During the senior author’s residency, he was instructed by a respected faculty member not to introduce a rigid esophagoscope with more than 2 pounds of pressure. A 2-pound “push” was measured with weights, and the 2-pound rule was adhered to as much as possible during esophageal dilations throughout the senior author’s career. The results were satisfactory in terms of complications. Details of this dilation technique have not been previouslyreported.Inthisarticle,wediscusstheseniorauthor’s experience with 1,226 esophageal dilations, patient complications, and the dilation technique used, with an emphasis on safety measures. Methodology Records of dilations performed by the senior author were reviewed. Patients with empiric dilation of the upper esophagealsphincterandpatientsundergoingdilationduring operations were included. Patients who had a dilator placed for intraoperative calibration of a Nissen fundoplication or diaphragm closure were excluded. Pneumatic dilation for achalasia was not included in this series. The number of patients was tabulated, and patients experiencing potentially serious complications were reviewed. Technique With the patient in the left lateral decubitus position after endoscopy,oneofthreetechniqueswasused,dependingon the following circumstances. The Savary guidewire system (Bard Interventional Products) was used for patients with a tortuous esophagus, esophageal diverticuli, cancer, a smallcaliber peptic stricture, an obstructing lesion longer than 3 cm, an esophageal anastomosis, or a previous fundoplication. The Hurst Maloney system (Medovation) was used for patients with a straight esophagus. A water-filled balloon system (Boston Scientific Corp) was used for patients with anastomotic strictures in which Decadron (Merck) was to be injected. Savary guidewire system At endoscopy, the guidewire was introduced through the endoscope biopsy channel after being lubricated with a silicon spray or gel. The spring tip was placed next to, but not necessarily through, the pylorus. The endoscope was removed over the guidewire incrementally, with the operator calling out “five” each time the guidewire was pushed 5 cm into the endoscope. At the time of the “five,” the nurse assistant pulled 5 cm of endoscope out, using the face plate of the bite block as the point of reference. After the endoscope was off the guidewire, the size of the first dilator was chosen on the basis of endoscopic findings. If the endoscope was too large for the obstructing lesion, a pediatric endoscope or a transnasal endoscope was used. If the latter could not pass the obstruction, the guidewire wasadvancedslowlyuntillightresistancewasencountered. This was done only if the lumen could be seen beyond the obstruction; otherwise, the procedure was performed under fluoroscopic control. All Savary dilators in our laboratory have been marked