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Endoscopic dilation with bougies versus balloons in caustic esophageal strictures: 17-year experience from a tertiary care center

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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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Authors and Affiliations

  1. Department of Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India

    Anupam Kumar Singh, Saroj Kant Sinha & Rakesh Kochhar

  2. Department of Gastroenterology, STAR Hospital, Nanakramguda, Hyderabad, India

    Yalaka Rami Reddy

  3. Department of Gastroenterology, Topiwala National Medical College & BYL Nair Hospital, Mumbai, India

    Anuraag Jena

  4. Department of Medical Gastroenterology, KIMS Hospital, Secunderabad, India

    Sreekanth Appasani

  5. Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Pankaj Gupta

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Contributions

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.

Corresponding author

Correspondence to Rakesh Kochhar.

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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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