ESOPHAGEAL DILATATIONS

Abstract

508 esophageal dilatations were performed in our unit from January 2003 to May 2005. These
dilatations were performed using Savary Gilliard dilator system. Instead of using image intensifier to confirm guide wire
position, abdominal palpation was used for this purpose. 508 dilatations were performed in a total of 119 patients. Sixty
three patients underwent more than one dilatation. 71 dilatations were performed under local anaesthesia using flexed
scope 437 were performed under general anaesthesia using rigid scope. Our postoperative observation protocol is
given which was developed to pick up iatrogenic esophageal tear at an early stage. Out of 508 dilatation performed,
18 perforations occurred. Eleven patients had a minor confined leak. They were managed conservatively and all
survived. Seven patients had a major leak. Out of those, three died resulting in an overall 0.59% procedure related
mortality, while mortality for major leak group was 43%. None of the patients undergoing dilatation under local
anaesthetic had a perforation. Following the protocol, no significant iatrogenic esophageal injury was missed. We
conclude that esophageal dilatation can safely be performed using Savary Gilliard dilator system. Correct positioning
of guide wire can confidently be confirmed by abdominal palpation in a large majority of patients. Minor leaks can be
managed conservatively with excellent outcome. A well functioning protocol to pick up any iatrogenic esophageal injury
early is vital to keep a dilatation programme safe.