Liu Ping, Guo Changqing, Wu Gang, Ren Jianzhuang, Han Xinwei, Bi Yonghua
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China (P.L., C.G.).
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou 450052, China (G.W., J.R., X.H., Y.B.).
Acad Radiol. 2025 Aug;32(8):4573-4582. doi: 10.1016/j.acra.2025.03.055. Epub 2025 Apr 15.
The optimal treatment for benign esophageal strictures (BES) is still unknown, small balloon dilation (6-24mm in diameter) and bougie dilator dilation (5-17mm in diameter) are usually used clinically, while large balloon dilation (25-30mm in diameter) is rarely used due to the potential risk of esophageal rupture and massive bleeding. According to the different choices of treatment, we grouped the patients into three groups and compared their safety and effectiveness to explore the optimal treatment of BES.
Between July 2016 and March 2024, 104 consecutive patients with BES who underwent dilation of small balloon (Group S, n=30), bougie dilator (Group B, n=38) or large balloon (Group L, n=36) were retrospectively evaluated. Data were collected to analyze the technical success, safety and clinical outcome of the dilations as evaluated by dysphagia score, complications and recurrence.
Technically success rates of Group S, Group B and Group L were 97.0%, 96.7% and 89.9%, respectively (P=0.0507). Recurrence of stricture and esophageal rupture were the reasons for technical failures in balloon and bougie dilation. Esophageal ruptures occurred in 11 dilations as follows: 4 (3.0%) in the Group S, 2 (1.7%) in the Group B and 5 (7.2%) in the Group L (P=0.1184). Among them, two patients with type III rupture had temporary removable esophageal stent placed, and rupture healed after stents removal. Two patients with type II rupture had the rupture clamped with titanium clips. A total of 55/104 patients (52.9%) were cured with no dysphagia after the end of follow-up as follows: 12 (40.0%) in the Group S, 18 (47.4%) in the Group B and 25 (69.4%) in the Group L (P=0.0385). Less No. of dilation sessions and shorter duration of treatment were required in the Group L than in the Group S or the Group B (P<0.05). Total hospitalization cost was higher in the Group S than in the Group B or the Group L (P<0.05).
Both balloon dilation and bougie dilation are safe and effective for patients with benign esophageal strictures. Large balloon dilation seems to be preferable to small balloon dilation and bougie dilation regardless of the condition of adult BES, as they are associated with higher clinical effectiveness, less required dilation, and reduced duration of treatment.
良性食管狭窄（BES）的最佳治疗方法仍不明确，临床通常使用小气囊扩张（直径6 - 24mm）和探条扩张器扩张（直径5 - 17mm），而大球囊扩张（直径25 - 30mm）由于存在食管破裂和大出血的潜在风险而很少使用。根据治疗选择的不同，我们将患者分为三组，比较其安全性和有效性，以探索BES的最佳治疗方法。
回顾性评估2016年7月至2024年3月期间连续104例接受小气囊扩张（S组，n = 30）、探条扩张器扩张（B组，n = 38）或大气囊扩张（L组，n = 36）的BES患者。收集数据以分析扩张的技术成功率、安全性和临床结局，通过吞咽困难评分、并发症和复发情况进行评估。
S组、B组和L组的技术成功率分别为97.0%、96.7%和89.9%（P = 0.0507）。狭窄复发和食管破裂是气囊扩张和探条扩张技术失败的原因。11次扩张发生了食管破裂，情况如下：S组4例（3.0%），B组2例（1.7%），L组5例（7.2%）（P = 0.1184）。其中，2例III型破裂患者放置了临时可移除的食管支架，支架取出后破裂愈合。2例II型破裂患者用钛夹夹住破裂处。104例患者中有55例（52.9%）在随访结束后治愈且无吞咽困难，情况如下：S组12例（40.0%），B组18例（47.4%），L组25例（69.4%）（P = 0.0385）。L组所需的扩张次数和治疗时间比S组或B组少（P < 0.05）。S组的总住院费用高于B组或L组（P < 0.05）。
气囊扩张和探条扩张对良性食管狭窄患者均安全有效。无论成人BES的病情如何，大气囊扩张似乎比小气囊扩张和探条扩张更可取，因为其临床疗效更高，所需扩张次数更少，治疗时间缩短。
