Various methods are available for endoscopic treatment of benign stenoses in the upper gastrointestinal tract. In the classic method, a stricture in the esophagus is dilated using a Savary bougie after advancement of a guide wire. The difficulty with this is the lack of direct visual control of the bougienage procedure. A new method that allows direct visual control uses what are known as “bougie caps.” These are explained here in more detail.
The bougie cap is a conically shaped cap that can be attached to the endoscope, which is then used to carry out sequential bougienage. Three sizes of cap are available for a standard gastroscope with a diameter of 10 mm, for example: 12-mm, 14-mm, and 16-mm bougie caps. The bougie cap is a single-use product. It is attached to the endoscope using the special adhesive tape that is supplied with it. Suction and rinsing can be carried out via two side openings. The opening at the front can also have a wire advanced through it when needed. The bougienage is carried out by advancing the endoscope through the stenosis. On contact with tissue, the bougie cap allows good visualization of the surrounding tissue. The mucosal tears caused by the bougienage procedure are thus directly visible.
The first case is that of a 61-year-old patient with a marked peptic stenosis in the esophagus who had been suffering increasing symptoms of dysphagia for solid food, despite consistent intake of high-dose proton-pump inhibitors.
Endoscopy revealed a high-grade stenosis in the area of the lower esophagus that could not be passed with a standard endoscope.
The stenosis now undergoes sequential bougienage, starting with the 12-mm bougie cap and with a slight rotational movement.
The 14-mm bougie cap is now applied. The mucosal tears cause by the bougienage are easily visible. Comparison of the images before treatment (on the left) and after treatment (on the right) clearly shows the effect of the therapy.
The final endoscopic check-up shows clear dilation of the lumen in the area of the previous stricture, which can now be passed using a standard gastroscope without any problems. The patient reported marked improvement in his dysphagia symptoms after the procedure.
The second case is that of a 33-year-old female patient with a pyloric stenosis, induced by many years of NSAID misuse. The clinical picture featured abdominal symptoms, with gastric outlet obstruction. Endoscopy shows a high-grade cicatricial stricture of the pylorus that cannot be passed with the standard gastroscope.
It was decided in this case as well to treat the stenosis with bougie caps rather than a dilation balloon. The case shows that bougie caps can also be used in complex positions.
The stenosis here undergoes bougienage with a 12-mm cap on a standard gastroscope. After the cap has been removed, passage with the standard device becomes possible again without any difficulty.