Team LivGastro provides utility based model of care that integrates specialists, primary care , laboratory, imaging and other health services to give patients a convenient and superior outcome along with a pleasant experience. Since we primarily focus on outdoor-patient care, on the site instant testing along with detailed and accurate results, we enable our patients and their families save
a lot of effort, time and money.
Chronic gastroesophageal reflux disease or GERD is considered to cause most benign strictures in the esophagus. Commonly known as ‘Peptic Strictures’, these generally occur in the distal esophagus and are shorter in length. As for proper diagnosis, even though symptoms such as difficulty in swallowing solid food, old history of GERD are often considered, endoscopy and barium meal swallow proves most accurate. As for the dilatory process, both endoscopy and dilation may be performed in one session.
Esophageal dilation is usually performed as ambulatory outpatient procedure using conscious sedation (topical anesthetic Oropharynx). However, sedation may not be required for uncomplicated bougie dilation for patients undergoing recurring procedures, while adequate Oropharyngeal topical anesthesia (1% lidocaine solution spray) serves the purpose.
As for dilators, there are two broad categories – (a) Mechanical (push-type or bougie); (b) Balloon type. Both types may or may not be used with a guide-wire. Among the mechanical dilators, the most commonly used is the Maloney (Medovations, USA) bougie dilator which is made of rubber, containing mercury or tungsten. It features a tapered tip and can be freely passed, sans any guide-wire. Yet another push-type dilator, the Savary-Gillard (Wilson-Cook, USA) is a tapered thermoplastic dilator that needs a guide-wire. Also used are the earlier rounded tip dilator (Hurst, Medovations, USA) and the wire-guided metallic olive-tip dilator (Eder-Puetow, Eder Instruments, USA). However, the dilation of the stricture take place by longitudinal force as well as radial force in progressive way as the larger part of the dilator passes through the stricture.
Balloon dilators, on the other hand, are passed through scope (TTS), while the dilation takes place by radial force as the balloon expands. Contemporary models of TTS balloon dilators (Boston Scientific Corp, USA) feature guide-wire competence, enabling expansion in three different dimensions at 1.5 mm increments, sans change of balloons.
Esophageal benign stricture dilation proves challenging, yet rewarding procedure for endoscopists all over our lonely planet. However, what matters most are endurance and the will to provide relief for the patient than craving for ultra-modern equipment.