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DOI: 10.1055/a-2081-9329
Three different strategies to overcome dilation failures of the bougie cap for upper gastrointestinal refractory strictures
Benign strictures of the upper gastrointestinal tract usually require endoscopic dilation either with balloons or bougies ([Fig. 1]) as the first-line treatment. Both techniques are equivalent in terms of efficacy and safety [1], but the use of bougies has a lesser environmental impact [2]. Compared to the reusable bougies, the BougieCap (Ovesco, Tübingen, Germany) allows for visual control during dilation [3] and has proven its effectiveness and safety in patients with eosinophilic esophagitis [4] with a low weight of disposable waste.
We report first a case of a second dilation attempt in a 60-year-old man with a pharyngeal stenosis following submucosal dissection for squamous cell carcinoma. Dilation with a 12-mm BougieCap and guidewire pushed through the cap was impossible. We dilated with a 12-mm balloon and thereafter passed a 13.5-mm BougieCap ([Video 1]).
Video 1 Three failures of bougie cap dilation: salvage strategies to achieve dilation.
Qualität:
We next report a case of two esophageal refractory strictures following a caustic ingestion. We succeeded in dilating the first stenosis, which was short at 10 cm from the dental arches, with a 14-mm BougieCap, but the second stricture was longer at 30 cm and could not be crossed with the 14-mm BougieCap. We dilated with a 13-mm Savary-Gilliard bougie and then we used a 14-mm BougieCap again to pass the stricture.
The last case was a refractory post-endoscopic submucosal dissection (ESD) stricture treated by dilation 3 months ago with a 15-mm dilation balloon. We first tried to pass the 15-mm bougie cap but were unsuccessful. We failed again with the 13/14-mm bougie cap device, but the 12-mm cap passed through the stricture and allowed successful consecutive dilation with the 13/14 and the 15/16 mm.
For certain strictures, the use of the BougieCap seems compromised and alternative strategies should be available to dilate the stricture when the bougie cap fails.
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Publikationsverlauf
Artikel online veröffentlicht:
15. Mai 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Josino IR, Madruga-Neto AC, Ribeiro IB. et al. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. Gastroenterol Res Pract 2018; 2018: 5874870
- 2 Yzet C, Figueiredo M, Michoud C. et al. Ecological impact of endoscopic dilatation using the bougie cap device: a low-tech innovation to reduce waste by 99. Endoscopy 2022; 54: E824-E825
- 3 Lafeuille P, Yzet C, Bonniaud P. et al. Use of a bougie-shaped cap for dilation with direct visual control for an esophageal stricture induced by radiation therapy. Endoscopy 2023; 55: E18-E19
- 4 Schoepfer AM, Henchoz S, Biedermann L. et al. Technical feasibility, clinical effectiveness, and safety of esophageal stricture dilation using a novel endoscopic attachment cap in adults with eosinophilic esophagitis. Gastrointest Endosc 2021; 94: 912-919.e2