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Current Opinion in Gastroenterology Jul 2020The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric... (Review)
Review
PURPOSE OF REVIEW
The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric distension while providing real-time visualization and objective measurement during the dilation procedure, potentially negating the need for fluoroscopy. This review aims to describe the use and application of EsoFLIP and the potential advantages this novel technology may afford.
RECENT FINDINGS
Small pilot and retrospective studies demonstrate EsoFLIP feasibility and safety, but larger studies are needed to understand its impact on clinical outcomes.
SUMMARY
EsoFLIP is an appealing new technology that offers advantages in therapeutic dilation of the lower esophageal sphincter in achalasia or of esophageal strictures because of previous surgery, gastroesophageal reflux disease, or radiation.
Topics: Dilatation; Esophageal Achalasia; Esophageal Stenosis; Humans; Retrospective Studies; Treatment Outcome
PubMed: 32398561
DOI: 10.1097/MOG.0000000000000639 -
The Gastroenterologist Mar 1998Esophageal dilation, a technique developed four centuries ago, continues to be an important method of treating the symptom of dysphagia in patients with luminal... (Review)
Review
Esophageal dilation, a technique developed four centuries ago, continues to be an important method of treating the symptom of dysphagia in patients with luminal narrowing of the esophagus. Dilation is safe, with < 0.5% chance of perforation and bleeding and a 0.01% risk of death. Mercury bougienage (Maloney dilators), hollow polyvinyl dilators (Savary-Guillard), and balloon dilators (Through the Scope) are the principal types of dilators in use today. Few trials have compared the differing dilating methods. The results of these trials are mixed, and further randomized trials are necessary to determine if any technique has advantages in efficacy and cost. Although most patients successfully treated with dilation suffer with peptic strictures, those with nonpeptic strictures due to lower esophageal mucosal rings, corrosive injury, and radiation injury can also be treated effectively with dilation. By reviewing the current literature, effective treatment algorithms can be used with patients suffering from dysphagia due to various types of strictures.
Topics: Algorithms; Controlled Clinical Trials as Topic; Dilatation; Esophageal Stenosis; Humans; Risk Factors
PubMed: 9531111
DOI: No ID Found -
Journal of Pediatric Gastroenterology... Jan 2023Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the... (Review)
Review
Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.
Topics: Adult; Child; Humans; Dilatation; Esophageal Stenosis; Esophagoscopy; Treatment Outcome
PubMed: 36122370
DOI: 10.1097/MPG.0000000000003614 -
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 -
The Journal of Laryngology and Otology Jul 2016Eustachian tube dysfunction is a disorder for which there are limited medical and surgical treatments. Recently, eustachian tube balloon dilation has been proposed as a... (Review)
Review
BACKGROUND
Eustachian tube dysfunction is a disorder for which there are limited medical and surgical treatments. Recently, eustachian tube balloon dilation has been proposed as a potential solution.
METHOD
A systematic literature review was performed. Abstracts were selected for relevance, and pooled data analysis and qualitative analysis was conducted.
RESULTS
Nine prospective studies, describing 713 eustachian tube balloon dilations in 474 patients (aged 18-86 years), were identified. Follow-up duration ranged from 1.5 to 18 months. Ability to perform a Valsalva manoeuvre improved from 20 to 177 out of 245 ears following eustachian tube balloon dilation and, where data were reported in terms of patient numbers, from 15 to 189 out of 210 patients. Tympanograms were classified as type A in 7 out of 141 ears pre-operatively and in 86 out of 141 ears post-operatively.
CONCLUSION
Prospective case series can confirm the safety of eustachian tube balloon dilation. As a potential solution for chronic eustachian tube dysfunction, further investigations are warranted to establish a higher level of evidence of efficacy.
Topics: Dilatation; Ear Diseases; Eustachian Tube; Humans; Treatment Outcome
PubMed: 27488333
DOI: 10.1017/S0022215116008252 -
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 -
Contraception Apr 2016First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually... (Review)
Review
First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction abortion is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester include increasing gestational age and provider inexperience. Cervical priming before first-trimester surgical abortion has been studied using osmotic dilators and pharmacologic agents, most commonly misoprostol. Extensive data demonstrate that a variety of agents are safe and effective at causing preoperative cervical softening and dilation; however, given the small absolute risk of complications, the benefit of routine use of misoprostol or osmotic dilators in first-trimester surgical abortion is unclear. Although cervical priming results in reduced abortion time and improved provider ease, it requires a delay of at least 1 to 3 h and may confer side effects. The Society of Family Planning does not recommend routine cervical priming for first-trimester suction abortion but recommends limiting consideration of cervical priming for women at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be challenging.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Dilatation; Female; Gestational Age; Humans; Laminaria; Misoprostol; Pregnancy; Pregnancy Trimester, First; Professional Practice Location
PubMed: 26683499
DOI: 10.1016/j.contraception.2015.12.001 -
Gastrointestinal Endoscopy Oct 2017Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type.
METHODS
We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event.
RESULTS
Of 923 identified articles, 37 met inclusion criteria and represented 2034 dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%).
CONCLUSIONS
Perforation from esophageal dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal dilation should be considered a safe procedure in EoE.
Topics: Chest Pain; Dilatation; Eosinophilic Esophagitis; Esophageal Perforation; Esophagoscopy; Gastrointestinal Hemorrhage; Hospitalization; Humans; Pain, Postoperative; Postoperative Complications; Postoperative Hemorrhage
PubMed: 28461094
DOI: 10.1016/j.gie.2017.04.028 -
Clinical Obstetrics and Gynecology Jun 2009Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of... (Review)
Review
Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of complications such as cervical laceration or uterine perforation. The cervix may be prepared with osmotic dilators such as laminaria, Lamicel, or Dilapan-S, or with pharmacologic agents such as misoprostol. Dilapan-S and Lamicel achieve their maximum dilation faster than laminaria, making same-day procedures possible. Misoprostol has limited data supporting its use in this setting. Decisions regarding which method is best are clinician-dependent, and factors such as gestational age and time allowed for preparation should be considered.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Biocompatible Materials; Cervix Uteri; Device Removal; Dilatation; Female; Humans; Laminaria; Magnesium Sulfate; Misoprostol; Polymers; Polyvinyl Alcohol; Pregnancy; Pregnancy Trimester, Second
PubMed: 19407523
DOI: 10.1097/GRF.0b013e3181a2b3cd -
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