Self-dilation for therapy-resistant benign esophageal strictures: towards a systematic approach

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Innovation

Background:

• Therapy-resistant benign esophageal strictures (TRBES) cause chronic dysphagia, necessitating frequent endoscopic dilations.
• Esophageal self-dilation offers a potential solution for selected patients, enhancing autonomy and reducing healthcare burden.

Purpose of the Study:

• To evaluate the clinical outcomes and efficacy of esophageal self-dilation in patients with TRBES.
• To assess the impact of self-dilation on the frequency of endoscopic procedures and patient-reported dysphagia.

Main Methods:

• Retrospective case series of 17 patients with TRBES undergoing esophageal self-dilation training between 2012-2016.
• Patients were trained weekly by a dedicated nurse using Savary-Gilliard bougie dilators.
• Primary outcome: number of endoscopic dilations before and after self-dilation initiation; secondary outcomes: technical success, final bougie size, dysphagia scores, adverse events.

Main Results:

• Technical success rate for learning self-bougienage was 94% (16/17).
• Median endoscopic dilations decreased from 17 to 1.5 per patient after initiating self-dilation (p < 0.001).
• 94% of patients achieved clinical success, tolerating solid foods (Ogilvie dysphagia score ≤ 1) with a median final bougie size of 14 mm.

Conclusions:

• Esophageal self-dilation, when performed under strict guidance, is a highly successful (94%) intervention for TRBES.
• This technique enables patients to achieve a stable condition, tolerating solid foods without further endoscopic dilations.
• Self-dilation improves patient autonomy and significantly reduces the requirement for repeated endoscopic procedures.