Benign oesophageal strictures: historical and technical aspects of dilatation

A review of the different bougies used over the years confirms that the dilators presently available are adequate for the conservative management of oesophageal benign strictures. Most of these are of an old but well-tested design. Several additional techniques may have to be tried in difficult patients. Dysphagia can be relieved by the passage os size 39 FG bougies but many will wish to increase this to 60 FG, if it is possible. Failure of conservative management by dilatation only can be defined as (a) technical impossibility to dilate sufficiently to relieve the dysphagia, which is rare, or (b) when the patient or the surgeon considers the procedure is being done too frequently, which must be measured in FG for the bougie and weeks for frequency. The more expert the surgeon becomes at dilatation, the safer it will become, and the necessity for surgical intervention will be less frequent.