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Journal of Pediatric Gastroenterology... May 2017Although several studies report on the experience with adult eosinophilic esophagitis (EoE)-related stricture, outcomes for pediatric patients with EoE-associated...
OBJECTIVES
Although several studies report on the experience with adult eosinophilic esophagitis (EoE)-related stricture, outcomes for pediatric patients with EoE-associated fibrostenosis and stricture is more limited. To address this, we aim to identify the adverse event (AE) rate and short-term outcomes of the largest reported cohort of children with EoE to undergo esophageal dilation for management of symptomatic esophageal narrowing.
METHODS
A retrospective assessment of all children, 18 years and younger, who underwent esophageal dilation at an academic children's hospital during a 5-year period was conducted. Clinical, endoscopic, histologic, and outcomes of dilation were extracted from the medical record. AEs were captured within a standardized endoscopic AE database. Grade 2 AEs (requiring unanticipated medical intervention) were termed significant. Dilation-related events were compared between patients with EoE, without EoE, and those undergoing standard upper endoscopy.
RESULTS
Of the 451 total dilations, 68 dilations were performed in 40 EoE patients (mean age 13.8 years, standard deviation 3.3 years [4.6-18.9 years]). Forty-three percent (17/40) had repeat dilation during the study period. Dilation-related grade 2 AE rates in EoE and in non-EoE patients were 2.9% and 3.1%, respectively (P > 0.5). Chest pain (any grade AE) was reported in 14.7% of EoE dilations. No significant associations were found between postprocedural pain and dilation method, final dilator size, medical therapy, or esophageal eosinophilia. No perforations or significant hemorrhage were reported.
CONCLUSIONS
We conclude that dilation can be performed safely in children with EoE. In the appropriate clinical setting, cautious dilation may be considered in the management of fibrostenotic EoE.
Topics: Adolescent; Child; Child, Preschool; Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagoscopy; Female; Follow-Up Studies; Humans; Male; Retrospective Studies; Treatment Outcome
PubMed: 28055990
DOI: 10.1097/MPG.0000000000001336 -
Saudi Journal of Gastroenterology :... 2016In recent years, endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been shown to be an effective technique for the removal of... (Review)
Review
In recent years, endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been shown to be an effective technique for the removal of large or difficult common bile duct (CBD) stones, as an alternative to EST. Reviewing the literature published since 2003, it is understood that EPLBD has fewer associated overall complications than EST. Bleeding occurred less frequently with EPLBD than with EST. There was no significant difference in postendoscopic retrograde cholangiopancreatography pancreatitis or perforation. Recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events, when performed under appropriate guidelines. Since use of a larger balloon can tear the sphincter as well as the bile duct, possibly resulting in bleeding and perforation, a balloon size that is equal to or smaller in diameter than the diameter of the native distal bile duct is recommended. The maximum transverse diameter of the stone and the balloon-stone diameter ratio have a tendency to affect the success or failure of complete removal of stones by large balloon dilation to prevent adverse effects such as perforation and bleeding. One should take into account the size of the native bile duct, the size and burden of stones, the presence of stricture of distal bile duct, and the presence of the papilla in or adjacent to a diverticulum. Even though the results of EPLBD indicate that it is a relatively safe procedure in patients with common duct stones with a dilated CBD, the recommended guidelines should be followed strictly for the prevention of major adverse events such as bleeding and perforation.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Dilatation; Humans; Randomized Controlled Trials as Topic; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 27488319
DOI: 10.4103/1319-3767.187599 -
Surgical Endoscopy Jul 2018Patients with therapy-resistant benign esophageal strictures (TRBES) suffer from chronic dysphagia and generally require repeated endoscopic dilations. For selected...
BACKGROUND
Patients with therapy-resistant benign esophageal strictures (TRBES) suffer from chronic dysphagia and generally require repeated endoscopic dilations. For selected patients, esophageal self-dilation may improve patient's autonomy and reduce the number of endoscopic dilations. We evaluated the clinical course and outcomes of patients who started esophageal self-dilation at our institution.
METHODS
This study was a retrospective case series of patients with TRBES who started esophageal self-dilation between 2012 and 2016 at the Academic Medical Center Amsterdam. To learn self-dilation using Savary-Gilliard bougie dilators, patients visited the outpatient clinic on a weekly basis where they were trained by a dedicated nurse. Endoscopic dilation was continued until patients were able to perform self-bougienage adequately. The primary outcome was the number of endoscopic dilation procedures before and after initiation of self-dilation. Secondary outcomes were technical success, final bougie size, dysphagia scores, and adverse events.
RESULTS
Seventeen patients started with esophageal self-dilation mainly because of therapy-resistant post-surgical (41%) and caustic (35%) strictures. The technical success rate of learning self-bougienage was 94% (16/17). The median number of endoscopic dilation procedures dropped from 17 [interquartile range (IQR) 11-27] procedures during a median period of 9 (IQR 6-36) months to 1.5 (IQR 0-3) procedures after the start of self-dilation (p < 0.001). The median follow-up after initiation of self-dilation was 17.6 (IQR 11.5-33.3) months. The final bougie size achieved with self-bougienage had a median diameter of 14 (IQR 13-15) mm. All patients could tolerate solid foods (Ogilvie dysphagia score ≤ 1), making the clinical success rate 94% (16/17). One patient (6%) developed a single episode of hematemesis related to self-bougienage.
CONCLUSIONS
In this small case series, esophageal self-dilation was found to be successful 94% of patients when conducted under strict guidance. All patients performing self-bougienage achieved a stable situation where they could tolerate solid foods without the need for endoscopic dilation.
Topics: Adult; Aged; Dilatation; Endoscopy; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Patient Education as Topic; Retrospective Studies; Self Care
PubMed: 29349540
DOI: 10.1007/s00464-018-6037-z -
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 -
Journal of Equine Veterinary Science Dec 2023This retrospective case series describes the use of progressive urethral dilation in 22 client-owned male horses undergoing perineal urethrotomy (PU) for cystolith...
This retrospective case series describes the use of progressive urethral dilation in 22 client-owned male horses undergoing perineal urethrotomy (PU) for cystolith removal. Medical records of horses undergoing PU and urethral dilation for treatment of cystolithiasis were reviewed. Dilation of the pelvic urethra was performed following PU and using customized dilators with the same length (30cm) and with various outer diameters (25 to 45mm). Analyzed data included: signalment, cystolith size, renal ultrasound findings, method used for cystolith removal, diameter of urethral dilators, intra- and post-operative complications, and hospitalization time. Cystolith size ranged between 37mm and 90mm. Dilation of the pelvic urethra was as follows: 35mm (n=8), 25mm (n=6), 39mm (n=3), 33mm (n=2), 28mm (n=2) and 45mm (n=1). In 6 cases, the cystolith was removed without fragmentation. In the remaining 16 horses, lithotripsy was performed with forceps (n=9) or a pneumatic scaler (n=7). In 15 horses a retrieval device was used to aid in calculi removal. Hospitalization time ranged between 1 and 5 days. Intra-operative complications occurred in one horse. No post-operative complications were recorded. Follow-up information was available for 21 horses (range 1-8 years). Urethral dilation via PU may be a viable option for cystolith removal in male horses.
Topics: Male; Horses; Animals; Urethra; Urinary Bladder Calculi; Retrospective Studies; Dilatation; Horse Diseases
PubMed: 37866799
DOI: 10.1016/j.jevs.2023.104955 -
The Annals of Otology, Rhinology, and... 1988A total of 687 dilations of esophageal strictures were performed on 59 patients in the operating room over a 17-year period. Seventy-nine percent of the strictures were... (Comparative Study)
Comparative Study Review
A total of 687 dilations of esophageal strictures were performed on 59 patients in the operating room over a 17-year period. Seventy-nine percent of the strictures were secondary to caustic ingestion and 89% of the dilations were in these patients. Antegrade dilations were performed 389 times and retrograde dilations were performed 298 times. Esophageal perforation occurred seven times with antegrade dilations. There were no perforations with retrograde dilations. The retrograde method using Tucker bougies is the safest and most successful method of dilating severe strictures.
Topics: Adolescent; Adult; Burns, Chemical; Child; Child, Preschool; Dilatation; Esophageal Perforation; Esophageal Stenosis; Female; Humans; Male
PubMed: 3052221
DOI: 10.1177/000348948809700505 -
Journal of Clinical Gastroenterology Aug 2002Esophageal strictures from a variety of benign and malignant causes require dilation therapy when patients develop symptoms of dysphagia. Dilation can be accomplished... (Review)
Review
Esophageal strictures from a variety of benign and malignant causes require dilation therapy when patients develop symptoms of dysphagia. Dilation can be accomplished using a variety of dilating devices and adjunctive techniques. The approach to management of esophageal strictures is reviewed with a focus on dilation technique and special considerations for various stricture types.
Topics: Adrenal Cortex Hormones; Dilatation; Esophageal Stenosis; Esophagoscopy; Humans; Injections, Intralesional
PubMed: 12172355
DOI: 10.1097/00004836-200208000-00001 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2023Corrosive substance ingestion, history of esophageal surgery, and reflux esophagitis are the main causes of benign esophageal strictures in children. Esophageal dilation...
Esophageal dilation through bouginage or balloon catheters in children, as the treatment of benign esophageal strictures: results, considering the etiology, and the methods.
BACKGROUND
Corrosive substance ingestion, history of esophageal surgery, and reflux esophagitis are the main causes of benign esophageal strictures in children. Esophageal dilation is the first treatment option. Bougies and balloons are the most frequently used dilation tools. The literature record on esophageal dilation methods and their results is mostly composed of data gathered from adults, who differ from children in many terms, including etiology, indications, and results. This study aims to evaluate esophagial dilation in children; comparing the two mentioned modalities; and considering the impact of different diseases on dilation success.
METHODS
The benign esophageal stricture cases who had undergone esophageal dilation between 2001 and 2009, at two tertiary health-care centers of a university were evaluated retrospectively with regard to stricture etiology, treatment methods, and their results. In addition, balloon and bougie dilations were compared.
RESULTS
Fifty-four cases were dilated in 447 sessions. The strictures were due to corrosive ingestion or anastomoses in 72.2% of the cases. Of the dilation sessions, 52.6% were performed with Savary-Gilliard bougies, and the rest with balloon dilators. No guidewire was needed in 53.2% of the bougie sessions. Fluoroscopy was used during balloon dilation sessions as a routine part of the method, while it was needed only to check the guide location when needed during the bougie dilation sessions. The complication rates of balloon and bougie dilation sessions were 2.4% and 2.1%, respectively. The mean session length was 26.2±11.8 and 42.6±13.7 min, for bougie and balloon, respectively. Success rate was 93.7% for the balloon, while 98.2% of the bougie sessions. Balloon catheters used were disposable.
CONCLUSION
Savary-Gilliard bougies have advantages over balloon catheters with less need of fluoroscopy, shorter duration of sessions, and lower cost. Both methods are equivalently safe with close complication rates.
Topics: Adult; Humans; Child; Esophageal Stenosis; Dilatation; Retrospective Studies; Caustics; Constriction, Pathologic; Esophagoscopy; Catheters; Treatment Outcome
PubMed: 37145049
DOI: 10.14744/tjtes.2022.03881 -
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 -
Surgical Endoscopy Nov 2023Endoscopic dilation is the preferred management strategy for caustic esophageal strictures (CES). However, the differences in outcome for different dilators are not...
INTRODUCTION
Endoscopic dilation is the preferred management strategy for caustic esophageal strictures (CES). However, the differences in outcome for different dilators are not clear. We compared the outcome of CES using bougie and balloon dilators.
METHODS
Between January 2000 and December 2016, the following data of all the patients with CES were collected: demographic parameters, substance ingestion, number of strictures, number of dilations required to achieve ≥ 14 mm dilation, post-dilation recurrence, and total dilations. Patients were divided into two groups for the type of dilator, i.e., bougie or balloon. The two groups were compared for baseline parameter, technical success, short- and long-term clinical success, refractory strictures, recurrence rates, and major complications.
RESULTS
Of the 189 patients (mean age 32.17 ± 12.12 years) studied, 119 (62.9%) were males. 122 (64.5%) patients underwent bougie dilation and 67 (35.5%) received balloon dilation. Technical success (90.1% vs. 68.7%, p < 0.001), short-term clinical success (65.6% vs. 46.3%, p value 0.01), and long-term clinical success (86.9% vs. 64.2%, p < 0.01) were higher for bougie dilators compared to balloon dilators. Twenty-four (12.7%) patients developed adverse events which were similar for two groups. On multivariate analysis, use of bougie dilators (aOR 4.868, 95% CI 1.027-23.079), short-term clinical success (aOR 5.785, 95% CI 1.203-27.825), and refractory strictures (aOR 0.151, 95% CI 0.033-0.690) were independent predictors of long-term clinical success.
CONCLUSION
Use of bougie dilators is associated with better clinical success in patients with CES compared to balloon dilators with similar rates of adverse events.
Topics: Male; Humans; Young Adult; Adult; Female; Esophageal Stenosis; Caustics; Dilatation; Constriction, Pathologic; Tertiary Care Centers; Retrospective Studies; Treatment Outcome; Esophagoscopy
PubMed: 37653157
DOI: 10.1007/s00464-023-10384-4