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Neurogastroenterology and Motility Jul 2019One of the most used treatments for achalasia is pneumatic dilation of the lower esophageal sphincter to improve esophageal emptying. Multiple treatment protocols have... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
One of the most used treatments for achalasia is pneumatic dilation of the lower esophageal sphincter to improve esophageal emptying. Multiple treatment protocols have been described with a varying balloon size, number of dilations, inflation pressure, and duration. We aimed to identify the most efficient and safe treatment protocol.
METHODS
We performed a systematic review and meta-analysis of studies on pneumatic dilation in patients with primary achalasia. Clinical remission was defined as an Eckardt score ≤3 or adequate symptom reduction measured with a similar validated questionnaire. We compared the clinical remission rates and occurrence of complications between different treatment protocols.
RESULTS
We included 10 studies with 643 patients. After 6 months, dilation with a 30-mm or 35-mm balloon gave comparable mean success rates (81% and 79%, respectively), whereas a series of dilations up to 40 mm had a higher success rate of 90%. Elective additional dilation in patients with insufficient symptom resolution was somewhat more effective than performing a predefined series of dilations: 86% versus 75% after 12 months. Perforations occurred most often during initial dilations, and significantly more often using a 35-mm balloon than a 30-mm balloon (3.2 vs 1.0%); P = 0.027. A subsequent 35-mm dilation was safer than an initial dilation with 35 mm (0.97% vs 9.3% perforations), P = 0.0017.
CONCLUSIONS
The most efficient and safe method of dilating achalasia patients is a graded approach starting with a 30-mm dilation, followed by an elective 35-mm dilation and 40 mm when there is insufficient symptom relief.
Topics: Catheterization; Dilatation; Esophageal Achalasia; Esophageal Sphincter, Lower; Humans
PubMed: 30697952
DOI: 10.1111/nmo.13548 -
Current Eye Research Jul 2022Pupil dilation is a commonly used procedure in vision research. While often considered a minimal risk procedure, there is the potential for significant adverse effects....
Pupil dilation is a commonly used procedure in vision research. While often considered a minimal risk procedure, there is the potential for significant adverse effects. Currently, there is variance in practices and protocols among researchers and institutions, perhaps due to a lack of guidelines for safe pupil dilation practices in research settings. In this perspective, we explore variables that can increase the potential for adverse effects and provide suggestions to limit their impact. Prior to dilation, an investigator can assess an individual's medical status and drug regimen when deciding upon a mydriatic agent to be used. Assessing the angle through a variety of methods (i.e. penlight test, van Herick slit lamp, optical coherence tomography, gonioscopy) can also prevent inappropriate dilation of pupils with concerning anatomical features. During dilation, an investigator should look to limit the potential of infection and use caution in repeat dosing of dilation-resistant pupils. Post-dilation, an investigator should closely monitor eyes with elevated risk factors and improve an individual's health literacy on angle closure complications. When combined with proper informed consent processes regarding adverse effects, the aforementioned can allow for risk mitigation in studies using pupil dilation.
Topics: Dilatation; Glaucoma, Angle-Closure; Gonioscopy; Humans; Mydriatics; Pupil; Tomography, Optical Coherence
PubMed: 35499263
DOI: 10.1080/02713683.2022.2053723 -
The Turkish Journal of Gastroenterology... Apr 2023The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients.
BACKGROUND
The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients.
METHODS
Achalasia patients over the age of 65 and those under the age of 65 as the control group who received pneumatic dilation as the first-line treatment were evaluated in the study.
RESULTS
The average age of geriatric patients was 72.5 ± 55.92 years (65-90), with 50.3% of them being male. Follow-up was conducted for a mean of 64.52 ± 38.73 months. While pneumatic dilation was successful in 98.6% (141/143) of geriatric patients, it was also successful in 94% (141/150) of non-geriatric patients. Remission after single balloon dilatation was observed in 81.8% of geriatric patients, while it was observed in only 52.7% of non-geriatric patients (P = .000). When comparing remission after single dilatation and multiple dilatations, it was observed that geriatric patients who achieved remission after multiple balloon dilatation had higher lower esophageal sphincter pressure and Eckardt scores at the diagnosis and higher lower esophageal sphincter pressure and esophageal body resting pressures after the first balloon dilatation.
CONCLUSIONS
The proportion of elders in the world population is increasing daily and this disease has been known to disproportionately afflict this group. Although surgical treatments, in particular per-oral endoscopic myotomy, have recently gained popularity as therapies for achalasia, pneumatic dilation remains the most commonly used in geriatric patients.
Topics: Humans; Male; Aged; Aged, 80 and over; Female; Esophageal Achalasia; Dilatation; Treatment Outcome; Digestive System Surgical Procedures; Patients; Esophageal Sphincter, Lower
PubMed: 36789986
DOI: 10.5152/tjg.2023.22178 -
Minerva Urology and Nephrology Apr 2021The aim of this study was to compare four renal access techniques in percutaneous nephrolithotomy (PCNL). (Comparative Study)
Comparative Study
BACKGROUND
The aim of this study was to compare four renal access techniques in percutaneous nephrolithotomy (PCNL).
METHODS
A total of 437 patients who underwent PCNL at our center from January 2015 to December 2019 were included in the analysis. Telescopic metallic coaxial dilation (TMD) was used in 146 patients, single step balloon dilation (BD) in 98 patients, one-shot dilation with 30F Amplatz (OS 30F) in 106 patients, and one-shot dilation with 16F Amplatz (OS 16F) in 87 patients. Primary endpoints were perioperative outcomes and complications of the procedures.
RESULTS
Similar baseline characteristics were observed in the four groups. Fluoroscopy time was significantly shorter in OS 30F and OS 16F groups (P<0.0001). The drop in hemoglobin level was not significantly different between TMD and BD groups, but it was significantly lower in OS 16F group versus the OS 30F group and lower in OS 30F group versus the BD Group (P<0.0001). Despite this, the rate of blood transfusion was similar across groups (P=0.837). Moreover, a smaller tract was associated with reduced postoperative morbidity including time to nephrostomy removal (P=0.001), hospital stay (P<0.0001), VAS scale (P<0.0001). There were no significant differences in postoperative complications (P=0.683), and Clavien-Dindo grade ≥3 complication rates (P=0.486) among the groups. Stone-free rates and number of auxiliary procedures required to achieve stone-free status were also similar among all groups (P=0.964 and 0.988, respectively). Multinomial logistic regression analysis showed that BMI (P=0.002), stone size (P=0.002) and previous PCNL (P=0.038) were predictive factors associated with the choice of OS 16 approach.
CONCLUSIONS
Different dilation methods are equally effective and safe to use in a PCNL procedure for kidney stone treatment, allowing similar stone free rates and risk of complications. The OS dilation techniques seem to allow a shorter X-ray exposure time, which might be beneficial for both patients and operators. The use of a 16 F dilator can reduce the postoperative morbidity. Risk of sepsis should be always kept in mind.
Topics: Adult; Aged; Dilatation; Female; Humans; Kidney Calculi; Logistic Models; Male; Middle Aged; Nephrolithotomy, Percutaneous; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32638574
DOI: 10.23736/S2724-6051.20.03836-9 -
Acta Bio-medica : Atenei Parmensis Dec 2018Esophageal strictures in pediatric age are a quite common condition due to different etiologies. Esophageal strictures can be divided in congenital, acquired and... (Review)
Review
BACKGROUND
Esophageal strictures in pediatric age are a quite common condition due to different etiologies. Esophageal strictures can be divided in congenital, acquired and functional. Clinical manifestations are similar and when symptoms arise, endoscopic dilation is the treatment of choice. Our aim was to consider the efficacy of this technique in pediatric population, through a wide review of the literature.
METHOD
A search on PubMed/Medline was performed using "esophageal strictures", "endoscopic dilations" and "children" as key words. Medline, Scopus, PubMed publisher and Google Scholar were searched as well. As inclusion criteria, we selected clinical studies describing dilations applied to all type of esophageal strictures in children. Papers referred to single etiology strictures dilations or to adult population only were excluded, as well as literature-review articles.
RESULTS
We found 17 studies from 1989 to 2018. Overall, 738 patients in pediatric age underwent dilation for esophageal strictures with fixed diameter push-type dilators (bougie dilators) and/or radial expanding balloon dilators. Severe complications were observed in 33/738 patients (4,5%) and perforation was the most frequent (29/33). Conversion to surgery occurred only in 16 patients (2,2%).
CONCLUSIONS
Endoscopic dilation is the first-choice treatment of esophageal strictures, it can be considered a safe procedure in pediatric age. Both, fixed diameter push-type dilators and radial expanding balloon dilators, showed positive outcomes in term of clinical results and cases converted to surgery. However, it's essential to perform these procedure in specialized Centers by an experienced team, in order to reduce complications.
Topics: Child; Dilatation; Equipment Design; Esophageal Perforation; Esophageal Stenosis; Esophagoscopy; Humans; Treatment Outcome
PubMed: 30561414
DOI: 10.23750/abm.v89i8-S.7862 -
Respiratory Care Nov 2014The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety.... (Review)
Review
BACKGROUND
The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better.
METHODS
A systematic review with critical appraisal of the literature was done. Literature in multiple databases was searched. Randomized controlled trials comparing different tracheostomy methods were selected. Clinical and methodological characteristics were assessed. A meta-analysis using fixed effect models was planned for statistically homogeneous outcomes.
RESULTS
Fourteen randomized controlled trials were included, most of them with small sample sizes and with comparisons of multiple methods. Blue Rhino methods were less difficult for surgeons (risk difference of 14.7% [95% CI 8-21.5]) and had more minor bleeding events (risk difference of -6.3% [95% CI -13.58 to 0.8]). There were no differences in major bleeding events. Statistically, heterogeneity and lack of data impede comparison with other outcomes.
CONCLUSIONS
The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method.
Topics: Critical Illness; Dilatation; Equipment Design; Humans; Tracheostomy
PubMed: 25185145
DOI: 10.4187/respcare.03050 -
Acta Bio-medica : Atenei Parmensis Jan 2019The nasal valve deserves relevant in patients presenting with nasal obstruction. In particular, the nasal valve plays an important role in nasal airflow control, it is... (Comparative Study)
Comparative Study Review
The nasal valve deserves relevant in patients presenting with nasal obstruction. In particular, the nasal valve plays an important role in nasal airflow control, it is relevant for the otolaryngologist to not only consider but also fully evaluate the nasal valve when seeing a patient with nasal obstruction. These data reported in this Supplement confirms the clinical relevance of the nasal valve in different groups of patients and normal subjects. In fact, an integrity of nasal valve is fundamental to ensure a physiological nasal breathing that in turn guarantees a correct pulmonary function. The possibility to use the non-surgical and well-accepted option constituted by the nasal internal dilator represent an interesting opportunity for both the physician and the patient.
Topics: Cross-Sectional Studies; Dilatation; Female; Humans; Male; Nasal Cavity; Nasal Obstruction; Nasal Septum; Quality of Life; Reference Values; Respiration
PubMed: 30715036
DOI: 10.23750/abm.v90i2-S.8105 -
Journal of Crohn's & Colitis Feb 2018Restorative proctocolectomy with ileal pouch-anal anastomosis removes the diseased tissue in ulcerative colitis but also allows gastrointestinal continuity and... (Review)
Review
BACKGROUND
Restorative proctocolectomy with ileal pouch-anal anastomosis removes the diseased tissue in ulcerative colitis but also allows gastrointestinal continuity and stoma-free living. Pouch strictures are a complication with a reported incidence of 5-38%. The three areas where pouch strictures occur are in the pouch inlet, mid-pouch and pouch-anal anastomosis.
AIM
To undertake a systematic review of the literature and to identify management strategies available for pouch-anal, mid-pouch and pre-pouch ileal strictures and their outcomes.
METHODS
A computer-assisted search of the online bibliographic databases MEDLINE and EMBASE limited to 1966 to February 2016 was performed. Randomized controlled trials, cohort studies, observational studies and case reports were considered. Those where data could not be extracted were excluded.
RESULTS
Twenty-two articles were considered eligible. Pouch-anal strictures have been initially managed using predominately dilators which include bougie and Hegar dilators with various surgical procedures advocated when initial dilatation fails. Mid-pouch strictures are relatively unstudied with both medical, endoscopic and surgical management reported as successful. Pouch inlet strictures can be safely managed using a combined medical and endoscopic approach.
CONCLUSION
The limited evidence available suggests that pouch-anal strictures are best treated in a stepwise fashion with initial treatment to include digital or instrumental dilatation followed by surgical revision or resection. Management of mid-pouch strictures requires a combination of medical, endoscopic and surgical management. Pouch inlet strictures are best managed using a combined medical and endoscopic approach. Future studies should compare different treatment modalities on separate stricture locations to enable an evidenced-based treatment algorithm.
Topics: Colonic Pouches; Constriction, Pathologic; Digestive System Surgical Procedures; Dilatation; Endoscopy, Gastrointestinal; Humans; Ileum
PubMed: 29155985
DOI: 10.1093/ecco-jcc/jjx151 -
Jornal Brasileiro de Pneumologia :... Aug 2023
Topics: Humans; Dilatation; Bronchiectasis
PubMed: 37610963
DOI: 10.36416/1806-3756/e20230235 -
The Cochrane Database of Systematic... Sep 2014Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically distressing.
OBJECTIVES
To assess the benefits and harms of different types of vaginal dilation methods offered to women treated by pelvic radiotherapy for cancer.
SEARCH METHODS
Searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 5), MEDLINE (1950 to June week 2, 2013), EMBASE (1980 to 2013 week 24) and CINAHL (1982 to 2013).
SELECTION CRITERIA
Comparative data of any type, which evaluated dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and therefore analysed no data.
MAIN RESULTS
We identified no studies for inclusion in the original review or for this update. However, we felt that some studies that were excluded warranted discussion. These included one randomised trial (RCT), which showed no improvement in sexual scores associated with encouraging women to practise dilation therapy; a recent small RCT that did not show any advantage to dilation over vibration therapy during radiotherapy; two non-randomised comparative studies; and five correlation studies. One of these showed that objective measurements of vaginal elasticity and length were not linked to dilation during radiotherapy, but the study lacked power. One study showed that women who dilated tolerated a larger dilator, but the risk of objectivity and bias with historical controls was high. Another study showed that the vaginal measurements increased in length by a mean of 3 cm after dilation was introduced 6 to 10 weeks after radiotherapy, but there was no control group; another case series showed the opposite. Three recent studies showed less stenosis associated with prophylactic dilation after radiotherapy. One small case series suggested that dilation years after radiotherapy might restore the vagina to a functional length.
AUTHORS' CONCLUSIONS
There is no reliable evidence to show that routine, regular vaginal dilation during radiotherapy treatment prevents stenosis or improves quality of life. Several observational studies have examined the effect of dilation therapy after radiotherapy. They suggest that frequent dilation practice is associated with lower rates of self reported stenosis. This could be because dilation is effective or because women with a healthy vagina are more likely to comply with dilation therapy instructions compared to women with strictures. We would normally suggest that a RCT is needed to distinguish between a casual and causative link, but pilot studies highlight many reasons why RCT methodology is challenging in this area.
Topics: Anti-Inflammatory Agents; Benzydamine; Brachytherapy; Constriction, Pathologic; Dilatation; Estrogens; Female; Humans; Hyperbaric Oxygenation; Pelvis; Radiation Injuries; Radiotherapy; Rupture; Sexual Dysfunction, Physiological; Time Factors; Vagina
PubMed: 25198150
DOI: 10.1002/14651858.CD007291.pub3