Mercury-filled esophageal devices are commonly used to dilate the esophagus of a patient in response to medical conditions or treatments that cause esophageal narrowing or tissue shrinkage. This information guide reviews tungsten-filled dilators as a suitable alternative to mercury-filled dilators. Benefits include a reduced potential for impact to the environment from inadvertent release of mercury during disposal or in the event of a spill.
Applicable Regulations

Overview of Procedure
Patients having medical conditions such as: strictures, tumors, acid reflux, or medical treatments such as surgery or radiation, may benefit from esophageal dilation. Esophageal dilators are commonly used in thoracic surgery, otolaryngology, and the medical procedures unit. During the procedure, the dilator is slipped down the patient's throat into the esophagus, past the narrowed section, using calibrated markings on the side of the dilator as a guide. The dilator is allowed to remain in place for about two minutes and is then extracted. This procedure may be repeated several times per year, depending on the patient's condition and needs.

Mercury, because of its great density and liquid state, has been used in esophageal dilators as a weight. The mercury-filled devices are constructed of a thick latex outer coating encapsulating about two pounds of mercury. Repeated use and cleaning of the mercury-filled dilators sometimes caused the latex covering to become brittle. Due to the potential for the latex covering to become compromised, each dilator has an expiration date associated with it. In addition, the manufacturer of the devices has indicated that they had received reports of mercury-containing dilators rupturing during handling causing potential environmental, patient, and employee exposures.

Waste Minimization Procedure
The Otolaryngology Department investigated and found that tungsten-filled dilators are a suitable alternative to the mercury-filled esophageal devices. The tungsten-filled esophageal devices are used exactly the same as mercury-filled devices, which meant that no changes in operating techniques or procedures were necessary. In addition, the latex units required lubrication, but the silicone units do not.

Unlike mercury, tungsten is not a liquid at room temperature. Therefore, the tungsten contained within the device is in the form of a powder suspended in a gel. This form allows the dilator to be flexible and conform to the shape of the esophagus, exerting the proper pressure to enlarge the narrow section.

Like the mercury-filled dilators, the tungsten-filled dilators also have an expiration date associated with each one. When the devices expire, the Occupational Safety and Environmental Health Hazardous Materials group is notified for proper disposal.

Known Limitations
None known.

Safety & Health Precautions/Personal Protective Equipment
Follow all applicable safety and health protocols and regulations as established by your institution.

The tungsten-filled devices eliminate the need for mercury, thereby eliminating the potential for inadvertent environmental release from disposal or spills.

By replacing the latex covering with a silicone covering, patients with latex allergy are not exposed and placed at risk of allergic reaction.

None known.

Project Related Costs
The approximate cost of a mercury-filled dilator is $68; a tungsten-filled dilator is $118. The service life of the tungsten-filled dilator is the same as the mercury-filled dilator. This is due to the fact that service life is dependent upon the integrity of the exterior.

When determining the cost effectiveness of implementing these devices, the cost savings from elimination of mercury disposal and spill clean up must also be considered.