Wireguided Polyvinyl Dilators

The Savary and Eder-Puestow dilators are mechanical dilators passed through strictures over a previously passed guidewire. The Savary has largely replaced the olive-shaped Eder-Puestow dilators, which were developed before flexible endoscopy. The Savary dilators are reusable, noncom-pressible, gradually tapered dilators (see Figure 17-1). These ditators contain a central opening through which a guidewire can be passed. They also contain radiopaque markers to aid in fluoroscopic detection. A kit of these dilators includes various sizes in 3 F (1 mm) intervals up to a size of 60 F (20 mm). The set also includes replacement guidewires, which is marked at standard lengths. These dilators are strongly recommended over unguided dilators when dealing with narrow, complicated strictures or anatomic abnormalities, such as esophageal diverticula or large hiatal hernias (Kadakia et al, 1991; Anand, 1992). They also are used when unguided dilators are unsuccessfully passed through a stricture. Disadvantages to these dilators are the need for fluoroscopy or endoscopy to properly position the guidewire. In addition, guidewire associated complications can occur. Bends in the wire can lead to point of trauma in either the esophagus or gastric mucosa. Curling of wire can also lead to inadequate passage of the dilator and laceration or hematoma. Despite these potential complications, the morbidity and mortality is low when using these dilators (Marshal et al, 1996).

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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