BougieCap®: significant symptomatic improvement of esophageal strictures achieved by a single bougienage in patients with eosinophilic esophagitis

A cohort study of 50 patients with symptomatic eosinophilic esophagitis treated with a single dilation session using the BougieCap showed 100 % technical success, a drop of median symptom severity from 32 to 0 points, and no severe adverse events.

A. M. Schoepfer et al., Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland, presented a study evaluating technical feasibility, clinical efficacy, and safety of the BougieCap for esophageal stricture dilation in patients with eosinophilic esophagitis (EoE). The BougieCap is a bougienage instrument that allows optical and tactile feedback during endoscopic stricture dilation in the upper gastrointestinal tract.

Fifty EoE-patients (30 % female, median age 41 years) with presence of esophageal strictures (esophageal diameter ≤ 14 mm) and stricture-related symptoms were included. Median disease duration in patients was 4 years, 50 % were being treated with swallowed topical corticosteroids, 10 % with proton pump inhibitors, 14 % with combined swallowed topical corticosteroids plus proton pump inhibitors, 14 % with elimination diet, and 12 % were without anti-eosinophil therapy. Symptoms were assessed before and 2 weeks after BougieCap treatment using the validated Eosinophilic Esophagitis Activity Index Patient Reported Outcomes (EEsAI PRO) questionnaire (score ranges from 0 – 100 points).

Endoscopic bougienage was technically successful in 100 %. All procedures were performed without introduction of a guidewire and without fluoroscopic guidance. Median esophageal diameter increased from 12 mm (IQR 12-13) to 16 mm (IQR 16-16, p < 0.001). Median symptom severity dropped from 32 points (IQR 27-41) to 0 points (IQR 0-10, p < 0.001) at 2 weeks post dilation. In one patient the BougieCap was temporarily lost after stricture dilation in the hypopharynx but could be retrieved. No severe adverse events were reported.

The authors concluded that in adults with EoE, endoscopic treatment of esophageal strictures using the BougieCap is technically feasible, safe and offers significant symptomatic improvement in the short term.

Technical feasibility, clinical effectiveness, and safety of esophageal stricture dilation using a novel endoscopic
attachment cap in adults with eosinophilic esophagitis
Schoepfer AM, Henchoz S, Biedermann L, Schreiner P, Greuter T, Reinhard A, Senn J, Franke A, Burri E, Juillerat P, Simon H-U, Straumann A, Safroneeva E, Godat S
Gastrointestinal Endoscopy (2021), doi: https://doi.org/10.1016/j.gie.2021.05.017.