■ Bougie Dilation
► Principle: Tapered bougies in graduated sizes are passed over a guide wire, converting longitudinal forces into radial forces that dilate the stricture.
- Requires frequent repetition
► Benign cicatricial strictures in the esophagus
- Peptic strictures
- Postoperative strictures
► Malignant strictures, before implanting a prosthesis
► Savary bougies, 5-20 mm in diameter
► Eder-Puestow dilators
► Other dilators
► 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.
■ 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.
► Benign pyloric strictures not treatable with bougies
► Benign peptic strictures of the pyloric region
► Some malignant strictures
► Balloon catheters of various designs (Fig. 4.52)
► 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
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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