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Diseases of the Esophagus : Official... Dec 2022Despite decreasing overall morbidity with minimally invasive esophagectomy (MIE), conduit functional outcomes related to delayed emptying remain challenging, especially...
Despite decreasing overall morbidity with minimally invasive esophagectomy (MIE), conduit functional outcomes related to delayed emptying remain challenging, especially in the immediate postoperative setting. Yet, this problem has not been described well in the literature. Utilizing a single institutional prospective database, 254 patients who underwent MIEs between 2012 and 2020 were identified. Gastric conduit dilation was defined as a conduit occupying >40% of the hemithorax on the postoperative chest X-ray. Sixty-seven patients (26.4%) demonstrated acute conduit dilation. There was a higher incidence of conduit dilation in the patients who underwent Ivor Lewis esophagectomy compared to those with a neck anastomosis (67.2% vs. 47.1%; P = 0.03). Patients with dilated conduits required more esophagogastroduodenoscopies (EGD) (P < 0.001), conduit-related reoperations within 180 days (P < 0.001), and 90-day readmissions (P = 0.01). Furthermore, in 37 patients (25.5%) undergoing Ivor Lewis esophagectomy, we returned to the abdomen after intrathoracic anastomosis to reduce redundant conduit and pexy the conduit to the crura. While conduit dilation rates were similar, those who had intraabdominal gastropexy required EGD significantly less and trended toward a lower incidence of conduit-related reoperations (5.6% vs. 2.7%). Multivariable analysis also demonstrated that conduit dilation was an independent predictor for delayed gastric conduit emptying symptoms, EGD within 90 days, conduit-related reoperation within 180 days, and 30-day as well as 90-day readmission. Patients undergoing MIE with acute gastric conduit dilation require more endoscopic interventions and reoperations.
Topics: Humans; Esophagectomy; Dilatation; Postoperative Complications; Retrospective Studies; Stomach; Anastomosis, Surgical; Esophageal Neoplasms; Minimally Invasive Surgical Procedures; Laparoscopy
PubMed: 35649395
DOI: 10.1093/dote/doac033 -
World Journal of Gastroenterology Jul 2014To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the...
AIM
To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE).
METHODS
The medical records of all patients diagnosed with EoE between January 2002 and July 2010 were retrospectively reviewed. Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis (≥ 15 eos/hpf per current guidelines). Patients were divided into 2 groups: patients who did not receive dilation therapy and those who did. Demographics, clinical history, the use of pharmacologic therapy, endoscopic and pathology findings, and the number of biopsies and dilations carried out, if any, and their locations were recorded for each patient. The dilation group was further examined based on the interval between diagnosis and dilation, and whether or not a complication occurred.
RESULTS
Sixty-one patients were identified with EoE and 22 (36%) of them underwent esophageal dilations for stricture/narrowing. The peak eos/hpf was significantly higher in patients who received a dilation (P = 0.04). Four (18% of pts.) minor complications occurred: deep mucosal tear 1, and small mucosal tears 3. There were no cases of esophageal perforations. Higher peak eos/hpf counts were not associated with increased risk of complications.
CONCLUSION
Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate. No correlation was found between the peak of eosinophil count and complication rate. Complications can occur independently of the histologic features. The long-term outcome of EoE treatment, with or without dilation, needs to be determined.
Topics: Adolescent; Adult; Biopsy; Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagoscopy; Female; Florida; Humans; Male; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
PubMed: 25071351
DOI: 10.3748/wjg.v20.i28.9549 -
The Turkish Journal of Gastroenterology... Mar 2017Endoscopic balloon dilation (EBD) can serve as an alternative to surgery for intestinal stenosis associated with Crohn's disease (CD). However, there has been...
BACKGROUND/AIMS
Endoscopic balloon dilation (EBD) can serve as an alternative to surgery for intestinal stenosis associated with Crohn's disease (CD). However, there has been controversy regarding the efficacy and safety of EBD. Here we sought to determine the therapeutic efficacy and safety of EBD for intestinal stenosis in CD.
MATERIALS AND METHODS
Of 43 patients with CD accompanied by intestinal stenosis, 30 underwent EBD. These 30 patients were examined retrospectively in terms of the scope passage rate, surgery-free rate, and whether or not the observation of the distal intestinal tract influenced the therapeutic strategy.
RESULTS
The overall scope passage and surgery-free rates were 90.0% and 76.7%, respectively. There were no statistically significant differences in the site of the dilated intestinal tract among groups. Patients who had inflammation in the distal intestinal tract alone after EBD accounted for 56.7%. The rate of re-dilation was 46.7%, and time until re-dilation was 6.6±3.6 months.
CONCLUSION
EBD was associated with favorable short-term and long-term outcomes and good safety. Observation of the distal intestinal tract influenced the decision-making process for therapeutic strategies. The results of this study suggest that EBD may allow the postponement or even avoidance of surgery, enabling not only intestinal dilation but also the evaluation of mucosal healing to be performed. Thus, EBD is considered to be an effective alternative treatment for intestinal stenotic lesions in patients with CD.
Topics: Adult; Balloon Enteroscopy; Constriction, Pathologic; Crohn Disease; Dilatation; Female; Humans; Intestines; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 28195539
DOI: 10.5152/tjg.2017.16598 -
Ear, Nose, & Throat Journal Sep 2021Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related...
Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related complications have also been reported. Here, we report a case of pneumocephalus and cerebrospinal fluid leak following BSD of the frontal sinus. Additionally, a review of the literature regarding BSD complications was performed.
Topics: Aged; Dilatation; Frontal Sinus; Humans; Male; Neuroimaging; Paranasal Sinus Diseases; Pneumocephalus; Skull Base; Tomography, X-Ray Computed
PubMed: 34392735
DOI: 10.1177/01455613211037629 -
Oral Oncology Apr 2019Neopharyngeal stenosis is a recognized sequela of total laryngectomy (TL). We aim to investigate the incidence of stenosis requiring dilation, risk factors for stenosis...
BACKGROUND
Neopharyngeal stenosis is a recognized sequela of total laryngectomy (TL). We aim to investigate the incidence of stenosis requiring dilation, risk factors for stenosis and complications of dilation.
METHODS
Retrospective cohort study of patients undergoing TL in two dedicated head and neck centers in the Netherlands.
RESULTS
A total of 477 patients, (81% men, median age of 64 at TL) were included. Indication for TL was previously untreated primary tumor in 41%, salvage following (chemo)radiotherapy (CRT) in 44%, dysfunctional larynx in 9% and a second primary tumor in 6%. The cumulative incidence of dilatation at 5 years was 22.8%, and in total 968 dilatations were performed. Median number of dilations per patient was 3 (range 1-113). Female gender, a hypopharynx tumor, and (C)RT before or after the TL were significantly associated with stenosis requiring dilation. We observed 8 major complications (0.8%) predominantly during the first dilation procedures. Use of general anesthesia is a risk factor for complications. The most frequent major complication was severe esophageal perforation (n = 6 in 5 patients).
CONCLUSION
The cumulative incidence of pharyngeal stenosis needing dilation was 22.8% at 5 years. Roughly half of these patients could be treated with a limited number of dilations, the rest however needed ongoing dilations. Major complications are rare (0.8%) but can be life threatening. General anesthetics is a risk factor for complications, and complications occurred predominantly during the first few dilations procedures. This should alert the physician to be extra careful in new patients.
Topics: Adult; Aged; Aged, 80 and over; Dilatation; Female; Humans; Incidence; Laryngectomy; Male; Middle Aged; Retrospective Studies; Risk Factors; Young Adult
PubMed: 30926055
DOI: 10.1016/j.oraloncology.2019.02.025 -
Journal of the Mechanical Behavior of... Aug 2021In this paper, we report a physics based mathematical model to describe the mechanotransduction at the luminal surface of the brachial artery during a flow-mediated...
In this paper, we report a physics based mathematical model to describe the mechanotransduction at the luminal surface of the brachial artery during a flow-mediated dilation (FMD) process. To account for the effect of the released vasodilators in response to the sudden blood flow resurgence, a scalar property is introduced as a signal radially diffusing through the arterial wall, locally affecting its compliance. The model was evaluated on 19 in vivo responses of brachial artery FMD (BAFMD) in 12 healthy subjects. It successfully reproduces the time-dependent dilation of the brachial artery. The predicted artery's outer-to-inner radius ratio was also found to be consistent with the measurements within an acceptable margin of error. Physically meaningful dimensionless parameters quantifying the artery's physical state arose from the model, providing a description to how sensitive or responsive the artery is to the changes of wall shear stress (WSS). Future applications of this model, via incorporating inexpensive, relatively quick, and non-invasive imaging, could potentially help detect early stages of developing forms of cardiovascular diseases.
Topics: Brachial Artery; Dilatation; Endothelium, Vascular; Mechanotransduction, Cellular; Stress, Mechanical; Vasodilation
PubMed: 34044251
DOI: 10.1016/j.jmbbm.2021.104606 -
The Laryngoscope Oct 2017To evaluate the safety and efficacy of bronchoscopic interventions in the management of tissue-engineered tracheal graft (TETG) stenosis.
OBJECTIVE
To evaluate the safety and efficacy of bronchoscopic interventions in the management of tissue-engineered tracheal graft (TETG) stenosis.
STUDY DESIGN
Animal research study.
METHODS
TETGs were constructed with seeded autologous bone marrow-derived mononuclear cells on a bioartificial graft. Eight sheep underwent tracheal resection and orthotopic implantation of this construct. Animals were monitored by bronchoscopy and fluoroscopy at 3 weeks, 6 weeks, 3 months, and 4 months. Bronchoscopic interventions, including dilation and stenting, were performed to manage graft stenosis. Postdilation measurements were obtained endoscopically and fluoroscopically.
RESULTS
Seven dilations were performed in six animals. At the point of maximal stenosis, the lumen measured 44.6 ± 8.4 mm predilation and 50.7 ± 14.1 postdilation by bronchoscopy (P = 0.3517). By fluoroscopic imaging, the airway was 55.9 ± 12.9 mm predilation and 65.9 ± 22.4 mm postdilation (P = 0.1303). Stents were placed 17 times in six animals. Pre- and poststenting lumen sizes were 62.8 ± 38.8 mm and 80.1 ± 54.5 mm by bronchoscopy (P = 0.6169) and 77.1 ± 38.9 mm and 104 ± 60.7 mm by fluoroscopy (P = 0.0825). Mortality after intervention was 67% with dilation and 0% with stenting (P = 0.0004). The average days between bronchoscopy were 8 ± 2 for the dilation group and 26 ± 17 in the stenting group (P = 0.05). One hundred percent of dilations and 29% of stent placements required urgent follow-up bronchoscopy (P = 0.05).
CONCLUSION
Dilation has limited efficacy for managing TETG stenosis, whereas stenting has a more lasting clinical effect.
LEVEL OF EVIDENCE
NA. Laryngoscope, 127:2219-2224, 2017.
Topics: Animals; Bioprosthesis; Bronchoscopy; Dilatation; Fluoroscopy; Postoperative Complications; Prosthesis Design; Sheep; Stents; Tissue Engineering; Trachea; Tracheal Stenosis; Treatment Outcome
PubMed: 28349659
DOI: 10.1002/lary.26504 -
Alimentary Pharmacology & Therapeutics Nov 2015Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies.
AIM
To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored.
METHODS
A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics.
RESULTS
Twenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60-78.8%), 90.6% (95% CI: 87.8-92.8%), 6.4% (95% CI: 5.0-8.2) and 3% (95% CI: 2.2-4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis.
CONCLUSIONS
Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
Topics: Constriction, Pathologic; Crohn Disease; Dilatation; Endoscopy; Humans; Treatment Outcome
PubMed: 26358739
DOI: 10.1111/apt.13388 -
The Journal of International Medical... May 2020This study aimed to present our experience of concomitant management of renal calculi and recurrent ureteropelvic junction obstruction (UPJO) with percutaneous...
OBJECTIVE
This study aimed to present our experience of concomitant management of renal calculi and recurrent ureteropelvic junction obstruction (UPJO) with percutaneous nephrolithotomy (PCNL) and antegrade balloon dilation.
METHODS
We retrospectively reviewed 31 patients who underwent PCNL and antegrade balloon dilation for treatment of renal calculi and recurrent UPJO. The inclusion criterion was the presence of UPJO after failed pyeloplasty with ipsilateral renal calculi. Success was defined as achievement of both symptomatic and radiographic resolution of any stones and obstruction.
RESULTS
All operations were successful without grade III or higher postoperative complications. A stone-free status was observed in all patients and the overall success rate of the procedure was 87.1% (27/31). The success rate of the procedure was significantly higher in patients with mild or moderate preoperative hydronephrosis (96%) than in those with high-grade preoperative hydronephrosis (50%). Moreover, the success rate of the procedure was lower in patients with poor preoperative renal function (0%) than in those with good or moderate renal function (93.1%).
CONCLUSION
Combined PCNL and antegrade balloon dilation management represents a safe and effective approach for patients with renal calculi and recurrent UPJO after failed pyeloplasty.
Topics: Adolescent; Adult; Combined Modality Therapy; Dilatation; Female; Humans; Hydronephrosis; Kidney Calculi; Kidney Pelvis; Male; Middle Aged; Nephrolithotomy, Percutaneous; Postoperative Complications; Recurrence; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Ureteral Obstruction; Young Adult
PubMed: 32356681
DOI: 10.1177/0300060520911252 -
World Journal of Gastroenterology Dec 2017To evaluate the therapeutic role of double-balloon enteroscopy (DBE) in small bowel strictures and to propose a standard approach to small bowel strictures. (Review)
Review
AIM
To evaluate the therapeutic role of double-balloon enteroscopy (DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.
METHODS
Systematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded.
RESULTS
In total 13 studies were included, in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation, 46% were treated with re-dilatation and only 17% required surgery.
CONCLUSION
DBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.
Topics: Constriction, Pathologic; Dilatation; Double-Balloon Enteroscopy; Humans; Intestinal Obstruction; Intestine, Small; Postoperative Complications; Treatment Outcome
PubMed: 29259383
DOI: 10.3748/wjg.v23.i45.8073