UK guidelines on oesophageal dilatation in clinical practice

Abstract

These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques—including stents—will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop­ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.

Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx - flexible endoscopic management using a novel technique: A case report and review of literature

“…The dilatation and electroincision of GI strictures can potentially result in several complications, such as perforation, bleeding, pulmonary aspiration and pain. The standard measures used to prevent these complications have been elaborately discussed elsewhere[ 6 ] and were followed in this study. Besides the aforesaid complications, there is an additional concern while addressing hypopharyngeal strictures with the technique described above.…”

Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects

“…To reduce this risk, high-risk patients may benefit from post-procedure steroid injection or oral corticosteroid therapy. 68,69 Ablative therapies, especially RFA, can also pose risks to the development of strictures. After EMR, ESD and ablative treatment, patients should receive high-dose proton pump therapy to mitigate stricture formation, following evidence of its use in reflux esophagitis.…”

How to Approach a Patient With Refractory or Recurrent Benign Esophageal Stricture

“…A target bougie size of 14 mm is aimed for because this allows patients to eat solid foods. 15 Complications are rare when patients follow a well-structured training program. Strictures that ideally qualify for this technique are simple and proximally located strictures.…”