Comparison among the perforation rates of Maloney, balloon, and savary dilation of esophageal strictures.
BACKGROUND
Traditionally, mercury-filled rubber bougies are used for dilation of simple or mild-to-moderate esophageal strictures, whereas through-the-scope balloon dilators and wire-guided polyvinyl bougies have become standard for more complex strictures. Because few comparative trials are available, the choice of dilator and technique is largely based on the training and experience of the operator.


METHODS
We reviewed 348 esophageal dilation procedures performed on a total of 142 patients over a 4-year period (January 1, 1993, to January 1, 1997). The location and cause of stricture, the maximum diameter of the instrument used per session, the rate of perforation, and the rate of fluoroscopy use were recorded.


RESULTS
Maloney, balloon (hydrostatic and pneumatic type), and Savary dilations were performed in 102, 156, and 90 sessions, respectively. Perforations occurred in 4 patients. All of these perforations occurred when Maloney dilators were passed blindly into complex strictures (Fisher's exact test, p = 0.011, two-tailed). Three of these four patients had undergone endoscopy with conscious sedation immediately before the dilation. The immediate outcome of surgery was good in all 4 patients with no deaths.


CONCLUSIONS
Perforation was most commonly associated with the blind passage of Maloney bougies into complex strictures.
Hernandez
L V
LV
Department of Medicine, Section of Gastroenterology, University of Wisconsin Medical School, Milwaukee Clinical Campus, Sinai-Samaritan Medical Center, Milwaukee, Wisconsin, USA.
Jacobson
J W
JW
Harris
M S
MS
Hernandez
L J
LJ
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D004869:Equipment Safety; D004939:Esophageal Perforation / Q000453:epidemiology* / Q000209:etiology*; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment