Abstract
Introduction
Endoscopic dilation is the preferred management strategy for caustic esophageal strictures (CES). However, the differences in outcome for different dilators are not clear. We compared the outcome of CES using bougie and balloon dilators.
Methods
Between January 2000 and December 2016, the following data of all the patients with CES were collected: demographic parameters, substance ingestion, number of strictures, number of dilations required to achieve ≥ 14 mm dilation, post-dilation recurrence, and total dilations. Patients were divided into two groups for the type of dilator, i.e., bougie or balloon. The two groups were compared for baseline parameter, technical success, short- and long-term clinical success, refractory strictures, recurrence rates, and major complications.
Results
Of the 189 patients (mean age 32.17 ± 12.12 years) studied, 119 (62.9%) were males. 122 (64.5%) patients underwent bougie dilation and 67 (35.5%) received balloon dilation. Technical success (90.1% vs. 68.7%, p < 0.001), short-term clinical success (65.6% vs. 46.3%, p value 0.01), and long-term clinical success (86.9% vs. 64.2%, p < 0.01) were higher for bougie dilators compared to balloon dilators. Twenty-four (12.7%) patients developed adverse events which were similar for two groups. On multivariate analysis, use of bougie dilators (aOR 4.868, 95% CI 1.027–23.079), short-term clinical success (aOR 5.785, 95% CI 1.203–27.825), and refractory strictures (aOR 0.151, 95% CI 0.033–0.690) were independent predictors of long-term clinical success.
Conclusion
Use of bougie dilators is associated with better clinical success in patients with CES compared to balloon dilators with similar rates of adverse events.
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References
Li Y, Langworthy J, Xu L, Cai H, Yang Y, Lu Y, Wallach SL, Friedenberg FK (2020) Nationwide estimate of emergency department visits in the United States related to caustic ingestion. Dis Esophagus 33(6):doaa012
Pannu AK, Bhalla A, Vamshi V, Upadhyay MK, Sharma N, Kumar S (2022) Changing spectrum of acute poisoning in North India: a hospital-based descriptive study. Turk J Emerg Med 22(4):192–199
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Osterthaler KM, Banner W (2018) 2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 35th annual report. Clin Toxicol 56(12):1213–1415
Zargar SA, Kochhar R, Mehta S, Mehta SK (1991) The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 37(2):165–169
Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A (2012) Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children. World J Gastroenterol 18(10):1098–1103
Katibe R, Abdelgadir I, McGrogan P, Akobeng AK (2018) Corticosteroids for preventing caustic esophageal strictures: systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 66(6):898–902
Mahawongkajit P, Tomtitchong P, Boochangkool N, Mingmalairak C, Awsakulsutthi S, Havanond C (2021) A prospective randomized controlled trial of omeprazole for preventing esophageal stricture in grade 2b and 3a corrosive esophageal injuries. Surg Endosc 35(6):2759–2764
Wang RW, Zhou JH, Jiang YG, Fan SZ, Gong TQ, Zhao YP, Tan QY, Lin YD (2006) Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns. Eur J Cardiothorac Surg 30(2):207–211
Tiryaki T, Livanelioğlu Z, Atayurt H (2005) Early bougienage for relief of stricture formation following caustic esophageal burns. Pediatr Surg Int 21(2):78–80
Bruzzi M, Chirica M, Resche-Rigon M, Corte H, Voron T, Sarfati E, Zagdanski AM, Cattan P (2019) Emergency computed tomography predicts caustic esophageal stricture formation. Ann Surg 270(1):109–114
Kim JH, Song HY, Kim HC, Shin JH, Kim KR, Park SW, Jung HY, Lee GH, Park SI (2008) Corrosive esophageal strictures: long-term effectiveness of balloon dilation in 117 patients. J Vasc Interv Radiol 19(5):736–741
Broor SL, Raju GS, Bose PP, Lahoti D, Ramesh GN, Kumar A, Sood GK (1993) Long term results of endoscopic dilatation for corrosive oesophageal strictures. Gut 34(11):1498–1501
Gupta P, Gulati A, Reddy YR, Samanta J, Kochhar R (2019) Does esophageal wall thickness on computed tomography predict response to endoscopic dilatation in patients with corrosive esophageal strictures? J Gastroenterol Hepatol Open 3(5):405–408
Uygun I, Arslan MS, Aydogdu B, Okur MH, Otcu S (2013) Fluoroscopic balloon dilatation for caustic esophageal stricture in children: an 8-year experience. J Pediatr Surg 48(11):2230–2234
Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K (1999) Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc 49(4 Pt 1):509–513
Ilkin Naharci M, Tuzun A, Erdil A, Ates Y, Bagci S, Yamanel L, Dagalp K (2006) Effectiveness of bougie dilation for the management of corrosive esophageal strictures. Acta Gastroenterol Belg 69(4):372–376
Singhal S, Kar P (2007) Management of acid- and alkali-induced esophageal strictures in 79 adults by endoscopic dilation: 8-years’ experience in New Delhi. Dysphagia 22(2):130–134
Joshi P, Yadav R, Dangi A, Kumar P, Kumar S, Gupta V, Gupta V, Chandra A (2020) Corrosive esophageal strictures: from dilatation to replacement: a retrospective cohort study. Dysphagia 35(4):558–567
Saeed ZA, Winchester CB, Ferro PS, Michaletz PA, Schwartz JT, Graham DY (1995) Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc 41(3):189–195
Kochman ML, McClave SA, Boyce HW (2005) The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 62(3):474–475
ASGE Standards of Practice Committee, Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD (2012) Adverse events of upper GI endoscopy. Gastrointest Endosc. 76(4):707–718
Vermeulen BD, de Zwart M, Sijben J, Soons E, van der Weerd L, Arese D, von den Hoff DW, Craviotto V, Tan ACITL, Groenen MJM, Bogte A, Repici A, Spaander MCW, Siersema PD (2020) Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study. Gastrointest Endosc. 91(5):1058–1066
Josino IR, Madruga-Neto AC, Ribeiro IB, Guedes HG, Brunaldi VO, de Moura DTH, Bernardo WM, de Moura EGH (2018) Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. Gastroenterol Res Pract 2018:5874870
Tharavej C, Pungpapong SU, Chanswangphuvana P (2018) Outcome of dilatation and predictors of failed dilatation in patients with acid-induced corrosive esophageal strictures. Surg Endosc 32(2):900–907
Poley JW, Steyerberg EW, Kuipers EJ, Dees J, Hartmans R, Tilanus HW, Siersema PD (2004) Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc 60(3):372–377
Povilavičius J, Samalavičius NE, Verkauskas G, Trainavičius K, Povilavičienė M (2019) Conservative treatment of caustic oesophageal injuries in children: 15 years of experience in a tertiary care paediatric centre. Gastroenterol Rev 14(4):286–291
Doo EY, Shin JH, Kim JH, Song HY (2009) Oesophageal strictures caused by the ingestion of corrosive agents: effectiveness of balloon dilatation in children. Clin Radiol 64(3):265–271
Taşkinlar H, Bahadir GB, Yiğit D, Erdoğan C, Avlan D, Nayci A (2017) Effectiveness of endoscopic balloon dilatation in grade 2a and 2b esophageal burns in children. Minim Invasive Ther Allied Technol 26(5):300–306
Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A (2010) Long-term management of corrosive esophageal stricture with balloon dilation in children. Surg Endosc 24(9):2287–2292
Hammoudi N, Giaoui A, Lambert J, Dhooge M, Corte H, Tran-Minh ML, Cattan P, Gornet JM (2022) Predictive factors for the success of endoscopic dilation of esophageal caustic stricture: the experience of a French tertiary reference center. Surg Endosc 36(8):5660–5668
Gün F, Abbasoğlu L, Celik A, Salman ET (2007) Early and late term management in caustic ingestion in children: a 16-year experience. Acta Chir Belg 107(1):49–52
Karnak I, Tanyel FC, Büyükpamukçu N, Hiçsönmez A (1998) Esophageal perforations encountered during the dilation of caustic esophageal strictures. J Cardiovasc Surg 39(3):373–377
Rao KS, Ananthakrishnan N, Banerjee A (1988) Corrosive oesophagitis: an analysis of 50 cases. Aust N Z J Surg 58(9):723–726
Fan Y, Song HY, Kim JH, Park JH, Ponnuswamy I, Jung HY, Kim YH (2011) Fluoroscopically guided balloon dilation of benign esophageal strictures: incidence of esophageal rupture and its management in 589 patients. Am J Roentgenol 197(6):1481–1486
Gündoğdu HZ, Tanyel FC, Büyükpamukçu N, Hiçsönmez A (1992) Conservative treatment of caustic esophageal strictures in children. J Pediatr Surg 27(6):767–770
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AKS and AJ wrote the initial manuscript; YRR, SA, and PG collected the data; AKS performed the analysis; SKS and RK did all the endoscopic procedures; RK critically revised the manuscript. All authors reviewed and approved the final version.
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Dr. Anupam Kumar Singh, Dr. Yalaka Rami Reddy, Dr. Anuraag Jena, Dr. Sreekanth Appasani, Dr. Pankaj Gupta, Prof. Saroj Kant Sinha, and Prof Rakesh Kochhar have no conflicts of interest or financial ties to disclose.
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Singh, A.K., Reddy, Y.R., Jena, A. et al. Endoscopic dilation with bougies versus balloons in caustic esophageal strictures: 17-year experience from a tertiary care center. Surg Endosc 37, 8236–8244 (2023). https://doi.org/10.1007/s00464-023-10384-4
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DOI: https://doi.org/10.1007/s00464-023-10384-4