Parasher V K
Endoscopy Section, Beebe Medical Center, Lewes, DE 19958, USA.
Gastrointest Endosc. 2000 Jun;51(6):730-1. doi: 10.1067/mge.2000.105072.
Dilation of non-traversable complex strictures is frequently difficult. For a tight stricture, over-the-wire dilation is difficult using a flexible biliary guidewire as opposed to a more rigid guidewire with a spring tip made for use with polyvinyl over-the-wire dilators (Savary). However, passage of the more rigid, spring-tipped wire is not always possible. A new method is discussed here whereby a biliary guidewire is exchanged consistently with a rigid, spring-tipped wire to facilitate dilation of complex strictures.
The wire exchange was carried out using a 10F stent pusher. The latter is readily available and semi-rigid, and its large lumen easily accommodates a Savary guidewire. Furthermore, because it can be passed through an endoscope, it can be passed without difficulty through an extremely tight stricture because the device does not buckle in the proximal esophagus or mouth.
Dilation was successful in 6 patients using this technique with no complications. Four patients required placement of the stent pusher through a therapeutic endoscope.
A method is described that facilitates dilation of complex, tight esophageal strictures by exchange of a flexible biliary guidewire with a more rigid Savary wire using a stent pusher.
不可通过的复杂性狭窄的扩张常常很困难。对于紧密狭窄，与用于聚乙烯套叠式扩张器（Savary）的带有弹簧尖端的更硬导丝相比，使用柔性胆道导丝进行导丝引导下的扩张很困难。然而，更硬的、带有弹簧尖端的导丝并不总是能够通过。本文讨论了一种新方法，通过该方法可将胆道导丝持续更换为刚性的、带有弹簧尖端的导丝，以促进复杂性狭窄的扩张。
使用10F支架推送器进行导丝更换。后者容易获得且为半刚性，其大腔道可轻松容纳Savary导丝。此外，由于它可以通过内窥镜，所以可以毫无困难地通过极其紧密的狭窄，因为该装置不会在食管近端或口腔中弯曲。
使用该技术，6例患者扩张成功，无并发症。4例患者需要通过治疗性内窥镜放置支架推送器。
描述了一种通过使用支架推送器将柔性胆道导丝更换为更硬的Savary导丝来促进复杂性紧密食管狭窄扩张的方法。
