P0563 - Comparison of Efficacy and Safety of Retrograde Balloon Pull-Through Technique vs Antegrade Savary Dilation for Benign Esophageal Strictures

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Shae Patel, DO

Loma Linda University Health
Placentia, CA

Shae Patel, DO¹, Paul Leonor, MD², Andrew Wright, MD², Wasseem Skef, MD³
¹Loma Linda University Health, Placentia, CA; ²Loma Linda University, Loma Linda, CA; ³Baylor College of Medicine, Houston, TX

Introduction: Static through the scope (TTS) balloon dilation has comparable efficacy and safety profile to Savary dilation (SD) but is occasionally limited in the setting of proximal stenosis, long strictures or subtle narrowing(s) not appreciated via endoscopy (i.e. eosinophilic esophagitis). Accordingly, these scenarios may require mechanical dilators. SD are antegrade, push, tapered dilators that work by exerting longitudinal and radial force from the proximal to the distal end of the stenosis. Resistance during dilator passage also allows the endoscopist to gauge dilation effect. In comparison, balloon pull-through dilation (BPTD) is a less common retrograde technique that exerts longitudinal and radial force in the opposite direction but also provides tactile feedback. In addition, it allows for sizing and dilation of benign strictures throughout the entire length of the esophagus under direct visualization. Given limited data on the latter technique, we opted to report our experience with antegrade Savary and retrograde balloon dilation of benign esophageal strictures.

Methods: Retrospective cohort study of adult patients who underwent upper endoscopy at our center from 01/2017 to 05/2022. Only esophageal or gastroesophageal junction benign stenosis were included. Wire-guided Savary and BPTD techniques were included. Static TTS dilation and other forms of dilation (i.e. pneumatic dilation) were excluded. 40 patients met inclusion criteria. Baseline variables were collected. The primary outcome was need for re-dilation within 1 year after therapeutic dilation was achieved (≥ 16 mm). Secondary outcomes were ability to reach therapeutic endpoint dilation and complication rate. Outcomes were compared by using the chi-square test for categorical variables.

Results: There was no difference in the need for re-dilation at 1-year in both groups (SD 34.6% vs BPTD 15.4%, p = 0.208). Target endpoint dilation efficacy was similar in both groups (SD 100% vs BPTD 92.9%, p = 0.168). One minor complication occurred in BPTD group. Nevertheless, the rates were statistically similar in both groups.

Discussion: Our experience suggests BPTD may be equally effective and safe as SD for benign esophageal stenosis. Prospective larger studies are needed to validate these preliminary findings.

Results of Comparison of Balloon Pull-Through Dilation and Savary Dilation
		Type Of Procedure
		Balloon pull-through			Savary Dilation
		Count (n=14)	N %	Mean (Median)	Count (n=26)	N %	Mean (Median)	p-value
Gender	Male	8	57.1%		12	46.2%
Gender	Female	6	42.9%		14	53.8%
Ethnicity	Hispanic or Latino	5	35.7%		5	19.2%
Ethnicity	Not hispanic or Latino	9	64.3%		21	80.8%
Race	Black or African American	2	14.3%		1	3.8%
	Hispanic	5	35.7%		5	19.2%
	White	7	50.0%		20	76.9%
BMI	< 18.5, underweight	2	14.3%		1	3.8%
	>40, morbidly obese	1	7.1%		1	3.8%
	18.5-24.9, healthy weight	2	14.3%		9	34.6%
	25-29.9, overweight	5	35.7%		12	46.2%
	30-39.9, obese	4	28.6%		3	11.5%
Sedation Type	Generalized anesthesia	2	14.3%		0	0.0%
Sedation Type	MAC	12	85.7%		26	100.0%
Location of Stricture	Lower Esophagus	10	71.4%		19	73.1%
	Middle Esophagus	2	14.3%		3	11.5%
	Upper Esophagus	2	14.3%		4	15.4%
LA Grade Esophagitis	LA Grade A	2	0.14%		2	7.7%
	LA Grade B	0	0.0%		0	0.0%
	LA Grade C	0	0.0%		1	0.04%
	LA Grade D	1	7.1%		0	0.0%
Barrett's Esophagus	Yes	3	21.4%		2	8.0%
Barrett's Esophagus	No	11	78.6%		23	92.0%
Fluoroscopy Used	Yes	0	0.0%		0	0.0%
	No	14	100.0%		26	100.0%
Anticoagulation	Yes	2	14.3%		1	3.8%
Anticoagulation	No	12	85.7%		25	96.2%
DAPT Therapy	Yes	1	7.1%		0	0.0%
DAPT Therapy	No	13	92.9%		26	100.0%
Complication Occurred	Yes	1	7.1%		0	0.0%		0.168
	No	13	92.9%		26	100.0%
Type of Complication	Deep Mucosal Tear	1	7.1%		0	0.0%
	Bleeding	0	0.0%		0	0.0%
	Bacteremia	0	0.0%		0	0.0%
	Observation	0	0.0%		0	0.0%
	Aspiration	0	0.0%		0	0.0%
Therapeutic Dilation Achieved (therapeutic ≥ 16mm)	Yes	13	92.9%		26	100.0%		0.168
Therapeutic Dilation Achieved (therapeutic ≥ 16mm)	No	1	7.1%		0	0.0%
Need for re-dilation within one year after reaching therapeutic dilation	Yes	2	15.4%		9	34.6%		0.208
	No	11	84.6%		17	65.4%
Number of re-dilations in one year				1.5 (1.5)			1.44 (1)
Number of days to re-dilation				115			166

Table: Table 1. Comparison of Balloon Pull-Through Dilation and Savary Dilation: Demographics, Study Details, Complications, and Need for Re-dilation

Disclosures:

Shae Patel indicated no relevant financial relationships.

Paul Leonor indicated no relevant financial relationships.

Andrew Wright indicated no relevant financial relationships.

Wasseem Skef: GE Healthcare – Stock-publicly held company(excluding mutual/index funds).

Shae Patel, DO¹, Paul Leonor, MD², Andrew Wright, MD², Wasseem Skef, MD³. P0563 - Comparison of Efficacy and Safety of Retrograde Balloon Pull-Through Technique vs Antegrade Savary Dilation for Benign Esophageal Strictures, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.