Retrograde esophageal dilation using Savary dilators.

摘要

The technique of dilation for esophageal strictures has been practiced since the Middle Ages, with the technique of retrograde dilation described as early as the 1830s.1 Antegrade techniques were often inadequate in long, thick strictures because of the high risk of perforation, and retrograde techniques were favored. Fortunately, public health messages regarding poison prevention have reduced this injury, but a large number of patients still require dilation of the esophagus for various other pathologies.As dilation of the esophagus has moved to the endos-copy suite, the pathology requiring dilation is usually less severe. These strictures are quite amenable to antegrade dilation using unguided bougienage, wire guided Savary dilation, or balloon dilation. In the unusual circumstance that passage of an antegrade wire is impossible because of distortions of the anatomy and severity of the stricture, retrograde passage of a guidewire allows for safer passage of antegrade dilation. On the occasion of a severe, long stricture, the use of retrograde dilation such as the Eder-Puestow method may be preferable because of the reported reduced complication rates. Because of the infre-quency of these cases, many modern endoscopy suites are unequipped for, untrained in, or unfamiliar with retrograde techniques. We present a simple, unique retrograde dilation technique using the Savary dilator system, which is both available and familiar to most endoscopists. Use of this technique may be beneficial in the care of a patient with a severe esophageal stricture who is at high risk of injury when using a more standard antegrade technique.