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Medicina (Kaunas, Lithuania) May 2024: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric...
: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. : Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. : A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients' clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. : Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.
Topics: Humans; Male; Female; Gastrectomy; Middle Aged; Retrospective Studies; Dilatation; Adult; Treatment Outcome; Constriction, Pathologic; Postoperative Complications
PubMed: 38793016
DOI: 10.3390/medicina60050833 -
Journal of Pediatric Surgery Jun 2022Esophageal strictures are a common condition, and pediatric surgeons confront them regularly. Despite being performed very frequently, there ared not studies that...
INTRODUCTION
Esophageal strictures are a common condition, and pediatric surgeons confront them regularly. Despite being performed very frequently, there ared not studies that clearly identify prognostic factors for pediatric patients.
METHODS
Medical records of the children who were taken to esophageal dilatation due to strictures from January 2015 to December 2018 were reviewed. Statistical analysis was performed to establish prognostic factors.
RESULTS
Six hundred sixty-three procedures were performed in 111 patients. The majority of patients had antecedent of esophageal atresia 56%, corrosive stricture in 24%, idiopathic 11%, and Gastroesophageal Reflux (GER) in 9%. The effectiveness of the dilatations was evaluated against three parameters: Dysphagia 0 or 1 in the last assessment 82%. Discharge from dilatation protocol 64%, and no need for surgery 74%. The Global effectiveness was determined by fulfilling the three previous outcomes and was of 49%. The complication rate was 1.9%, being esophageal perforation the most frequent. The statistically significant predictors for the ineffective dilations were airway compromise and history of feeding surgery. The length fewer than 2 cm of the stricture, the location in the middle third of the esophagus and the endoscope passage in the first procedure were factors associated with a better prognosis. Airway involvement was also a variable associated with more significant complications.
CONCLUSIONS
Esophageal dilatations are a fundamental part of the management of strictures. This study found relevant prognostic factors for both the effectiveness of the dilatations and the complications of these. More studies are needed for a gold standard of effectiveness in this condition.
LEVEL OF EVIDENCE
This is a retrospective study of level III of evidence.
Topics: Child; Constriction, Pathologic; Dilatation; Esophageal Atresia; Esophageal Stenosis; Esophagus; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35184881
DOI: 10.1016/j.jpedsurg.2022.01.037 -
Computers in Biology and Medicine Jul 2021Medical image segmentation is a typical task in medical image processing and critical foundation in medical image analysis. U-Net is well-liked in medical image...
Medical image segmentation is a typical task in medical image processing and critical foundation in medical image analysis. U-Net is well-liked in medical image segmentation, but it doesn't fully explore useful features of the channel and capitalize on the contextual information. Therefore, we present an improved U-Net with residual connections, adding a plug-and-play, very portable channel attention (CA) block and a hybrid dilated attention convolutional (HDAC) layer to perform medical image segmentation for different tasks accurately and effectively, and call it HDA-ResUNet, in which we fully utilize advantages of U-Net, attention mechanism and dilated convolution. In contrast to the simple copy splicing of U-Net in the skip connection, the channel attention block is inserted into the extracted feature map of the encoding path before decoding operation. Since this block is lightweight, we can apply it to multiple layers in the backbone network to optimize the channel effect of this layer's coding operation. In addition, the convolutional layer at the bottom of the "U"-shaped network is replaced by a hybrid dilated attention convolutional (HDAC) layer to fuse information from different sizes of receptive fields. The proposed HDA-ResUNet is evaluated on four datasets: liver and tumor segmentation (LiTS 2017), lung segmentation (Lung dataset), nuclear segmentation in microscope images (DSB 2018) and neuron structure segmentation (ISBI 2012). The dice global scores of liver and tumor segmentation (LiTS 2017) reach 0.949 and 0.799. The dice coefficients of lung segmentation and nuclear segmentation are 0.9797 and 0.9081 respectively, and the information theoretic score for the last one is 0.9703. The segmentation results are all more accurate than U-Net with fewer parameters, and the problem of slow convergence speed of U-Net on DBS 2018 is solved.
Topics: Dilatation; Disease Progression; Humans; Image Processing, Computer-Assisted; Lung; Neural Networks, Computer
PubMed: 33993015
DOI: 10.1016/j.compbiomed.2021.104449 -
The Journal of Laryngology and Otology Jan 2020
Topics: Catheterization; Dilatation; Ear Diseases; Eustachian Tube; Humans; Middle Ear Ventilation; Nasal Decongestants; Otitis Media with Effusion; Otolaryngology
PubMed: 32048576
DOI: 10.1017/S0022215120000262 -
Journal of Pediatric Surgery Oct 2023To explore nurses' experiences with anal dilatations in babies with anorectal malformations.
AIMS AND OBJECTIVES
To explore nurses' experiences with anal dilatations in babies with anorectal malformations.
BACKGROUND
Most babies with anorectal malformations require repeated anal dilatations, either before and/or after reconstructive surgery. Anal dilatation is usually performed without sedation or pain medication. Nurses participate in anal dilatations by assisting doctors doing anal dilatation, doing anal dilatation themselves, and instructing parents how to do anal dilatations. No previous studies have explored how nurses experience being involved in anal dilatations.
DESIGN
Qualitative study design utilizing focus group interviews. The COREQ guidelines were applied.
METHODS
Nurses with either ≤2 or ≥10 years' working experience participated in two different focus group interviews. The focus group interviews were transcribed and analyzed with content analysis.
RESULTS
Twelve nurses, two males, participated. Three main themes emerged from the focus group interviews. The first main theme, "Anal dilatation causes distress", describes the nurses' worries about causing physical and/or psychological harm when doing anal dilatations. The second main theme, "Need for guidelines and training", contains nurses' recommendations for more theoretical training in addition to written guidelines on anal dilatations. The third main theme, "Collegial support is vital", describes nurses' needs and strategies for coping with difficult situations related to anal dilatations.
CONCLUSIONS
Anal dilatation causes distress in nurses, and collegial support is essential for coping. Guidelines and systematic training are recommended to improve current practice.
LEVEL OF EVIDENCE
VI.
Topics: Male; Infant; Humans; Anorectal Malformations; Focus Groups; Dilatation; Qualitative Research; Nurses
PubMed: 37246043
DOI: 10.1016/j.jpedsurg.2023.04.021 -
Gastrointestinal Endoscopy Sep 2021
Topics: Dilatation; Gastric Emptying; Gastroparesis; Humans; Pylorus
PubMed: 34218923
DOI: 10.1016/j.gie.2021.04.014 -
Surgical Endoscopy May 2023Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite...
BACKGROUND AND AIMS
Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite limited supporting literature. Our study investigated the etiologic spectrum of BDS and its response to endoscopic dilation.
METHODS
We performed a cohort study of a prospectively maintained database of BDS at our large tertiary academic center between 2002 and 2018. All patients who underwent EBD were analyzed. Dilation was performed using through-the-scope balloons. Technical and clinical successes of initial and repeat EBD were compared. Descriptive statistics, univariate, and multivariate analysis were performed.
RESULTS
The study included 86 patients with 54.7% female gender. Etiologies included 39 patients with PUD (45.3%), 19 patients with Crohn's disease (22.1%), 23 patients had idiopathic etiologies (26.7%), and 5 patients were listed as other etiologies (5.8%). Proximal stricture location (1st part of duodenum) occurred in 66% of females, whereas distal duodenal involvement was seen in 63.6% of males (p value 0.007). Usage of PPI was associated with 3.6 times higher clinical success rate (p value 0.04). Technical (97.4%) and clinical (77.8%) successes for index dilations in PUD were not significantly better than those of non-PUD patients (p values 0.99, 0.52).
CONCLUSION
EBD has both a high technical and clinical success for BDS regardless of etiology and should be considered over initial surgical intervention due to low risk profile. Males tend to have more distal duodenal involvement, and PPI usage is an independent predictor for clinical success.
Topics: Male; Humans; Female; Dilatation; Cohort Studies; Treatment Outcome; Endoscopy; Peptic Ulcer; Retrospective Studies
PubMed: 36624215
DOI: 10.1007/s00464-022-09844-0 -
Scandinavian Journal of Gastroenterology Jun 2023Endoscopic balloon dilatation (EBD) is a standard treatment for intestinal strictures in Crohn's disease (CD). No evidence-based guidelines exist regarding the balloon... (Observational Study)
Observational Study
OBJECTIVE
Endoscopic balloon dilatation (EBD) is a standard treatment for intestinal strictures in Crohn's disease (CD). No evidence-based guidelines exist regarding the balloon diameter or the balloon pressure to be used, with recent studies suggesting the use of a smaller diameter than classically used. We sought to analyze the factors associated with safety and efficacy of EBD in CD strictures, particularly looking at balloon diameter and dilatation pressure.
METHODS
We conducted a monocentric retrospective study of patients who underwent EBD between 2005 and 2020.
RESULTS
Our endoscopy department performed EBD in 94 CD patients during the considered period. The mean size of balloon dilatation was 16 mm (±2.5; including 21 patients with balloon <14 mm) and the mean dilatation pressure was 5.3 atm (±1.5). No perforation was observed. Over a median follow-up of 5.6 years, the probability of being operated was 5.4% at 1 year and 10.4% at 3 years. Smaller height (HR = 0.90, = 0.022) and a higher BMI (HR = 1.23, = 0.014) were associated with the risk of operation. The probability of being operated or redilated was 30.1% at 1 year and 52.5% at 3 years. No factor was significantly associated with this risk. The size of the balloon had no impact on outcomes.
CONCLUSION
In this retrospective cohort, including a significant proportion of CD patients dilated with balloon <14 mm, no perforation was observed and the size of the balloon or the dilatation pressure had no impact on the risk of surgery or redilatation.
Topics: Humans; Crohn Disease; Constriction, Pathologic; Dilatation; Endoscopy, Gastrointestinal; Gastric Balloon; Treatment Outcome; Retrospective Studies; Male; Female; Adult; Middle Aged
PubMed: 36533307
DOI: 10.1080/00365521.2022.2156808 -
Digestive and Liver Disease : Official... May 2024Endoscopic treatments such as peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) are commonly used to treat achalasia. Although POEM has gained popularity due... (Review)
Review
Endoscopic treatments such as peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) are commonly used to treat achalasia. Although POEM has gained popularity due to its high efficacy, the technique is more complex and may be associated with a higher risk of long-term complications compared to PD. This narrative review will focus on efficacy and safety of PD and POEM, and their suitability for different patient populations. While evidence suggests that POEM may be preferred for type III achalasia, PD remains a valuable alternative for patients with a straight, non-dilated esophagus, who prioritize the preservation of anatomical integrity and a lower risk of post-procedural gastroesophageal reflux disease (GERD). While PD carries a non negligibile risk of perforation, it has an excellent safety profile in terms of GERD and is minimally likely to cause permanent esophageal deformation. PD can be repeated with minimal risks to maintain symptom relief, whereas reversing permanent anatomical modifications related to POEM is difficult. The choice of treatment for achalasia should be patient-tailored, considering benefits and drawbacks of each intervention. The importance of personalized approach in the "POEM era" is highlighted, emphasizing the reasons why PD should still be considered a valuable option in the therapeutic armamentarium for achalasia. Areas requiring further research will be also outlined.
Topics: Esophageal Achalasia; Humans; Dilatation; Gastroesophageal Reflux; Esophagoscopy; Myotomy; Treatment Outcome
PubMed: 37932169
DOI: 10.1016/j.dld.2023.10.019 -
Cardiology in the Young Oct 2023I read with interest the article by Haddad et al concerning the bench testing of BeSmooth peripheral tests, and I would like to share some thoughts and highlight few...
I read with interest the article by Haddad et al concerning the bench testing of BeSmooth peripheral tests, and I would like to share some thoughts and highlight few points.BeSmooth stent is behaving like any pre-mounted stent available on the market. None can achieve the Holy Grail of being dilatable to adult size without losing their integrity. Until dedicated stents are available, pre-mounted stents are preferred to unmounted stents because of their better profile and deliverability. Technically, proper post-dilatation should be performed in order to avoid and extensive foreshortening and the formation of a ring that would limit further expansion of the stent. BeSmooth stent like other pre-mounted stents can also be used without restriction in situations where overexpansion is not required.BeSmooth stent platform with the knowledge of its intrinsic properties is, in our opinion, a good add-on to the armamentarium of pre-mounted stents used in paediatric cardiology.
Topics: Child; Humans; Prosthesis Design; Stents; Dilatation; Cardiology
PubMed: 37721027
DOI: 10.1017/S1047951123003074