Bougienage

Bougienage is a medical procedure used to dilate a narrowed tubular structure, most commonly the esophagus or the urethra, by passing a series of slender dilators called bougies through the lumen. The goal is to relieve obstruction from benign strictures caused by peptic injury, inflammation, radiation, postoperative scar, or congenital narrowing. It is not a definitive cure for malignant obstruction, but can provide temporary relief or serve as a bridge to other treatments.

Equipment and sizes: Bougies are available in rigid or flexible forms and are graduated in size. The diameter is expressed in French units (1 Fr equals 0.33 mm). A typical dilatation plan uses multiple bougies of increasing diameter, from small to larger sizes, over a guidewire or directly along the lumen, depending on anatomy and the practitioner’s preference.

Technique: The procedure may be performed in an endoscopy suite or clinic. The lumen is lubricated; anesthetic or topical analgesia is used as appropriate. The clinician advances the smallest bougie across the stricture and sequentially introduces larger sizes, stopping if resistance or patient discomfort occurs. Fluoroscopic or endoscopic guidance may be employed for complex strictures.

Risks and alternatives: Potential complications include perforation, bleeding, infection, chest or abdominal pain, or creation of a false passage. Bougienage may be repeated if needed. Alternatives or adjuncts include endoscopic balloon dilation, laser or incision-based stricturotomy, stent placement, or surgical reconstruction for refractory obstructions.