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Advances in Therapy Jun 2019Late second trimester dilation and evacuation is a challenging subset of surgical abortion. Among the reasons for this is the degree of cervical dilation required to... (Review)
Review
Late second trimester dilation and evacuation is a challenging subset of surgical abortion. Among the reasons for this is the degree of cervical dilation required to safely extricate fetal parts. Cervical dilation is traditionally achieved by placing multiple sets of osmotic dilators over two or more days prior to the evacuation procedure; however, there is interest in shortening cervical preparation time. The use of adjuvant mifepristone and misoprostol in conjunction with osmotic dilators has been studied for this purpose, and their use demonstrates that adequate cervical dilation can be achieved in less time than with dilators alone. We present a review of the current evidence surrounding adjunctive agents for cervical preparation, and contend that for women presenting for surgical abortion care above 19 weeks gestation, the use of adjunctive mifepristone and/or misoprostol should be strongly considered along with osmotic dilator insertion when cervical preparation in less than 24 h is needed.
Topics: Abortifacient Agents, Nonsteroidal; Adult; Cervix Uteri; Dilatation; Extraction, Obstetrical; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Preoperative Care
PubMed: 31004327
DOI: 10.1007/s12325-019-00953-2 -
The British Journal of Surgery Dec 1981A review of the different bougies used over the years confirms that the dilators presently available are adequate for the conservative management of oesophageal benign...
A review of the different bougies used over the years confirms that the dilators presently available are adequate for the conservative management of oesophageal benign strictures. Most of these are of an old but well-tested design. Several additional techniques may have to be tried in difficult patients. Dysphagia can be relieved by the passage os size 39 FG bougies but many will wish to increase this to 60 FG, if it is possible. Failure of conservative management by dilatation only can be defined as (a) technical impossibility to dilate sufficiently to relieve the dysphagia, which is rare, or (b) when the patient or the surgeon considers the procedure is being done too frequently, which must be measured in FG for the bougie and weeks for frequency. The more expert the surgeon becomes at dilatation, the safer it will become, and the necessity for surgical intervention will be less frequent.
Topics: Aged; Child; Dilatation; Esophageal Achalasia; Esophageal Stenosis; Europe; History, 16th Century; History, 17th Century; History, 18th Century; History, 20th Century; Humans; United Kingdom; United States
PubMed: 7032643
DOI: 10.1002/bjs.1800681202 -
Gastrointestinal Endoscopy Jun 1985Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the...
Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.
Topics: Dilatation; Esophageal Neoplasms; Esophageal Stenosis; Fluoroscopy; Humans
PubMed: 4007434
DOI: 10.1016/s0016-5107(85)72038-x -
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 -
Tidsskrift For Den Norske Laegeforening... May 1990During the period 1979-88, 129 patients (49 women and 89 men) were dilated for oesophageal strictures. The total number of dilatations was 811. The main causes were...
During the period 1979-88, 129 patients (49 women and 89 men) were dilated for oesophageal strictures. The total number of dilatations was 811. The main causes were gastro-oesophageal reflux (54 patients), achalasia (17 patients) and malignant stenosis (27 patients). Almost all strictures were successfully dilated, but with short duration of effect in the malignant group. During the ten-year period, the method of dilatation has changed from almost exclusively Eder-Puestow dilators to balloon dilators. Four perforations of the oesophagus were experienced with the use of Eder-Puestow dilators (448 dilatations), whereas no perforations were experienced with the use of balloon dilatation (363 dilatations). The article presents a follow-up study of 37 available patients from the 54 with gastro-oesophageal reflux. It is concluded that endoscopic dilatation is a safe and efficient treatment for oesophageal strictures.
Topics: Adolescent; Adult; Aged; Catheterization; Child; Child, Preschool; Dilatation; Esophageal Stenosis; Female; Follow-Up Studies; Gastroesophageal Reflux; Humans; Infant; Male; Middle Aged
PubMed: 2368054
DOI: No ID Found -
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 -
The American Journal of Gastroenterology Feb 2016The saga of esophageal dilation for patients with eosinophilic esophagitis and strictures reads like a historical novel. Currently, data from over 500 eosinophilic...
The saga of esophageal dilation for patients with eosinophilic esophagitis and strictures reads like a historical novel. Currently, data from over 500 eosinophilic esophagitis (EoE) patients now convincingly prove that esophageal dilation is effective for prolonged relief and safe. It can easily be performed in the gastroenterologists community but follow the basic tenets of starting low with small diameter bougies/balloons and progressing slowly as you gradually dilate these strictures to 16-18 mm. Table 1 outlines my approach.
Topics: Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagoplasty; Female; Humans; Male
PubMed: 26882944
DOI: 10.1038/ajg.2015.433 -
World Journal of Surgery 1990The efficiency and safety of the 2 most commonly used endoscopic dilators, Savary-Gilliard and pressure balloons, were compared in 2 groups, each including 30 patients,... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
The efficiency and safety of the 2 most commonly used endoscopic dilators, Savary-Gilliard and pressure balloons, were compared in 2 groups, each including 30 patients, with benign esophageal strictures. Four additional patients with tight and tortuous cervical esophageal strictures were initially managed by balloon dilatation followed by Savary-Gilliard dilatation. These patients could not be dilated by each of the methods alone. Sixty patients [35 males and 25 females with a mean age of 52 years (range, 4-91)] underwent 165 esophageal dilatations. The etiologies of strictures included reflux esophagitis (65%), caustic damage (18.3%), and postoperative (anastomotic, or post-Nissen operation) in 16.7%. Dysphagia improved in all patients; however, 2 patients (1 from each group) with hard postoperative anastomotic stricture eventually underwent surgical resection of stricture. There were no major complications or mortality related to the dilatations. Both methods were highly effective and well tolerated, yet Savary-Gilliard dilators were slightly more effective and simpler to use than balloons. Nevertheless, tortuous cervical strictures and multiple closely-placed strictures were more effectively managed by initial use of balloon followed by Savary dilators.
Topics: Burns, Chemical; Catheterization; Dilatation; Esophageal Stenosis; Esophagitis, Peptic; Esophagoscopy; Female; Humans; Male; Middle Aged; Prospective Studies
PubMed: 2382455
DOI: 10.1007/BF01658680 -
JAMA Facial Plastic Surgery Sep 2016The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter... (Comparative Study)
Comparative Study Review
IMPORTANCE
The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve.
OBJECTIVE
To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism.
EVIDENCE REVIEW
A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded.
FINDINGS
An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators.
CONCLUSIONS AND RELEVANCE
Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.
Topics: Airway Resistance; Dilatation; Humans; Nasal Obstruction
PubMed: 27367589
DOI: 10.1001/jamafacial.2016.0291 -
Obstetrical & Gynecological Survey Jul 2004This article reviews safety, efficacy, and complications of intracervical osmotic devices and discusses diagnostic, therapeutic, and preventative measures for managing... (Review)
Review
This article reviews safety, efficacy, and complications of intracervical osmotic devices and discusses diagnostic, therapeutic, and preventative measures for managing them. Osmotic dilators have been used to ripen the cervix in gynecologic and obstetric procedures for centuries. Their gradual effect in softening and dilating the cervix reduces the chance of stretch injury or perforation and could enhance completeness of evacuation of the uterine cavity. Natural and synthetic devices are available, each with unique properties. Notwithstanding major advances in prostaglandin analogs as cervical ripeners, these mechanical devices continue to play a vital role in cervical preparation. In the event of an unfavorable cervix, they are adjuncts for accelerating inductions of labor and for safe uterine entry during hysteroscopy and diagnostic dilation and curettage. For inducing pregnancy, they are routinely used as cervical ripeners from the late first trimester onward. The English-language literature was surveyed. The author used citations from a MEDLINE search, 2 unpublished case reports, and personal experience. Laminaria and Dilapan dilators can get trapped and fragment with the potential for serious adverse clinical and legal consequences. Lamicel devices do not share this feature. Serious infection is uncommon and anaphylaxis is rare. Timely, well-selected imaging techniques can aid diagnosis. Preventative measures could reduce the number and severity of osmotic dilator-associated complications. Measures suggested by some include predilating with metal dilators, incorporating laminaria or Lamicel devices with Dilapan, adding misoprostol, and using sonohysterography. However, these measures, singly and in combination, are unlikely to eliminate all complications.
Topics: Abortion, Induced; Adult; Anaphylaxis; Catheterization; Cervix Uteri; Device Removal; Dilatation; Equipment Safety; Female; Gynecology; Humans; Infections; Laminaria; Malpractice; Obstetrics; Osmosis; Polymers; Pregnancy; Treatment Outcome; United States
PubMed: 15199271
DOI: 10.1097/00006254-200407000-00022