Does Increasing Size of Bougienage Improve Response to Esophageal Dilation?

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.