September 24, 1932


Author Affiliations

Boston; Guatemala

From the Gastro-Intestinal Clinic, the Boston City Hospital, and the Department of Medicine, Tufts College Medical School.

JAMA. 1932;99(13):1084-1085. doi:10.1001/jama.1932.27410650001011a

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The necessity of using a guide for the passage of esophageal dilators, when dilation is done by so-called blind bouginage (i. e., without direct visualization through the esophagoscope) has been recognized. Plummer and Mixter have advised the swallowing of many feet of thread in the hope that this will have passed the obstruction and become entwined in the intestine; the thread held taut may then be used as a guide by inserting it into a suitable opening in the tip of the dilating instrument. In spite of the physician's most painstaking instructions and the cooperation of an intelligent patient, this often fails to pass the obstruction or becomes knotted and is thus useless for the passing of the instrument. Such difficulties are found more particularly in cardiospasm, in which the thread becomes enmeshed in the sac oral to the obstruction.

It is well known that the old-fashioned stomach tube (Ewald

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