Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects.

OBJECTIVES: Endoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H-EVT) for the treatment of TGID. METHODS: Retrospective multicenter study including patients who underwent H-EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure. RESULTS: A total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H-EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33-1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H-EVT placement (HR 0.70; 95% CI 0.55-0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H-EVT (odds ratio 3.08; 95% CI 1.19-7.95) was a significant predictor of clinical success. Three device-related adverse events (2.08%) occurred. CONCLUSIONS: The use of the H-EVT is feasible, safe, and effective for the management of TGID.

Occurrence and seasonality of Campylobacter spp. in Portuguese dairy farms.

The growing idea that natural products are better for consumption is creating behaviors that can lead to food safety problems and an increase of healthcare costs. One of the trending products is raw milk, which in some countries is sold by vending machines outside dairy farms. Campylobacteriosis is the most common gastrointestinal infection in humans in the European Union since 2005. Several outbreaks have been associated with the consumption of raw milk contaminated with Campylobacter spp. In the present study, the occurrence and seasonality of Campylobacter spp. in raw cow's milk were determined. Other samples from the dairy farm environment were also analyzed to understand the possible routes of contamination. The study was conducted from November 2020 to September 2021 in randomly selected dairy farms located in northern Portugal. One liter of milk was collected from bulk cooling tanks transported to the laboratory and analyzed within 24 h. Campylobacter spp. detection and identification were performed using real-time PCR methodology and confirmation followed ISO standards. From 100 dairy farms evaluated, the occurrence of Campylobacter spp. was estimated at 4.0 % in raw cow's milk samples. In the samples from the environment of the farms, only contaminated fecal samples were found, corresponding to an occurrence of 4.2 %. Positivity was observed in summer months. The results of this study indicate the potential risk of campylobacteriosis after the consumption of raw milk. Consumers who seek raw milk for health reasons should be aware of the risk, especially if they belong to vulnerable groups. Moreover, it raises the question of how climate change will impact food safety, suggesting that routine surveillance for zoonotic pathogens should be implemented in dairy farms.

Empirical and semi-empirical chlorophyll-a modeling for water quality assessment through river-lake transition in extreme Southern Brazil.

Mirim lagoon is the second largest lacustrine water body in Southern Brazil, providing water for local communities. However, algae growth and water quality in the lagoon and in tributaries rivers is influenced by nutrient's increase. In this context, this study performs the empirical and semi-empirical chlorophyll-a (Chl-a) modeling using remote sensing and in situ data for water quality assessment. Water quality data were collected at 15 sample locations in the lagoon on the date of Sentinel-2 satellite overpass. Surface reflectance data were derived from the Sen2Cor atmospheric correction method and correlated with Chl-a concentration. The best model presented a Pearson's correlation coefficient = 0.81 and Mean Absolute Error = 0.13µg.L-1. Low Chl-a concentration is observed at the Northern lagoon, possibly due to suspended solids presence. The same occurs in the left margin, being associated with the influence of land use for agriculture. High Chl-a concentrations are associated with shallower and lentic areas. The mean Chl-a concentration predicted by the model was 17.34µg.L-1, similar to the observed value in situ (16.32µg.L-1). Overall, the empirical model developed can be applied as a tool to reduce costs and efforts in fieldwork measures and to understand eutrophication in this river-lake transition ecosystem.

Minimum streamflow regionalization in a Brazilian watershed under different clustering approaches.

Estimating the minimum streamflows in rivers is essential to solving problems related to water resources. In gauged watersheds, this task is relatively easy. However, the spatial and temporal insufficiency of gauged watercourses in Brazil makes researchers rely on the hydrological regionalization technique. This study's objective was to compare different hierarchical and non-hierarchical clustering approaches for the delimitation of hydrologically homogeneous regions in the state of Rio Grande do Sul, Brazil, aiming to regionalize the minimum streamflow that is equaled or exceeded in 90% of the time (Q90). The methodological development for the regionalization of Q90 consisted of using regression analysis supported by multivariate statistics. With respect to independent variables for regionalization, this study considered the morphoclimatic attributes of 100 watersheds located in southern Brazil. The results of this study highlighted that: (i) the clustering techniques had the potential to define hydrologically homogeneous regions, in the context of Q90 in the Rio Grande do Sul State, mostly the Ward algorithm associated with the Manhattan distance; (ii) drainage area, perimeter, centroids X and Y, and mean annual total rainfall aggregated important information that increased the accuracy of the cluster; and (iii) the refined mathematical models provided excellent performance and can be used to estimate Q90 in ungauged rivers.

Laparoscopic SpyGlass cholangioscopy evaluation during bilioenteric anastomosis for hepatolithiasis, a case report.

INTRODUCTION: Careful evaluation of intrahepatic injury of biliary tract diseases is crucial to assure proper management and estimate disease prognosis. Hepatholithiasis is a rare condition that can be associated to cholestatic liver diseases. Additional tools to improve diagnosis and patient care are of great interest specially if associated to decreased morbidity. Recently the spread of single-operator platforms of cholangioscopy brought this procedure back to scene. Our aim was to identify safety, feasibility and utility of SpyGlass cholangioscopy of biliary tract during laparoscopic hepaticojejunostomy. PRESENTATION OF CASE: A 53 years-old man with hepatolithiasis associated to choledolithiasis under treatment with ursodeoxycholic acid and fenofibrate for 8 months, was submitted to laparoscopic hepaticojejunostomy with cholangioscopy for biliary duct evaluation. Spyscope was inserted through a right lateral laparoscopic trocar entering the common bile duct. Examination of intra-hepatic bile ducts showed injury of right biliary. Few microcalculi were visualized. Left biliary ducts presented normal mucosa. Histopathological examination showed a chronic inflammatory process. During the procedure contrasted radiologic images were performed to assure Spyscope location. Following cholangioscopy evaluation, a Roux-en-Y hepaticojejunostomy was performed. To enlarge hepatic duct, a small longitudinal incision was made, and a PDS-5.0 running suture was used for bilioenteric anastomosis. Patient was discharged on postoperative day 6, with drain removal on day 20. CONCLUSION: SpyGlass cholangioscopy during laparoscopic hepaticojejunostomy is feasible leading to minimal additional invasion of the surgical. In this case the method was performed safely, providing detailed examination of injured biliary ducts, adding elements to determine disease prognosis and patient care.

Seasonal assessment of water quality parameters in Mirim Lagoon, Rio Grande do Sul State, Brazil.

This paper aimed at to evaluate the qualitative effects of climatic seasonality in a subtropical lagoon, using Discriminant Analysis, as well to identify the most sensitive and responsible parameters for these changes. The Mirim Lagoon watershed is one of the main transboundary basins in South America and is of great economic importance for the region because its waters are used for irrigation of rice fields and for the potable water supply to populations close to it, in this way, these uses may affect the quality of the basin waters. The data used in the study were provided and collected by the Mirim Lagoon Development Agency. Water quality parameters were selected in a five-year database and submitted to statistical tests that demonstrated their distinctions throughout the climatic seasons. The results showed that the parameters temperature, pH, dissolved oxygen, biochemical oxygen demand, total nitrogen and total phosphorus differ statically between the four climatic seasons. Were also identified four discriminative parameters between the seasons, being them dissolved oxygen, biochemical oxygen demand, total nitrogen and total phosphorus. In this way, it can be concluded that the seasonality mainly affects anthropogenic pollution sources such as agricultural activities and domestic discharges.

Use of multivariate statistical methods to analyze the monitoring of surface water quality in the Doce River basin, Minas Gerais, Brazil.

The objective of the present study was to evaluate the water quality data in the Minas Gerais portion of the Doce River basin in order to analyze the current monitoring network by identifying the main variables to be maintained in the network, their possible sources of pollution, and the best sampling frequency. Multivariate statistical techniques (factor analysis/principal components analysis, FA/PCA and cluster analysis, CA) complemented by the analysis of violation of the framing classes were used for this purpose. Water quality variables common to 64 monitoring sites were analyzed for the base period from 2010 to 2017. The water quality variables were analyzed considering the different monitoring campaigns: (a) partial campaigns; (b) total campaigns; and (c) monthly campaigns. It was identified from the FA/PCA results, that, when the partial campaign data were analyzed, the variables selected represent the high susceptibility that the basin presents to erosion and the release of domestic effluents in its water bodies. When the data of total campaigns were evaluated, representative variables of the contamination by heavy metals from industrial and mining activities were included. Therefore, the analysis of violation of the framing classes made possible to identify five critical variables: thermotolerant coliforms, dissolved iron, total phosphorus, and total manganese, which reinforced the results obtained in FA/PCA. Based on the results of the analyses, it was recommended to include variables associated with heavy metal contamination in the partial campaigns, prioritizing the dissolved iron and total manganese, as well as total chloride sampling only for the total campaigns. The evaluated data from the monthly campaigns, the CA showed that although the quarterly monitoring frequency is satisfactory, the monthly monitoring is more appropriate for the monitoring of water quality in the Minas Gerais portion of the Doce River basin.

Methodological proposal for the allocation of water quality monitoring stations using strategic decision analysis.

In order to fill a gap in the monitoring of water quality in Brazil, the objective of this study was to propose a methodology to support the allocation of water quality monitoring stations in river basins. To achieve this goal, eight criteria were selected and weighted according to their degree of importance. It was taken into account the opinion of water resources management experts. In addition, a decision support system was designed so that the methodology could be used in the allocation of water quality monitoring stations by researchers and management bodies of water resources, to be fully implemented in geographic information system environment. In order to demonstrate the potential of the proposed methodology, which can be used in places that have or not existing monitoring networks, it has been applied in the Minas Gerais portion of the Doce river basin. Because the area already has a monitoring network with 65 stations in operation under the responsibility of the Minas Gerais Water Management Institute (IGAM), an expansion of the network was suggested and a simulation of a scenario was performed considering that the study area did not have an established network. The results of the analyses consisted of maps of suitability, indicating the locations with greater and lesser suitability for the establishment of the stations. With the application of the methodology, seven new sites were proposed so that the study area had the density recommended by the National Water Agency (ANA), and it was verified that the Caratinga River Water Resources Management Unit (UGRH5 Caratinga) has the most deficiency of stations among the six units evaluated in the Minas Gerais portion of the Doce river basin. In the simulated scenario considering the non-existence of a network, the adequacy map obtained was compared with the existing monitoring network and it was possible to classify the stations according to the purpose for which they were established, such as monitoring environments under anthropic activities or establishing benchmarks for the water bodies. Overall, the proposed methodology proved itself robust, and although the results were specific to one basin, the criteria and decision support system used are fully applicable to other areas of study.

Gastrointestinal ischemia: endoscopic findings in the context of vascular insufficiency.

Gastrointestinal ischemia may result from different causes: hemodynamic shock, thromboembolism, endoscopic or surgical complications, among other causes. Its symptoms are pain, vomiting, bleeding and bloating. Endoscopic findings are pale or blackened mucosa, and exudative and confluent ulcerative lesions. This paper aims to report a case of gastroduodenal ischemia associated with hemodynamic shock and disseminated intravascular coagulation (DIC). This is a case of a 56-years- old male with multiple comorbidities, presenting with refractory septic shock and DIC. He underwent an upper gastrointestinal endoscopy (UGE) for investigation of melena, which revealed an extensive deep and exudative gastric ulcer, associated with edematous purplish duodenal mucosa. Due to the severity of the underlying condition, the patient evolved to death, evidencing septic shock as cause of death. Gastroduodenal ischemia is associated with a poor prognosis, in which early diagnosis by UGE is fundamental to guide potential interventions.

Cholangioscopy-guided steroid injection for refractory post liver transplant anastomotic strictures: a rescue case series.

BACKGROUND AND AIMS: Post liver transplant biliary anastomotic strictures have traditionally been treated with balloon dilation and multiple plastic stents. Fully covered self-expandable metallic stents may be used as an initial alternative or after multiple plastic stents failure. Refractory strictures can occur in 10-22% and require revisional surgery. Alternatively, cholangioscopy allows direct visualization and therapeutic approaches. We aimed to assess the feasibility, safety, and efficacy of balloon dilation combined with cholangioscopy-guided steroid injection for the treatment of refractory anastomotic biliary strictures. METHODS: Three post-orthotopic liver transplant patients who failed standard treatment of their biliary anastomotic strictures underwent endoscopic retrograde cholangiopancreatography with balloon dilation followed by cholangioscopy-guided steroid injection at a tertiary care center. Patients had follow-up with images and laboratorial tests to evaluate for residual stricture. RESULTS: Technical success of balloon dilation + cholangioscopy-guided steroid injection was achieved in all patients. Cholangioscopy permitted accurate evaluation of bile ducts and precise localization for steroid injection. No adverse events occurred. Mean follow-up was 26 months. Two patients are stent free and remain well in follow-up, with no signs of biliary obstruction. No further therapeutic endoscopic procedures or revisional surgery were required. One patient did not respond to balloon dilation + cholangioscopy-guided steroid injection after 11 months of follow-up and required repeat balloon dilation of new strictures above the anastomosis. CONCLUSION: Cholangioscopy-guided steroid injection combined with balloon dilation in the treatment of refractory post liver transplant strictures is feasible and safe. This method may be used as a rescue alternative before surgical approach. Randomized controlled trials comparing balloon dilation + cholangioscopy-guided steroid injection to fully covered self-expandable metallic stents are needed to determine the role of this treatment for anastomotic biliary strictures.

Gastrointestinal ischemia: endoscopic findings in the context of vascular insufficiency

Gastrointestinal ischemia may result from different causes: hemodynamic shock, thromboembolism, endoscopic or surgical complications, among other causes. Its symptoms are pain, vomiting, bleeding and bloating. Endoscopic findings are pale or blackened mucosa, and exudative and confluent ulcerative lesions. This paper aims to report a case of gastroduodenal ischemia associated with hemodynamic shock and disseminated intravascular coagulation (DIC). This is a case of a 56-yearsold male with multiple comorbidities, presenting with refractory septic shock and DIC. He underwent an upper gastrointestinal endoscopy (UGE) for investigation of melena, which revealed an extensive deep and exudative gastric ulcer, associated with edematous purplish duodenal mucosa. Due to the severity of the underlying condition, the patient evolved to death, evidencing septic shock as cause of death. Gastroduodenal ischemia is associated with a poor prognosis, in which early diagnosis by UGE is fundamental to guide potential interventions.

La isquemia gastroduodenal puede resultar por diferentes causas: shock hemodinámico, tromboembolismo, complicaciones post-procedimientos endoscópicos o quirúrgicos, entre otras. Sus síntomas son dolor, vómito, hemorragia y distensión abdominal. Los hallazgos endoscópicos son mucosa pálida o ennegrecida, lesiones ulcerativas exudativas y confluentes. Este trabajo relata un caso de isquemia gastrointestinal, asociada a choque hemodinámico y coagulación intravascular diseminada (CID). Este es un caso de un hombre de 56 años de edad, con múltiples comorbilidades, que presenta con shock séptico refractario a tratamiento y CID. El paciente se sometió a una endoscopia digestiva alta (EDA) para la investigación de melena, que reveló una extensa úlcera gástrica exudativa y profunda, asociada con mucosa duodenal violácea e inflamada. Debido a la gravedad de la enfermedad de base, el paciente evolucionó a la muerte, siendo el shock séptico como causa principal. La isquemia gastrointestinal es asociada a un mal pronóstico, en el que el diagnóstico precoz por EDA es fundamental para orientar las posibles intervenciones.

Endoscopic versus surgical treatment for pancreatic pseudocysts: Systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). METHODS: The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. RESULTS: There was no significant difference between treatment success rate (risk difference [RD] -0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD -0.02; 95% CI [-0.04,0.08]; P = .48), general adverse events (RD -0.05; 95% CI [-0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [-0.04,0.07]; P = .58) between surgical and endoscopic treatment.Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI [-5.18, -3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI [-5.43,-3.94]; P < .00001). CONCLUSION: There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.

A rare non-oncological pancreatic mass: eosinophilic pancreatitis diagnosis through EUS-FNA.

Background and study aims Eosinophilic pancreatitis (EP) is a rare etiology of chronic pancreatitis, and few cases have been reported. It is characterized by eosinophilic infiltration of the pancreas and elevated IgE levels. EP is difficult to distinguish from pancreatic cancer based on clinical symptoms and auxiliary exams. We present a case of EP and debate the routine performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for resectable pancreatic mass.

Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis.

BACKGROUND: To evaluate the effectiveness of virtual reality simulator (VRS) training compared to box-trainer training (BT) for learning outcomes in minimally invasive surgery (MIS) techniques. MATERIALS AND METHODS: A systematic review of the literature was performed using CENTRAL, MEDLINE, EMBASE, Scopus, CINAHL, LILACS. The primary outcomes were time to perform MIS and performance score in MIS. After being selected, the articles were evaluated for methodological quality and risk of bias. The results were evaluated for quality of evidence and meta-analysis was performed. RESULTS: 20 randomized clinical trials were included in the qualitative analysis and 14 were used in the meta-analysis. VRS training was more efficient than BT training (P < 0.00001, 95% CI: 35.08 to -25.01) when evaluating participant time needed to complete the peg task. In descriptive analysis, VRS training was better than BT training in participant performance score to perform MIS. There was no statistical difference in the meta-analysis in the time needed to perform surgery, time to complete basic or advanced tasks and performance score for basic or advanced tasks. CONCLUSIONS: VRS training was better than BT training in participant performance scores when performing MIS and in the time needed to complete the basic task of peg transfer. In all other outcomes, regardless of the student's level of experience or type of activity, the two forms of training were equivalent.

Índice de qualidade de água modificado pela análise multivariada: estudo de caso do Arroio Pelotas, RS, Brasil / Water quality index modified by using multivariate analysis: a case study of Pelotas Stream, RS, Brazil

RESUMO O objetivo deste estudo foi desenvolver um índice de qualidade de água modificado (IQAMod), por meio de análises multivariadas, e comparar com o índice utilizado pela Companhia Ambiental do Estado de São Paulo (Cetesb) (IQACETESB), para ser aplicado no Arroio Pelotas, Rio Grande do Sul, Brasil. Foram usados dados secundários de qualidade da água superficial do Arroio Pelotas, para o sítio de amostragem GER 48, localizado no município de Pelotas, monitorados e disponibilizados pela Fundação Estadual de Proteção Ambiental Henrique Luís Roessler (FEPAM), no período entre 1997 e 2013. Entre as análises multivariadas, empregou-se a análise fatorial (AF)/análise de componentes principais (ACP). Os resultados indicaram que a ACP extraiu duas componentes principais que explicaram 100% da variância total dos dados na matriz de correlação, enquanto os escores fatoriais para o cálculo do IQAMod foram extraídos do primeiro fator, que explicou 70,6% da variância total. Concluímos que o IQAMod mostrou demanda bioquímica de oxigênio (DBO5), turbidez (TH) e sólidos totais (ST) como as variáveis de mais importância na construção do índice, diferindo do IQACETESB, que apresentou as variáveis oxigênio dissolvido (OD), coliformes termotolerantes (CT) e potencial hidrogeniônico (pH) como as de mais relevância, demonstrando assim a necessidade da calibração do IQACETESB para aplicação nesse ecossistema específico.

ABSTRACT This research aimed at developing a modified water quality index (WQIMod) by using multivariate analysis, from a comparison with the WQI used by the Environmental Company of São Paulo (Companhia Ambiental do Estado de São Paulo-Cetesb) (IQACETESB), to be applied in the Pelotas Stream, RS, Brazil. Secondary data from Pelotas Stream surface water quality were used, collected in the sampling site GER 48, located in the municipality of Pelotas, where they were monitored and provided by the State Foundation of Environmental Protection Henrique Luís Roessler (Fundação Estadual de Proteção Ambiental Henrique Luís Roessler-FEPAM) between 1997 and 2013. Among the multivariate analyses, the factor analysis/principal component analysis (PCA) was used. The results indicated that the PCA extracted two principal components, which explained 100% of the total data variance in the correlation matrix, while the factorial scores for WQIMod calculation were extracted from the first factor, which explained 70.6% of the total data variance. We concluded that the WQIMod exhibits biochemical oxygen demand (BOD5), turbidity (TH) and total solids (TS) as the most important variables for the index construction, differing from the WQICETESB, which shows the variables dissolved oxygen (DO), thermotolerant coliforms (TC) and hydrogenionic potential (pH) as the most relevant ones, indicating the need of WQICETESB calibration for applying in this specific ecosystem.

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials.

Background and study aims The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation (OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely used technique is placement of multiple plastic stents, but discussions are ongoing on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation. This study aimed to compare results from use of plastic and metal stents to treat biliary stricture after transplantation. Patients and methods Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases, and only randomized studies comparing the two techniques were included in the meta-analysis. Results Our study included four randomized clinical trials totaling 205 patients. No difference was observed between the stricture resolution rate (RD: 0.01; 95 %CI [-0.08 - 0.10]), stricture recurrence (RD: 0.13; 95 %CI [-0.03 - 0.28]), and adverse events (RD: -0.10; 95 %CI [-0.65 - 0.44]) between the plastic and metallic stent groups. The metallic stent group demonstrated benefits in relation to the number of ERCPs performed (MD: -1.86; 95 %CI [-3.12 to -0.6]), duration of treatment (MD: -105.07; 95 %CI [-202.38 to -7.76 days]), number of stents used (MD: -10.633; 95 %CI [-20.82 to -0.44]), and cost (average $ 8,288.50 versus $ 18,580.00, P  < 0.001). Conclusions Rates of resolution and recurrence of stricture are similar, whereas the number of ERCPs performed, number of stents used, duration of treatment, and costs were lower in patients treated with FCEMS, which shows that this device is a valid option for initial treatment of post-OLTX biliary stricture.

Endoscopic Dilation with Bougies versus Balloon Dilation in Esophageal Benign Strictures: Systematic Review and Meta-Analysis.

BACKGROUND: The use of bougies and balloons to dilate benign esophageal strictures (BES) is a consolidated procedure. However, the amount of evidence available in scientific literature supporting which is the best technique is very low, despite the great prevalence and importance of such pathology. This systematic review with meta-analysis aims at comparing both techniques, providing good quality of evidence. METHODS: We searched for randomized clinical trials (RCTs) published from insertion to November 2017, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, and grey literature. After the data extraction, a meta-analysis was performed. The main outcomes were symptomatic relief and recurrence rate. The secondary outcomes were bleeding, perforation, and postprocedure pain. RESULTS: We included 5 randomized clinical trials (RCTs), totalizing 461 patients. Among them, 151 were treated with bougie dilation and 225 underwent balloon dilation. Regarding symptomatic relief, recurrence, bleeding, and perforation rates, there were no differences between the methods. Concerning postprocedure pain, patients submitted to balloon dilation had less intense pain (RD 0.27, 95% IC -0.42 to -0.07, P = 0.007). CONCLUSION: We conclude that there is no difference between bougie and balloon dilation of BESs regarding symptomatic relief, recurrence rate at 12 months, bleeding, and perforation. Patients undergoing balloon dilation present less severe postprocedure pain.