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A novel approach to facilitate dilation of complex non-traversable esophageal strictures by efficient wire exchange
1Endoscopy Section, Beebe Medical Center, Lewes, DE 19958, USA.
Background:
Dilation of non-traversable complex strictures is frequently difficult. For a tight stricture, over-the-wire dilation is difficult using a flexible biliary guidewire as opposed to a more rigid guidewire with a spring tip made for use with polyvinyl over-the-wire dilators (Savary). However, passage of the more rigid, spring-tipped wire is not always possible. A new method is discussed here whereby a biliary guidewire is exchanged consistently with a rigid, spring-tipped wire to facilitate dilation of complex strictures.
Methods:
The wire exchange was carried out using a 10F stent pusher. The latter is readily available and semi-rigid, and its large lumen easily accommodates a Savary guidewire. Furthermore, because it can be passed through an endoscope, it can be passed without difficulty through an extremely tight stricture because the device does not buckle in the proximal esophagus or mouth.
Results:
Dilation was successful in 6 patients using this technique with no complications. Four patients required placement of the stent pusher through a therapeutic endoscope.
Conclusion:
A method is described that facilitates dilation of complex, tight esophageal strictures by exchange of a flexible biliary guidewire with a more rigid Savary wire using a stent pusher.