FOUR YEAR RESULTS OF CONSERVATIVE TREATMENT OF BENIGN STRICTURES OF THE ESOPHAGUS WITH SVARY GILLIARD TECHNIQUE OF BOUGIENAGE: CROSS-SECTIONAL STUDY REPRESENTING FIRST EXPERIENCES IN REPUBLIC OF MACEDONIA

Abstract

Background: Benign esophageal strictures are complications that result from various causes. They can be structurally categorized in two groups: simple and complex. Treatment is similar in most of cases that require dilatation and means use of three general types of dilators that are currently in use. However, despite the last guidelines on esophageal dilatation, the therapeutic response, optimal timing of treatment and interval between sessions can vary and there is no strong consensus in the literature regarding this fact. Aims: To analyze, the first 4 year experience of Digestive Endoscopy Unit of the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia, in treating benign esophageal strictures, since the Savary-Gilliard technique of “bougienage” was introduced for the first time in Republic of Macedonia, at our Institution in December 2013, by assessing etiology, length of stricture, number of dilations required to achieve satisfactory therapeutic response, as well as the relationship between the type, extent of stenosis and therapeutic response. Methods: One hundred and forty five dilations, during a period from 20-th December 2013, until March 2017 were analyzed in 31 patients. Results: The caustic strictures were the most prevalent, occurring in 15 (48%) of patients, followed by peptic stenosis presenting 26% of patients. The long and corrosive strictures needed more sessions to the absence of dysphagia. Peptic and short stenoses best answered on treatment and need fewer dilatation sessions per patient. Conclusion: caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long one. Peptic stenosis is the second one cause of benign esophageal strictures and responded well to endoscopic therapy. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage using Savary-Gilliard or American type of technique, irrespective of type and extent of esophageal stenosis is safe and grateful procedure.