-
The Korean Journal of Gastroenterology... Feb 2021Dysphagia is difficulty in swallowing that can be caused by a number of disorders that involve either the oropharynx or the esophagus. Specific endoscopic treatment for... (Review)
Review
Dysphagia is difficulty in swallowing that can be caused by a number of disorders that involve either the oropharynx or the esophagus. Specific endoscopic treatment for dysphagia depends on its etiology, whether the dysphagia is caused by mechanical narrowing or a motor disorder. Variable endoscopic treatment strategies can be used to manage dysphagia. Patient with dysfunction of the upper esophageal sphincter may benefit from esophageal dilationor injection of botulinum toxin. Pneumatic balloon dilation, injection of botulinum toxin, peroral endoscopic myotomy can be considered as treatment options for esophageal motility disorders. Endoscopic dilation is the treatment choice of esophageal stricture, while intraluminal steroid injection and temporary stent can be considered in refractory benign esophageal stricture. Self-expandable metal stent insertion can be considered for dysphagia with malignant cause.
Topics: Deglutition Disorders; Dilatation; Endoscopy, Gastrointestinal; Humans
PubMed: 33632998
DOI: 10.4166/kjg.2021.025 -
Journal of Cardiothoracic and Vascular... Aug 2022Tracheal stenosis is a debilitating condition that often presents as an emergency and is challenging to treat. Dilatation may avoid tracheostomy or costly tracheal... (Observational Study)
Observational Study
OBJECTIVES
Tracheal stenosis is a debilitating condition that often presents as an emergency and is challenging to treat. Dilatation may avoid tracheostomy or costly tracheal resection and reconstruction. Traditional dilators cause complete occlusion, preventing oxygenation and ventilation, limiting the safe duration of dilatation, and increasing the risk of hypoxic injury or barotrauma. The study authors here assessed an innovative nonocclusive tracheal dilatation balloon, which may improve patient safety by allowing continuous gas exchange.
DESIGN
A prospective observational study of 20 discrete dilatation procedures performed in 13 patients under general anesthesia. The primary outcomes were the ability to ventilate during dilatation and the preservation of peripheral oxygen saturation. Secondary outcomes included a measured reduction in stenosis, improvement in Cotton-Myer grading, and procedure-related adverse events.
SETTING
At a single university (academic) hospital.
PARTICIPANTS
Consenting adult patients with acquired tracheal stenosis.
INTERVENTIONS
Access to the airway was maintained by a rigid bronchoscope or supraglottic airway device, as deemed appropriate. Continuous conventional ventilation was provided during 3-minute balloon dilatations.
MEASUREMENTS AND MAIN RESULTS
Heart rate, airway pressure, end-tidal carbon dioxide partial pressure, and peripheral oxygen saturation were measured, and adverse events were recorded. Ventilation was satisfactory in all patients. Peripheral saturation remained greater than 94% in 19 of the 20 (95%) procedures. Stenosis internal diameter and grading were improved. Two patients had minor reversible adverse events (coughing and laryngospasm), which did not prevent completion of the procedure.
CONCLUSIONS
The authors report the first human trial of the device, in which continuous conventional ventilation could be provided during all tracheal balloon dilatation procedures. Larger trials are needed to confirm improved patient safety and comparative efficacy.
Topics: Adult; Bronchoscopy; Constriction, Pathologic; Dilatation; Humans; Trachea; Tracheal Stenosis
PubMed: 35337744
DOI: 10.1053/j.jvca.2022.02.004 -
The Korean Journal of Internal Medicine Nov 2019Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal... (Review)
Review
Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal sphincter, which can be accomplished mechanically (balloon dilation or surgical myotomy) or chemically (Botox). True surgical treatment originated some 100 years ago and remained largely unchanged until the advent of thoracoscopic and then laparoscopic myotomy beginning in the 1980s. Because these procedures provided relatively definitive treatment and were well tolerated by patients, minimal invasive surgery assumed a primary role in the treatment algorithms for achalasia. In 2008, an endoscopic (incision-less) myotomy approach, per-oral endoscopic myotomy, was described. This even less invasive approach has rapidly been adopted in the majority of high-volume achalasia centers. Newer interventions, such as stenting and cell transplant, are under active investigation.
Topics: Acetylcholine Release Inhibitors; Botulinum Toxins, Type A; Cell Transplantation; Deglutition; Diffusion of Innovation; Dilatation; Esophageal Achalasia; Esophagoscopy; Esophagus; Humans; Laparoscopy; Palliative Care; Pyloromyotomy; Recovery of Function; Stents; Treatment Outcome
PubMed: 30866609
DOI: 10.3904/kjim.2018.439 -
The Turkish Journal of Gastroenterology... Apr 2023The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients.
BACKGROUND
The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients.
METHODS
Achalasia patients over the age of 65 and those under the age of 65 as the control group who received pneumatic dilation as the first-line treatment were evaluated in the study.
RESULTS
The average age of geriatric patients was 72.5 ± 55.92 years (65-90), with 50.3% of them being male. Follow-up was conducted for a mean of 64.52 ± 38.73 months. While pneumatic dilation was successful in 98.6% (141/143) of geriatric patients, it was also successful in 94% (141/150) of non-geriatric patients. Remission after single balloon dilatation was observed in 81.8% of geriatric patients, while it was observed in only 52.7% of non-geriatric patients (P = .000). When comparing remission after single dilatation and multiple dilatations, it was observed that geriatric patients who achieved remission after multiple balloon dilatation had higher lower esophageal sphincter pressure and Eckardt scores at the diagnosis and higher lower esophageal sphincter pressure and esophageal body resting pressures after the first balloon dilatation.
CONCLUSIONS
The proportion of elders in the world population is increasing daily and this disease has been known to disproportionately afflict this group. Although surgical treatments, in particular per-oral endoscopic myotomy, have recently gained popularity as therapies for achalasia, pneumatic dilation remains the most commonly used in geriatric patients.
Topics: Humans; Male; Aged; Aged, 80 and over; Female; Esophageal Achalasia; Dilatation; Treatment Outcome; Digestive System Surgical Procedures; Patients; Esophageal Sphincter, Lower
PubMed: 36789986
DOI: 10.5152/tjg.2023.22178 -
BMC Surgery Dec 2022To examine the benefits of interventional therapy for cicatricial constriction using a high-frequency electric knife, saccular dilatation, and cryotherapy.
BACKGROUND
To examine the benefits of interventional therapy for cicatricial constriction using a high-frequency electric knife, saccular dilatation, and cryotherapy.
METHODS
This case series included patients with central tracheobronchial cicatricial constriction admitted to the Department of Tuberculosis of Henan Provincial Chest Hospital from July 2018 to March 2021 and treated with bronchoscopic interventional therapies based on systemic anti-tuberculosis treatment.
RESULTS
96 patients were included, in whom 443 interventional therapies were performed. The total mid-(3 months) and long-term (12 months) effective rates were both 100%. The internal diameter of tracheobronchial stenosis increased after the operation, and the difference was statistically significant (all < 0.05). After interventional treatment, patients' symptoms of choking sensation in the chest and shortness of breath were relieved. Respiratory function was obviously improved. The ratios of hemorrhage, granulation hyperplasia, chest pain, and postoperative fever were 58.2%, 42.6%, 31.3%, and 26.7%, respectively. No focal transmission and progression of tuberculosis occurred, and no serious complications were observed.
CONCLUSION
The use of a high-frequency electric knife, saccular dilatation, and/or cryotherapy according to the pathological stage of the tracheobronchial cicatricial constriction is feasible, with good mid- and long-term curative effects and few complications.
Topics: Humans; Constriction, Pathologic; Constriction; Dilatation; Cryotherapy; Tuberculosis
PubMed: 36461086
DOI: 10.1186/s12893-022-01862-y -
JACC. Cardiovascular Interventions Apr 2019
Topics: Aortic Valve Stenosis; Balloon Valvuloplasty; Dilatation; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 30928443
DOI: 10.1016/j.jcin.2019.02.048 -
JACC. Cardiovascular Interventions Sep 2018
Topics: Aortic Valve Stenosis; Dilatation; Humans; Registries; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 30121278
DOI: 10.1016/j.jcin.2018.06.006 -
Surgical Endoscopy Oct 2023Many surgeons believe that pre-operative balloon dilatation makes laparoscopic myotomy more difficult in achalasia patients. Herein, we wanted to see if prior pneumatic...
Pre-operative endoscopic balloon dilatation and its impact on outcome of laparoscopic Heller cardiomyotomy for patients with achalasia: does the frequency and interval matter?
BACKGROUND
Many surgeons believe that pre-operative balloon dilatation makes laparoscopic myotomy more difficult in achalasia patients. Herein, we wanted to see if prior pneumatic balloon dilatation led to worse outcomes after laparoscopic myotomy. We also assessed if the frequency of dilatations and the time interval between the last one and the surgical myotomy could affect these outcomes.
METHODS
The data of 460 patients was reviewed. They were divided into two groups: the balloon dilation (BD) group (102 patients) and the non-balloon dilatation (non-BD) group (358 patients).
RESULTS
Although pre-operative parameters and surgical experience were comparable between the two groups, the incidence of mucosal perforation, operative time, and intraoperative blood loss significantly increased in the BD group. The same group also showed a significant delay in oral intake and an increased hospitalization period. At a median follow-up of 4 years, the incidence of post-operative reflux increased in the BD group, while patient satisfaction decreased. Patients with multiple previous dilatations showed a significant increase in operative time, blood loss, perforation incidence, hospitalization period, delayed oral intake, and reflux esophogitis compared to single-dilatation patients. When compared to long-interval cases, patients with short intervals had a higher incidence of mucosal perforation and a longer hospitalization period.
CONCLUSION
Pre-operative balloon dilatation has a significant negative impact on laparoscopic myotomy short and long term outcomes. It is associated with a significant increase in operative time, blood loss, mucosal injury, hospitalization period, and incidence of reflux symptoms. More poor outcomes are encountered in patients with multiple previous dilatations and who have a short time interval between the last dilatation and the myotomy.
Topics: Humans; Esophageal Achalasia; Dilatation; Heller Myotomy; Laparoscopy; Gastroesophageal Reflux; Treatment Outcome
PubMed: 37517041
DOI: 10.1007/s00464-023-10314-4 -
World Journal of Gastroenterology Dec 2013Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon... (Review)
Review
Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD.
Topics: Cholelithiasis; Dilatation; Endoscopy, Digestive System; Humans; Patient Selection; Risk Assessment; Risk Factors; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 24363517
DOI: 10.3748/wjg.v19.i45.8258 -
World Journal of Gastrointestinal... Apr 2017To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation;...
AIM
To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement.
METHODS
All balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES).
RESULTS
Four hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker's diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques ( = 0.5). Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunction, Zenker's diverticulum, age or gender ( > 0.05). The only complication noted was uvular edema and a shallow ulcer after static dilatation in one patient, which resolved spontaneously and did not require hospital admission.
CONCLUSION
UES dilatation with a through-the-scope balloon by either static or retrograde technique is safe and effective for the treatment of dysphagia due to CP dysfunction. To our knowledge, this is the first study evaluating retrograde balloon dilatation of the UES.
PubMed: 28465785
DOI: 10.4253/wjge.v9.i4.183