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Digestive Diseases and Sciences Jul 2022Endoscopic dilation is an important therapeutic option for treatment of corrosive strictures. Its safety is unclear with variable perforation rates in previous studies.... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Endoscopic dilation is an important therapeutic option for treatment of corrosive strictures. Its safety is unclear with variable perforation rates in previous studies. We aimed to evaluate its safety with regard to perforations and the effect of dilator type to perforation risk.
METHODS
A systematic review of published literature from inception to April 24, 2021, using PubMed and EMBASE databases was conducted. Studies in adult subjects (mean age ≥ 18 years) reporting perforation rates of endoscopic dilation of corrosive esophageal and/or gastric strictures were included. Pooled cumulative perforation rates were computed as primary outcome. Secondary outcomes included, perforation with each dilator subtypes, surgical or conservative modes of management and mortality. Random effect meta-analysis was used to estimate the frequency of each of these outcomes. Variables were reported as percentages with 95% CI.
RESULTS
A total of 712 subjects (N) who underwent 4840 dilations (n) were noted in the 15 studies that were included. Of which, eight were retrospective, while the remaining seven were prospective. On meta-analysis, the cumulative pooled perforation rate was 1% (1-2%) of the number of dilations (n%). The perforation rates with SG (1%, 0-3%) and balloon (1%, 0-5%) dilators were similar (p value < 0.01). 45/64 (59%, 11-94%) perforations were subjected to surgery while the remaining 14/64 (41%, 6-89%) was managed conservatively. Choice of management strategy was biased to the norms of the treating team. About 3/712 patients (0%, 0-2%) succumbed following perforation.
CONCLUSION
Perforation from endoscopic dilation of corrosive strictures occurs rarely, and there is no significant difference in perforation risk related to the type of dilator.
Topics: Adolescent; Adult; Caustics; Constriction, Pathologic; Dilatation; Esophageal Stenosis; Humans; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 34739625
DOI: 10.1007/s10620-021-07295-6 -
Gastrointestinal Endoscopy Feb 2002Dysphagia frequently develops shortly after fundoplication but is usually self-limited. This is an evaluation of the timing, frequency, indications, and outcome of...
BACKGROUND
Dysphagia frequently develops shortly after fundoplication but is usually self-limited. This is an evaluation of the timing, frequency, indications, and outcome of dilation after fundoplication.
METHODS
Two hundred thirty-three consecutive patients who underwent fundoplication were included. Preoperative motility, postoperative symptoms, endoscopic and radiographic data, timing and number of dilations, and caliber of the dilator used were evaluated in patients who required dilation.
RESULTS
Twenty-nine of 233 (12.4%) patients underwent dilation(s). The mean time to dilation after surgery was 72 days (range 3 to 330 days). Ten of 29 (34.5%) required more than 1 dilation (mean 1.5, range 1 to 5). The mean diameter to which the fundoplication was dilated was 18.6 mm (range 15-20 mm). There were no complications. The indication for dilation was dysphagia in 20, chest pain 4, epigastric pain 1, globus 1, gas bloat 1, belching 1, and vomiting in 1 patient. Two patients were lost to follow-up. Dysphagia resolved with dilation in 12 of 18 (67%) patients. Of the 6 patients whose symptoms did not improve after dilation, 3 noted improvement after further surgery. Two patients with tight fundoplications still require periodic dilation. One patient had a stricture before surgery that persisted after surgery. Symptoms did not improve in any patient who underwent dilation for an indication other than dysphagia.
CONCLUSIONS
Dilation after fundoplication was required in 12.4% of patients and was successful in most with dysphagia. Dilation shortly after surgery was safe and only a single dilation was required for most patients. Symptoms other than dysphagia did not respond to dilation.
Topics: Deglutition Disorders; Dilatation; Esophagoscopes; Female; Follow-Up Studies; Fundoplication; Humans; Male; Middle Aged; Postoperative Complications; Recurrence
PubMed: 11818926
DOI: 10.1067/mge.2002.121226 -
Surgical Endoscopy Aug 2023Controlled radial expansion (CRE) balloon dilators are traditionally used to dilate esophageal strictures during an esophagogastroduodenoscopy (EGD). EndoFLIP is a...
BACKGROUND
Controlled radial expansion (CRE) balloon dilators are traditionally used to dilate esophageal strictures during an esophagogastroduodenoscopy (EGD). EndoFLIP is a diagnostic tool used during an EGD to measure important parameters of the gastrointestinal lumen, capable of assessing treatment before and after dilation. EsoFLIP is a related device that combines a balloon dilator with high-resolution impedance planimetry to provide some of the luminal parameters in real time during dilation. We sought to compare procedure time, fluoroscopy time, and safety profile of esophageal dilation using either CRE balloon dilation combined with EndoFLIP (E + CRE) versus EsoFLIP alone.
METHODS
A single-center retrospective review was performed to identify patients ≤ 21 years of age who underwent an EGD with biopsy and esophageal stricture dilation using E + CRE or EsoFLIP between October 2017 and May 2022.
RESULTS
Twenty-nine EGDs with esophageal stricture dilation were performed in 23 patients (19 E + CRE and 10 EsoFLIP). The two groups did not differ in age, gender, race, chief complaint, type of esophageal stricture, or history of prior gastrointestinal procedures (all p > 0.05). The most common medical history in the E + CRE and EsoFLIP groups were eosinophilic esophagitis and epidermolysis bullosa, respectively. Median procedures times were shorter in the EsoFLIP cohort compared to E + CRE balloon dilation (40.5 min [IQR 23-57 min] for the EsoFLIP group; 64 min [IQR 51-77 min] for the E + CRE group; p < 0.01). Median fluoroscopy times were also shorter for patients who underwent EsoFLIP (0.16 min [IQR 0-0.30 min] for EsoFLIP dilation; 0.30 min [IQR 0.23-0.55] for the E + CRE group; p = 0.003). There were no complications or unplanned hospitalizations in either group.
CONCLUSION
EsoFLIP dilation of esophageal strictures was faster and required less fluoroscopy than CRE balloon dilation combined with EndoFLIP in children, while being equally as safe. Prospective studies are needed to further compare the two modalities.
Topics: Humans; Child; Esophageal Stenosis; Constriction, Pathologic; Dilatation; Treatment Outcome; Retrospective Studies
PubMed: 37198410
DOI: 10.1007/s00464-023-10129-3 -
Digestive Diseases and Sciences May 2008To study practice patterns in the management of non-obstructive dysphagia among U.S. gastroenterologists.
AIMS
To study practice patterns in the management of non-obstructive dysphagia among U.S. gastroenterologists.
DATA SOURCE
Endoscopic data repository from 100 U.S. gastroenterology practices during 1998-2003 (Clinical Outcomes Research Initiative, CORI).
METHODS
All initial esophago-gastro-duodenoscopies (EGDs) performed in adult patients between 1998 and 2003 (n = 181,261) were evaluated for demographic data, endoscopic findings, and the occurrence of esophageal dilation. A case population of 7,256 patients receiving empiric dilation for dysphagia for non-obstructive dysphagia was compared to a control population of 5764 patients with dilation for peptic strictures.
RESULTS
The group of patients with empiric dilation was younger than the group of patients with peptic strictures and contained more women. Reflux symptoms and erosive esophagitis were less frequent in the empiric dilation group than in the strictures group. Empiric dilations were mostly performed using rubber bougies, whereas strictures were most frequently dilated over a guidewire. For all types of dilators, the diameters were significantly larger in empiric than stricture dilation. Repeat dilations within 1 year after the initial procedure occurred in 4% of the empiric and 13% of the stricture dilations.
CONCLUSIONS
Compared with the dilation of peptic strictures, empiric dilation of non-obstructive dysphagia is a more common clinical practice that is performed in a different patient population and utilizes different techniques.
Topics: Age Factors; Chi-Square Distribution; Deglutition Disorders; Dilatation; Endoscopy, Gastrointestinal; Female; Humans; Male; Middle Aged; Practice Patterns, Physicians'; Recurrence; Risk Factors; Severity of Illness Index; Treatment Outcome; United States
PubMed: 17932762
DOI: 10.1007/s10620-007-0024-x -
Journal of Hepato-biliary-pancreatic... Mar 2015The use of limited endoscopic sphincterotomy with large balloon dilation (ESLBD) has recently been shown to be useful for removal of large common bile duct stones in a... (Review)
Review
The use of limited endoscopic sphincterotomy with large balloon dilation (ESLBD) has recently been shown to be useful for removal of large common bile duct stones in a dilated bile duct. The technique can reduce the need of mechanical lithotripsy, risk of adverse events and costs of the procedure. The aim of the review is to provide an overview in the current status of ESLBD with particular focus on the technical aspects of the technique for bile duct stone removal.
Topics: Catheterization; Cholelithiasis; Dilatation; Equipment Design; Humans; Sphincterotomy, Endoscopic
PubMed: 25366474
DOI: 10.1002/jhbp.185 -
Dysphagia Feb 2020This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic... (Comparative Study)
Comparative Study
BACKGROUND AND AIMS
This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).
MATERIALS AND METHODS
Patients with anastomotic strictures (enrolled during January 1996-December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.
RESULTS
Of the 142 patients, 124 (mean age-44.02; males-74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2-10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.
CONCLUSION
Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.
Topics: Adult; Burns, Chemical; Deglutition Disorders; Dilatation; Esophageal Stenosis; Esophagoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 30929058
DOI: 10.1007/s00455-019-10004-1 -
New Zealand Veterinary Journal Sep 2022Two dogs were referred to Veterinary Specialists Aotearoa for evaluation and treatment after sustaining significant head trauma. Case 1 was a 7-month-old, female...
CASE HISTORY
Two dogs were referred to Veterinary Specialists Aotearoa for evaluation and treatment after sustaining significant head trauma. Case 1 was a 7-month-old, female Staffordshire Bull Terrier who was hit by a car at low speed. Case 2 was a 2-year old, male neutered German Shepherd who sustained a gunshot wound to the head whilst on duty for the New Zealand Police Dog Unit.
CLINICAL FINDINGS
The dog in Case 1 suffered numerous facial fractures which caused collapse of the ventral nasal meatus and dorsal nasopharyngeal wall. The dog in Case 2 had extensive osseous and soft tissue damage to the nose, nasopharynx and cervical region with severe narrowing of the ventral meatuses, nasopharyngeal meatus and rostral nasopharynx due to multiple fracture fragments and shrapnel pieces. A diagnosis of traumatic nasopharyngeal stenosis was made in each case by computed tomography. Mechanical balloon dilation was used to treat the stenosis in both dogs. The balloon dilations were performed using a 12-mm balloon dilation catheter inserted in an antegrade fashion. In the first dog, the procedure was performed blind and was repeated three times with 5- and 9-day intervals between dilations. In the second dog, the procedure was performed under endoscopic guidance and again, was repeated three times with a 7-day interval between dilations. Clinical success was reported in both patients following treatment and the second dog also underwent a follow-up computed tomography scan which confirmed resolution of the stenosis.
DIAGNOSIS
Traumatic nasopharyngeal stenosis that was successfully treated with balloon dilation.
CLINICAL RELEVANCE
Findings suggest that balloon dilation may be an effective technique for the treatment of traumatic nasopharyngeal stenosis in dogs. Multiple dilation procedures are likely required, but the procedure can ultimately result in long term clinical resolution. CT: Computed tomography; VSA: Veterinary Specialists Aotearoa.
Topics: Animals; Catheterization; Constriction, Pathologic; Dilatation; Dog Diseases; Dogs; Female; Male; Nasopharyngeal Diseases; Treatment Outcome; Wounds, Gunshot
PubMed: 35506314
DOI: 10.1080/00480169.2022.2073918 -
Digestive Diseases and Sciences Nov 2013Simple benign strictures may be relieved with one to three dilation sessions. Resistant benign strictures are anatomically complex and resistant to therapy. We sought to...
GOALS AND BACKGROUND
Simple benign strictures may be relieved with one to three dilation sessions. Resistant benign strictures are anatomically complex and resistant to therapy. We sought to determine the efficacy and safety of esophageal self-dilation with bougie dilators in the largest series to date.
STUDY
A retrospective chart review was performed to identify patients who underwent esophageal self-dilation at two tertiary referral centers (Mayo Clinic, Scottsdale, Arizona and Mayo Clinic Rochester, Minnesota) between January 1, 2003 and June 30, 2012. Demographic details and clinical information regarding relief of dysphagia, complications, and frequency of endoscopic and self-dilation were abstracted.
RESULTS
Of the 32 patients who began self-dilation for nonmalignant strictures, 30 [22 men; median (range) age, 62 years (22-86 years)] were included in the study. Median (range) follow-up was 37 months (14-281 months). Stricture etiology included radiation therapy (n = 8), anastomotic stricture (n = 9), eosinophilic esophagitis (n = 4), caustic ingestion (n = 3), photodynamic therapy (n = 2), granulation tissue (n = 2), peptic stricture (n = 1) and one patient had radiation therapy and peptic stricture. The average number (range) of physician performed dilations before self-dilation was 12 (4-55). Esophageal self-dilation was successful in treating 90 % of patients. Dysphagia score (2 vs. 1; P < 0.001), stricture diameter (median; 5 vs. 12 mm; P < 0.001) and weight (median; 73 vs. 77 kg; P < 0.001) were significantly different between EDG dilation versus self-dilation.
CONCLUSIONS
Esophageal self-dilation is a safe, effective treatment for resistant, benign esophageal strictures. This management strategy should be strongly considered in this patient population.
Topics: Adult; Aged; Aged, 80 and over; Dilatation; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Young Adult
PubMed: 23925823
DOI: 10.1007/s10620-013-2822-7 -
Chest Surgery Clinics of North America Aug 1995The widespread use of flexible upper gastrointestinal (GI) endoscopy has renewed interest in management of strictures of the esophagus, including dilation. The rubber...
The widespread use of flexible upper gastrointestinal (GI) endoscopy has renewed interest in management of strictures of the esophagus, including dilation. The rubber Maloney dilator is the most common dilator used, usually for symmetrical strictures 1.2 cm or greater in diameter. The "through the scope" (TTS) balloon dilators usually are used in asymmetrical strictures 1.2 cm or greater in diameter and are especially valuable if fluoroscopy is not available. The new thermoplastic Savary dilators, used with a guidewire and usually with fluoroscopy, have replaced the Eder-Puestow bougies. They are especially useful in difficult strictures that are 1.0 cm or less in diameter and are fibrotic or have transmural fibrosis.
Topics: Catheterization; Dilatation; Esophageal Stenosis; Evaluation Studies as Topic; Humans
PubMed: 7583033
DOI: No ID Found -
Journal of Endourology Jun 2000The 6/12 AQ hydrophilically coated tapered dilator is a newly developed device for ureteral dilation prior to rigid and flexible ureteroscopy.
BACKGROUND AND PURPOSE
The 6/12 AQ hydrophilically coated tapered dilator is a newly developed device for ureteral dilation prior to rigid and flexible ureteroscopy.
PATIENTS AND METHODS
To evaluate the efficacy, safety, and cost-effectiveness of this device, it was used to gain ureteral access in 80 consecutive patients undergoing ureteroscopy for diagnostic purposes, stone treatment, or stricture dilation.
RESULTS
In all 80 cases, the ureteral orifice and intramural ureter were dilated successfully. One complication occurred: an embedded stone was extruded through the ureteral wall. Each dilation procedure using the 6/12 AQ tapered dilator costs 20% of a balloon dilation, a saving of approximately $764 per dilation.
CONCLUSION
Ureteral dilation with the 6/12 AQ tapered dilator is a safe, effective, and inexpensive alternative to traditional dilation techniques.
Topics: Constriction, Pathologic; Cost-Benefit Analysis; Dilatation; Equipment Design; Humans; Ureter; Ureteroscopy; Urinary Calculi; Urologic Diseases
PubMed: 10958569
DOI: 10.1089/end.2000.14.447