From the Guidelines
A bougie, or esophageal dilator, is a medical device used to dilate strictures in the esophagus, and it can be either a bougie or balloon dilator, with the choice depending on the individual case and the nature of the stricture. The use of a bougie for esophageal dilatation is supported by the UK guidelines on oesophageal dilatation in clinical practice 1, which discusses the possible complications of the procedure, including pulmonary aspiration, bleeding, perforation, risks of sedation, and chest pain. According to the guidelines, the risk of perforation varies depending on the type of stricture and the experience of the endoscopist, with a reported perforation rate of 0.53% in a large retrospective case series of 1497 procedures 1. The guidelines also recommend using either bougie or balloon dilators, with the decision individualized on a case-by-case basis dependent on the nature of the stricture, with a low grade of evidence and a weak strength of recommendation 1. Key points to consider when using a bougie for esophageal dilatation include:
- The type of stricture, including benign, malignant, or caustic strictures
- The experience of the endoscopist, with less experienced endoscopists─performed <500 previous diagnostic endoscopies─ having a greater risk of perforation
- The use of wire-guided dilators, such as Savary-Gilliard bougies, which have been shown to have a lower risk of perforation compared to non-wire guided dilators 1.
From the Research
Definition and Use of a Bougie
- A bougie, also known as an endotracheal tube introducer, is a device used to aid in tracheal intubation, particularly in cases with difficult airways 2.
- It is a semirigid introducer that can be placed into the trachea to facilitate a Seldinger-like technique of tracheal intubation 3.
- The bougie is typically reserved for difficult or failed intubations, but its use as a primary tool for intubation is being studied 4, 5.
Characteristics and Placement Technique
- The bougie is characterized by its ability to be guided into the trachea with a "clicks" sensation as it passes over the tracheal rings and a "hold up" when entering the distal airways 2.
- The placement technique involves inserting the bougie into the trachea, followed by the endotracheal tube, using a Seldinger-like technique 3.
- The use of a bougie can improve first-attempt intubation success, particularly in patients with difficult airway characteristics 4.
Comparison with Other Intubation Aids
- The bougie has been compared to other intubation aids, such as the fiberoptic stylet, in terms of effectiveness in facilitating tracheal intubation in simulated difficult airways 6.
- Studies have shown that the bougie can be as effective as, or more effective than, other intubation aids in certain situations, but further research is needed to determine its optimal use 4, 5, 6.
Clinical Evidence and Studies
- Several studies have investigated the use of the bougie in emergency intubation, including the BOugie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial 3, 5.
- These studies have provided evidence on the effectiveness and safety of the bougie in various clinical settings, but more research is needed to fully understand its role in airway management 2, 4, 5, 6.