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South African Journal of Surgery.... Aug 1999Acute dilatation or bouginage of strictures gives only temporary relief, and slow continuous dilatation was therefore tried and found to give superior results in...
Acute dilatation or bouginage of strictures gives only temporary relief, and slow continuous dilatation was therefore tried and found to give superior results in treating benign and malignant strictures, particularly of the oesophagus. Slow stretch methods are discussed and compared with other methods. Methods are described that were evolved for dilating both by the 'acute' and slow-continuous methods, including use of the Didcott dilator (DD), invented in 1956. For oesophageal cancer this, combined with brachytherapy, has resulted in increased longevity and quality of life. Mortality from the dilatation and introduction of a DD for a week, followed by its removal without anaesthesia, is less than 2%. Relief of dysphagia lasts 2-10 months. Thereafter the procedure can be repeated and finally, when the patient is obviously near-terminal, a permanent indwelling stent can be used. This can be a modified DD stent or a Livingstone or Celestin tube. These are also used in tracheo-oesophageal fistulas. Complete cure is often possible in benign strictures, especially if short.
Topics: Dilatation; Equipment Design; Esophageal Stenosis; Humans
PubMed: 10540574
DOI: No ID Found -
The American Journal of Gastroenterology Apr 1989Esophageal dilatation by endoscopists is a commonly performed procedure. The introduction of tapered polyvinyl dilators by Savary has made the procedure even more...
Esophageal dilatation by endoscopists is a commonly performed procedure. The introduction of tapered polyvinyl dilators by Savary has made the procedure even more popular. In the United States, esophageal dilatation with guide wires has been traditionally performed with fluoroscopy. By using a marked guide wire and by adhering to specific safety guidelines, the passage of the guide wire can be precise, even without fluoroscopy, and radiographic definition is not always required. This study describes the new guide wire and the technique.
Topics: Dilatation; Equipment Design; Esophageal Stenosis; Humans; Pilot Projects
PubMed: 2929554
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Apr 2019Bedside percutaneous dilatational tracheostomy has become one of the most commonly used interventions in ICU medicine. Different techniques have been developed, but...
Bedside percutaneous dilatational tracheostomy has become one of the most commonly used interventions in ICU medicine. Different techniques have been developed, but guidance of percutaneous dilatational tracheostomy by video bronchoscope has been suggested to be clinically reasonable for direct visualization. The current Step-by-Step tutorial gives a detailed instruction of the procedure with visualization of every single step offering tips and pitfalls of the procedure.
Topics: Bronchoscopy; Contraindications, Procedure; Dilatation; Humans; Point-of-Care Systems; Tracheostomy
PubMed: 30986863
DOI: 10.1055/a-0665-6444 -
Surgical Endoscopy Jul 2021The magnetic sphincter augmentation device (MSA) provides effective relief of gastroesophageal reflux symptoms. Dysphagia after MSA implantation sometimes prompts...
BACKGROUND
The magnetic sphincter augmentation device (MSA) provides effective relief of gastroesophageal reflux symptoms. Dysphagia after MSA implantation sometimes prompts endoscopic dilation. The manufacturer's instructions are that it be performed 6 or more weeks after implantation under fluoroscopic guidance to not more than 15 mm keeping 3 or more beads closed. The purpose of this study was to assess adherence to these recommendations and explore the techniques used and outcomes after MSA dilation.
METHODS AND PROCEDURES
We conducted a multicenter retrospective review of patients undergoing dilation for dysphagia after MSA placement from 2012 to 2018.
RESULTS
A total of 144 patients underwent 245 dilations. The median size of MSA placed was 14 beads (range 12-17) and the median time to dilation was 175 days. A second dilation was performed in 67 patients, 22 patients had a third dilation and 7 patients underwent 4 or more dilations. In total, 17 devices (11.8%) were eventually explanted. The majority of dilations were performed with a balloon dilator (81%). The median dilator size was 18 mm and 73.4% were done with a dilator larger than 15 mm. There was no association between dilator size and need for subsequent dilation. Fluoroscopy was used in 28% of cases. There were no perforations or device erosions related to dilation.
DISCUSSION
There is no clinical credence to the manufacturer's recommendation for the use of fluoroscopy and limitation to 15 mm when dilating a patient for dysphagia after MSA implantation. Use of a larger size dilator was not associated with perforation or device erosion, but also did not reduce the need for repeat dilation. Given this, we would recommend that the initial dilation for any size MSA device be done using a 15 mm through-the-scope balloon dilator. Dysphagia prompting dilation after MSA implantation is associated with nearly a 12% risk of device explantation.
Topics: Dilatation; Esophageal Sphincter, Lower; Gastroesophageal Reflux; Humans; Magnetic Phenomena; Retrospective Studies; Treatment Outcome
PubMed: 32671521
DOI: 10.1007/s00464-020-07799-8 -
Catheterization and Cardiovascular... Feb 2021To determine over-dilation potential of commercially available covered stents.
OBJECTIVES
To determine over-dilation potential of commercially available covered stents.
BACKGROUND
Covered stents including the Atrium iCast, Gore VBX, and Lifestream stents (LS) can treat ruptures, dissections, and aneurysms in small vessels. Especially in growing patients, stents often require serial dilations beyond their implant or nominal diameters. Tolerance of serial dilations is clinically important information for interventionalists.
METHODS
Serial dilations of 5-12 mm iCast, VBX, and LS covered stents were performed in 1-2 mm increments (up to 20 mm). With each dilation, foreshortening and recoil were measured, and stent strut and covering integrity were assessed. High-pressure balloons were used to expand the stents until they fractured or could not be further expanded.
RESULTS
The 5-8 mm LS tolerated dilation to 14.5-16 mm. The 10-12 mm LS stents tolerated dilation to 18 mm and fractured on the 20 mm balloon. LS stents foreshortened 35%-45% on average after 8 mm of over-dilation and had 5%-10% recoil on <6 mm over-dilation. All iCast stents tolerated dilation to 12-13 mm and required fracture for dilation to >14 mm. ICast stents foreshortened 19%-29% at maximum dilation, with 3-6% recoil on <2 mm over-dilation, and < 3% thereafter. VBX stents over-dilated to 2.9-4.7 mm above nominal, foreshortening 40%-50% after 4-6 mm of over-dilation before collapsing into a ring. VBX stent recoil was <2.5% on all dilations.
CONCLUSIONS
LS stents had the greatest over-dilation potential. VBX stents had the least recoil but tended to foreshorten significantly 3-4 mm above nominal. Regardless of nominal size, all iCast stents (including the 5 mm) tolerated dilation to a maximum of 12-13 mm.
Topics: Dilatation; Humans; Prosthesis Design; Stents; Treatment Outcome
PubMed: 33283447
DOI: 10.1002/ccd.29421 -
Journal of Biomechanics Aug 2008Mitral valve (MV) annulus mechanics and its effect on annulus dilatation are not well understood. The objective of the current study was to understand annulus tension...
Mitral valve (MV) annulus mechanics and its effect on annulus dilatation are not well understood. The objective of the current study was to understand annulus tension (AT) during valve closure. A porcine MV rested on top of annulus rings with papillary muscles (PMs) held at slack, normal and taut conditions. The annulus was held by strings in the periphery during valve closure under static trans-mitral pressures. String tensions were measured and further used to calculate the anterior and posterior ATs. Three rings of different sizes were used to simulate normal and dilatated annuli. Fourteen MVs were tested. The anterior ATs were 37.21+/-11.03, 53.86+/-14.98 and 58.87+/-15.72N/m, respectively, at the slack, normal and taut PM positions in the normal annulus at the trans-mitral pressure of 16.3kPa (122mmHg). The posterior ATs were 24.52+/-5.68, 36.29+/-8.89 and 42.32+/-11.82N/m, respectively, at the slack, normal and taut PM positions in the normal annulus at the trans-mitral pressure of 16.3kPa (122mmHg). AT increased as the PM changed from slack to normal, then to taut PM positions. The AT increases with the increase of annulus area and linearly with the increase of trans-mitral pressure. The AT increases with the increases of apical PM displacement and dilatated annulus area, and reduces the potential of annulus dilatation. Low trans-mitral pressure due to existent mitral regurgitation, and MV prolapse increase the potential of annulus dilatation.
Topics: Animals; Dilatation; Mitral Valve; Muscle Tonus; Papillary Muscles; Surface Properties; Swine
PubMed: 18573496
DOI: 10.1016/j.jbiomech.2008.05.006 -
Otolaryngology--head and Neck Surgery :... Mar 2019Current therapeutic strategies for pharyngoesophageal stricture, while effective in the short term, are protracted and costly in the longer term. Conceptually, if a...
Current therapeutic strategies for pharyngoesophageal stricture, while effective in the short term, are protracted and costly in the longer term. Conceptually, if a stricture can be dilated with minimal tissue injuries, the rate of fibrosis and the resultant stricture recurrence could be reduced. We evaluated a prototype computer-controlled syringe pump device programmed to distend a commercially available balloon dilator at variable rate, asserting incremental lumen distension pressures tailored to the resistive force encountered within the stricture. We completed 17 graded dilatation procedures among 4 total laryngectomy patients. All patients had a short-term response (1 month), with a mean decrement (improvement) in Sydney Swallow Questionnaire score of 448 (total score range, 0-1700; normal <234). The overall procedural tolerability and safety were encouraging; the only complication was the displacement of the voice prosthesis during 1 dilatation. From a technical viewpoint, the main challenge was to maintain the balloon in position during dilatation.
Topics: Constriction, Pathologic; Deglutition Disorders; Dilatation; Esophageal Stenosis; Feasibility Studies; Humans; Laryngectomy; Pharynx; Postoperative Complications; Treatment Outcome
PubMed: 30526296
DOI: 10.1177/0194599818815164 -
AJR. American Journal of Roentgenology Jan 1987Percutaneous balloon dilatation of ureteral strictures has not gained widespread acceptance, despite proven success with the techniques for dilating stenotic blood...
Percutaneous balloon dilatation of ureteral strictures has not gained widespread acceptance, despite proven success with the techniques for dilating stenotic blood vessels. Thirty-one ureteral strictures (in 30 patients) that were dilated during a 42-month period were reviewed to assess the results and to determine which patients are most likely to benefit from the procedure. Eighteen (58%) of 31 strictures were successfully dilated and remained patent for at least 6 months. Thirteen (42%) of 31 strictures resulted in failed patency either immediately (two patients) or within 3 months (seven patients), 6 months (three patients), or 21 months (one patient). Fourteen (64%) of 22 strictures less than 7 months of age were successfully dilated. All dilations for strictures more than 7 months of age failed. Four strictures were of unknown age. Nine (69%) of 13 strictures located in the proximal or midureter remained patent, and three (60%) of five dilations at a ureteroileal anastomosis were successful. Neither of two strictures at a ureterocolic anastomosis was treated successfully. We conclude that percutaneous balloon dilatation is an effective treatment of ureteral strictures in some patients, especially when the strictures are less than 7 months of age.
Topics: Adult; Aged; Aged, 80 and over; Child; Dilatation; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Radiography; Retrospective Studies; Ureteral Obstruction; Urinary Catheterization
PubMed: 3491510
DOI: 10.2214/ajr.148.1.181 -
Gut Jul 1996Pneumatic dilatation of the oesophagus is a well established treatment for achalasia. Oesophageal perforation is the most serious complication that occurs in 2% to 6% of...
BACKGROUND/AIMS
Pneumatic dilatation of the oesophagus is a well established treatment for achalasia. Oesophageal perforation is the most serious complication that occurs in 2% to 6% of cases. The aim of this retrospective survey was to identify predictive risk factors for perforation in a consecutive series of 218 patients with achalasia.
METHODS
Between 1983 and 1993, 270 pneumatic dilatations were performed in 218 patients. A Witzel dilator was used in 58 cases and a Rigiflex dilator in 212. Eight oesophageal perforations occurred (3%). The clinical, radiological, endoscopic, manometric, and technical data for the eight perforated patients were compared with those of 30 patients randomly sampled among those without perforation.
RESULTS
All perforations occurred during the first dilatation. Perforations were fewer during dilatations with the Rigiflex dilator than with the Witzel dilator (2.4% v 5.2%). Perforations were all located above the cardia, on the left side of the oesophagus. In a multivariate analysis, a small weight loss and a high amplitude of oesophageal contractions in the group of patients with perforations were predictive of complications (respectively, p = 0.001 and p = 0.026). A contraction amplitude higher than 70 cm H2O in the lower part of the oesophagus was observed in three of eight patients with perforations but was not seen in any of the 30 patients without perforation (p < 0.01).
CONCLUSIONS
This identification of risk factors should facilitate the choice between pneumatic dilatation or a surgical approach.
Topics: Aged; Cohort Studies; Dilatation; Esophageal Achalasia; Esophagus; Female; Humans; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Rupture
PubMed: 8881799
DOI: 10.1136/gut.39.1.9 -
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