A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures

Marjan L. Hordijk, Jeanin E. van Hooft, Bettina E. Hansen, Paul Fockens, Ernst J. Kuipers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Benign gastroesophageal anastomotic strictures are common and often refractory to treatment. Various endoscopic dilation techniques have been reported, but none of these methods has been proven to be superior. Objective: Comparison of the efficacy and safety of dilation of previously untreated anastomotic strictures by using electrocautery incision (EI) and Savary bougienage (SB). Design: Randomized, prospective study Setting: Multicenter study Patients: Sixty-two patients with an anastomotic stricture after esophagogastrostomy and dysphagia Atkinson grades II to IV were included. Interventions: Patients were treated with El or SB. Main Outcome Measurements: Objective and subjective results were compared with baseline and 1, 3, and 6 months after the first treatment. Complications of both treatments were noted. Primary endpoints after 6 months were the mean number of dilation sessions and success rate (percentage of patients with <= 5 dilations in 6 months). Study participation ended after 6 months or if dysphagia grades 11 to IV recurred despite 5 treatment sessions. Results: No complications occurred with both treatments, There was no significant difference between the El and SB groups in the mean number of dilations (2.9; 95% Cl, 2.7-4.1 vs 3.3; 95% Cl, 2.3-3.61; P = .46) or the success rate (80.6% vs 67.7%, P = .26 and 96.2% vs 80.8%, P = .19). Limitations: In a small study with negative primary endpoints, secondary endpoints and subgroup analyses are hypothesis generating only Conclusions: This prospective trial demonstrated that El of gastroesophageal anastomotic strictures is a safe therapy and equivalent to SB as a primary therapy. El can be used as an alternative or additional therapy to SB. (Registered with Current Controlled Trials, Ltd, registration number ISRCTN81239664.) (Gastrointest Endosc 2009;70:849-55.)
Original languageEnglish
Pages (from-to)849-855
JournalGastrointestinal endoscopy
Volume70
Issue number5
DOIs
Publication statusPublished - 2009

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