Does Increasing Size of Bougienage Improve Response to Esophageal Dilation?

Purpose of Review: Because dysphagia occurs when the esophageal luminal diameter is < 13 mm, the traditional goal of dilation is set at 14–16 mm (42–48 Fr) to relieve symptoms. This study was designed to determine whether increasing the size of dilators further would improve durability of response to bougienage. Recent Findings: Patients with severe or non-severe esophageal stricture and dysphagia were randomized to two different sizes of dilators. Diet and Dysphagia scores were calculated before and after index dilation, then every 4–8 weeks by phone for 12 months. Of 35 patients (mean age 63.1 yrs, 37.1% male) in the study, 11 had severe post-radiation strictures randomized to 42 Fr (n = 5) vs. 51 Fr (n = 6) Savary, 24 had non-severe strictures randomized to 46 Fr (n = 11) vs. 60 Fr (n = 13) Maloney. For severe strictures, number of dilations was nonsignificantly less with the larger 51 Fr versus 42 Fr (4.0 ± 1.73 vs. 5.2 ± 2.17, p = 1.00), and duration between dilations was longer (167 ± 154 vs. 64 ± 25 days, p = 0.41). For non-severe strictures, the smaller size 46 Fr dilator versus 60 Fr was associated with nonsignificantly fewer dilations (1.74 ± 0.81 vs. 1.77 ± 0.83, p = 0.70) and longer duration between sessions (265 ± 123 vs. 239 ± 103 days, p = 0.63). Summary: Bougienage with dilators larger than 14–16 mm (42–48 Fr) does not improve durability of symptomatic relief, either by decreasing the total number of dilations required or by increasing the symptom-free duration of response between sessions.