Esophageal Stricture Dilation Using the Novel BougieCap

An older adult man presented with recurrent meat boluses, and examination revealed a tight, fibrotic Schatzki ring (Figure 1, panels A, B). Destruction of Schatzki rings can be accomplished with dilation using Savary or Maloney bougies, balloon dilation, star-like incisions, circumferential excision using an IT knife, cold biopsy mini-excisions, or with the novel, single-use, disposable BougieCap (Ovesco). In this case, we elected to use the BougieCap for several reasons: The cap is transparent (Figure 1, panels C-G) and has 3 dilating sizes, which are marked on the cap (Figure 1, panels C-F), and the entire dilation (bougienage) procedure can be observed through the cap, in contrast to Savary or Maloney dilations (Figure 1, panels D-G). Also, because many countries have embraced a throwaway approach to utensils (one-time use, disposable devices, including Savary dilators), selecting the cheapest and equally or most effective device makes sense.

Figure 1. Dilation of a Schatzki ring with BougieCap.

(A) Tight fibrotic distal stenosis.

(B) After removing the food bolus with a cylindrical cap, inspection of the distal esophagus revealed a Schatzki ring with a remaining lumen of about 9 mm.

(C) BougieCap view of tongue.

(D) The distal tip of the cap is reaching the distal esophagus.

(E) The stretching or dilation of the stricture is easily seen.

(F) Two mucosal lacerations are seen, reflecting excellent dilation.

(G) Cap crossing the gastroesophageal junction (notice the Z-line).

(H) Cap within the stomach.

Figure 2. The BougieCap.

The BougieCap enables effective and safe dilation of strictures with direct visual feedback, offering significant advantages compared with conventional techniques.

Images courtesy of EndoCollab.

This distally transparent, conically shaped cap is attached to the distal scope, making the scope a “bougie dilator” (Figure 2). The BougieCap is available in various sizes, each with 2 different dilation diameters, allowing gentle stricture dilation and potentially minimizing the risk for complications.

The conical BougieCap is attached distally to the endoscope with special tape and advanced to the stenosis. By pushing forward and gently rotating the endoscope, the endoscopist can dilate the mucosal stricture (Figure 1, panel E). The BougieCap includes a front aperture for advancing a 0.021- to 0.035-inch (biliary) guide wire (maximum 1 mm) when required, and 2 lateral apertures that permit air insufflation, water irrigation, and suction (Figure 2).

Direct visual control during endoscopy is enabled by the transparent plastic material of the BougieCap. In addition, vessel compression by the BougieCap enhances mucosal examination, which improves the visibility of mucosal tears and reduces the risk for mucosal bleeding.

The single-use BougieCap is especially advantageous in the context of green endoscopy initiatives because it reduces plastic waste by up to 99% compared with traditional dilation techniques. Moreover, the cap is much less expensive than disposable balloons and Savary dilators.

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Nonetheless, Savary bougies and dilation balloons are safe and efficient techniques that have been available for more than 5 decades. Thus, prospective studies evaluating the novel BougieCap with other dilation methods are warranted.

Dr. Mergener is a member of the Gastroenterology & Endoscopy News editorial board.

See endocollab.com for more information, including videos, quick tips, and lectures on these and many other practical endoscopy tricks and techniques.