Dilation of difficult gastrointestinal strictures using a modified wire-guided technique.

We describe here 18 patients with gastrointestinal strictures through which a standard guide wire could not be passed, and which were dilated using a modified technique. After a 0.035" guide wire had been passed through a 5-Fr metal-tipped catheter, the narrow strictures were dilated using a 10-Fr biliary dilator. A modified Savary-Gilliard guide wire (olive-tipped with a hole) was passed over the 0.035" guide wire beyond the stricture. After removing the 0.035" guide wire, the strictures were dilated with Savary-Gilliard dilators passed over the olive-tipped guide wire. Seventeen patients had upper gastrointestinal strictures, and one had a sigmoid colon stricture. The strictures were caused by tumor in two, radiation therapy in six, esophagogastric resection for cancer in five, and a combination of two or more factors in five patients. The modified technique was successful in 17 patients, without any complications. Adequate symptomatic relief was achieved in 15 patients.