Technique

A complete endoscopic examination is performed in the standard left lateral position. The patient is then positioned in either an upright position or in a left lateral position at 30 degrees in preparation for the dilatation. The upright position may be awkward in a sedated patient but has been associated with better success rates. The patient's chin should be tilted downward to reduce the angle leading into the laryngeal vestibule and to facilitate passage into the esophagus. The patient's pharynx should be anesthetized with topical spray and the dilator should be lubricated in preparation for the procedure. Two of the endoscopist's fingers (preferably the fellow's fingers) should be used to hold down the tongue in order to guide the dilator away from the hard and soft palate at the appropriate angle. The dilator is rotated both clockwise and counterclockwise while it is maneuvered down the esophagus. The dilator is then removed with a steady, swift movement.

FIGURE 17-1. The top dilators represent tungsten filled Maloney dilators. The bottom two dilators are wire guided Savary dilators. The marked guidewire and hemostats are included.
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Constipation Prescription

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