Shine Amal, Eisa Mohamed, Omer Endashaw, Heckroth Matthew, Eiswerth Michael, Rogers Benjamin, Tennant Paul, Nguyen Vincent, Maung Aye Aye, Kong Maiying, McClave Stephen A
University of New Mexico School of Medicine, Albuquerque, NM, USA.
SUNY Upstate Medical University, Syracuse, NM, USA.
Curr Gastroenterol Rep. 2025 Jun 11;27(1):39. doi: 10.1007/s11894-025-00982-8.
Because dysphagia occurs when the esophageal luminal diameter is < 13 mm, the traditional goal of dilation is set at 14-16 mm (42-48 Fr) to relieve symptoms. This study was designed to determine whether increasing the size of dilators further would improve durability of response to bougienage.
Patients with severe or non-severe esophageal stricture and dysphagia were randomized to two different sizes of dilators. Diet and Dysphagia scores were calculated before and after index dilation, then every 4-8 weeks by phone for 12 months. Of 35 patients (mean age 63.1 yrs, 37.1% male) in the study, 11 had severe post-radiation strictures randomized to 42 Fr (n = 5) vs. 51 Fr (n = 6) Savary, 24 had non-severe strictures randomized to 46 Fr (n = 11) vs. 60 Fr (n = 13) Maloney. For severe strictures, number of dilations was nonsignificantly less with the larger 51 Fr versus 42 Fr (4.0 ± 1.73 vs. 5.2 ± 2.17, p = 1.00), and duration between dilations was longer (167 ± 154 vs. 64 ± 25 days, p = 0.41). For non-severe strictures, the smaller size 46 Fr dilator versus 60 Fr was associated with nonsignificantly fewer dilations (1.74 ± 0.81 vs. 1.77 ± 0.83, p = 0.70) and longer duration between sessions (265 ± 123 vs. 239 ± 103 days, p = 0.63). Bougienage with dilators larger than 14-16 mm (42-48 Fr) does not improve durability of symptomatic relief, either by decreasing the total number of dilations required or by increasing the symptom-free duration of response between sessions.
由于当食管腔直径<13mm时会发生吞咽困难，传统的扩张目标设定为14 - 16mm（42 - 48F）以缓解症状。本研究旨在确定进一步增大扩张器尺寸是否会提高探条扩张术的反应持久性。
患有严重或非严重食管狭窄及吞咽困难的患者被随机分配至两种不同尺寸的扩张器组。在首次扩张前后计算饮食和吞咽困难评分，然后在12个月内每4 - 8周通过电话随访。在该研究的35例患者（平均年龄63.1岁，男性占37.1%）中，11例有严重放疗后狭窄，随机分为42F（n = 5）与51F（n = 6）的沙氏扩张器组；24例有非严重狭窄，随机分为46F（n = 11）与60F（n = 13）的马洛尼扩张器组。对于严重狭窄，使用较大的51F扩张器与42F扩张器相比，扩张次数无显著减少（4.0±1.73次 vs. 5.2±2.17次，p = 1.00），且两次扩张之间的间隔时间更长（167±154天 vs. 64±25天，p = 0.41）。对于非严重狭窄，较小尺寸的46F扩张器与60F扩张器相比，扩张次数无显著减少（1.74±0.81次 vs. 1.77±0.83次，p = 0.70），且两次扩张之间的间隔时间更长（265±123天 vs. 239±103天，p = 0.63）。使用大于14 - 16mm（42 - 4Eight）的扩张器进行探条扩张术，无论是通过减少所需的扩张总数还是通过增加两次扩张之间的无症状反应持续时间，都不会提高症状缓解的持久性。
