Self-bougienage: long-term relief of corrosive esophageal strictures.
BACKGROUND
Corrosive esophageal strictures require dilatation at frequent intervals.


OBJECTIVE
To determine the efficacy of self-dilatation in treatment of corrosive esophageal strictures.


METHODS
Retrospective analysis of data from 51 patients with corrosive esophageal strictures seen in a surgical unit. Eighteen patients underwent per-oral antegrade dilatation of stricture using gum elastic bougies (Group I); 15 patients underwent retrograde dilatation with endless string using an India rubber dilator devised at the authors' institution, followed by per-oral antegrade dilatation (Group II); 15 patients underwent retrograde dilatation followed by antegrade dilatation with endless string through esophagostomy (Group III). In three patients with stricture of the entire esophagus, endless string could not be passed; they were subjected to esophagocoloplasty. All patients were taught self-dilatation with gum elastic bougies as the final step, and were put on a progressive, domiciliary, self-dilatation program. Quarterly follow up was done for one year, to ascertain whether self-bougienage was being performed properly.


RESULTS
All patients responded well to treatment, with significant relief of dysphagia and improvement in health and barium study findings. Six patients developed mediastinitis (3, 2 and 1 in Groups I, II and III, respectively) during initial dilatation; all improved with conservative management. Only one patient who failed to carry out self-bougienage had to be readmitted and retrained in the procedure, after which he remained asymptomatic.


CONCLUSIONS
Patients with corrosive esophageal strictures can be treated with a long-term self-bougienage program, which avoids the need for frequent hospital admissions for esophageal dilatation.
Bapat
R D
RD
Department of General Surgery, Seth G S Medical College and KEM Hospital, Mumbai.
Bakhshi
G D
GD
Kantharia
C V
CV
Shirodkar
S S
SS
Iyer
A P
AP
Ranka
S
S
D000293:Adolescent; D000328:Adult; D002057:Burns, Chemical / Q000150:complications; D004106:Dilatation / Q000379:methods*; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000628:therapy*; D004946:Esophagostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012648:Self Care; D016896:Treatment Outcome