Esophageal Dilation Using a Novel Attachment Cap Clinically Effective in EoE
NEW YORK (Reuters Health) – In adults with eosinophilic esophagitis (EoE), endoscopic treatment of esophageal strictures using a novel attachment cap is technically feasible, safe and offers significant short-term improvement in symptoms, researchers report.
BougieCap from Ovesco Endoscopy AG is a new device recently marketed in Europe for esophageal bougienage of strictures of the upper GI tract that allows optical and tactile feedback during stricture dilation.
In a paper in Gastrointestinal Endoscopy, Dr. Alain Schoepfer of the University of Lausanne, Switzerland, and colleagues report their experience with a one-time esophageal-stricture dilation using BougieCap in 50 adults with EoE.
The cohort was 70% male, with a median age of 41 years and a median disease duration of four years; 50% were treated with swallowed topical corticosteroids, 10% with proton-pump inhibitors, 14% with combined swallowed topical corticosteroids plus proton-pump inhibitors, 14% with elimination diet, 12% without anti-eosinophil therapy.
Endoscopic bougienage was technically successful in all patients. The median esophageal diameter increased from 12 mm to 16 mm, and median symptom severity on a validated index dropped from 32 points to zero points two weeks after the procedure on a a scale ranging from zero to 100.
In one patient (the sixth out of 50), the BougieCap was temporarily lost after stricture dilation but could be retrieved.
In this patient, a BougieCap of 16 mm diameter got detached from the tip of the endoscope and was found subsequently in the hypopharynx in the proximity of the vocal cords, they explain. The patient did not suffer any complications, but this event could have led to “potentially worrisome” outcomes such as desaturation or laryngospasm, they note.
In subsequent patients, the team found that an effective solution for the problem of the “slipped BougieCap” is replacing the circular tape provided in the BougieCap kit by the highly adhesive Strappal tape.
“While using the Strappal tape for the fixations of the BougieCap, we no longer encountered any BougieCap slipping,” they report.
They note that their experience mirrors that of clinicians from Germany described recently in the journal Endoscopy (https://bit.ly/3hTT5be).
The German group were also the first to describe the problem of losing the BougieCap in two patients during the intervention. In these two patients, the BougieCap was lost in the stomach and passed spontaneously with a bowel movement.
This research was supported by grants from the Swiss National Science Foundation, the Swiss EoE Foundation, Sanofi-Genzyme, Astra-Zeneca and Dr Falk Pharma. None of the authors have any financial relationship with Ovesco Endoscopy AG, the company that makes the BougieCap, or BSN medical which produces Strappal tape.
SOURCE: https://bit.ly/3wAk2F8 Gastrointestinal Endoscopy, online May 15, 2021.
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