Upper Gastrointestinal Stenoses Dilation Methods

■ Bougie Dilation

Principle and Key Characteristics

► Principle: Tapered bougies in graduated sizes are passed over a guide wire, converting longitudinal forces into radial forces that dilate the stricture.

► Disadvantages

- Laborious

- Requires frequent repetition

Indications

► Benign cicatricial strictures in the esophagus

- Peptic strictures

- Postoperative strictures

► Malignant strictures, before implanting a prosthesis

Materials

► Savary bougies, 5-20 mm in diameter

► Eder-Puestow dilators

► Other dilators

Technique

► Pass a guide wire under endoscopic vision.

► If endoscopy is not possible, place the guide wire under fluoroscopic guidance.

► Check the wire position fluoroscopically.

► Carefully insert the smallest bougie.

► Check endoscopically for esophageal tears.

► Progressively increase the size of the bougies in 1 mm increments.

► Pass three dilators per session.

Complications

► Perforation

■ Balloon Dilation

Principle and Key Characteristics

► Principle: A balloon is passed into the stenosis and inflated.

► The inflation exerts radial forces that dilate the stenosis.

Indications

► Benign pyloric strictures not treatable with bougies

► Benign peptic strictures of the pyloric region

► Some malignant strictures

Materials

► Balloon catheters of various designs (Fig. 4.52)

Technique

► Three techniques are available for balloon placement:

1. Pass a guide wire under endoscopic vision. Remove the endoscope, advance the dilating balloon over the guide wire into the stenosis (through-the-channel, TTC), and inflate the balloon.

2. Visualize the stenosis endoscopically. Pass a dilating balloon down the instrument channel of the scope and advance it into the stenosis (through-the-scope, TTS). Inflate the balloon.

3. Mount the dilating balloon on the endoscope, advance the endoscope-balloon assembly into the stenosis, and inflate the balloon.

► Duration: one to three minutes

Complications

► Perforation

1

Fig. 4.51 Balloon dilation in achalasia. The endoscope is visible next Fig. 4.52 Systems for balloon dilation to the dilating balloon

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