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Annals of Thoracic and Cardiovascular... 2012Radical treatment for achalasia is currently unavailable. At present, most palliative procedures are designed improve the passage of food through the gastroesophageal... (Review)
Review
Radical treatment for achalasia is currently unavailable. At present, most palliative procedures are designed improve the passage of food through the gastroesophageal junction and thereby alleviate symptoms. Drug therapy is of limited, transient effectiveness. Pneumatic dilation (PD) is considered superior to endoscopic botulinum toxin injection (EBTI). The mainstay of surgical treatment for achalasia is laparoscopic Heller myotomy (LHM) with fundoplication, currently considered superior to PD. Per oral endoscopic myotomy (POEM), a "state-of-the-art" procedure for minimally invasive surgery, holds great promise for the future management of achalasia. Definitive conclusions regarding the benefits and risks of currently available treatments for achalasia must await the accumulation of evidence from well-designed clinical trials.
Topics: Dilatation; Esophageal Achalasia; Esophagogastric Junction; Esophagoplasty; Fundoplication; Humans; Laparoscopy; Treatment Outcome
PubMed: 23099422
DOI: 10.5761/atcs.ra.12.01949 -
Respiratory Care Nov 2014The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety.... (Review)
Review
BACKGROUND
The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better.
METHODS
A systematic review with critical appraisal of the literature was done. Literature in multiple databases was searched. Randomized controlled trials comparing different tracheostomy methods were selected. Clinical and methodological characteristics were assessed. A meta-analysis using fixed effect models was planned for statistically homogeneous outcomes.
RESULTS
Fourteen randomized controlled trials were included, most of them with small sample sizes and with comparisons of multiple methods. Blue Rhino methods were less difficult for surgeons (risk difference of 14.7% [95% CI 8-21.5]) and had more minor bleeding events (risk difference of -6.3% [95% CI -13.58 to 0.8]). There were no differences in major bleeding events. Statistically, heterogeneity and lack of data impede comparison with other outcomes.
CONCLUSIONS
The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method.
Topics: Critical Illness; Dilatation; Equipment Design; Humans; Tracheostomy
PubMed: 25185145
DOI: 10.4187/respcare.03050 -
Revista Espanola de Enfermedades... Sep 2017Complete gastrointestinal strictures are a technically demanding problem. In this setting, an anterograde technique is associated with a high risk of complications and a...
BACKGROUND AND AIM
Complete gastrointestinal strictures are a technically demanding problem. In this setting, an anterograde technique is associated with a high risk of complications and a combined anterograde-retrograde technique requires a prior ostomy. Our aim was to assess the outcome of a first case series for the management of complete gastrointestinal strictures using endoscopic ultrasound (EUS)-guided puncture as a novel endoscopic approach.
PATIENTS AND METHODS
This retrospective case-series describes four cases that were referred for treatment of complete benign gastrointestinal strictures, three upper and one lower. Recanalization was attempted with EUS-guided puncture using a 22G or 19G needle and contrast filling was visualized by fluoroscopy. Afterwards, a cystotome and/or a dilator balloon were used under endoscopic and fluoroscopic guidance. A fully covered metal stent was placed in two cases, keeping the strictures open in order to prevent another stricture. Feasibility, adverse events, efficacy and the number of dilations required after recanalization were evaluated.
RESULTS
Technical and clinical success was achieved in three of the four cases (75%). A first dilation was performed using a dilator balloon in all successful cases and fully covered metal stents were used in two cases. These patients underwent a consecutive number of balloon dilatations (range 1-4) and all three were able to eat a soft diet. No adverse events were related to the EUS-guided approach. In the failed case with a long stricture (> 3 cm), an endoscopic rendezvous technique was attempted which caused a pneumothorax requiring a chest tube placement.
CONCLUSION
EUS-guided recanalization, as a first approach in the treatment of complete digestive stricture, is a feasible and promising procedure that can help to avoid major surgery.
Topics: Constriction, Pathologic; Digestive System Surgical Procedures; Dilatation; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Retrospective Studies; Stents; Surgery, Computer-Assisted; Treatment Failure; Ultrasonography, Interventional
PubMed: 28724308
DOI: 10.17235/reed.2017.4972/2017 -
Fertility and Sterility Nov 1986TBT is a new technique that by use of a balloon catheter technique in a fashion similar to that of balloon angioplasty allows reestablishment of tubal patency in...
TBT is a new technique that by use of a balloon catheter technique in a fashion similar to that of balloon angioplasty allows reestablishment of tubal patency in selected cases of tubal occlusion. The case presented here describes the first transcervical dilatation and recanalization of a proximally occluded fallopian tube in a patient with infertility.
Topics: Adult; Constriction, Pathologic; Dilatation; Fallopian Tube Diseases; Female; Humans
PubMed: 3781014
DOI: No ID Found -
The Journal of Laryngology and Otology Mar 2024To evaluate the feasibility and safety of employing a Eustachian tube video endoscope with a supporting balloon as a viable treatment and examination option for patients...
OBJECTIVE
To evaluate the feasibility and safety of employing a Eustachian tube video endoscope with a supporting balloon as a viable treatment and examination option for patients with Eustachian tube dysfunction.
METHODS
A study involving nine fresh human cadaver heads was conducted to investigate the potential of balloon dilatation Eustachian tuboplasty using a Eustachian tube video endoscope and a supporting balloon catheter. The Eustachian tube cavity was examined with the Eustachian tube video endoscope during the procedure, which involved the dilatation of the cartilaginous portion of the Eustachian tube with the supporting balloon catheter.
RESULTS
The utilisation of the Eustachian tube video endoscope in conjunction with the supporting balloon catheter demonstrated technical ease during the procedure, with no observed damage to essential structures, particularly the Eustachian tube cavity.
CONCLUSION
This newly introduced method of dilatation and examination of the Eustachian tube cavity using a Eustachian tube video endoscope and the supporting balloon is a feasible, safe procedure.
Topics: Humans; Eustachian Tube; Dilatation; Tympanoplasty; Ear Diseases; Endoscopes; Treatment Outcome
PubMed: 38084610
DOI: 10.1017/S0022215123001202 -
The Cochrane Database of Systematic... 2014Achalasia is an oesophageal motility disorder, of unknown cause, which results in increased lower oesophageal sphincter (LOS) tone and symptoms of difficulty swallowing.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Achalasia is an oesophageal motility disorder, of unknown cause, which results in increased lower oesophageal sphincter (LOS) tone and symptoms of difficulty swallowing. Treatments are aimed at reducing the LOS tone. Current endoscopic therapeutic options include pneumatic dilation (PD) or botulinum toxin (BTX) injection.
OBJECTIVES
To undertake a systematic review comparing the efficacy and safety of two endoscopic treatments, PD and intrasphincteric BTX injection, in the treatment of oesophageal achalasia.
SEARCH METHODS
Trials were initially identified by searching MEDLINE (1966 to August 2008), EMBASE (1980 to September 2008), ISI Web of Science (1955 to September 2008), The Cochrane Library Issue 3, 2008. Searches in all databases were conducted in October 2005 and updated in September 2008 and April 2014. The Cochrane highly sensitive search strategy for identifying randomised trials in MEDLINE, sensitivity maximising version in the Ovid format, was combined with specific search terms to identify randomised controlled trials in MEDLINE. The MEDLINE search strategy was adapted for use in the other databases that were searched.
SELECTION CRITERIA
Randomised controlled trials comparing PD to BTX injection in individuals with primary achalasia.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study quality assessment and data extraction.
MAIN RESULTS
Seven studies involving 178 participants were included. Two studies were excluded from the meta-analysis of remission rates on the basis of clinical heterogeneity of the initial endoscopic protocols. There was no significant difference between PD or BTX treatment in remission within four weeks of the initial intervention; with a risk ratio of remission of 1.11 (95% CI 0.97 to 1.27). There was also no significant difference in the mean oesophageal pressures between the treatment groups; with a weighted mean difference for PD of -0.77 (95% CI -2.44 to 0.91, P = 0.37). Data on remission rates following the initial endoscopic treatment were available for three studies at six months and four studies at 12 months. At six months 46 of 57 PD participants were in remission compared to 29 of 56 in the BTX group, giving a risk ratio of 1.57 (95% CI 1.19 to 2.08, P = 0.0015); whilst at 12 months 55 of 75 PD participants were in remission compared to 27 of 72 BTX participants, with a risk ratio of 1.88 (95% CI 1.35 to 2.61, P = 0.0002). No serious adverse outcomes occurred in participants receiving BTX, whilst PD was complicated by perforation in three cases.
AUTHORS' CONCLUSIONS
The results of this meta-analysis suggest that PD is the more effective endoscopic treatment in the long term (greater than six months) for patients with achalasia.
Topics: Anti-Dyskinesia Agents; Botulinum Toxins; Catheterization; Dilatation; Esophageal Achalasia; Humans; Randomized Controlled Trials as Topic; Remission Induction; Time Factors
PubMed: 25485740
DOI: 10.1002/14651858.CD005046.pub3 -
Ear, Nose, & Throat Journal Dec 2021
Topics: Dilatation; Ear Diseases; Eustachian Tube; Humans; Middle Ear Ventilation; Otorhinolaryngologic Surgical Procedures
PubMed: 32453641
DOI: 10.1177/0145561320925208 -
Thoracic Cancer Jun 2022Balloon dilatation (BD) is a common treatment for esophagogastric anastomotic stricture (EAS), but with complications. This study investigates the risk factors,...
BACKGROUND
Balloon dilatation (BD) is a common treatment for esophagogastric anastomotic stricture (EAS), but with complications. This study investigates the risk factors, prevention, and management of BD complications to provide clinical guidance.
METHODS
We retrospectively analyzed the clinical data of 378 patients with EAS treated by BD from March 2011 to June 2021. The association between esophagogastric anastomotic rupture outcome and patient and stricture characteristics and treatment were analyzed by logistic regression.
RESULTS
BD was performed 552 times and technical success, 98.0%; overall clinical success, 97.8%; major adverse events, 1.3%; minor adverse events, 9.4%; mortality, 0.3%. Logistic regression showed that age (p = 0.080), sex (p = 0.256), interval from surgery to stricture development (p = 0.817), number of dilatations (p = 0.054), cause of stricture (p ≥ 0.168), and preoperative chemotherapy (p = 0.679) were not associated with anastomotic rupture. Balloon diameter (p < 0.001), preoperative radiotherapy (p = 0.003), and chemoradiotherapy (p = 0.021) were correlated with anastomotic rupture. All patients with type I and II ruptures resumed oral feeding without developing into type III rupture. Type III rupture occurred in six cases, who resumed oral feeding after 7-21 days of nasal feeding and liquid feeding. One patient died of massive bleeding after BD.
CONCLUSIONS
Symptomatic treatment for type I and II ruptures and transnasal decompression and jejunal nutrition tubes for type III rupture, are suggested pending rupture healing. Tumor recurrence, preoperative radiotherapy, and balloon diameter affected the anastomotic rupture outcome.
Topics: Constriction, Pathologic; Dilatation; Fluoroscopy; Humans; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35481875
DOI: 10.1111/1759-7714.14389 -
Lower Urinary Tract Symptoms May 2022To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual...
OBJECTIVE
To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self-dilatation (ISD).
METHODS
Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow-up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed.
RESULTS
Overall, 106 patients were included with a median follow-up of 12 months (interquartile range 8-13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis.
CONCLUSIONS
This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.
Topics: Constriction, Pathologic; Dilatation; Female; Humans; Male; Recurrence; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture
PubMed: 34794210
DOI: 10.1111/luts.12419 -
Critical Care (London, England) Feb 2006As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical... (Review)
Review
As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT.
Topics: Critical Illness; Dilatation; Humans; Tracheostomy
PubMed: 16356203
DOI: 10.1186/cc3900