The “rule of 3” holds that bougie dilation of an esophageal stricture should not progress
beyond 3 mm in a single session. Despite the existence of this “rule” for at least
40 years, two studies have found that dilation >2 mm with bougie or balloon does not
increase risk of perforation. One recent study found that non-adherence to the rule
for balloon and bougie dilations did not increase the risk of perforation. All these
studies were done in adult populations; no studies have examined the rule of 3 in
pediatric patients. In addition, no study has suggested a maximum dilation size that
can be safely performed in one session.
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© 2019 Published by Elsevier Inc.
