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• W1992293107 abstract "Recent studies have placed emphasis on the position of the patient during esophageal dilation. Historically, esophageal dilation with the flexible Maloney dilator has been performed in the left lateral or the supine position.1Webb WA. Esophageal dilation: personal experience with current instruments and techniques.Am J Gastroenterol. 1988; 83: 471-475PubMed Google Scholar However, McClave et al.2McClave SA Wright RA Brady PG. Prospective randomized study of Maloney esophageal dilation: blinded versus fluoroscopic guidance.Gastrointest Endosc. 1990; 36: 272-275Abstract Full Text PDF PubMed Scopus (32) Google Scholar showed that dilation in this position frequently leads to improper passage of the dilator. The use of fluoroscopy to aid in the passage of the dilator has improved the accuracy and results of this technique.3Tucker LE. The importance of fluoroscopic guidance for Maloney dilation.Am J Gastroenterol. 1992; 87: 1709-1711PubMed Google Scholar, 4McClave SA Brady PG Wright RA Goldschmid S Minocha A. Does fluoroscopic guidance for Maloney esophageal dilation impact on the clinical endpoint of therapy: relief of dysphagia and achievement of luminal patency.Gastrointest Endosc. 1996; 43: 93-97Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar There is also very reliable passage of the Maloney dilator through the esophagus when patients are placed in the upright position.5Ho SB Cass O Katsman RJ et al.Fluoroscopy is not necessary for Maloney dilation of chronic esophageal strictures.Gastrointest Endosc. 1995; 41: 11-14Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 6Bailey AD Goldner F. Can clinicians accurately assess esophageal dilation without fluoroscopy?.Gastrointest Endosc. 1990; 34: 373-375Abstract Full Text PDF Scopus (12) Google Scholar Some experts have called for comparisons of different dilation techniques.7Graham DY. Fluoroscopy or no for esophageal dilation: the passing of an era.Gastrointest Endosc. 1996; 43 ([editorial]): 171-173Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar A theoretic disadvantage of the upright technique is that some patients require sedation for the dilation. Others have an endoscopy prior to the dilation. For Maloney dilation, we routinely sedate our patients and place them in the upright, sitting position. A special procedure bed (535 PACU stretcher/bed, Midmark Corp., Ohio) is used for all patients undergoing procedures in our endoscopy suite. This bed allows elevation of the head of the bed, while the patient remains lying down. Patients are given intravenous sedation with monitoring of heart rate, blood pressure, and oxygen saturation. The head of the bed is raised to 90° with the side rails up. The Maloney dilation is performed with the physician standing on a footstool to the right of the patient. The dilation may be performed alone or following an upper endoscopy. From November 1, 1993, to November 1, 1995, 103 patients (58 men and 48 women, mean age 57 years) underwent 189 sessions of Maloney dilation (85 dilations after endoscopy and 104 dilations alone). The amount of intravenous sedation given was 80 ± 25 mg of meperidine, with 5 ± 3 mg of diazepam or 5 ± 3 mg of midazolam. The number of dilators used per session was 3 ± 2. The sizes of initial and final dilators per session were 45F ± 6F and 49F ± 5F, respectively. There were no hemodynamic complications. Dilation sessions were generally considered to be successful. In the 44 patients (43%) dilated for peptic stricture, only 1.3 ± 0.9 sessions per patient were required. In the 13 (13%) patients dilated for Schatzki's ring, only 1.3 ± 0.5 sessions per patient were required. Maloney dilation of the esophagus is safe and effective in a sedated patient placed in the upright position. Patients who require sedation or who have completed an endoscopy do not have to have esophageal dilation in an unsatisfactory position or be exposed to the risk of fluoroscopy to have a successful dilation session." @default.
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• W1992293107 date "1996-12-01" @default.
• W1992293107 modified "2023-09-26" @default.
• W1992293107 title "Esophageal dilation in the sitting, sedated patient is safe and effective" @default.
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• W1992293107 doi "https://doi.org/10.1016/s0016-5107(96)70074-3" @default.
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