PROSPECTIVE RANDOMIZED COMPARISON OF POLYVINYL BOUGIES AND THROUGH-THE-SCOPE BALLOONS FOR DILATION OF PEPTIC STRICTURES OF THE ESOPHAGUS

We prospectively compared the efficacy of polyvinyl bougies (Savary ty pe) passed over a guide wire and through-the-scope balloons for the di lation of peptic esophageal strictures in a randomized study. Thirty-f our patients, 17 in each treatment arm, were studied. At entry, dyspha gia was assessed according to a six-point scale (0, unable to swallow; 5, normal). The end-point for dilation was to size 45F or 15 mm. Disc omfort during the procedure was graded on a four-point scale (0, no di scomfort; 1, mild; 2, moderate; 3, severe discomfort). Follow-up visit s were at 1 week, 1 month, 3 months, and every 3 months thereafter for 2 years. At the 1-week visit, the size of esophageal lumen was measur ed by 8-, 10-, and 12-mm pills. Both devices effectively relieved dysp hagia. By life-table analysis, stricture recurrence during the first y ear of follow-up was similar in both groups, but during the second yea r, the risk of recurrence was significantly lower in patients whose st rictures were dilated with balloons. Other advantages of balloons incl uded the need for fewer treatment sessions to achieve the defined end- diameter for dilation (1.1 + 0.1 versus 1.7 + 0.2, p < .05), and less procedural discomfort (p < .05). The differences in luminal size after dilation, measured by the barium pill test, were not significant. Abi lity to pass the 12-mm pill and absence of dysphagia were correlated. Our results indicate that both devices are effective in relieving dysp hagia, but balloons may have a long-term advantage.