Blindly Passed Dilators

The two types of unguided bougies are the Maloney and Hurst dilators. The Hurst was the first of these dilators to be developed and consists of a mercury core encased by a rubber shell with a blunt end. The Maloney is a modified version of the Hurst, which has a tapered end instead of a blunt end (Figure 17-1). This improved design allows for easier entry into the esophagus with less shearing stress and is therefore the more common of the unguided dilators used today. These dilators used to be known as the mercury filled dilators, but this potentially toxic metal has been removed from all new dilators. Maloney dilators are made in a variety of sizes up to 60 F (20 mm) although dilators

< 30 F are rarely used. Success rates between 80 and 98% have been seen using the Maloney dilator (Wesdorp et al, 1982). Morbidity rates of 4% and a perforation rate of up to 0.3% have been documented (Hernandez et al, 2000). The use of dilators without the guidance of a wire or endoscopy should be limited. Clearly, only uncomplicated, relatively wide diameter strictures in an esophagus without diverticula or tortuousity should be considered for such techniques. Historically, Maloney dilators have often been favored because of their low cost, ease of use, relative safety, and because they are easily reusable. Furthermore, dilatations using the Maloney can be performed without sedation or fluoroscopy in a cooperative patient. (Pereira-Lima et al, 1999; McClave et al, 1993). Such an approach was common in the era before proton pump inhibitors (PPIs) were used to treat reflux. The major disadvantages of these dilators are that they have the ability to coil in the esophagus above a narrow stricture, a tumor shelf, or a large hiatal hernia. The use of fluoroscopic guidance in preventing these complications is controversial. It is believed that fluoroscopy is most useful in patients with large hiatal hernias or peptic-induced strictures rather than Schatzi's ring (Tucker, 1992). In addition, fluoroscopy has been shown to improve relief of dysphagia and luminal patency over the blinded techniques.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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