GIF type n-30 gastroscope for passage through esophageal strictures: An alternative to fluoroscopic placement of guide-wires for the dilation of impassable strictures

Guide-wire assisted esophageal dilation with fluoroscopy is an established and safe technique for the dilation of esophageal strictures that cannot be negotiated with an endoscope. However, the requirement for its use cannot be predicted prior to index endoscopy, which may necessitate repeated endoscopy when fluoroscopy is available. METHODS. An Olympus GIF type N-30 gastroscope (pediatric GI fiber-scope) was evaluated for passage through esophageal strictures that were impassable using a standard 9.8 mm gastroscope. The GIF N-30 has a 5.3 mm diameter with a standard 2.0 mm instrument channel. From 10/94 to 12/95 41 pts with esophageal strictures that would not allow passage of a standard 9.8 mm endoscope were evaluated. The pts ranged in age from 54 to 86 yrs (Mean 71.0, 26M). The esophageal strictures were neoplastic in 23 pts: adenocarcinoma-12, squamous Cell-8, lung cancer- 3. In 18 pts the strictures were benign: radiation- 7, Peptic-8, anastomotic- 2, and lye- 1. Mean stricture length was 5.59 cm and location was proximal-12, mid- 8, and distal- 21. RESULTS: At index endoscopy the N-30 gastroscope successfully passed 33 of 41 strictures (80.0%) that were impassable using a standard gastroscope. Success was achieved in 18/23 neoplastic strictures (78.2%) and in 15/18 benign strictures (83.3%). Conventional Savary dilation was then performed with the passage of standard guide-wires followed by dilators. The N-30 successfully traversed strictures in 3 pts who had failed fluoroscopic attempts at guidewire placement during index endoscopy. No complications were experienced. In the 8 pts who had impassable strictures: 5 had repeated endoscopy that same day when fluoroscopic time was available, but required resedation; 3 pts were rescheduled with fluoroscopy on another day. Fluoroscopic guide-wire placement followed by stricture dilation was successful in all 8 pts. CONCLUSIONS: (1) The N-30 gastroscope is safe and effective for passing esophageal strictures through which standard gastroscopes cannot pass. (2) The scope offers a viable alternative at index endoscopy in cases of impassable strictures and may obviate another endoscopic session when fluoroscopy is not readily available.