Introduction The incidence of benign oesophageal strictures is 0.5% in patients with dyspeptic symptoms.1 It affects the quality of life by causing dysphagia, regurgitation and in severe cases weight loss. The first line of management is balloon or bougie dilatation. There is ambiguity about the complication rates associated with this procedure. We therefore did a systematic review and metanalysis on complications (bleeding and perforation) associated with endoscopic dilatation.
Methods We searched several electronic databases including Pubmed for full journal articles published after 1990 reporting on the use of endoscopic dilatation using bougies or balloons in the treatment of beingn oesophageal strictures. We hand searched the reference lists of all retrieved articles. Cohort or prospective studies involving 10 or more adult patients were included in the analysis. Studies on corrosive/caustic strictures and radiological non-endoscopy guided diltations were excluded. We calculated the pooled proportion of patients who had a complication (perforation or bleed) to therapy in the selected studies. Heterogeneity between the studies was assessed using the I 2 statistic.
Results Our search identified 32 studies that were included in the final analysis (26 cohort studies and 6 randomised control trials). There were 11 studies that reported on balloon, 8 on bougie and 13 studies reported on both balloon and bougie dilatations. There were 18104 patients, 7195 balloon dilations and 15,936 bougie dilations. There were 7711 (42.5%) males and 7305 (40.3%) females. The pooled rate of perforation was 0.5% (95% CI, 0.3–0.8, I2–7.5%) and 0.3% (95% CI, 0.2–0.5, I2–41.1%) for balloon and bougie respectively. The rate of bleeding was 0.6% (95% CI 0.4–1.1, I2–17.1%), and 0.3% (95% CI, 0.2–0.8, I2–60.6%) for balloon and bougie dilatations respectively.
Conclusion This large meta analysis on 18104 patients shows that the risk of perforation and bleeding is low and comparable in both endoscopic guided balloon and bougie dilatations. The rates are lower than the commonly accepted figure of 1% and should be reassuring to both patients and endoscopists.
Reference 1 Breslin NP, Thomson ABR, Bailey RJ, et al. Gastric cancer and other en- doscopic diagnoses in patients with benign dyspepsia. Gut 2000;46.
Disclosure of Interest None Declared
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