Dilatation Procedures Using Benzalkonium Chloride

Introduction to Dilatation Procedures

The American Gastroenterological Association recommends limiting the frequency of dilatations, performing weekly or two-weekly dilatation sessions only until reaching the target diameter (typically ≥15 mm) along with symptomatic improvement, to minimize the risk of tissue damage associated with benzalkonium chloride (BAK) [1]
The European Association for the Study of the Liver suggests selecting a balloon caliber up to the maximum caliber of the ducts delimiting the stricture and avoiding oversizing, which may increase the risk of perforation [2]

The American Gastroenterological Association advises monitoring for complications during and after dilatation procedures, watching for persistent pain, fever, breathlessness, or tachycardia, which may indicate complications, and providing patients with contact information for the on-call team should they experience concerning symptoms [1]
Patients with complex strictures (post-radiation, caustic, long, angulated, or multiple) may require more dilatations but also carry a higher risk of complications [1]

The American Gastroenterological Association recommends considering alternative treatment methods, such as surgical options, for complex strictures or patients requiring multiple dilatations, as repeated dilatations may indicate poor long-term response to dilatation therapy [1]
For patients requiring frequent repeat dilatations, evaluation for alternative treatment approaches is necessary to minimize the risk of permanent tissue damage [1]