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Gastrointestinal Endoscopy Dec 1998
Review
Topics: Dilatation; Esophageal Achalasia; Esophageal Stenosis; Humans
PubMed: 9852480
DOI: No ID Found -
Annals of Plastic Surgery Feb 2019Despite advances in supermicrosurgical techniques, the ability to anastomose vessels with a diameter of less than 0.2 mm remains limited. One of the reasons for this...
Despite advances in supermicrosurgical techniques, the ability to anastomose vessels with a diameter of less than 0.2 mm remains limited. One of the reasons for this limitation is that the dilation methods currently available, such as inserting the tip of a microforceps into the lumen or topical application of a vasodilator such as papaverine hydrochloride or xylocaine spray, are not effective in very small vessels. To overcome this problem, we have developed a method whereby nylon monofilaments are placed inside the vessel lumen to act as a dilator. Using this method, a smaller nylon monofilament is inserted into the vessel as a guide before inserting a larger nylon monofilament as a dilator. After the smaller guide monofilament has been inserted, it is then much easier to insert another monofilament for dilation, even if it is a larger one. Using this method, even a vessel with a diameter of less than 0.1 mm could be dilated to greater than 0.2 mm. The dilator monofilament can also be used as an intravascular stent in the anastomosis. We have found that anastomosis of vessels with a diameter of less than 0.1 mm is possible using this method. In our experience, the immediate patency rate has been 100%. We believe mechanical dilation with a nylon monofilament is helpful for supermicrosurgery and even ultramicrosurgery.
Topics: Anastomosis, Surgical; Dilatation; Humans; Microsurgery; Nylons; Stents; Vascular Surgical Procedures
PubMed: 30300221
DOI: 10.1097/SAP.0000000000001632 -
Gastroenterology Clinics of North... Dec 1991Esophageal cancer is incurable in most patients. Tumor anatomy must be carefully defined using radiographic and endoscopic techniques. These techniques can also provide... (Review)
Review
Esophageal cancer is incurable in most patients. Tumor anatomy must be carefully defined using radiographic and endoscopic techniques. These techniques can also provide useful information to plan palliative treatment. The goals of palliation must be explicitly discussed and defined with the patient and family. Palliative manipulation is best done by a physician with experience in the procedures, after consideration of all available options to ensure effective palliation with minimal risk of complications. Esophageal dilation is an integral part of most palliative treatment programs, either as sole or adjunctive therapy. Dilation can maintain luminal patency in most patients and can be performed easily, effectively, and safely in an outpatient setting. An esophageal prosthesis can further alleviate symptoms in patients in whom more conventional palliative techniques are unsuccessful. Because prosthesis placement is associated with a relatively high rate of complications, it should be reserved for patients with advanced refractory disease or tracheo-esophageal fistula, for whom no other palliative alternatives exist.
Topics: Combined Modality Therapy; Dilatation; Esophageal Neoplasms; Humans; Palliative Care; Prostheses and Implants
PubMed: 1723968
DOI: No ID Found -
Gastrointestinal Endoscopy Dec 1998Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this...
BACKGROUND
Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this study was to determine the rate of bacteremia after esophageal dilatation in a large series and the source of the organisms recovered.
METHODS
Blood cultures and oral temperatures were obtained before esophageal dilation and at 5 and 30 minutes after dilation. Dilators were cultured immediately before dilation. Procedural data collected included type of dilation, number of passes, and presence of malignancy.
RESULTS
Of 100 procedures in 86 patients undergoing esophageal dilation, 22 (22%) were associated with a positive post-dilation blood culture. Bacteremia was more frequent with dilation of malignant strictures compared with benign strictures (9 of 17 [52.9%] vs. 13 of 83 [15.7%], respectively, p = 0.002) and with passage of multiple dilators compared with passage of a single dilator (16 of 46 [34.8%] versus 6 of 54 [11.1%], respectively, p = 0.007). Bacterial isolates from 22 positive blood cultures matched those from a dilator in only one episode (4.5%).
CONCLUSION
The rate of bacteremia after esophageal dilation is 22% and is associated with dilation of malignant strictures or passage of multiple dilators. Organisms cultured from the blood are not transmitted from the dilator.
Topics: Bacteremia; Dilatation; Disinfection; Equipment Contamination; Esophageal Neoplasms; Esophageal Stenosis; Humans; Risk Factors; Time Factors
PubMed: 9852444
DOI: 10.1016/s0016-5107(98)70036-7 -
Missouri Medicine 2020The author dilated 3,112 patients with esophageal strictures over 36 years. Most strictures were peptic, esophageal rings, cervical webs or eosinophilic. Strictures were...
The author dilated 3,112 patients with esophageal strictures over 36 years. Most strictures were peptic, esophageal rings, cervical webs or eosinophilic. Strictures were assessed for presence of hiatal hernia, hernia size, stricture diameter, and type and size of dilator used. Complex strictures were present in 19.7% of patients. Re-dilation was needed in 30% of patients within five years. Three adverse reactions occurred, one perforation and two bleeds in 3,112 patients (0.1%) and 5,960 dilations (0.05%).
Topics: Constriction, Pathologic; Dilatation; Esophageal Stenosis; Humans; Private Practice; Prospective Studies; Retrospective Studies
PubMed: 33311788
DOI: No ID Found -
Contraception Apr 2021Cervical preparation with laminaria reduces complications with 2nd trimester dilation and evacuation. During a surgical abortion at 22 weeks, we could not remove...
Cervical preparation with laminaria reduces complications with 2nd trimester dilation and evacuation. During a surgical abortion at 22 weeks, we could not remove laminaria manually or with ring forceps due to laminaria "dumbbelling" [1]. Without pushing laminaria into the uterus, we mechanically dilated the cervix and removed the incarcerated laminaria.
Topics: Abortion, Induced; Dilatation; Female; Humans; Laminaria; Pregnancy; Pregnancy Trimester, Second; Prisoners
PubMed: 33285099
DOI: 10.1016/j.contraception.2020.10.016 -
Gastrointestinal Endoscopy Jun 1985
Topics: Dilatation; Esophageal Stenosis; Humans
PubMed: 4007446
DOI: 10.1016/s0016-5107(85)72053-6 -
Otology & Neurotology : Official... Feb 2022Balloon dilation of the eustachian tube is a new therapeutic option for eustachian tube dysfunction. One of the limiting factors of wider adoption of this technique in...
BACKGROUND
Balloon dilation of the eustachian tube is a new therapeutic option for eustachian tube dysfunction. One of the limiting factors of wider adoption of this technique in many parts of the world is the high cost of the devices, in spite of regulatory approval of safety.
OBJECTIVE
Evaluate the performance and usability of standard less-expensive endovascular balloons for eustachian tube dilation in comparison to an approved device in a preclinical study.
STUDY DESIGN
Comparative cadaver feasibility study.
SETTING
University tertiary care facility.
METHODS
Ten eustachian tube dilations were performed with an approved eustachian tube dilation device. Ten other procedures were carried out with an endovascular balloon of similar dimensions. Cone beam computerized tomography was performed to evaluate the extent of dilation and possible damages. The lumen and mucosal lining were inspected endoscopically post-dilation. Volume measurements were compared before and after the procedure in both groups using contrast enhancement.
RESULTS
All 20 eustachian tube dilations were carried out successfully. No tissue damages could be identified on cone-beam computerized tomography or via endoscopic examination. There was a statistically significant difference of eustachian tube volumes between pre- and post-dilations, with no statistically significant difference between the devices.
CONCLUSION
Eustachian tube dilation with a less costly endovascular balloon achieved similar results to an approved eustachian tube dilation device. No damages or any other safety concerns were identified in a cadaver study.
Topics: Cadaver; Dilatation; Ear Diseases; Eustachian Tube; Feasibility Studies; Humans
PubMed: 34739430
DOI: 10.1097/MAO.0000000000003404 -
The Journal of International Medical... Nov 2023To evaluate the efficacy and safety of a novel endoscopic dilation (END) method during percutaneous nephrolithotomy under ultrasonographic guidance.
OBJECTIVE
To evaluate the efficacy and safety of a novel endoscopic dilation (END) method during percutaneous nephrolithotomy under ultrasonographic guidance.
METHODS
We retrospectively reviewed the clinical records of 138 patients who underwent percutaneous nephrolithotomy from June 2020 to December 2021. The patients were divided into three groups based on the method of nephrostomy tract creation: those who underwent fascial Amplatz serial fascial dilation (AMD) (n = 45), one-shot dilation (OSD) (n = 45), and END (n = 48). For END, a 20-Fr dilator with sheath was accessed over the first guidewire. A second guidewire was inserted into the collecting system via the endoscope. The nephroscope was then accessed to enlarge the renal puncture point using both guidewires. Demographic variables and important intraoperative and postoperative findings were compared among the three groups.
RESULTS
The preoperative characteristics were similar among the three groups. The END group had a significantly shorter access time than both the AMD and OSD groups and significantly less severe hemoglobin loss than the OSD group. There were no significant differences in the other important perioperative findings.
CONCLUSION
Use of this novel END method with two guidewires may be associated with less blood loss and a reduced access time.
Topics: Humans; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Dilatation; Retrospective Studies; Kidney; Treatment Outcome
PubMed: 38008900
DOI: 10.1177/03000605231213228 -
Endoscopy Nov 2015Pneumatic dilation is a commonly used treatment in achalasia. Recent studies have shown that esophageal distensibility measurements can be used to assess the effect of... (Clinical Trial)
Clinical Trial
BACKGROUND AND AIM
Pneumatic dilation is a commonly used treatment in achalasia. Recent studies have shown that esophageal distensibility measurements can be used to assess the effect of dilation and possibly the risk of perforation. A new hydraulic dilation balloon allows visualization of the shape of the balloon in vivo and measurement of distensibility during dilation. We aimed to evaluate the technical feasibility of a 30-mm shape-measuring hydraulic dilation balloon for the treatment of achalasia.
METHODS
Consecutive patients with newly diagnosed achalasia were dilated using a 30-mm shape-measuring hydraulic dilation balloon. Patients were contacted 1 week, 1 month, and 3 months after dilation. Technical success, clinical success, and major complications were evaluated.
RESULTS
Technical success was achieved in all of the 10 patients included. Median esophagogastric junction distensibility (mm(2)/mmHg) increased from 1.1 (IQR 0.6 - 1.3) before dilation therapy to 7.0 (IQR 5.5 - 17.8) afterwards (P = 0.005). No major complications were seen. Three patients (30 %) reported recurrent dysphagia.
CONCLUSION
Hydraulic dilation with a shape-measuring balloon in achalasia patients is feasible. In vivo esophageal distensibility measurements may allow for an individualized, patient-specific dilation regimen.The Netherlands National Trial Register: NTR4371.
Topics: Adolescent; Adult; Aged; Catheterization; Dilatation; Esophageal Achalasia; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Manometry; Middle Aged; Prospective Studies; Treatment Outcome; Young Adult
PubMed: 26349065
DOI: 10.1055/s-0034-1392481