Using the DV8 Esophageal Retractor

DV8 Insertion Process

• NOTE: For the initial insertion, the contrast port orientation will indicate the direction of balloon deviation within the esophagus. If a temperature probe is being employed, place the temperature probe before inserting the DV8 retractor.

• Use a water-soluble lubricant to fully coat the balloon area of the DV8 Retractor prior to insertion.

• Under fluoroscopy, gently insert the DV8 Retractor into the esophagus. A laryngoscope may be used if desired. Use the distal radiopaque marker band to estimate insertion depth. Guide the device to the level of the diaphragm just above the gastroesophageal junction. Do not advance the distal tip of the esophageal retractor beyond the gastro-esophageal junction.

• Use the central marker bands to position the central section of the balloon where maximum retraction is desired

• Inject up to 20 ml of undiluted contrast through the contrast port to visualize the esophagus; gently slide the DV8 device “in and out” about 5 cm to insure uniform spread of the contrast media within the esophagus in the area of the balloon.

 

Retraction of the Esophagus 

• Fill the syringe inflation device with the 30% contrast/water solution. The device requires 35-40ml for full inflation. Attach syringe inflation device to the inflation port (stopcock); use an additional syringe as a reservoir if more volume is required to inflate the balloon.

• Inflate balloon using the syringe inflation device to 1-2 ATM to confirm orientation prior to full inflation.

• Gently slide the DV8 device “in and out” about 5 cm to minimize friction while rotating the device in a single direction until the desired orientation is achieved. If a temperature probe is used, orient it on the trailing edge of the esophagus (direction opposite deflection).

• Once orientation is satisfactory, continue inflation until desired amount of retraction is achieved (typically 6-8 ATM). If correct positioning is not achieved with inflation of 10 ATM consider reorientation of the device. After the esophageal retraction distance is judged to be sufficient, the balloon pressure can be reduced.

• Cushion the device shaft in the patient’s mouth.

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 DV8 Repositioning 

• Deflate the balloon leaving approximately 1–2 ATM residual pressure within the balloon to help the balloon rotate.

• Gently slide the DV8 Retractor “in and out” about 5 cm to enable easier rotation of the balloon section.

• Under fluoroscopic guidance, rotate the DV8 Retractor in a single direction until the new attitude of deflection reaches approximately 180º from the previous position.

• “Over-rotation” may be necessary to obtain desired orientation.

• Once the desired orientation is achieved, inflate the balloon with 30% contrast solution