Post written by Shae Patel, DO, from Loma Linda University, Loma Linda, California, USA, and Wasseem Skef, MD, from the Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA.

The focus of this study was to evaluate the efficacy and safety of retrograde balloon dilation compared with traditional antegrade savary dilation for managing benign esophageal strictures (BESs).

Savary dilation is a well-established technique but involves multiple dilators, endoscope reintubations, and increased patient discomfort. In addition, we believe that the retrograde balloon pull-through technique allows for better estimation of stenosis caliber, dilation under direction visualization, and perhaps improved efficiency. Therefore, we wanted to demonstrate that this newer technique is safe and effective for all types of BESs.

This technique was initially investigated in patients with eosinophilic esophagitis by Dr Evan S. Dellon’s group at the University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.¹ Our study expanded on this and showed that retrograde balloon dilation is an effective and safe alternative to traditional antegrade savary dilation for BESs.

Specifically, we found that the retrograde balloon pull-through technique achieved the primary endpoint of a luminal diameter of ≥16 mm in 22 of 23 patients (95.7%)–statistically similar to savary dilation. Only 1 adverse event occurred in the retrograde balloon pull-through dilation group: a deep mucosal tear that did not require intervention.

We believe that an appropriate next study would be a randomized trial comparing savary with retrograde balloon dilation. This would be especially helpful in patients with proximal and complex strictures where savary dilation is traditionally favored.

We thank iGIE for the opportunity to share our experience.

1. Madanick RD, Shaheen NJ, Dellon ES. A novel balloon pull-through technique for esophageal dilation in eosinophilic esophagitis (with video). Gastrointest Endosc 2011;73:138-42. ↩︎

(1) Benign esophageal stenosis. (2) Retrograde dilation using a through-the-scope balloon dilator. (3) Antegrade savary dilation. (4) Post-dilation improvement in stricture diameter.

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