Introduction: Recent evidence supports performing esophageal dilation with Maloney dilators in the sitting position. However, some patients require sedation while others have an endoscopy, making dilation in the upright position questionable. We routinely sedate our patients for esophageal dilation and place them in the upright, sitting position. Aim: To review our experience in performing Maloney dilation in the sitting sedated patient. Methods: A special procedure bed (535 PACU stretcher/bed, Midmark Corp., Ohio) was used for all patients undergoing procedures at our endoscopy suite. This bed allows elevation of the head of the bed while the patient remains lying down. Patients were given intravenous sedation for Maloney dilation, either alone or in combination with upper endoscopy. The patient was placed in the sitting position, head of the bed raised to 90 degrees, and side rails up. Patient monitoring included blood pressure, heart rate, and oxygen saturation. The Maloney dilation was performed with the physician standing on a foot stool to the right of the patient. All parameters will be presented as mean ± standard of deviation. Results: From 11/1/93 to 11/1/95, 103 patients (55M/48F, mean age 57 yrs) 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 in conjunction of 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 45 ± 6 french and 49 ± 5 french respectively. 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. There were no complications observed. Conclusions: 1) Maloney dilation can be performed safely and effectively in a sedated patient in the upright, sitting position.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging