Technique

The objective in using Savary dilators is to correctly place the guidewire across the stricture and into the antrum of the stomach. Either endoscopic or fluoroscopic assistance can be used to achieve this goal. In the endoscopic method, the endoscope is advanced carefully through the stricture and into the stomach. A guidewire is then passed through the endoscope under direct visualization and advanced into the antrum. In cases in which the endoscope cannot be passed through the stricture, it is prudent to advance the endoscope to the proximal edge of the stricture and then use fluo-roscopy to manipulate the guidewire past the stricture and into the stomach (Kadakia et al, 1993). In cases in which the guidewire meets resistance, it is prudent to withdraw a small portion of the wire, change the angle or wiggle the wire and then try to advance again. Some endoscopists have passed the wire through a tight untraversable stricture without the use of fluoroscopy; however, this is neither standard nor advisable. Once the guidewire is placed, the endoscope must be carefully removed without disturbing the position of the wire. This can best be accomplished by the "one to one" method in which an assistant withdraws the endscope as the endoscopist advances the wire in a one to one manner. Using the markings on the guidewire as the sole means for insuring placement has proved inaccurate with wire migration of up to 30 cm. Once the endoscope has been removed, a hemostat should be placed at the mouth to stabilize the wire in position. The dilator should then be passed over the guidewire to the level of the hemostat, and then a second hemostat is placed at the proximal end of the dilator. The hemostat at the mouth is then removed and the dilator is passed through the mouth and esophagus while it is carefully ensured that a constant length of wire remains outside the mouth. The dilator is passed expeditiously, but gently, using a rotating motion. The angle of the dilator should be as straight as possible and the guidewire should remain taut to prevent kinking. Once the dilator is fully inserted it can be removed over the wire. Up to 3 dilators (each 1 or 2 mm larger than the former) can be performed over the same wire at 1 session. If further dilatation is necessary, another session can be performed in 3 days.

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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