ESOPHAGEAL DILATION CAN BE DONE SAFELY USING SELECTIVE FLUOROSCOPY AND SINGLE DILATING SESSIONS

Maxims for safe esophageal dilation have included recommendations to u se fluoroscopy in all instances and to limit dilation sessions to 2-mm increments. We reviewed a 34-month experience of all esophageal dilat ions undertaken at a large multispecialty clinic to define adherence t o these recommendations and to delineate whether deviation was associa ted with significant complications. Four hundred thirty-two patients u nderwent 716 courses of esophageal dilation during this time, 92% of w hom had benign disease. Eighty-nine percent of patients were dilated w ith polyvinyl dilators (Savary/American) and only 8% of these patients required fluoroscopic monitoring for the bougienage. Seventy-eight pe rcent of the dilating sessions for patients without achalasia were und ertaken using either a single large dilator (greater than or equal to 45 Fr) or employed incremental dilator sizes > 2 mm (6 Fr) in a single session. There was a single perforation in 662 nonachalasia dilations and this was a consequence of attempted placement of an esophageal en doprosthesis. We conclude that use of guide wire technology and newer dilating techniques do away with the need for routine fluoroscopic con trol. Moreover, single large dilators or dilator increments > 2 mm may be safely used, contingent on endoscopic stricture assessment.