Small Balloon Dilation Versus Bougie Dilation Versus Large Balloon Dilation for the Treatment of Benign Esophageal Strictures in Adult Patients.

Rationale and objectives: The optimal treatment for benign esophageal strictures (BES) is still unknown, small balloon dilation (6-24mm in diameter) and bougie dilator dilation (5-17mm in diameter) are usually used clinically, while large balloon dilation (25-30mm in diameter) is rarely used due to the potential risk of esophageal rupture and massive bleeding. According to the different choices of treatment, we grouped the patients into three groups and compared their safety and effectiveness to explore the optimal treatment of BES.

Materials and methods: Between July 2016 and March 2024, 104 consecutive patients with BES who underwent dilation of small balloon (Group S, n=30), bougie dilator (Group B, n=38) or large balloon (Group L, n=36) were retrospectively evaluated. Data were collected to analyze the technical success, safety and clinical outcome of the dilations as evaluated by dysphagia score, complications and recurrence.

Results: Technically success rates of Group S, Group B and Group L were 97.0%, 96.7% and 89.9%, respectively (P=0.0507). Recurrence of stricture and esophageal rupture were the reasons for technical failures in balloon and bougie dilation. Esophageal ruptures occurred in 11 dilations as follows: 4 (3.0%) in the Group S, 2 (1.7%) in the Group B and 5 (7.2%) in the Group L (P=0.1184). Among them, two patients with type III rupture had temporary removable esophageal stent placed, and rupture healed after stents removal. Two patients with type II rupture had the rupture clamped with titanium clips. A total of 55/104 patients (52.9%) were cured with no dysphagia after the end of follow-up as follows: 12 (40.0%) in the Group S, 18 (47.4%) in the Group B and 25 (69.4%) in the Group L (P=0.0385). Less No. of dilation sessions and shorter duration of treatment were required in the Group L than in the Group S or the Group B (P<0.05). Total hospitalization cost was higher in the Group S than in the Group B or the Group L (P<0.05).

Conclusion: Both balloon dilation and bougie dilation are safe and effective for patients with benign esophageal strictures. Large balloon dilation seems to be preferable to small balloon dilation and bougie dilation regardless of the condition of adult BES, as they are associated with higher clinical effectiveness, less required dilation, and reduced duration of treatment.