-
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 -
Endoscopy Mar 2022Little is known about esophageal dilation as a long-term treatment approach for eosinophilic esophagitis (EoE). We examined the impact of a "dilate and wait" strategy on...
BACKGROUND
Little is known about esophageal dilation as a long-term treatment approach for eosinophilic esophagitis (EoE). We examined the impact of a "dilate and wait" strategy on symptom management and safety of patients with EoE.
METHODS
This retrospective cohort study included two patient groups: those who underwent a dilation-predominant approach (≥ 3 dilations as sole therapy or for histologically refractory disease [> 15 eos/hpf]); and those who had routine care (< 3 dilations or histologic response). Group characteristics were compared and outcomes for the dilation-only group assessed.
RESULTS
53/205 patients (26 %) received the dilation-predominant strategy (total 408 dilations), predominantly for histologic treatment nonresponse (75 %). These patients were younger (33 vs. 41 years; = 0.003), had a narrower baseline esophageal diameter (9.8 vs. 11.5 mm; = 0.005), underwent more dilations (7.7 vs. 3.4; < 0.001), but achieved a smaller final diameter (15.7 vs. 16.7 mm; = 0.01) vs. routine care. With this strategy, 30 patients (57 %) had ongoing symptom improvement, with esophageal caliber change independently associated with symptom response (adjusted odds ratio 1.79, 95 % confidence interval 1.16-2.78); 26 (49 %) used the strategy as a bridge to clinical trials. Over a median follow-up of 1001 days (interquartile range 581-1710), no deaths or dilation-related perforations occurred, but there were nine emergency room visits, including one for post-dilation bleeding and four for food impaction.
CONCLUSIONS
A dilation-predominant long-term treatment strategy allowed for symptom control or bridge to clinical trials for patients with difficult-to-treat EoE. Close follow-up and monitoring for complications are required.
Topics: Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Humans; Retrospective Studies
PubMed: 33910259
DOI: 10.1055/a-1493-5627 -
Alimentary Pharmacology & Therapeutics Oct 2013Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an increased rate of complications.
AIM
To perform a meta-analysis of population-based studies of the risks associated with dilation and the clinical efficacy and duration of response to dilation in EoE.
METHODS
Using MEDLINE and EMBASE, a systematic search was performed for published articles since 1977 describing cohort or randomised controlled trials of dilation in EoE. Summary estimates, including 95% confidence interval (CI), were calculated for the occurrence of complications associated with dilations (perforations, haemorrhage, chest pain, lacerations) and percentage of patients with symptom improvement following dilation. Heterogeneity was calculated using the I² statistic.
RESULTS
The search resulted in 232 references, of which 9 studies were included in the final analysis. The studies described 860 EoE patients, of whom 525 patients underwent at least one oesophageal dilation and a total of 992 dilations. There were three cases of perforation (95% CI 0-0.9%, I² 0%) and one haemorrhage (95% CI 0-0.8%, I² 0%). Six studies reported postprocedural chest pain in 2% of cases (95% CI 1-3, I² 53%). Clinical improvement from dilation occurred in 75% of patients (95% CI 58-93%, I² 86%).
CONCLUSIONS
Dilation in patients with eosinophilic oesophagitis is a safe procedure with a low rate of serious complications (<1%), and seems to result in at least a short-term improvement of symptoms in the majority of patients.
Topics: Chest Pain; Dilatation; Eosinophilic Esophagitis; Humans
PubMed: 23915046
DOI: 10.1111/apt.12438 -
Gastrointestinal Endoscopy Clinics of... Apr 1996Endoscopic dilations are infrequently attended by complications. Despite the acceleration in dilation rate for benign strictures that seems to have accompanied the... (Review)
Review
Endoscopic dilations are infrequently attended by complications. Despite the acceleration in dilation rate for benign strictures that seems to have accompanied the introduction of balloon dilators, perforations in such situations remain uncommon. Perforation is more likely with malignant esophageal strictures and possibly with caustic strictures. The outcome of perforation, when it does occur, is more severe with malignant strictures and possibly with radiation-related strictures. Bacteremia-related complications are important not because of their frequency but because of their potential severity and insidious presentation. The endoscopy-assisted dilation techniques when applied throughout the gastrointestinal tract compare favorably with other dilation methods from the standpoint of complications. The additional advantages of endoscopy rather than differences in complication rates factor into the overall efficacy of these dilation techniques.
Topics: Bacteremia; Catheterization; Dilatation; Endoscopy, Gastrointestinal; Esophageal Achalasia; Esophageal Perforation; Esophageal Stenosis; Humans; Intestinal Perforation
PubMed: 8673331
DOI: No ID Found -
The Laryngoscope Nov 2023Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management....
OBJECTIVE
Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management. Reported complications have been limited and include patulous Eustachian tube dysfunction (PETD). This multicenter study investigates the incidence of PETD and associated factors.
METHODS
Consecutive patients at three academic centers undergoing BDET (January 2014-November 2019) for OETD refractory to medical therapy were included. PETD was diagnosed by patient-reported symptoms of autophony of voice and/or breathing. Associated factors studied include age, sex, comorbidities, balloon size, duration of inflation, repeat BDET, and adjunctive procedures.
RESULTS
BDET procedures (n = 295 Eustachian tubes) were performed on 182 patients. Mean age was 38.4 years (SD 21.0; range 7-78) and 41.2% were female. Twenty cases of PETD (6.8% of procedures; 9.3% of patients) occurred following BDET. Risk of PETD did not vary by institution, comorbidities, or adjunctive procedure. Age ≤18 years (adjusted risk ratio [RR] = 3.26; 95% confidence interval [CI]: 1.24, 8.54; p = 0.02), repeat BDET (RR = 3.26; 95% CI: 2.15, 4.96; p < 0.001), and severe preoperative Eustachian tube inflammation (RR = 2.83; 95% CI: 1.10, 7.28; p = 0.03) were associated with increased risk of developing PETD in the multivariable model. Most symptoms were reported as mild or intermittent.
CONCLUSION
BDET caused PETD symptoms in approximately 7% of dilated Eustachian tubes in this study with increased risk for younger patients and those with severe inflammation or undergoing repeat dilations. Although most cases were self-limited, symptoms can persist. Awareness of risk factors may aid clinicians in limiting this complication.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:3152-3157, 2023.
Topics: Adolescent; Adult; Female; Humans; Male; Catheterization; Dilatation; Ear Diseases; Endoscopy; Eustachian Tube; Inflammation; Otitis Media; Child; Young Adult; Middle Aged; Aged
PubMed: 36929856
DOI: 10.1002/lary.30659 -
Pulmonology 2022Acquired subglottic stenosis (SGS) occurs in 1-2% of children with a history of intubation. An alternative treatment is endoscopic dilation with rigid dilators.
INTRODUCTION
Acquired subglottic stenosis (SGS) occurs in 1-2% of children with a history of intubation. An alternative treatment is endoscopic dilation with rigid dilators.
MATERIAL AND METHODS
Seventy-four patients with SGS grade I to III were treated between 2003 and 2017. Dilations were performed with Hegar-type rigid dilators every 2-3 weeks.
RESULTS
Eighty-two percentage of patients responded to the treatment. 10% presented SGS grade I, 35% grade II and 55% grade III. Previous intubation time in successful cases was 12.4 days and it was 32 days in those that failed (p=0.02). The average number of dilations was 3.23 in the group that responded and 2.98 for those that did not respond (p=0.51). The presence of tracheostomy reduced the effectiveness of the treatment (p=0.002). The average follow-up was 43.5 months.
CONCLUSION
The use of rigid dilators under endoscopic control is an effective minimally invasive method for treating patients with SGS grades I to III. Previous intubation time and the presence of tracheostomy were identified as poor prognostic factors.
Topics: Child; Constriction, Pathologic; Dilatation; Humans; Laryngostenosis; Retrospective Studies; Treatment Outcome
PubMed: 32461059
DOI: 10.1016/j.pulmoe.2020.03.007 -
Alimentary Pharmacology & Therapeutics Jul 2017Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE). Earlier reports described an increased risk of complications associated with dilation.
AIM
Perform a systematic review and meta-analysis to assess the efficacy and safety of endoscopic dilation in children and adults with EoE.
METHODS
Professional librarians searched MEDLINE, EMBASE, the Cochrane library, Scopus, and Web of Science for articles in any language describing studies of dilation in EoE through December 2016. Studies were selected and data were abstracted independently and in duplicate. Random effects modelling was used to generate summary estimates for clinical improvement and complications (haemorrhage, perforation, hospitalisation, and death).
RESULTS
The search resulted in 3495 references, of which 27 studies were included in the final analysis. The studies described 845 EoE patients, including 87 paediatric patients, who underwent a total of 1820 oesophageal dilations. The median number of dilations was 3 (range: 1-35). Clinical improvement occurred in 95% of patients (95% CI: 90%-98%, I : 10%, 17 studies). Perforation occurred in 0.38% (95% CI: 0.18%-0.85%, I : 0%, 27 studies), haemorrhage in 0.05% (95% CI: 0%-0.3%, I : 0%, 18 studies), and hospitalisation in 0.67% (95% CI: 0.3%-1.1%, I : 44%, 24 studies). No deaths occurred (95% CI: 0%-0.2% I : 0%, 25 studies).
CONCLUSIONS
Endoscopic dilation is consistently effective in children and adults with EoE, resulting in improvement in 95% of patients with very low rates (<1%) of major complications.
Topics: Adult; Child; Dilatation; Eosinophilic Esophagitis; Esophagoscopy; Humans
PubMed: 28513085
DOI: 10.1111/apt.14123 -
Revista de Gastroenterologia Del Peru :... Jan 2015The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and... (Review)
Review
The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation indications, benefits and risks for each of the existing systems of dilations.
Topics: Constriction, Pathologic; Contraindications; Digestive System Diseases; Dilatation; Endoscopy, Digestive System; Humans; Treatment Outcome
PubMed: 25875518
DOI: No ID Found -
World Journal of Urology Jun 2020To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this...
PURPOSE
To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this technique.
METHODS
Patients who underwent PCNL with only one access (24 Fr) using the balloon dilator or sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to May 2018 in Beijing Tsinghua Changgung Hospital were retrospectively reviewed. Patients' demographic information, intra- and postoperative data were analyzed. Factors which would increase the success rate of ultrasound-guided balloon dilation were investigated by logistic regression analysis.
RESULTS
There were 986 PCNLs performed. 207 cases underwent balloon dilation, while 411 underwent sequential dilation. The two groups did not significantly differ in age, sex, BMI, stone diameter, access location, operation time, postoperative complication rate, and stone-free rate. The balloon dilation group comprised 207 patients (115 males, 92 females) with a mean age of 51 ± 10 years. Mean BMI was 25.2 ± 3.3 kg/m. Mean stone size was 3.6 ± 1.2 cm, 47.3% of which were staghorn stones. Hydronephrosis of the targeted calyx occurred in 78.3% of patients. Within the balloon dilation group, tract dilation failed in 24 cases (11.6%) on the first attempt. The successful and failed subgroups had comparable outcomes. Multivariate analysis revealed that the risk factors for the failure of access establishment were the presence of staghorn stones (p = 0.032), prior ipsilateral open nephrolithotomy (p = 0.026), and lower pole access (p = 0.039), while the success rate was significantly higher in those with a hydronephrotic target calyx (p = 0.001).
CONCLUSIONS
Tract dilation using balloon catheter can be safely monitored by ultrasound, and is most suited to patients with a hydronephrotic target calyx.
Topics: Adult; Dilatation; Feasibility Studies; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrolithotomy, Percutaneous; Retrospective Studies; Ultrasonography, Interventional
PubMed: 31312892
DOI: 10.1007/s00345-019-02876-7 -
Expert Review of Medical Devices Jan 2015The Vent-Os Sinus Dilation System is an osmotically driven device that provides a means to access the sinus space and to dilate the maxillary sinus ostia and associated... (Review)
Review
The Vent-Os Sinus Dilation System is an osmotically driven device that provides a means to access the sinus space and to dilate the maxillary sinus ostia and associated spaces in adults for diagnostic and therapeutic procedures. Unlike balloon dilation devices that use rapid, high-pressure inflation, this self-expanding device is designed to gently and gradually open the maxillary ostia. The procedure can be safely and easily completed in-office with minimal anesthetics and analgesics on board. Clinical results support excellent patency and safety outcomes with the use of this product in patients with chronic rhinosinusitis.
Topics: Adult; Chronic Disease; Dilatation; Female; Humans; Male; Nasal Surgical Procedures; Osmosis; Rhinitis; Sinusitis
PubMed: 25467029
DOI: 10.1586/17434440.2015.975116