LAUSR

Benign strictures of the upper gastrointestinal tract usually require endoscopic dilation either with balloons or bougies (▶Fig. 1) as the first-line treatment. Both techniques are equivalent in terms of efficacy and safety [1], but the use of bougies has a lesser environmental impact [2]. Compared to the reusable bougies, the BougieCap (Ovesco, Tübingen, Germany) allows for visual control during dilation [3] and has proven its effectiveness and safety in patients with eosinophilic esophagitis [4] with a low weight of disposable waste. We report first a case of a second dilation attempt in a 60-year-old man with a pharyngeal stenosis following submucosal dissection for squamous cell carcinoma. Dilation with a 12-mm BougieCap and guidewire pushed through the cap was impossible. We dilated with a 12-mm balloon and thereafter passed a 13.5-mm BougieCap (▶Video 1). We next report a case of two esophageal refractory strictures following a caustic ingestion. We succeeded in dilating the first stenosis, which was short at 10 cm from the dental arches, with a 14-mm BougieCap, but the second stricture was longer at 30 cm and could not be crossed with the 14-mm BougieCap. We dilated with a 13-mm Savary-Gilliard bougie and then we used a 14-mm BougieCap again to pass the stricture. The last case was a refractory post-endoscopic submucosal dissection (ESD) stricture treated by dilation 3 months ago with a 15-mm dilation balloon. We first tried to pass the 15-mm bougie cap but were unsuccessful. We failed again with the 13/14-mm bougie cap device, but the 12-mm cap passed through the stricture and allowed successful consecutive dilation with the 13/14 and the 15/16mm. For certain strictures, the use of the BougieCap seems compromised and alternative strategies should be available to dilate the stricture when the bougie cap fails.