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

Received 14 November 2008; accepted 19 February 2009. published online 02 July 2009.

Refers to article:

CME Activity: Continuing Medical Education Exam: November 2009
Raquel E. Davila, Jeffrey H. Lee, William Ross, Shou-Jiang Tang, G.S. Raju, George Triadafilopoulos
Gastrointestinal Endoscopy
November 2009 (Vol. 70, Issue 5, Pages 976-976.e6)
Full-Text PDF (4806 KB)

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 EI 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 II to IV recurred despite 5 treatment sessions.

Results

No complications occurred with both treatments. There was no significant difference between the EI and SB groups in the mean number of dilations (2.9; 95% CI, 2.7-4.1 vs 3.3; 95% CI, 2.3-3.6l; 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 EI of gastroesophageal anastomotic strictures is a safe therapy and equivalent to SB as a primary therapy. EI can be used as an alternative or additional therapy to SB. (Registered with Current Controlled Trials, Ltd, registration number ISRCTN81239664.)

Rotterdam, Amsterdam, The Netherlands

Abbreviations: EI, electrocautery incision, RR, relative rate, SB, Savary bougienage

Current affiliations: Departments of Gastroenterology and Hepatology (M.L.H., B.E.H., E.J.K.), Internal Medicine (E.J.K.), and Biostatics (B.E.H.), Erasmus MC, University Medical Center, Rotterdam, Departments of Gastroenterology and Hepatology (J.E.H., P.F.), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands

Reprint requests: Marjan L. Hordijk, MD, Erasmus MC, University Medical Center, Rotterdam, c/o Kastanjelaan 71-B, 2665 GA Bleiswijk, The Netherlands.

DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

See CME section; p. 976.

Presented at Digestive Disease Week, May 19, 2008, San Diego, California (Gastrointest Endosc 2008;67:AB90).

If you would like to chat with an author of this article, you may contact him at vanveenhordijk@planet.nl.

PII: S0016-5107(09)00422-2

doi:10.1016/j.gie.2009.02.023

13 of 56