BALLOON DILATION VERSUS EDERPUESTOW: BIGGER AND BETTER?Treatment of Benign Esophageal Stricture by EderPuestow or Balloon Dilators: A Comparison between Randomized and Prospective Non‐Randomized Trials

Harold Lipsky, Jamie S. Barkin

Research output: Contribution to journalReview articlepeer-review

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Abstract

This study compared the short‐ and long‐term responses to esophageal dilation performed with either the Eder‐Puestow (E‐P) or balloon dilators. The study population consisted of 123 patients who required initial esophageal dilation for benign disease. This group was divided into a randomized study group of 31 patients and a nonrandomized group of 92 patients. All but six of the patients treated with the E‐P technique (n = 68) were dilated to 45‐Fr (15 mm), whereas all patients treated with the balloon technique (n = 49) were dilated to 20 mm (60‐Fr). Randomized groups. These patients (n = 31) tended to have less severe esophageal disease than those in the nonrandomized group. There were no significant differences between E‐P dilation and balloon dilation, with regard to the estimated probability of recurrent dysphagia (p= 0.98) or the necessity for a second dilation (p= 0.24). Dysphagia recurred after E‐P and balloon technique in 69% and 80%, respectively, and the median time to recurrent dysphagia was 0.35 year and 0.26 year, respectively. Redilation was necessary in 38% and 27% of patients, respectively, and the median time to redilation was 1.2 yr and greater than 2.4 yr, respectively. The immediate success rate for relief of dysphagia was 100% with both E‐P and balloon dilation. Nonrandomized group. These patients were likely to have moderate to severe esophagitis. In this group of 92 patients, 58 received E‐P dilation whereas only 34 received balloon dilation. No significant differences were noted between the two techniques with regard to estimated probability of recurrent dyspbagia (p= 0.98), the necessity for a second dilation (p= > 0.05), and median time to dysphagia (0.24 yr with each technique). Also, when E‐P and balloon techniques were compared, the percentage of patients who eventually bad recurrent dysphagia (88%vs. 94%), the percentage of patients who eventually bad a second dilation (43%vs. 50%) and the median time to redilation (1.43 yr vs. 1.63 yr) were quite similar. The immediate success rate for relief of dysphagia was 99% after E‐P dilation and 100% after balloon dilation. Combined group. For statistical purposes, the two groups were then analyzed as one group. There was no significant difference in the two techniques with regard to probability of recurrent dysphagia (p= 0.83), probability of redilation (p= 0.60) and the median time to recurrence of dysphagia (0.25 yr for both groups). Also, the results were quite similar in E‐P versus balloon technique with regard to percentage of patients in whom dysphagia eventually redeveloped (84%vs. 90%), median time to redilation (1.4 yr vs. 2.0 yr), and percentage who underwent redilation (42%vs. 43%). Complications. Of the 123 patients, six bad minor complications and one bad major complications (free perforation). Only two of these complications (both minor) occurred on the initial dilation. Five of the complications (including the perforation) occurred in the nonrandomized group. Six of the complications, including the perforation, occurred with the E‐P techniques(13%) whereas one mhinor complication occurred with the balloon technique (4%). The authors concluded that the E‐P and balloon technique are equally effective, but the E‐P technique was associated with a higher rate of complication. They thought that this was due to the fact that balloons apply radial forces, whereas E‐P applies longitudinal and radial forces, the former being potentially dangerous.

Original languageEnglish (US)
Pages (from-to)609-610
Number of pages2
JournalThe American journal of gastroenterology
Volume88
Issue number4
DOIs
StatePublished - Apr 1993

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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