The importance of fluoroscopic guidance for Maloney dilation.

One hundred and forty-five patients were evaluated for the importance of fluoroscopic monitoring during Maloney esophageal dilation. In 35 patients (24%), fluoroscopy altered the dilation technique. Dilation of peptic strictures (27 of 75, 36%) was much more likely to be affected by fluoroscopy than Schatzki's rings (eight of 70, 11%, p < 0.05). Patients whose stricture was altered by fluoroscopy also had larger size hiatal hernias (6.5 vs. 4.3 cm, p < 0.05). Patients with Schatzki's ring with a hiatal hernia size of less than or equal to 4.0 cm did not benefit from fluoroscopy. In 26 of 35 cases, successful redirection of the dilator and passage under fluoroscopy was accomplished. In nine patients, Maloney dilation was impossible, and use of Savary wire-guided dilators was needed. We had no morbidity and mortality. We advise the use of fluoroscopy for Maloney dilation for peptic strictures and for large hiatal hernias.