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Visually controlled dilatation with the BougieCap is effective and prevents complications due to overdilatation

Multicenter study shows high technical success rate and significant improvement of dysphagia symptoms.

B Walter et al. presented a multicenter study (Ulm, Southampton and Essen) evaluating dilatation of benign esophageal stenoses with the BougieCap. The BougieCap allows, in contrast to Savary bougies, direct visual control of the process without the need for x-ray.

50 patients (25 f, 25 m, median age 67.1 ± 16.8) with benign stenosis of the esophagus and clinically apparent symptoms of dysphagia were included. Cause of the stenosis was peptic (n=23), radiation (n=13), anastomotic (n=6), caustic ingestion (n=4), Post-ESD (n=2), EoE (n=1) and unknown (n=1). Dilatation was successful in 96 % of all cases (48/50). In eight cases a pediatric gastroscope with guidewire was used. In two cases a standard gastroscope with guidewire was used. In the two cases, passage of the stenosis was not possible, no attempt with guidewire had taken place. BougieCap (median 2.3 ± 0.7) of different sizes were used per session. Dysphagia symptoms were reduced from a median DS value of 3.0 ± 0.6 before dilatation to 1.6 ± 0.7 after dilatation (Mann-Whitney, p < 0.0001). No major complications occured. In two cases, a BougieCap was lost in the stomach; no clinical discomfort of complications resulted.

The authors stated that endoscopic treatment of benign esophageal stenoses with the BougieCap allows direct visual control of the dilatation process and of beginning mucosal lacerations. Thus, in contrast to the conventional blind method, overdilatation and re-traumatization are reduced and the dilatation process can be performed with better adaptation to the stenosis. Usage of a guidewire is reasonable and necessary in special cases (i.e. very high-grade stenosis, usage of a pediatric gastroscope).

The BougieCap: a new method for endoscopic treatment of esophageal strictures*
Walter B, Schmidbaur S, Rahman I, Schumacher B, Albers D, Meining A

*UEG Week, Vienna, Austria, October 20-24, 2018