Breaking the “Rule of Three” for Esophageal Dilation

Adherence to the rule of three did not affect the rate of adverse events.

The “rule of three” in dilation of esophageal strictures suggests that in a single session, no more than three bougie dilators of sequentially larger size should be passed once moderate or greater resistance is evident. (Dilators passed with no or mild resistance do not count toward this total.) Despite its ubiquity in guideline and expert recommendations, this “rule” has never been validated.

In a retrospective chart review, researchers assessed the effect of the rule of three on adverse event occurrence in 297 randomly selected patients undergoing 2216 dilation sessions. Stricture features included proximal esophagus location (47%), benign (93%), radiation-related (22%), postsurgery-related (20%), and complex (67%; defined as asymmetric, w…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors