Slow continuous dilatation of oesophageal strictures using the Didcott dilator, with reference to its wider use.
Acute dilatation or bouginage of strictures gives only temporary relief, and slow continuous dilatation was therefore tried and found to give superior results in treating benign and malignant strictures, particularly of the oesophagus. Slow stretch methods are discussed and compared with other methods. Methods are described that were evolved for dilating both by the 'acute' and slow-continuous methods, including use of the Didcott dilator (DD), invented in 1956. For oesophageal cancer this, combined with brachytherapy, has resulted in increased longevity and quality of life. Mortality from the dilatation and introduction of a DD for a week, followed by its removal without anaesthesia, is less than 2%. Relief of dysphagia lasts 2-10 months. Thereafter the procedure can be repeated and finally, when the patient is obviously near-terminal, a permanent indwelling stent can be used. This can be a modified DD stent or a Livingstone or Celestin tube. These are also used in tracheo-oesophageal fistulas. Complete cure is often possible in benign strictures, especially if short.