Department of Gastroenterology & Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Surg Endosc. 2018 Jul;32(7):3200-3207. doi: 10.1007/s00464-018-6037-z. Epub 2018 Jan 18.
Patients with therapy-resistant benign esophageal strictures (TRBES) suffer from chronic dysphagia and generally require repeated endoscopic dilations. For selected patients, esophageal self-dilation may improve patient's autonomy and reduce the number of endoscopic dilations. We evaluated the clinical course and outcomes of patients who started esophageal self-dilation at our institution.
This study was a retrospective case series of patients with TRBES who started esophageal self-dilation between 2012 and 2016 at the Academic Medical Center Amsterdam. To learn self-dilation using Savary-Gilliard bougie dilators, patients visited the outpatient clinic on a weekly basis where they were trained by a dedicated nurse. Endoscopic dilation was continued until patients were able to perform self-bougienage adequately. The primary outcome was the number of endoscopic dilation procedures before and after initiation of self-dilation. Secondary outcomes were technical success, final bougie size, dysphagia scores, and adverse events.
Seventeen patients started with esophageal self-dilation mainly because of therapy-resistant post-surgical (41%) and caustic (35%) strictures. The technical success rate of learning self-bougienage was 94% (16/17). The median number of endoscopic dilation procedures dropped from 17 [interquartile range (IQR) 11-27] procedures during a median period of 9 (IQR 6-36) months to 1.5 (IQR 0-3) procedures after the start of self-dilation (p < 0.001). The median follow-up after initiation of self-dilation was 17.6 (IQR 11.5-33.3) months. The final bougie size achieved with self-bougienage had a median diameter of 14 (IQR 13-15) mm. All patients could tolerate solid foods (Ogilvie dysphagia score ≤ 1), making the clinical success rate 94% (16/17). One patient (6%) developed a single episode of hematemesis related to self-bougienage.
In this small case series, esophageal self-dilation was found to be successful 94% of patients when conducted under strict guidance. All patients performing self-bougienage achieved a stable situation where they could tolerate solid foods without the need for endoscopic dilation.
患有治疗抵抗性良性食管狭窄（TRBES）的患者患有慢性吞咽困难，通常需要反复进行内镜扩张。对于某些患者，食管自我扩张可能会提高患者的自主性并减少内镜扩张的次数。我们评估了在我们机构开始食管自我扩张的患者的临床过程和结局。
这是一项回顾性病例系列研究，纳入了 2012 年至 2016 年期间在阿姆斯特丹学术医学中心接受治疗抵抗性良性食管狭窄的患者。为了使用 Savary-Gilliard 探条扩张器进行自我扩张，患者每周到门诊就诊，在那里他们接受专门护士的培训。继续进行内镜扩张，直到患者能够充分进行自我探条扩张。主要结局是开始自我扩张前后内镜扩张的次数。次要结局是技术成功率、最终探条尺寸、吞咽困难评分和不良事件。
17 名患者开始进行食管自我扩张，主要是因为治疗抵抗性手术后（41%）和腐蚀性（35%）狭窄。学习自我探条扩张的技术成功率为 94%（16/17）。中位内镜扩张次数从 9 个月（IQR 6-36）期间的 17 次（IQR 11-27）降至自我扩张开始后的 1.5 次（IQR 0-3）（p<0.001）。开始自我扩张后的中位随访时间为 17.6 个月（IQR 11.5-33.3）。自我探条扩张达到的最终探条尺寸的中位数直径为 14mm（IQR 13-15）。所有患者均能耐受固体食物（Ogilvie 吞咽困难评分≤1），临床成功率为 94%（16/17）。1 名患者（6%）发生与自我探条扩张相关的单次呕血事件。
在这项小型病例系列研究中，当在严格指导下进行时，食管自我扩张被发现对 94%的患者有效。所有进行自我探条扩张的患者均达到了稳定的状态，能够耐受固体食物，无需内镜扩张。
