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Esophageal dilation can be done safely using selective fluoroscopy and single dilating sessions
R A Kozarek1, D J Patterson, T J Ball
1Section of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98111-0900, USA.
Journal of Clinical Gastroenterology
|April 1, 1995
Summary
Esophageal dilation can be safely performed without routine fluoroscopy or strict 2-mm increments. Newer techniques and guidewire use allow for larger dilator sizes, reducing complications in esophageal stricture treatment.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Safety
Background:
- Traditional maxims for esophageal dilation recommend routine fluoroscopy and incremental dilator sizes (2-mm increments).
- These practices aim to minimize complications during esophageal dilation procedures.
Purpose of the Study:
- To evaluate adherence to established esophageal dilation recommendations.
- To determine if deviations from these recommendations are associated with significant complications.
Main Methods:
- Retrospective review of 716 esophageal dilation courses in 432 patients over 34 months.
- Analysis of dilation techniques, including fluoroscopic use, dilator types, and size increments.
- Correlation of dilation methods with complication rates, particularly perforations.
Main Results:
- Only 8% of dilations used fluoroscopic monitoring; 78% used single large dilators (>45 Fr) or >2 mm increments.
- A single perforation occurred in 662 non-achalasia dilations, unrelated to dilation technique.
- High adherence to polyvinyl dilator use (89%) was observed.
Conclusions:
- Routine fluoroscopic control is unnecessary with modern guidewire technology and dilation techniques.
- Incremental dilator sizes greater than 2 mm or single large dilators can be safely employed.
- Endoscopic stricture assessment is crucial for safe, individualized esophageal dilation.