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The Laryngoscope Oct 2019To determine the appropriate balloon size for dilation using a previously described reproducible survival animal model of subglottic stenosis.
OBJECTIVE
To determine the appropriate balloon size for dilation using a previously described reproducible survival animal model of subglottic stenosis.
STUDY DESIGN
Prospective animal study.
METHODS
We conducted a prospective study including 16 New Zealand White rabbits. The airway of each animal was sized with an endotracheal tube (ETT), and subglottic stenosis (SGS) was endoscopically induced using Bugbee electrocautery to 75% of the circumference of the subglottis, followed by 4-hour intubation. Two weeks postoperatively, the rabbits' airways were sized and then dilated using a 6-, 7-, 8-, or 9-mm balloon, with four animals in each experimental group. Following dilation, animals were again sized and subsequently euthanized. The cricoid lumen was measured microscopically in each animal.
RESULTS
Prior to inducing stenosis, all animals were sized with a 3.5 ETT. After inducing injury but prior to dilation, airways showed grade 2 SGS that sized with a 2.5 ETT with no leak. Postdilation, animals dilated with 6- or 7-mm balloons (n = 8) sized with a 3.0 ETT, and animals dilated with an 8- or 9-mm balloon (n = 8) sized with a 3.5 ETT. Postdilation median cricoid lumen measurements were 12.5 mm (6-mm balloon), 13.92 mm (7 mm), 16.83 mm (8 mm), and 17.15 mm (9 mm); two cricoid fractures occurred in the 9-mm group.
CONCLUSION
The postdilation cricoid lumen diameter increased with increased balloon size, and the use of an 8-mm balloon achieved the largest cricoid lumen diameter without causing fracture. Further research is necessary to determine the ideal duration of dilation and optimal intervals between dilations.
LEVEL OF EVIDENCE
NA Laryngoscope, 129:2409-2413, 2019.
Topics: Animals; Dilatation; Disease Models, Animal; Glottis; Laryngeal Muscles; Laryngostenosis; Prospective Studies; Rabbits; Treatment Outcome
PubMed: 30548849
DOI: 10.1002/lary.27574 -
World Journal of Gastroenterology Aug 2002Endoscopic dilation of esophageal strictures is a commonly performed procedure in the management of dysphagia. The procedure is usually done with fluoroscopic guidance....
AIM
Endoscopic dilation of esophageal strictures is a commonly performed procedure in the management of dysphagia. The procedure is usually done with fluoroscopic guidance. The aim of this study was to assess the use of Tracer guide wire in conjunction with Savary-Gilliard dilators in the dilation of tight esophageal strictures without fluoroscopy.
METHODS
Fifty-five patients with significant dysphagia from strictures due to a variety of causes were dilated endoscopically. The procedure consisted of two parts. First, a guidewire was passed using endoscopic guidance, and then, dilation was performed without fluoroscopy. A modified Tracer wire was employed and was particularly effective in negotiating very tight esophageal strictures, in which the lumen is less than 6 mm. In general, the "Rule of Three" and "2-3 sessions in 10 days, maximum dilation up to 42 French" rules were followed. 401 dilations in a total of 55 patients(malignant strictures 30, benign 25) in 177 sessions were carried out.
RESULTS
The guide wire placement and Savary-Gilliard dilation were successfully performed without fluoroscopy, and improvement of dysphagia was achieved in all patients. Esophageal plastic stent (out diameter 40 French) was placed in five patients with malignant stricture-three of them with tracheo-esophageal fistula.
CONCLUSION
Dilation using Tracer guide wire without fluoroscopy is safe and effective in treatment of even very tight esophageal strictures.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Dilatation; Esophageal Stenosis; Esophagoscopy; Female; Fluoroscopy; Humans; Male; Middle Aged
PubMed: 12174394
DOI: 10.3748/wjg.v8.i4.766 -
The Journal of Family Practice Jul 1980Treatment of male urethral strictures can be safely performed in the office. Urinary tract infections should be treated with appropriate antibiotics prior to urethral...
Treatment of male urethral strictures can be safely performed in the office. Urinary tract infections should be treated with appropriate antibiotics prior to urethral dilation. Complications from urethral instrumentation, such as bleeding and perforation, can be minimized by careful selection of instruments and gentleness on the part of the physician. If frequent dilations are necessary or the instrumentation is poorly tolerated by the patient, definitive surgical repair of the stricture should be considered.
Topics: Dilatation; Humans; Male; Urethra; Urethral Diseases; Urethral Stricture
PubMed: 7411032
DOI: No ID Found -
Contraception Aug 2007First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction aspiration is usually...
First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. Use of laminaria for cervical priming reduces the risk of cervical laceration and, to a lesser extent, uterine perforation. While pharmacological priming agents may potentially have the same effects, no published studies to date have been large enough to assess these outcomes. Given an experienced provider, the risk of these injuries during suction aspiration is very small. Cervical priming can be achieved with osmotic dilators or pharmacological agents. The advantages of osmotic dilators such as laminaria, Dilapan-S and Lamicel are their ability to produce wide cervical dilation, and for the synthetic types, their advantages include predictable effects and rapid onset of action. A disadvantage of osmotic dilators is that they require a speculum examination and a trained clinician to perform the insertion. When cervical priming is performed, misoprostol is the prostaglandin analogue most commonly used worldwide. Compared to laminaria, vaginal misoprostol requires a shorter period of time to achieve the same dilatation, is associated with less discomfort and is preferred by women. The sublingual route appears as effective as vaginal administration and requires less time for priming (2 h), but it is associated with more side effects. Oral administration can produce equivalent dilation to vaginal or sublingual administration, but higher doses and longer treatment periods (8 to 12 h) are required. Buccal administration of misoprostol appears to have a pharmacokinetic and physiologic profile similar to vaginal administration; however, there are no published studies of buccal misoprostol prior to first-trimester suction abortion. While extensive data demonstrate that a variety of agents are safe and effective at causing cervical softening and dilation preoperatively, there are not enough data to conclude that routine cervical priming is necessary to reduce complications of first-trimester surgical abortion. Cervical priming increases preoperative cervical dilation, making the procedure easier and quicker for the physician. However, in order to preoperatively dilate the cervix, the woman must receive the agent at least 3 to 4 h prior to her procedure. Besides the additional waiting, the woman might experience bleeding and cramping prior to the procedure. There are insufficient data evaluating how cervical priming affects women's quality of life in relation to abortion. Based on existing evidence, the Society of Family Planning does not recommend routine cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider cervical priming only for women who may be 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 difficult due to either patient factors or provider experience.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Biocompatible Materials; Dilatation; Female; Humans; Laminaria; Magnesium Sulfate; Misoprostol; Polymers; Polyvinyl Alcohol; Pregnancy; Pregnancy Trimester, First; Risk Factors
PubMed: 17656184
DOI: 10.1016/j.contraception.2007.05.001 -
Journal of Surgical Oncology Nov 1996There is little information on dilation of proximal strictures following surgical and/or radiation therapy for head and neck cancer. We studied the feasibility and...
BACKGROUND
There is little information on dilation of proximal strictures following surgical and/or radiation therapy for head and neck cancer. We studied the feasibility and efficacy of dilating proximal strictures following therapy for head and neck cancer using Savary Gilliard dilators.
METHODS
Twenty-one consecutive patients with proximal strictures resulting from surgery and/or radiation therapy of head and neck cancer were studied. Savary Gilliard dilation was performed using the standard and a modified method. Dysphagia was graded before and after dilation using a 5-point scale.
RESULTS
Technical success, dysphagia relief, complications, and duration of relief were noted. Technical success was achieved in 20 (95%) patients. Adequate dysphagia relief was obtained in 15/20 (75%) patients, which lasted for 4-36 weeks (median 14 weeks). There were no perforations, bleeding, or deaths. Four patients required repeat dilation after a median interval of 12 weeks.
CONCLUSIONS
Savary Gilliard dilation is a safe and effective method for dilating strictures caused by therapy for head and neck cancer.
Topics: Adult; Aged; Constriction, Pathologic; Deglutition Disorders; Dilatation; Esophagus; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Male; Middle Aged; Radiotherapy, Adjuvant; Treatment Outcome
PubMed: 8944064
DOI: 10.1002/(SICI)1096-9098(199611)63:3<187::AID-JSO10>3.0.CO;2-2 -
Gastrointestinal Endoscopy 1994During a 2-year period, 103 consecutive patients undergoing dilation of esophageal strictures induced by radiation therapy for cancer of the esophagus were prospectively...
During a 2-year period, 103 consecutive patients undergoing dilation of esophageal strictures induced by radiation therapy for cancer of the esophagus were prospectively studied. The length of the strictures ranged from 0.5 to 13.5 cm (median, 5 cm) and the luminal diameter from 1 to 11 mm (median, 6 mm). Patients were referred for dilation from 2 weeks to 5 years (median, 2 months) after completion of radiation therapy. The guide wire was placed using fluoroscopy in 21 patients, endoscopy in 61, and a combination of endoscopy and fluoroscopy in 21. At least one dilator larger than the stricture could be passed in 101 (98%) patients. Five strictures were dilated to 16 mm, 29 to 15 mm, 28 to 14 mm, 16 to 12.8 mm, and 23 to 12 mm or less during the initial procedure. Development of complications and severe resistance were the limiting factors for optimal dilation. Relief of dysphagia was adequate in 66% of patients. The duration of dysphagia relief was 3 to 84 weeks (median, 16 weeks). Complications included persistent pain in 7 patients, unexplained fever in 2, perforation in 2, and delayed tracheo-esophageal fistula in 1. Two patients died of treatment-related complications. Repeated dilation was required in 32 of the 75 patients on long-term follow-up. We conclude that adequate palliation of dysphagia can be achieved by dilation in two-thirds of patients with radiation therapy-induced strictures of the esophagus. Dilation of these strictures is relatively simple and safe if performed with care.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Barium Sulfate; Brachytherapy; Carcinoma, Squamous Cell; Deglutition Disorders; Dilatation; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Female; Fluoroscopy; Follow-Up Studies; Humans; Male; Middle Aged; Palliative Care; Prospective Studies; Radiotherapy; Treatment Outcome
PubMed: 7520011
DOI: 10.1016/s0016-5107(94)70062-1 -
Journal of Pediatric Gastroenterology... Nov 2016Data on management of esophageal narrowing related to eosinophilic esophagitis (EoE) in children are scanty. The aim of the present study is to assess the safety and...
OBJECTIVES
Data on management of esophageal narrowing related to eosinophilic esophagitis (EoE) in children are scanty. The aim of the present study is to assess the safety and effectiveness of esophageal dilation in pediatric EoE from the largest case series to date.
METHODS
Children diagnosed with EoE during 2004 to 2015 were reviewed for the presence of esophageal narrowing. Esophageal narrowing was categorized as short segment narrow caliber, long segment narrow caliber, and single short stricture. The characteristics of the narrowed esophagus, therapeutic approach, clinical outcome, and complications were reviewed.
RESULTS
Of the 50 EoE cases diagnosed during the study period, 11 cases (9 boys; median age 9 years, range 4-12) were identified with esophageal narrowing (22%). Six had short segment narrow caliber esophagus and 5 had long segment narrow caliber esophagus (median length of the narrowing was 4 cm, range 3-20 cm). Three cases with narrow caliber esophagus also had esophageal stricture 2 to 3 cm below the upper esophageal sphincter. Nineteen dilation sessions were performed in 10 cases using Savary dilator. Esophageal size improved from median 7 mm to median 13.4 mm. Good response was obtained in all cases. Following the dilation procedure, longitudinal esophageal mucosal tear occurred in all cases without esophageal perforation or chest pain.
CONCLUSIONS
Esophageal dilation using Savary dilator is safe and highly effective in the management of esophageal narrowing related to EoE in children. Dilation alone does not improve the inflammatory process, and hence a combination with dietary or medical intervention is required.
Topics: Child; Child, Preschool; Dilatation; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagus; Female; Humans; Male; Retrospective Studies; Treatment Outcome
PubMed: 27111342
DOI: 10.1097/MPG.0000000000001247 -
The Laryngoscope Jun 2019Posterior glottic stenosis (PGS) results in severe derangement of laryngeal configuration and function with significant morbidity as a sequalae. Presently, there is no...
OBJECTIVES
Posterior glottic stenosis (PGS) results in severe derangement of laryngeal configuration and function with significant morbidity as a sequalae. Presently, there is no treatment for patients with "early" PGS. Dilation is often used for stenotic disease, but present dilation methods are limited to a round shape and the glottis is a sector (teardrop-shaped). Round dilation of the larynx results in compression of the membranous vocal folds (with potential for injury) and minimal expansion of the posterior larynx. We present a novel laryngeal dilation method that matches the unique anatomic shape of the glottis: teardrop-shaped glottis dilation (TSGD).
METHODS
We present a clinical series of early PGS patients treated with a TSGD. Five patients with dyspnea and significantly reduced vocal fold mobility due to early PGS were treated with TSGD, which involves placement of a triangular static stent in the anterior glottis, with simultaneous use of a round balloon dilator in the posterior glottis.
RESULTS
All patients reported improved ease of breathing and decrease in Dyspnea Index score and were decannualated following treatment. Video perceptual analysis of pre-/postlaryngoscopy examinations was performed with five blinded reviewers, and all patients were scored to have improved posterior glottic airway space following treatment with a mean improvement of 2.4 on a 11-point scale.
CONCLUSION
These clinical results demonstrate that there is enormous potential for the identification and treatment of patients with early PGS and use of a laryngeal dilation technique that matches the anatomic configuration of the glottis.
LEVEL OF EVIDENCE
4 Laryngoscope, 129:1428-1432, 2019.
Topics: Adult; Dilatation; Dyspnea; Female; Glottis; Humans; Laryngoscopes; Laryngostenosis; Male; Middle Aged; Severity of Illness Index; Stents; Treatment Outcome; Vocal Cords
PubMed: 30588628
DOI: 10.1002/lary.27594 -
Gastrointestinal Endoscopy 1990Forceful dilation of the lower esophageal sphincter is considered primary therapy for achalasia. The Witzel pneumatic balloon dilator, unlike fluoroscopically placed...
Forceful dilation of the lower esophageal sphincter is considered primary therapy for achalasia. The Witzel pneumatic balloon dilator, unlike fluoroscopically placed dilators, is placed over a standard gastroscope allowing positioning and dilation under direct vision. We report our experience with the Witzel dilator in 45 patients with achalasia over a 5-year period. All patients had at least one major symptom score of 8 out of 10 for dysphagia and/or regurgitation before dilation. After Witzel dilation, symptomatic response was graded as excellent (score 0 to 2), good (score 3 to 5), fair (score 6 to 8), and poor (no improvement). Symptom response was assessed after 1 week, 1 month, 6 month, 1 year, and present. The mean period of follow-up was 25 months (range, 3 to 85 months). Passage of the balloon across the gastroesophageal junction was technically unsuccessful in three patients. Esophageal perforation occurred in two patients (4%) and transient chest pain greater than 2 days in three patients (7%). There was no bleeding or death. Symptomatic long-term improvement was excellent in 25 patients (63%), good in 6 patients (15%), fair in 4 patients (10%), and poor in 5 patients (12%). A repeat Witzel dilation was performed in five patients but resulted in good/excellent improvement in only one patient. We conclude that pneumatic dilation with the Witzel balloon is a safe, effective procedure for achalasia.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dilatation; Esophageal Achalasia; Esophagogastric Junction; Female; Follow-Up Studies; Humans; Male; Middle Aged
PubMed: 2227320
DOI: 10.1016/s0016-5107(90)71120-0 -
Cell Reports Sep 2017Pupil size is collectively controlled by the sympathetic dilator and parasympathetic sphincter muscles. Locus coeruleus (LC) activation has been shown to evoke pupil...
Pupil size is collectively controlled by the sympathetic dilator and parasympathetic sphincter muscles. Locus coeruleus (LC) activation has been shown to evoke pupil dilation, but how the sympathetic and parasympathetic pathways contribute to this dilation remains unknown. We examined pupil dilation elicited by LC activation in lightly anesthetized rats. Unilateral LC activation evoked bilateral but lateralized pupil dilation; i.e., the ipsilateral dilation was significantly larger than the contralateral dilation. Surgically blocking the ipsilateral, but not contralateral, sympathetic pathway significantly reduced lateralization, suggesting that lateralization is mainly due to sympathetic contribution. Moreover, we found that sympathetic, but not parasympathetic, contribution is correlated with LC activation frequency. Together, our results unveil the frequency-dependent contributions of the sympathetic and parasympathetic pathways to LC activation-evoked pupil dilation and suggest that lateralization in task-evoked pupil dilations may be used as a biomarker for autonomic tone.
Topics: Animals; Dilatation; Locus Coeruleus; Male; Pupil; Rats
PubMed: 28954227
DOI: 10.1016/j.celrep.2017.08.094