Kadakia S C, Parker A, Carrougher J G, Shaffer R T
Department of Medicine, Brooke Army Medical Center, San Antonio, Texas.
Am J Gastroenterol. 1993 Sep;88(9):1381-6.
One hundred thirty-eight patients with esophageal stricture underwent polyvinyl bougie dilations whereby American Endoscopy dilators were passed over a marked guidewire that had been placed endoscopically. Fluoroscopy was not utilized during the dilations. The dilations were performed only after the guidewire was properly placed, with 60-cm markings at the incisors, which ensured that the tip of the guidewire was in the antrum. One hundred fourteen patients had benign strictures and 24 had malignant strictures. There were 197 sessions of dilations for a total of 748 individual dilations. In 97 of 138 patients, the guidewire was placed in the antrum under direct vision. The remaining 41 patients had significant esophageal stenosis which prevented passage of the endoscope into the stomach; therefore, the guidewire was placed by advancing it blindly through the stenosis. There were no procedure-related complications. During this period, eight patients were dilated without complications, using fluoroscopic placement of guidewire because endoscopic placement of the guidewire was not considered safe. We conclude that esophageal strictures can be safely dilated in most patients by means of the American Endoscopy dilator system and the marked guidewire without the aid of fluoroscopy.
138例食管狭窄患者接受了聚乙烯探条扩张术，即通过一根经内镜放置的有标记导丝，将美国内镜扩张器送过狭窄部位。扩张过程中未使用荧光透视。仅在导丝正确放置后进行扩张，导丝在切牙处有60厘米的标记，以确保导丝尖端位于胃窦部。114例患者为良性狭窄，24例为恶性狭窄。共进行了197次扩张，总计748次单次扩张。138例患者中有97例在直视下将导丝置入胃窦部。其余41例患者存在严重食管狭窄，导致内镜无法进入胃内；因此，通过盲目推进导丝穿过狭窄部位来放置导丝。无与操作相关的并发症。在此期间，有8例患者因认为内镜放置导丝不安全，采用荧光透视放置导丝进行扩张，未出现并发症。我们得出结论，在大多数患者中，借助美国内镜扩张器系统和有标记导丝，无需荧光透视即可安全地扩张食管狭窄。
