Piotet Elsa, Escher Anette, Monnier Philippe
Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne, 1011 Lausanne, Switzerland.
Eur Arch Otorhinolaryngol. 2008 Mar;265(3):357-64. doi: 10.1007/s00405-007-0456-0. Epub 2007 Sep 26.
Treatment of symptomatic pharyngeal and esophageal strictures requires endoscopic dilatation. The Savary-Gilliard bougienage was developed by our department and has been used since 1980 for this purpose. We report our experience using this technique. The records of patients seen from January 1, 1963 to December 31, 2005, who had pharyngeal and esophageal strictures needing dilatation, were reviewed. The prevalence of different etiologies, and the incidence of complications using the Savary-Gilliard dilators were assessed. Efficiency of dilatation was assessed over a 17-year segment of this period, using number of dilatations and time intervals between dilatations until resolution of symptoms as outcome measures. Of the 2,652 pharyngeal and esophageal strictures reviewed, 90% were of organic origin (45% benign and 55% malignant stenoses), and 10% were of functional etiology. The most common etiologies were peptic strictures before the era of proton pump inhibitors, and postoperative anastomotic strictures thereafter. A total of 1,862 dilatations using the Savary-Gilliard technique were analyzed. Complication and mortality rates were 0.18 and 0.09% for benign and 4.58 and 0.81% for malignant etiologies, respectively. The number of dilatations per stricture and the time interval between different sessions were dependent on the type of strictures, varying from 1 to 23 dilatations and 7 days to 16 years, respectively. Pharyngeal and esophageal dilatations using the Savary-Gilliard technique were safe when used together with fluoroscopy. Overall, the efficiency of the dilatation procedure was good, but some types of strictures (e.g., caustic, post-surgical and/or post radiotherapy) were refractory to treatment and required repeated dilatations.
有症状的咽和食管狭窄的治疗需要内镜下扩张。Savary-Gilliard探条扩张术由我们科室研发，自1980年起用于此目的。我们报告使用该技术的经验。回顾了1963年1月1日至2005年12月31日期间因咽和食管狭窄需要扩张的患者记录。评估了不同病因的患病率以及使用Savary-Gilliard扩张器的并发症发生率。以扩张次数和症状缓解前扩张间隔时间作为结局指标，评估了该时期17年时间段内扩张的有效性。在回顾的2652例咽和食管狭窄中，90%为器质性病因（45%为良性，55%为恶性狭窄），10%为功能性病因。最常见的病因在质子泵抑制剂时代之前是消化性狭窄，之后是术后吻合口狭窄。共分析了1862例使用Savary-Gilliard技术的扩张。良性病因的并发症和死亡率分别为0.18%和0.09%，恶性病因分别为4.58%和0.81%。每个狭窄的扩张次数和不同疗程之间的时间间隔取决于狭窄类型，分别从1次到23次扩张以及7天到16年不等。Savary-Gilliard技术用于咽和食管扩张时，与荧光镜检查联合使用是安全的。总体而言，扩张程序的有效性良好，但某些类型的狭窄（如腐蚀性、术后和/或放疗后）治疗效果不佳，需要反复扩张。
