. Pfau PR, Ginsberg GG, Lew RJ, et al. Esophageal dilation for endosonographic evaluation of malignant esophageal strictures is safe and effective. Am J Gastroenterol. 2000; 95: 2813-5.
• 12. Sreenivas DV, Kumar A, Mannar KV, Babu GR. Results of Savary-Gilliard dilatation in the management of cervical web of esophagus. Hepatogastroenterology. 2002; 49: 188-90.
• 13. Siddeshi E R KMV, Jaiswal D, Krishna M M. Safety and outcome using endoscopic dilation for benign esophageal stricture without fluoroscopy. J Dig Endosc 2015; 6: 55-8.
• 14. Standards of Practice C, Egan JV, Baron TH, et al. Esophageal dilation. Gastrointest Endosc. 2006; 63: 755-60.
• 15. Kabbaj N, Salihoun M, Chaoui Z, et al. Safety and outcome using endoscopic dilatation for benign esophageal stricture without fluoroscopy. World J Gastrointest Pharmacol Ther. 2011; 2: 46-9.
• 16. Raymondi R, Pereira-Lima JC, Valves A, et al. Endoscopic dilation of benign esophageal strictures without fluoroscopy: experience of 2750 procedures. Hepatogastroenterology. 2008; 55: 1342-8.
• 17. Hordijk ML, van Hooft JE, Hansen BE, et al. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures. Gastrointest Endosc. 2009; 70: 849-55.