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Surgical Endoscopy Nov 2023Endoscopic dilation is the preferred management strategy for caustic esophageal strictures (CES). However, the differences in outcome for different dilators are not...
INTRODUCTION
Endoscopic dilation is the preferred management strategy for caustic esophageal strictures (CES). However, the differences in outcome for different dilators are not clear. We compared the outcome of CES using bougie and balloon dilators.
METHODS
Between January 2000 and December 2016, the following data of all the patients with CES were collected: demographic parameters, substance ingestion, number of strictures, number of dilations required to achieve ≥ 14 mm dilation, post-dilation recurrence, and total dilations. Patients were divided into two groups for the type of dilator, i.e., bougie or balloon. The two groups were compared for baseline parameter, technical success, short- and long-term clinical success, refractory strictures, recurrence rates, and major complications.
RESULTS
Of the 189 patients (mean age 32.17 ± 12.12 years) studied, 119 (62.9%) were males. 122 (64.5%) patients underwent bougie dilation and 67 (35.5%) received balloon dilation. Technical success (90.1% vs. 68.7%, p < 0.001), short-term clinical success (65.6% vs. 46.3%, p value 0.01), and long-term clinical success (86.9% vs. 64.2%, p < 0.01) were higher for bougie dilators compared to balloon dilators. Twenty-four (12.7%) patients developed adverse events which were similar for two groups. On multivariate analysis, use of bougie dilators (aOR 4.868, 95% CI 1.027-23.079), short-term clinical success (aOR 5.785, 95% CI 1.203-27.825), and refractory strictures (aOR 0.151, 95% CI 0.033-0.690) were independent predictors of long-term clinical success.
CONCLUSION
Use of bougie dilators is associated with better clinical success in patients with CES compared to balloon dilators with similar rates of adverse events.
Topics: Male; Humans; Young Adult; Adult; Female; Esophageal Stenosis; Caustics; Dilatation; Constriction, Pathologic; Tertiary Care Centers; Retrospective Studies; Treatment Outcome; Esophagoscopy
PubMed: 37653157
DOI: 10.1007/s00464-023-10384-4 -
Ear, Nose, & Throat Journal Feb 2022Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and...
OBJECTIVES
Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and then confirmed using direct laryngobronchoscopy. Other adjunctive diagnostic methods, including spirometry, have been proposed. This study aimed to evaluate the relationship between tracheal stenosis severity and pre- and post-balloon dilatation spirometry parameters in order to assess for significant changes in spirometry values and to evaluate for the effects of stenosis-associated factors on post-dilation spirometry values, including vertical length and grade of the stenosis, as well as the role of wound-modifying agents.
METHODS
This retrospective study included adults (>18 years of age) with isolated tracheal stenosis who underwent endoscopic balloon dilations at King Saud University Medical City from June 2015 to May 2019, with detailed documentation of operative findings and valid spirometry measurements pre- and post-balloon dilation. Basic demographic data and operative note details, including information about the percentage of tracheal stenosis, distance of tracheal stenosis from vocal cords, vertical length of stenotic segment, and use of wound-modifying agents (topical mitomycin C or triamcinolone injections), were extracted.
RESULTS
Fourteen patients with spirometry measurements obtained on 50 occasions (25 pre-balloon dilation and 25 post-balloon dilation) were included. Each 1-unit increase in the vertical length of the stenosis showed a statistically significant negative relationship (-1.47 L/s) with pre-balloon dilation peak expiratory flow (PEF; = .034). Post-balloon dilation spirometric values showed statistically significant improvements for most variables.
CONCLUSIONS
The vertical length of an isolated tracheal stenosis can be predicted before surgical interventions using PEF values and may be a significant indicator of anticipated post-balloon dilation surgical success. Our study suggested that spirometry is a very useful technique for evaluating patients with tracheal stenosis due to its noninvasiveness, cost-effectiveness, with a good clinical value.
Topics: Adult; Dilatation; Female; Humans; Male; Retrospective Studies; Spirometry; Tracheal Stenosis
PubMed: 32692288
DOI: 10.1177/0145561320936968 -
Dysphagia Feb 2020This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic... (Comparative Study)
Comparative Study
BACKGROUND AND AIMS
This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).
MATERIALS AND METHODS
Patients with anastomotic strictures (enrolled during January 1996-December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.
RESULTS
Of the 142 patients, 124 (mean age-44.02; males-74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2-10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.
CONCLUSION
Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.
Topics: Adult; Burns, Chemical; Deglutition Disorders; Dilatation; Esophageal Stenosis; Esophagoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 30929058
DOI: 10.1007/s00455-019-10004-1 -
The Laryngoscope Jan 2018Balloon dilation is a new entity in the therapeutic approach of Eustachian tube dysfunction. The aim of this systematic review is to evaluate the success of balloon... (Review)
Review
OBJECTIVE
Balloon dilation is a new entity in the therapeutic approach of Eustachian tube dysfunction. The aim of this systematic review is to evaluate the success of balloon dilation of the tuba auditiva in reducing symptoms in adult patients with Eustachian tube dysfunction.
DATA SOURCES
Embase, PubMed, and Cochrane Library.
REVIEW METHODS
The systematic literature search was conducted independently by two authors based on title and abstracts, and resulted in 36 articles. These articles were screened as full text, 15 of them were eligible for critical appraisal. Data were extracted from selected studies and presented in this article. A meta-analysis was conducted for four subgroups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as a writing guideline for this systematic review.
RESULTS
All 15 included studies were case series. A total of 1,155 patients were treated with balloon dilation of the tuba auditiva. Outcome parameters were relief of symptoms, otoscopy, Valsalva maneuver or Toynbee test, audiometry, tympanometry, Eustachian tube dysfunction classification, and Eustachian tube score. All articles showed short-term improvement of original symptoms; some showed further improvement over time. Follow-up ranged from just after therapy to 50 months. Relatively mild and self-limiting complications were described in 36 patients.
CONCLUSION
All current studies suggest that balloon dilation of the Eustachian tube can be a helpful treatment in patients with Eustachian tube dysfunction. However, placebo controlled trials are still warranted. Laryngoscope, 128:237-247, 2018.
Topics: Dilatation; Ear Diseases; Eustachian Tube; Humans
PubMed: 28799657
DOI: 10.1002/lary.26800 -
Gastrointestinal Endoscopy Oct 2017Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type.
METHODS
We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event.
RESULTS
Of 923 identified articles, 37 met inclusion criteria and represented 2034 dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%).
CONCLUSIONS
Perforation from esophageal dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal dilation should be considered a safe procedure in EoE.
Topics: Chest Pain; Dilatation; Eosinophilic Esophagitis; Esophageal Perforation; Esophagoscopy; Gastrointestinal Hemorrhage; Hospitalization; Humans; Pain, Postoperative; Postoperative Complications; Postoperative Hemorrhage
PubMed: 28461094
DOI: 10.1016/j.gie.2017.04.028 -
World Journal of Urology Jun 2020To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this...
PURPOSE
To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this technique.
METHODS
Patients who underwent PCNL with only one access (24 Fr) using the balloon dilator or sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to May 2018 in Beijing Tsinghua Changgung Hospital were retrospectively reviewed. Patients' demographic information, intra- and postoperative data were analyzed. Factors which would increase the success rate of ultrasound-guided balloon dilation were investigated by logistic regression analysis.
RESULTS
There were 986 PCNLs performed. 207 cases underwent balloon dilation, while 411 underwent sequential dilation. The two groups did not significantly differ in age, sex, BMI, stone diameter, access location, operation time, postoperative complication rate, and stone-free rate. The balloon dilation group comprised 207 patients (115 males, 92 females) with a mean age of 51 ± 10 years. Mean BMI was 25.2 ± 3.3 kg/m. Mean stone size was 3.6 ± 1.2 cm, 47.3% of which were staghorn stones. Hydronephrosis of the targeted calyx occurred in 78.3% of patients. Within the balloon dilation group, tract dilation failed in 24 cases (11.6%) on the first attempt. The successful and failed subgroups had comparable outcomes. Multivariate analysis revealed that the risk factors for the failure of access establishment were the presence of staghorn stones (p = 0.032), prior ipsilateral open nephrolithotomy (p = 0.026), and lower pole access (p = 0.039), while the success rate was significantly higher in those with a hydronephrotic target calyx (p = 0.001).
CONCLUSIONS
Tract dilation using balloon catheter can be safely monitored by ultrasound, and is most suited to patients with a hydronephrotic target calyx.
Topics: Adult; Dilatation; Feasibility Studies; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrolithotomy, Percutaneous; Retrospective Studies; Ultrasonography, Interventional
PubMed: 31312892
DOI: 10.1007/s00345-019-02876-7 -
The American Journal of Gastroenterology Feb 2016The saga of esophageal dilation for patients with eosinophilic esophagitis and strictures reads like a historical novel. Currently, data from over 500 eosinophilic...
The saga of esophageal dilation for patients with eosinophilic esophagitis and strictures reads like a historical novel. Currently, data from over 500 eosinophilic esophagitis (EoE) patients now convincingly prove that esophageal dilation is effective for prolonged relief and safe. It can easily be performed in the gastroenterologists community but follow the basic tenets of starting low with small diameter bougies/balloons and progressing slowly as you gradually dilate these strictures to 16-18 mm. Table 1 outlines my approach.
Topics: Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagoplasty; Female; Humans; Male
PubMed: 26882944
DOI: 10.1038/ajg.2015.433 -
JAMA Facial Plastic Surgery Sep 2016The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter... (Comparative Study)
Comparative Study Review
IMPORTANCE
The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve.
OBJECTIVE
To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism.
EVIDENCE REVIEW
A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded.
FINDINGS
An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators.
CONCLUSIONS AND RELEVANCE
Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.
Topics: Airway Resistance; Dilatation; Humans; Nasal Obstruction
PubMed: 27367589
DOI: 10.1001/jamafacial.2016.0291 -
The American Journal of Gastroenterology Feb 2018Achalasia is currently diagnosed according to the Chicago Classification v3.0 using high-resolution manometry and treatment focuses on disruption of the esophagogastric...
Achalasia is currently diagnosed according to the Chicago Classification v3.0 using high-resolution manometry and treatment focuses on disruption of the esophagogastric junction. A paper in this issue examines the utility of a timed barium esophagram with a 13 mm tablet challenge in differentiating achalasia from other diagnoses, finding 100% sensitivity. However, a large proportion of patients with non-achalasia dysphagia are also identified. Another paper in this issue proposes utilizing intraprocedure functional luminal imaging probe measurement during pneumatic dilation as a guide for upsizing dilations. This appears promising, but prospective validation is necessary before this becomes standard of care.
Topics: Chicago; Dilatation; Esophageal Achalasia; Humans; Manometry; Prospective Studies
PubMed: 29467529
DOI: 10.1038/ajg.2017.445 -
The Journal of Maternal-fetal &... Dec 2023Induction of labor (IOL) is becoming a universal topic in Obstetrics, when the risk of continuing a pregnancy outweighs the benefits. Preinduction is a more recent tool... (Observational Study)
Observational Study
INTRODUCTION
Induction of labor (IOL) is becoming a universal topic in Obstetrics, when the risk of continuing a pregnancy outweighs the benefits. Preinduction is a more recent tool to prepare the cervix when the BISHOP-score is low. About one-third of IOL cases require cervical ripening, which is the physical softening, thinning, and dilation of the cervix in preparation for labor and birth. We report a single center experience regarding the use of hygroscopic dilators in the pre-labor phase to obtain cervical ripening before labor induction.
MATERIALS & METHODS
We conducted a retrospective observational study comparing patient records from the Gynecology and Obstetrics Unit in "Santo Stefano" Hospital in Prato, Tuscany. The inclusion criteria for participants were women who had undergone pre-labor induction because of a BISHOP-score < 3. The gestational age of all the pregnant women was at term (> 37 weeks).
RESULTS
From January 2022 to April 2022, a total of 581 women delivered at term of gestational age at the Gynecology and Obstetrics Unit in "Santo Stefano" Hospital. Cervical ripening was necessary for 82 women with a Bishop score < 3 and hygroscopic cervical dilators were used in 35/82 (42.7%) patients. All patients showed a change in Bishop-score upon removal of the dilators. All 35 patients (100%) reported an increase in terms of consistency and dilation of the cervix but not in terms of length. None of the patients reported discomfort during the 24 h that they kept the hygroscopic dilators in place. No patients reported uterine tachysystole on cardiotocographic tracing, vaginal bleeding, rupture of membranes or cervical tears.
CONCLUSIONS
Our results are in line with those in the literature, demonstrating the validity of hygroscopic dilators in cervical maturation of pregnancies at term and their efficacy was again highlighted in terms of both maternal and fetal safety and patient satisfaction.
Topics: Pregnancy; Female; Humans; Infant; Male; Cervix Uteri; Cervical Ripening; Dilatation; Labor, Induced; Parturition; Oxytocics
PubMed: 37574214
DOI: 10.1080/14767058.2023.2239422