Outcome of Bougienage Dilatation in Complex Corrosive Esophageal Strictures

Pakkavuth Chanswangphuvana, MD, Soravith Vijitpornkul, MD, Ajjana Techagumpuch, MD, Suppa-ut Pungpapong, MD, Suthep Udomsawaengsup, MD, Patpong Navicharern, MD, Chadin Tharavej, MD. Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Background :
Less was known regarding the effectiveness of bougienage dilatation in complex corrosive esophageal strictures.

Objective :
To determine the effectiveness and factors predicting outcome of bougienage dilation in complex corrosive esophageal strictures.

Methods :
We reviewed the medical records of all patients who developed corrosive esophageal stricture (2007-2012)

Results :
There were 34 patients diagnosed corrosive esophageal stricture. All patients enrolled to have bougienage dilatation with Savary Gillard dilators. Because of previous corrosive related operations (total gastrectomy), history of postdilatation esophageal perforation and complete esophageal luminal strictures, 16 patients underwent esophageal replacement procedures. 18 patients continued dilatation with conversion to esophageal replacement procedure in 10 patients. Perforation occured in 3 sessions (4.2%) from 72 sessions. We found that conversion groups had more numbers of pharyngeal involvement, high level of stricture, long length of stricture (> 10 cm), more frequency of dilatation (> 6 times per year) and more sessions of stricture tightness (p = 0.043, p < 0.01, p < 0.01, p < 0.01 and p = 0.046 respectively). We reported failure of dilatation in 76.5% and successful dilatation in 27.8% at a mean follow-up 19.4 months.

Conclusion :
Corrosive esophageal strictures with suicidal intent are usually complex. Bougienage dilatation is only moderately effective in terms of relieving dysphagia symptom. Pharyngeal involvement, high level of stricture, length of stricture (> 10 cm), frequency of dilatation (> 6 times per year) and stricture tightness are associated with high dilatation failure.

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