Objective: Improvements in dilator technology over the past decade have 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 describe our experience with wire-guided esophageal bougienage.
Methods: We retrospectively reviewed our experience with esophageal dilation using polyvinyl (American) dilators and marked guidewires over the period 1990-1994 to assess the practice habits of our endoscopists and the safety of the technique. We did 606 wire-guided dilations on 354 adult patients. Dilations were done by six different endoscopists.
Results: Fluoroscopy was used in only 32/606 dilations (5.3%) and then only to pass a guidewire when the scope could not be passed through the stricture. Fluoroscopy was not used to monitor dilator passage. Peptic strictures were dilated to their maximal target size (determined by the individual endoscopist) in one session in 195 of 253 instances (77.1%). Practice differences were seen between the individual endoscopists relating to how rapidly dilation was accomplished, the number of dilators passed per session, and the maximal dilator size passed. No perforations or other serious complications occurred in our series.
Conclusions: Wire-guided esophageal bougienage is a very safe procedure when careful attention to technique is observed. No perforations were seen in our series of over 600 dilations. Fluoroscopy is needed only in those cases in which a scope cannot be passed through a stricture to assist with guidewire passage. In a majority of cases, peptic strictures can be dilated to a 45-to 51-Fr size in a single session.