Dilation of the Esophagus: Wire-guided Bougie (Savary, American) and Balloon Dilators

Dilation of the Esophagus: Wire-guided Bougie (Savary, American) and Balloon Dilators

Chanakyaram A. Reddy, MD

Joan W. Chen, MD, MS

The two most common types of esophageal dilators used in endoscopy suites are fixed-diameter push-type “bougies” and balloons. Bougie dilators apply radial and axial forces along the entire stricture length, while balloon dilators apply radial force to portions of the stricture that come into contact with the balloon.

Wire-guided, compared to non-wire-guided, dilation offers the ability to dilate difficult and convoluted strictures with some control over the path of the bougie. Both of the two available systems, the Savary-Gilliard and the American endoscopy systems, offer a wire with a spring tip for insertion into the stomach. Neither system has been demonstrated to be superior to the other with respect to safety or quality of the dilation.

There are several esophageal balloon dilators with a variety of designs, lengths, and calibers. These include single-diameter or multiple sizes that can be used over a guidewire or through-the-scope (TTS). This chapter will focus on the use of TTS balloon dilators as this method allows for dilation at multiple sizes with one instrument and is more commonly used than other types of balloon dilators in current endoscopy practices. Balloons are expanded by injection of liquid (water or radiopaque contrast to facilitate fluoroscopic visualization if needed) with use of a handheld accessory.

Both wire-guided bougie and TTS esophageal dilators are commonly used without clear data indicating significant differences in efficacy or adverse events between the two techniques.1 Decision-making in regards to which dilation method to use may vary based on institutional practice, operator experience, or the location and characteristics of the stricture. Balloon dilators are usually limited to short-segment, mid to
distal esophageal strictures; whereas, bougie dilators can be used in long-segment and proximal strictures and in a diffusely narrowed esophagus. TTS balloon dilators require a 2.8 mm working channel and are not compatible with the majority of smaller-caliber endoscopes such as a neonatal endoscope. Furthermore, bougie dilators are reusable while majority of balloon dilators are single-use only. Lastly, TTS balloon dilators lack tactile feel that can be appreciated while using push-type bougie dilators but do offer direct endoscopic visualization of the dilation, and the use of multidiameter balloon dilators may shorten procedure time.


  • 1. Extrinsic malignant compression

  • 2. Motility disorders

  • 3. Empiric dilation for dysphagia with normal endoscopic findings2,3


  • 1. Subjects should be NPO for 6 hours prior to the examination.

  • 2. Obtain written consent.

  • 3. Administer a topical anesthetic for pharyngeal anesthesia.

  • 4. Start an intravenous line for the administration of systemic sedation.


May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Dilation of the Esophagus: Wire-guided Bougie (Savary, American) and Balloon Dilators
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