Abdominal compression during endoscopy (the Bolster technique) demonstrates hidden Schatzki rings (with videos)

Published:November 05, 2015DOI:

      Background and Aims

      Schatzki rings are found in the distal esophagus, are associated with hiatal hernias, and present with intermittent dysphagia to solid foods. They can be identified by radiology (GI series or barium swallow studies) or endoscopy. Rings are not always visualized during endoscopy in patients in whom they are suspected clinically. The Bolster technique involves application of epigastric abdominal pressure, which offers the potential to reveal a Schatzki ring that is otherwise obscured within a reduced hiatal hernia. The aim of this study was to determine whether the Bolster technique improves endoscopic detection of Schatzki rings.


      We reviewed 30 symptomatic patients with a history of a Schatzki ring in a tertiary care center. The Bolster technique was applied to patients in whom the ring was not visible during standard endoscopy. The main outcome measurement was identification of the Schatzki ring after the Bolster technique.


      A Schatzki ring was visible during standard endoscopy in 26 of the 30 patients. In the remaining 4, the ring was visible only after the application of the Bolster technique.


      The Bolster technique is a simple maneuver that can increase detection rates of Schatzki rings during endoscopy.
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      Linked Article

      • Yet another provocative maneuver to accentuate Schatzki rings
        Gastrointestinal EndoscopyVol. 84Issue 4
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          I read the New Methods article by Dr Jouhourian and colleagues1 with great interest.1 In brief, the authors describe a novel maneuver (Bolster technique) that may be used to accentuate and diagnose what may be a suspected but “hidden” Schatzki ring. The authors’ report also reviewed other techniques that have been used by radiologists. I have yet another option. Over 25 years ago, I had the privilege of training under Dr Donald O. Castell. When a suspected Schatzki ring was not visualized during upper GI endoscopy, Dr Castell suggested that we simply have the patient deeply inspire while the endoscope was positioned in the distal esophagus.
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