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Endoscopy Sep 1986Strictures of the esophagus following surgical resection present uncommonly. Reports are few describing the occurrence and management of this entity especially in the...
Strictures of the esophagus following surgical resection present uncommonly. Reports are few describing the occurrence and management of this entity especially in the contemporary literature. In general a postoperative stricture is approached in the same manner as any other type of esophageal stricture, i.e., by clinical, radiographic and endoscopic evaluation. In particular, the stricture is carefully examined endoscopically, appropriate biopsies and/or cytology obtained and dilation carried out. Methods of dilating these strictures include those techniques most commonly used and especially the method which is most familiar and comfortable for the endoscopist. Standard Eder-Puestow bougies, Maloney and Hurst dilators and Savary-Gilliard bougies exert forces along a longitudinal axis which may be more uncomfortable for the patient and associated with higher morbidity than balloon dilators, which exert forces along a radial axis. Dilatation of post-surgical esophageal strictures is performed as safely as possible with minimal discomfort to the patient and should provide long-term results requiring infrequent interventions.
Topics: Dilatation; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Humans; Postoperative Complications; Radiography
PubMed: 3757926
DOI: 10.1055/s-2007-1018440 -
Journal of Endourology May 2008In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both... (Comparative Study)
Comparative Study
PURPOSE
In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques.
MATERIALS AND METHODS
We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups.
RESULTS
There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups.
CONCLUSIONS
The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.
Topics: Blood Transfusion; Catheterization; Dilatation; Female; Hemoglobins; Humans; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 18429681
DOI: 10.1089/end.2007.0167 -
Open Veterinary Journal 2022Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory...
BACKGROUND
Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory or recurrent strictures do occur and remain a challenge to the endoluminal treatment. The aim of this report was to communicate a recurrent esophageal stricture resolution in a cat treated with balloon dilatation and steroid injections in Ciudad de Buenos Aires, Argentina.
CASE DESCRIPTION
A 1-year-old spayed mix-breed female cat was consulted to the Veterinary Endoscopy Service for recurring regurgitation after two previous esophageal dilations. The cat had received doxycycline for spp. infection and 20 days after the treatment consulted for dysphagia and regurgitation. Upper esophagogastroscopy (UGE) was performed with an Olympus CV-160 8.7 mm diameter endoscope; an annular 7 mm stricture was observed 3 cm caudal to the cranial esophagus sphincter. Three balloon dilatations procedures were performed with a Boston Scientific Controlled Radial Expansion (CRE) balloon 8-10-12 mm of 1 minute each. Because of ongoing clinical signs, another UGE was performed 15 days from the first procedure: a 3 mm stricture was encountered, balloon dilatation was repeated with 6-10-12 mm diameter, and a four-quadrant triamcinolone was injected in the submucosa. Clinically, the cat could eat with no alterations until day 20, where it started with mild dysphagia. Another UGE was performed, and the known stricture conserved a 11 mm diameter and balloon dilatation 12-15-16.5 mm with triamcinolone injection was repeated 30 days after the previous procedure. The cat could eat kibbles with no clinical signs in an 11-month follow-up.
CONCLUSION
The alternative to triamcinolone injection after balloon dilatation presented in this clinical report was successful and it could be a therapeutic option for recurrent esophageal strictures in cats as it is in human medicine.
Topics: Animals; Cat Diseases; Cats; Constriction, Pathologic; Deglutition Disorders; Dilatation; Esophageal Stenosis; Esophagoscopy; Female; Injections, Intralesional; Steroids; Triamcinolone
PubMed: 35603061
DOI: 10.5455/OVJ.2022.v12.i2.6 -
Gastrointestinal Endoscopy Clinics of... Jan 2018In eosinophilic esophagitis, the main cause of solid-food dysphagia is tissue remodeling resulting in strictures and narrowed esophagus. Endoscopy and biopsies help to... (Review)
Review
In eosinophilic esophagitis, the main cause of solid-food dysphagia is tissue remodeling resulting in strictures and narrowed esophagus. Endoscopy and biopsies help to identify the degree of inflammation but often miss the fibrosis. Although initially considered dangerous, esophageal dilation has evolved into an extremely effective and safe treatment in fibrostenotic disease. The key is starting low with small-diameter bougies or balloons, and gradually dilating the esophagus and strictures to 16 to 18 mm. Results in more than 1000 adults and children have shown low rates of complications, especially perforations, and no deaths, but postprocedure chest pain is common.
Topics: Chest Pain; Deglutition Disorders; Dilatation; Endoscopy, Gastrointestinal; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagus; Fibrosis; Humans; Manometry; Practice Guidelines as Topic
PubMed: 29129303
DOI: 10.1016/j.giec.2017.07.009 -
Journal of Pediatric Surgery Oct 2019Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar...
BACKGROUND
Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar dilators. In our setup, few parents will acquire Hegar dilators for home based anal dilatation but majority will use fingers as an alternative. The basis of this study was to determine the effectiveness of digital anal dilatations in preventing anal strictures.
MATERIALS AND METHODS
This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH) which recruited children post ARM repair undergoing digital anal dilatation. The diameters of the digits used for anal dilatation were assessed for adequacy using the desired anal size as a reference point. The main outcome variable was the presence of anal strictures. Data were entered in a data collection sheet and analyzed by use of SPSS (V.21.0 Chicago, Illinois). Chi-square test and Fisher's exact test were used to ascertain association among variables. A P-value of less than 0.05 was considered statistically significant.
RESULTS
50 patients with ARM post repair were recruited in the study. The rate of occurrence of anal stricture was 22%. Among the participants with anal strictures, only 27% were compliant to the dilatation regimen while 73% reported noncompliance. The mean diameter(mm) of the dilating digits at the level of the middle phalanx was Index finger (15.4 ± 0.58), middle finger (15.2 ± 0.61), ring finger (14.2 ± 0.71), small finger (12.5 ± 0.91) and thumb (17.6 ± 0.78). 46% of the participants were dilated with appropriately sized digits. The remainder had dilatations done with larger (22%) or smaller digits (32%). Notably, anal strictures occurred in participants who were dilated with inappropriately sized digits (P = 0.001).
CONCLUSION
Digital anal dilatation is safe and effective as a mode of anal dilation in the setting of compliance to a strict dilatation protocol, daily frequency of dilations and use of appropriately sized digits. Owing to the variability in the finger size, we recommend that digits be calibrated and education given to the caregivers on the use of the appropriately sized digit.
LEVEL OF EVIDENCE
Treatment study. Level III.
Topics: Adolescent; Anal Canal; Anorectal Malformations; Anus Diseases; Child; Child, Preschool; Constriction, Pathologic; Cross-Sectional Studies; Digestive System Surgical Procedures; Dilatation; Female; Fingers; Humans; Infant; Male; Patient Compliance; Postoperative Care; Postoperative Complications; Treatment Outcome
PubMed: 31053362
DOI: 10.1016/j.jpedsurg.2019.04.004 -
The American Surgeon Apr 2018Pneumatic dilation is a well-established treatment modality that has withstood the test of time. Prospective and randomized trials have shown that in expert hands, it... (Review)
Review
Pneumatic dilation is a well-established treatment modality that has withstood the test of time. Prospective and randomized trials have shown that in expert hands, it provides results similar to a laparoscopic Heller myotomy with fundoplication. In addition, it should be considered the primary form of treatment in patients who experience recurrence of symptoms after a surgical myotomy.
Topics: Dilatation; Esophageal Achalasia; Esophagoscopy; Humans; Treatment Outcome
PubMed: 29712591
DOI: No ID Found -
American Journal of Surgery Jun 1976We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using...
We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using intravenous diazepam, the majority on an outpatient basis. The only complication has been a single case of aspiration pneumonia. We have found this method of esophageal dilatation particularly useful in the preoperative dilatation of benign strictures, and in those elderly frail patients who are unsuitable for surgery. Transthoracic resection of the stricture is avoided and thus transabdominal repair of the hiatus hernia may be undertaken.
Topics: Aged; Dilatation; Esophageal Stenosis; Humans; Male; Radiography; Surgical Equipment
PubMed: 937648
DOI: 10.1016/0002-9610(76)90180-x -
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 -
Gastrointestinal Endoscopy May 2006
Topics: Deglutition Disorders; Dilatation; Esophageal Diseases; Esophageal Perforation; Esophageal Stenosis; Esophagitis; Humans
PubMed: 16650533
DOI: 10.1016/j.gie.2006.02.031 -
British Journal of Urology Jan 1988The effects of three methods of acute ureteric dilatation (by graded Teflon dilators, low and high pressure balloon dilators) were evaluated radiologically,...
The effects of three methods of acute ureteric dilatation (by graded Teflon dilators, low and high pressure balloon dilators) were evaluated radiologically, renographically and histologically in minipigs. The minipig ureter was dilated from its normal calibre of 4 F to 10 F. All three methods caused upper urinary tract dilatation and an obstructive nephropathy which had not resolved 96 h after dilatation. Histology at 24 h showed destruction of the transitional epithelium, with inflammation throughout the ureteric wall. Four weeks after dilatation the ureter was still dilated and urothelial nests were seen in the lamina propria and in the muscle coats. There was no evidence of ischaemic necrosis or ureteric stricture formation. The implications of these findings for clinical practice are discussed.
Topics: Animals; Dilatation; Endoscopy; Female; Male; Radiography; Radioisotope Renography; Swine; Swine, Miniature; Ureter
PubMed: 3342296
DOI: 10.1111/j.1464-410x.1988.tb09156.x