Iftikhar Hussain Khan, Khalid Hussain Qureshi, Muhammad Masood Ur Rauf Khan, Fuadul Hasan Khan.
Use of abdominal palpation instead of image intensifier to confirm correct positioning of guide wire in esophageal dilatation using Savory Gilliard dilators.
Pak J Med Health Sci Jan ;5(4):731-4.

Esophageal dilatation using Savory Gilliard dilator system is performed by passing serial dilators over a guide wire. Correct placement of guide wire is usually confirmed by screening using an image intensifier before dilatation is performed. We use abdominal palpation instead of image intensifier to check position of the guide wire. Our technique and results of 531 esophageal dilatations attempted in our unit from January 2008 to May 2010 are presented. In 508 cases (95.7 %), position of the guide wire could confidently be confirmed to be in the stomach by palpation. In these cases dilatation was performed. 18 patients (3.5% of all the dilatations done) sustained an esophageal tear. Eleven patients had minor and confined leak. These patients were managed conservatively and survived. Seven patients had a major leak. Out of them three died (0.59% overall procedure related mortality). In 17 patients who sustained an esophageal tear, evidence suggests that position of guide wire was correct and esophageal perforation occurred because of error of judgment in selecting size of the dilator. We therefore conclude that abdominal palpation is a safe, practical and efficient method to confirm correct position of the guide wire before dilatation. With careful application of this technique, only in a very small fraction of the patients image intensifier is needed. This will help in more efficient use of resources and will save the patient from unnecessary radiation exposure.

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