Esophageal Dilators

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The dilatation of cicatricial stenosis of the

esophagus can be done safely only by endoscopic methods. Blind

esophageal bouginage is highly dangerous, for the lumen of the

stricture is usually eccentric and the bougie is therefore apt to

perforate the wall rather than find the small opening. Often there is

present a pouching of the esophagus above a stricture, in which the

bougie may lodge and perforate. Bougies should be introduced under

visual guidance through the esophagoscope, which is so placed that the

lumen of the stricture is in the center of the endoscopic field. The

author's endoscopic bougies (Fig. 40) are made with a flexible

silk-woven tip securely fastened to a steel shaft. This shaft lends

rigidity to the instrument sufficient to permit its accurate

placement, and its small size permits the eye to keep the silk-woven

tip in view. These endoscopic bougies are made in sizes from 8 to 40,

French scale. The larger sizes are used especially for the dilatation

of laryngeal and tracheal stenoses. For the latter work it is

essential that the bougies be inspected carefully before they are

used, for should a defective tip come off while in the lower air

passages a difficult foreign body problem would be created.

Soft-rubber retrograde dilators to be drawn upward from the stomach by

a swallowed string are useful in gastrostomized cases (Fig. 35).

[FIG 38.--Half curved hook, 45 cm. and 60 cm. Full curved patterns are

made but caution is necessary to avoid them becoming anchored in the

bronchi. Spiral forms avoid this. The author makes for himself steel

probe-pointed rods out of which he bends hooks of any desired shape.

The rod is held in a pin-vise to facilitate bending of the point,

after heating in an alcohol or bunsen flame.]