Stenozele esofagiene benigne dilatarea cu bujii
Dilatarea cu bujii este utilizate in cazul stenozelor esofagiene
benignePot fi utilizate : bujii incarcate cu mercur Maloney sau
Hurst acestea sunt indicate in stenoze necomplicate, cu diametrul
mai mare de 10-12mm; au costuri relativ scazute si sunt usor de
realizat fara ghidare fluoroscopica; nu este necesara sedare sau
sedare minima; pot fi realizate si de catre pacient acasa. bujii
din polivinil ghidate prin fir Savary-Gilliard sunt relativ rigide
si indicate pentru stricturi lungi, stramte si neregulate; necesita
fluoroscopiei; acestea pot fi reutilizate; dezavatajul poate fi
reprezentat de lezarea traumatica a peretelui laringian si
disconfortul pacientului. Complicatiile ascotiate cu dilatarea
esofagiana sunt perforatia, hemoragia, infectia bacteriana,
odinofagia. Rata raportata de perforatie si hemoragie masiva este
de 0,3%, riscul fiind mai mare in in stenozele complicate si in
stenozele postcaustice. Se considera ca riscul de perforatie este
minim daca se aplica regula lui 3, adica diametrele de dilatare nu
depasesc 3mm la fiecare sedinta.
In cazul stenozelor esofagiene simple, sunt necesare intre 1-3
sedinte de dilatare pentru a ameliora simptomatologia, cu un
procent de 25-35% din pacienti necesitand repetarea
dilatarii.Stenozele esofagiene complicate, lungi (peste 2cm) sunt
mai dificil de tratat si au o rata de recurenta crescuta. Daca nu
pot fi dilatate la un diametru adecvat, care sa permita pasajul
alimentelor solide, reapar la un interval de 2-4 saptamani sau
necesita mai mult de 7-10 sedinte de dilatare, sunt considerate a
fi stenoze refractare si necesita introducerea unui stent sau
tratament chirurgical.
A prospective, randomized study with 17 patients in each arm
comparing balloon dilators with Savary dilators was performed by
Saeed et al over a 2-year period, with the end point being 45F.[15]
Stricture recurrence was similar in the first year but lower in the
second year for balloons. Fewer sessions were needed for balloons,
1.1 sessions +/- 0.1 versus 1.7 sessions +/- 0.2, and less
procedural discomfort occurred (P< 0.05). Both devices were
effective in relieving dysphagia.
Benign strictures of theesophagus: endoscopic approach with
Savary-Gilliardbougies[Article in Portuguese]Novais P,Lemme E,Equi
C,Medeiros C,Lopes C,Vargas C.SourceServio de Gastroenterologia,
HUCFF, UFRJ, RJ. [email protected]:Benign
esophageal strictures are complications that result from different
causes. They are usually similarly approached, most of the cases
needing endoscopic dilation. However the response to therapy,
optimal timing for treatment and interval between sessions can
vary.AIM:The authors evaluate 14 years of experience with benign
stricture of theesophagusfrom the endoscopic point of view in the
'Clementino Fraga Filho' University Hospital, Federal University of
Rio de Janeiro, RJ, Brazil. They evaluated etiology, length of
stricture, number of dilations needed to reach satisfactory
therapeutic response, and the relation between length of stricture
and therapeutic response.METHODS:We analyzed 2,568 endoscopic
dilations using Savary-Gilliard dilators in 236 patients. The
follow up period was 14 years and 10 months, until June of
2007.RESULTS:Peptic strictures were the more frequent, followed by
caustic strictures. Long strictures and caustic strictures needed
more sessions to abolish dysphagia. Peptic strictures and short
ones had better response to a smaller number of
sessions.CONCLUSION:In this study, peptic strictures were the
commonest etiology and responded best to endoscopic therapy, in
accordance with published literature. Caustic strictures were the
most refractory, mainly the long segments. The longer the extension
of stenosis, the greater was the number dilation sessions needed
for relief. Short strictures had a good prognosis in the great
majority of cases. The number of dilations depended directly on the
etiology and the extension of the stricture.
Long-term recurrence rates following dilation of symptomatic
Schatzki rings.Mller M,Gockel I,Knig J,Kuhr K,Eckardt
VF.SourceDepartment of Gastroenterology, Deutsche Klinik fr
Diagnostik, Aukammallee 33, 65191, Wiesbaden, Germany.
[email protected] AND AIMS:This
study investigated the long-term clinical course of patients with
Schatzki rings, who were treated by single bougie dilation.
Furthermore, it analyzed possible predictors for the time of
recurrence.PATIENTS AND METHODS:A total of 133 patients (100 males,
33 females) with a mean age of 57 14.6 years who were treated by
single dilation with the use of Maloneybougieswithout the aid of
fluoroscopy were prospectively registered and followed-up for a
mean duration of 58.3 months (range 12-240 months). Duration of
remission was evaluated by Kaplan-Meier estimates with regard to
recurrence. Log-rank test was performed to analyze possible
predictors for the time to second dilation (recurrence).RESULTS:No
complications occurred and all patients were symptom-free at the
first follow-up examination 4 weeks after dilation. However, later
on, 73 patients required a second dilation. The estimate remission
rates were 63.8% (95% CI: 55.6-72.0%) after 2 years, 44.3% (95% CI:
35.4-53.4%) after 5 years, and 39.9% (95% CI: 30.5-49.3%) after 10
years. Neither the initial morphological findings, nor age or
gender determined the need for repeated dilation. Only patients
treated with a large bougie diameter (52 F) seemed to have a
tendency for a longer time until symptomatic
recurrence.CONCLUSIONS:Single dilation of symptomatic Schatzki
rings is a safe and effective therapy. However, more than half of
the patients will need a second treatment. Recurrences are
unrelated to initial morphological findings, age, or gender. Only
the treatment with a large bougie diameter (52 F) showed a tendency
for a longer time of remission.
Bibliografie:1. Treatment Options for Esophageal Strictures:
Benign Esophageal Strictures -
http://www.medscape.org/viewarticle/569462_32. Esophageal Stricture
Treatment & Management -
http://emedicine.medscape.com/article/175098-treatment#a11283.
Benign strictures of the esophagus: endoscopic approch with Savary
Gilliard bougies - http://www.ncbi.nlm.nih.gov/pubmed/191483564.
Long-term recurrence rates following dilation of symptomatic
Schatzki rings - http://www.ncbi.nlm.nih.gov/pubmed/209766235.
Endoscopic dilation of benignesophagealstrictures without
fluoroscopy: experience of 2750 procedures -
http://www.ncbi.nlm.nih.gov/pubmed/18795685
