ESOPHAGEAL DILATATIONS

Abstract

508 esophageal dilatations were performed in our unit from January 2003 to May 2005. Thesedilatations were performed using Savary Gilliard dilator system. Instead of using image intensifier to confirm guide wireposition, abdominal palpation was used for this purpose. 508 dilatations were performed in a total of 119 patients. Sixtythree patients underwent more than one dilatation. 71 dilatations were performed under local anaesthesia using flexedscope 437 were performed under general anaesthesia using rigid scope. Our postoperative observation protocol isgiven 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 allsurvived. Seven patients had a major leak. Out of those, three died resulting in an overall 0.59% procedure relatedmortality, while mortality for major leak group was 43%. None of the patients undergoing dilatation under localanaesthetic had a perforation. Following the protocol, no significant iatrogenic esophageal injury was missed. Weconclude that esophageal dilatation can safely be performed using Savary Gilliard dilator system. Correct positioningof guide wire can confidently be confirmed by abdominal palpation in a large majority of patients. Minor leaks can bemanaged conservatively with excellent outcome. A well functioning protocol to pick up any iatrogenic esophageal injuryearly is vital to keep a dilatation programme safe.