ESOPHAGEAL DILATION WITH POLYVINYL (AMERICAN) DILATORS OVER A MARKED GUIDEWIRE - PRACTICE AND SAFETY AT ONE-CENTER OVER A 5-YR PERIOD

Objective: Improvements in dilator technology over the past decade hav e revolutionized esophageal dilation, There remains, however, a number of controversies relating to several technical aspects of wire-guided dilation, including whether or not fluoroscopy is necessary, We descr ibe our experience with wire-guided esophageal bougienage, Methods: We retrospectively reviewed our experience with esophageal dilation usin g polyvinyl (American) dilators and marked guidewires over the period 1990-1994 to assess the practice habits of our endoscopists and the sa fety of the technique, We did 606 wire-guided dilations on 354 adult p atients, Dilations were done by six different endoscopists, Results: F luoroscopy was used in only 32/606 dilations (5.3%) and then only to p ass a guidewire when the scope could not be passed through the strictu re, Fluoroscopy was not used to monitor dilator passage, Peptic strict ures were dilated to their maximal target size (determined by the indi vidual endoscopist) in one session in 195 of 253 instances (77.1%), Pr actice differences were seen between the individual endoscopists relat ing to how rapidly dilation was accomplished, the number of dilators p assed per session, and the maximal dilator size passed, No perforation s or other serious complications occurred in our series, Conclusions: Wire-guided esophageal bougienage is a very safe procedure when carefu l attention to technique is observed, No perforations were seen in our series of over 600 dilations, Fluoroscopy is needed only in those cas es in which a scope cannot be passed through a stricture to assist wit h guidewire passage, In a majority of cases, peptic strictures can be dilated to a 45-to 51-Fr size in a single session.