not so safe as esophagoscopic bouginage.

_Internal esophagotomy_ by the string-cutting instruments and
esophagotome are relatively dangerous methods, and perhaps yield in
the end no quicker results than the slower and safe bouginage per
tubam.

_Electrolysis_ has been used with varying results in the treatment of
cicatricial stenosis.

_Thermic bouginage_ with electrically heated bougies has been found
useful in some cases by Dean and Imperatori.

[258] _String-swallowing_, with the passage of olives threaded over
the string has yielded good results in the hands of some operators.
The string may be used to pull up dilators in increasing sizes,
introduced through a gastrostomic fistula. The string stretched across
the stomach from the cardia to the pylorus, is fished out with the
author's pillar retractor, or is found with the retrograde
esophagoscope (Fig. 43). The string is attached to a dilator (Fig.
35), and a fresh string is pulled in to replace the one pulled out.
This is the safest of the blind methods. It is rarely possible to get
a child under two years of age to swallow and tolerate a string. It is
better after each treatment to draw the upper end of the string
through the nose, as it is not so likely to be chewed off and is less
annoying. With the esophagoscope, the string is not necessary, because
the lumen of the stricture can be exposed to view by the
esophagoscope.

_Retrograde esophagoscopy_ through a gastrostomy wound offers some
advantages over peroral treatment; but unless the gastrostomy is high,
the procedure is undoubtedly more difficult. The approach to the
lowest stricture from below is usually funnel shaped and free from
dilatation and redundancy. It must be remembered the stricture seen
from below may not be the same one seen from above. Roentgenray
examination with barium mixture or esophagoscopes simultaneously in
situ above and below are useful in the study of such cases.

_Impermeable strictures_ of the cervical esophagus are amenable to
external esophagotomy, with plastic reformation of the esophagus.
Those in the middle third have not been successfully treated by
surgical methods, though various ingenious operations for the
formation of an extrathoracic esophagus have been suggested as means
of securing relief. Impermeable strictures of the lower third can with
reasonable safety be treated by the Brenneman method, which consists
in passing the esophagoscope down to the stricture w