Endoscopic bougienage of benign esophageal strictures using a Bougie Cap

Abstract

Relevance: Esophageal stricture is a narrowing of the lumen of the esophageal tube caused by the proliferation of connective tissue in its wall. This condition can develop against the background of esophagitis, peptic ulcers, chemical burns of the esophagus, and iatrogenic causes. Cicatricial changes of the esophagus occupy the second place among diseases of this organ after esophagitis and are formed in 70-80% of patients with post-burn strictures.

The study aimed to analyze the results of endoscopic treatment of benign esophageal stenosis using distal Bougie Cap caps and evaluate the effectiveness of this new device in the short term of use for treatment purposes.

Methods: The authors have retrospectively analyzed the first results of using Bougie Cap distal caps in the endoscopic treatment of benign esophageal stenosis in Kazakhstan. From 2022 to 2023, 81 bougie sessions with steel caps were performed in 55 patients with esophageal stenosis in the endoscopic department of the National Research Oncology Center (Astana, Kazakhstan).

Results: The main causes of esophageal stenosis were chemical burns (60% of patients), stenosis after radiation therapy (25.4%), and strictures of esophageal anastomosis (14.6%). The stenoses were short, up to 3.0 cm, in 37 patients (67.2%), extended – in 15 patients (27.2%), subtotal – in 2 patients (3.6%), and only one patient (1.8%) had a stenosis of 17 cm. The bougienage outcome was good in all patients with short stenoses, satisfactory – in patients with stenoses up to 9 cm, and unsatisfactory – in patients with subtotal and total stenoses. The number of sessions was 3 to 11. Three patients with total and subtotal stenosis were denied a bougienage due to a tortuous stenosis with a high risk of perforation, and a percutaneous gastrostomy was installed.

Conclusion: Endoscopic bougienage with distal caps of the Bougie Cap is a safe method of bougienage of benign esophageal strictures since the cap is transparent, and an endoscopist visually supervises the bougienage. During the three years of using distal caps to dilate esophageal stenosis, not a single case of perforation was registered in our department. Therefore, we recommend this method as the safest and most predictable method of bougienage, both in outpatient practice and in the hospitals in the republic.