A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures
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.)
Abbreviations: EI, electrocautery incision, RR, relative rate, SB, Savary bougienage
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
© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
Refers to article:
- CME Activity: Continuing Medical Education Exam: November 2009

