Şehmus ÖLMEZ, Bünyamin SARITAŞ, Süleyman SAYAR, Banu KARA, Burçak KAYHAN, Ersan ÖZASLAN, Hasan Tankut KÖSEOĞLU, EMİN ALTIPARMAK

Treatment of Esophageal Strictures with Savary-Guilliard Bougies

Amaç: Özofagus darlıkları, benign veya malign hastalıklara bağlı olarak gelişebilir. Benign darlıklar; peptik darlık, Schatzki Halkası, özofagus web, kostik madde alımı, radyoterapi sonrası veya cerrahi sonrası gelişen darlıklardır. Savary-Guillard Bujileri ile dilatasyon (SGD) en sık kullanılan endoskopik yöntemdir. Bu çalışmada Savary-Guillard Bujileri (SGB) ile dilatasyon tedavisinin etkinliğini değerlendirmeyi amaçladık. Yöntemler: Retrospektif olarak Ekim 2005-Haziran 2011 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesinde, SGB ile tedavi edilen hastaları analiz ettik. Tüm demografik ve klinik verileri, endoskopik dilatasyon sayısı ve komplikasyonları kaydettik. Bulgular: 73 hasta (33(%45,2) erkek ve 40(%54,8) kadın) çalışmaya alındı. Ortalama yaş 55,6±15,7 idi. 73 hastaya 169 seansta 536 dilatasyon uygulandı. Ortalama seans sayısı 2,3±2.9 ve dilatasyon sayısı da 7.4±9.4(165) idi. En sık görülen etiyoloji web (n=14, %19,2), radyoterapi sonrası (n=14, %19,2), anastomoz darlığı(n=11,%15,1), kostik madde alımı (n=9,%12,3) ve malign darlıklar(n=8,%11) idi. En sık görülen nedenler ve seans sayıları karşılaştırıldı. Radyoterapiyi sekonder ve kostik madde alımına sekonder darlıklar en sık görülen nedenlerdi. . Özofagus web tedavisinde tek seans yeterliydi. Perforasyon, major kanama veya sepsis gibi major komplikasyon görülmedi. Sonuç; SGB ile özofagus benign darlıklarının tedavisi güvenli, ucuz ve kolayca ve floroskopi olmaksızın uygulanabilen bir yöntemdir. Özofagus webi tek seansta tedavi edilebilmesine rağmen, radyoterapi ve kostik madde alımına bağlı gelişen darlıklarda tekrarlayan dilatasyon işlemlerine gereksinim vardır

Özofagus Darlıklarının Savary-Guillar Bujileri ile Dilatasyonu

Objective: Esophageal strictures may be caused by benign or malign disorders. Benign strictures are peptic stricture, Schatzki's ring, esophageal web, and caustic ingestion, post-radiotherapy or post-surgical strictures. Dilatation with Savary-Guilliard bougies (SGD) is the most common endoscopic treatment of choice. In this study, we aimed to investigate the effectiveness of dilatation with Savary-Guilliard Bougies (SGB). Methods: We retrospectively analyzed the cases treated with SGD in Ankara Numune Education and Research Hospital between October 2005 and June 2011. All the demographic and clinical datas were recorded as well as endoscopic dilatation count and complications. Results: 73 patients (33(45.2%) males and 40 (54.8%) females) involved in the study. Mean age was 55,6±15,7(1890) years old. A total of 536 dilatations of 73 patients performed in 169 sessions. Mean sessions of SGD 2,3±2.9and dilatation counts were 7.4±9.4. The most seen etiologies were esophageal web (n=14, 19.2%), postradiotherapy (n=14, 19.2%), anastomotic strictures (n=11, 15.1%) ingestion of corrosive substances (n=9, 12.3%) and malign strictures (n=8, 11%). The most seen benign causes and session counts were compared. Strictures secondary to radiotherapy and ingestion of caustic substances were the most common conditions treated with SGD. A single session was sufficient in strictures caused by esophageal web. No major complications such as perforation, major bleeding or sepsis were observed. Conclusion: SGD for the treatment of esophageal benign strictures is a safe, cheap, easily performed method without need for fluoroscopy. While treatment of esophageal web is usually treated with a single session, repeated endoscopic dilation sessions are required for the strictures caused by radiotherapy and corrosive ingestion.

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