Placement of Guidewire for Esophageal Dilation Improved Technique Joseph

D.

Marco, MD, Raymond M. Keltner, MD

esophageal strictures with dilators passed guidestring or guidewire is of proven usefulness. Techniques for the placement of such a guidewire include that originally described by Sippy in 1913, which depends on peristalsis for the passage of a string. Passage of a flexible wire with the aid of fluoroscopy or a conventional esophagoscope improved the original technique. The major disadvantage with these techniques is that the tip of the wire cannot be controlled for passage through the immediate area of the cicatricial narrowing. In difficult cases with marked narrowing, perforation is a likely complication. The most recent fiberoptic gastroscopes can be very ac-

Dilation

of

over a

for publication Feb 6, 1975. From the Department of Surgery, St. Louis City Hospital, Unit II Surgery, St. Louis University Medical School, St. Louis. Reprint requests to Department of Surgery, St. Louis University, 1325 S Grand Blvd, St. Louis, MO 63104 (Dr. Marco).

Accepted

Gastroscope, illustrating dilator guidewire within

access

curately controlled while in the lumen of the esophagus. It has been determined that the guidewire from a Peustow esophageal dilation set passes readily through the biopsyaspiration channel of a fiberoptic gastroscope (Figure). This permits passage of the guidewire through a stricture very precisely and under direct vision. METHOD The fiberoptic gastroscope is introduced with the patient in the left lateral decubitus position. The instrument is guided through the anesthetized pharynx by palpation of the glottis with the sur¬ geon's nondominant hand. Following introduction into the esoph¬ agus, the stricture is identified. The guidewire of the Peustow dilator set is then passed through the biopsy-aspiration channel until the tip of the wire is just visible through the fiberoptic gas¬ troscope. The wire may then be passed easily and precisely through the stricture. The esophagoscope is then removed, the wire remaining in place. The stricture may then be dilated by the usual technique with the Peustow instrument.

lumen.

Downloaded From: http://archsurg.jamanetwork.com/ by a New York University User on 05/18/2015

Placement of guidewire for esophageal dilation. Improved technique.

Placement of Guidewire for Esophageal Dilation Improved Technique Joseph D. Marco, MD, Raymond M. Keltner, MD esophageal strictures with dilators p...
1MB Sizes 0 Downloads 0 Views