Safety and Effectiveness of Endoscopic Savary-Gillaard Bougies Dilation in Moroccan Plummer-Vinson Syndrome Patients

The authors aimed to better define the clinical, biological, radiological, endoscopic, and evolutionary characteristics of patients presenting with Plummer-Vinson syndrome after endoscopic dilation and medical treatment in this study. There were 41 cases of Plummer-Vinson syndrome listed. All these patients presented dysphagia associated to anemia, and all have benefited endoscopic dilation and iron supplementation with a good clinical and biological course in 100% of cases. The Plummer-Vinson syndrome is a rare entity. The treatment, based essentially on endoscopic dilations, is effective and safe. 1. Background Plummer-Vinson syndrome is characterized by the classic triad cervical dysphagia, iron deficiency anemia, and upper esophageal web or webs. While this syndrome is known as Plummer-Vinson syndrome in the United States, it is known as Paterson-Brown Kelly syndrome in the United Kingdom [1, 2]. It has been known since the beginning of the 20th century. Plummer established the syndrome for the first time in 1912 and has published 21 cases with diffuse dilation of the esophagus and spasm of the upper esophagus without anatomic stenosis [1]. Then Vinson published another case with angulation of the esophagus [3]. Paterson and Kelly described for the first time the characteristic clinical signs of the syndrome [2, 4]. Even though the syndrome is very rare nowadays, its recognition is important because it identifies a group of patients at increased risk of squamous cell carcinoma of the pharynx and the esophagus [5]. The purpose of our study was to retrospectively evaluate the effectiveness of Savary-Gillard bougies dilation for the treatment of Plummer Vinson syndrome. 2. Material and Methods We retrospectively analyzed 62 bougienage dilations (BD) with Savary-Gilliard bougies in 41 patients for Plummer-Vinson syndrome during a period 2005–2010. The study included 36 women and 5 men with a median age 39 years ranging from 18 to 62 at the time of the initial dilation. All patients underwent a barium esophagography before performing bougies dilation to evaluate the stricture location (Figures 1 and 2). Figure 1: Barium swallow showing oesophageal web. Figure 2: Endoscopic view of oesophageal web. The dilations were performed in an ambulatory environment with varying intervals between sessions (Figure 3) by several endoscopists. The procedure was performed with the patient fasting for at least 8 hours, under sedation with intravenous propofol without fluoroscopic guidance. We used a flexible guide wire, inserted through the stricture under endoscopic