Technique of esophageal dilation

The widespread use of flexible upper gastrointestinal (GI) endoscopy has renewed interest in management of strictures of the esophagus, including dilation. The rubber Maloney dilator is the most common dilator used, usually for symmetrical strictures 1.2 cm or greater in diameter. The "through the scope" (TTS) balloon dilators usually are used in asymmetrical strictures 1.2 cm or greater in diameter and are especially valuable if fluoroscopy is not available. The new thermoplastic Savary dilators, used with a guidewire and usually with fluoroscopy, have replaced the Eder-Puestow bougies. They are especially useful in difficult strictures that are 1.0 cm or less in diameter and are fibrotic or have transmural fibrosis.