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Oesophageal dilators or bougies have been used since the Middle Ages. Early bougies were made of natural materials and were used to disimpact food boluses by pushing them “blindly” into the stomach. The technique of oesophageal dilatation has evolved considerably in recent years. A range of purpose built dilators is now available, and with present day diagnostic techniques it is possible to select a dilator and dilatation technique appropriate to the clinical setting.
The relatively low morbidity and mortality of oesophageal dilatation has encouraged its widespread use. Despite this wealth of clinical experience however, the practice of oesophageal dilatation has been subject to surprisingly few controlled studies. The purpose of these guidelines is to highlight areas of good practice and promote the use of standardised protocols within and between centres.
2.0 FORMULATION OF GUIDELINES
These guidelines have been produced to conform to the North of England evidence based guidelines development project.12 They are based on a Medline literature search using the search term “oesophageal dilatation” and on expert opinion and review. Although oesophageal dilatation may be performed during rigid oesophagoscopy and under radiological screening, this guidance relates primarily to oesophageal dilatation performed during flexible upper gastrointestinal endoscopy. Oesophageal dilatation in the paediatric population is considered outside the scope of these guidelines.
2.1 Categories of evidence
The strength of evidence used to formulate these guidelines was graded according to the following system:
Ia—Evidence obtained from meta-analysis of randomised controlled trials.
Ib—Evidence obtained from at least one randomised controlled trial.
IIa—Evidence obtained from at least one well designed controlled study without randomisation.
IIb—Evidence obtained from at least one other type of well designed quasi experimental study.
III—Evidence obtained from well designed non-experimental descriptive studies such as comparative studies, correlation studies, and case studies.
IV—Evidence obtained from expert committee reports or opinions, or clinical experiences of respected authorities.
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