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Esophageal dilation endoscopic

Riley D Stewart, Jeffrey Hawel, Daniel French, Drew Bethune, James Ellsmere
BACKGROUND: Achalasia is a chronic disease affecting the myenteric plexus of the esophagus and lower esophageal sphincter. Treatment is aimed at palliating symptoms to improve quality of life. Treatment options for symptom relapse after esophagomyotomy include botox injection, repeat myotomy, per-oral endoscopic myotomy, or pneumatic balloon dilation (PBD). Data demonstrating the safety and efficacy of PBD for recurrence are scarce. With a lack of published data, guidelines have suggested avoiding PBD for recurrent achalasia because of concern for a high risk of perforation...
June 15, 2018: Surgical Endoscopy
J W Chang, R Y Yeow, A K Waljee, J H Rubenstein
Treatment endpoints in eosinophilic esophagitis (EoE) are response of eosinophilic inflammation and of symptoms. Steroids and diet therapy are effective in inducing histologic response in EoE, but there may be poor correlation between histologic and symptomatic response. Despite this, we find that in clinical practice symptoms are commonly used to guide management without assessing histologic response. We hypothesized that symptom response alone is not reliable in assessing response to therapy and is confounded by endoscopic dilation...
June 11, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Tatsuya Osuga, Yoshihiro Ikura, Kazunori Hasegawa, Seiichi Hirano
Endoscopic balloon dilation (EBD) is an established therapy for esophageal stenosis. To assess its usefulness in children, we reviewed 11 years of pediatric cases of EBD in our hospital. Over the last 11 years, EBD was performed on 14 pediatric patients (10 boys and four girls; 7 months-11 years) at our hospital. All EBD sessions were performed under general anesthesia and fluoroscopic monitoring. The sessions were repeated every week or alternate weeks until resolution of dysphagia or development of smooth endoscope passage...
January 2018: Esophagus: Official Journal of the Japan Esophageal Society
Kexin He, Lili Zhao, Shoushan Bu, Li Liu, Xiang Wang, Min Wang, Zhining Fan
 Esophageal caustic stricture is a stubborn disease and postoperative restenosis limits the clinical efficacy of endoscopic dilation. Autologous mucosal grafts have been successfully applied in the treatment of urethral stricture and in the prevention of stricture after extensive mucosal resection. We aimed to use mucosal autografting performed endoscopically to treat refractory esophageal stricture. METHODS : Three patients with intractable corrosive esophageal stricture were treated endoscopically by combining dilation with autologous mucosal transplantation...
June 11, 2018: Endoscopy
Pernilla Stenström, Martin Salö, Magnus Anderberg, Einar Arnbjörnsson
Background: The aim was to explore if severe congenital heart disease (CHD) influenced the need for dilatation of anastomotic strictures (AS) after the repair of esophageal atresia (EA). Methods: A retrospective case-control study was conducted examining AS in children with EA and Gross type C. The spectra of CHD and cardiac interventions were reviewed. The frequency of dilatations of AS during the first year following EA reconstruction was compared between children with and without severe CHD requiring cardiac surgery during their first year of life...
2018: Gastroenterology Research and Practice
Daisy Walter, Maarten W van den Berg, Meike M Hirdes, Frank P Vleggaar, Alessandro Repici, Pierre H Deprez, Bartolomé L Viedma, Laurence B Lovat, Bas L Weusten, Raf Bisschops, Rehan Haidry, Elisa Ferrara, Keith J Sanborn, Erin E O'Leary, Jeanin E van Hooft, Peter D Siersema
BACKGROUND:  Dilation is the standard of care for recurrent benign esophageal strictures (BES). Biodegradable stents may prolong the effect of dilation and reduce recurrences. Efficacy and safety of dilation and biodegradable stent placement early in the treatment algorithm of recurrent BES were compared. METHODS:  This multicenter, randomized study enrolled patients with BES treated with previous dilations to ≥ 16 mm. The primary end point was number of repeat endoscopic dilations for recurrent stricture within 3 and 6 months...
June 8, 2018: Endoscopy
László Szapáry, Benedek Tinusz, Nelli Farkas, Katalin Márta, Lajos Szakó, Ágnes Meczker, Roland Hágendorn, Judit Bajor, Áron Vincze, Zoltán Gyöngyi, Alexandra Mikó, Dezső Csupor, Péter Hegyi, Bálint Erőss
AIM: To analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures. METHODS: A comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the random-effects method of DerSimonian and Laird...
June 7, 2018: World Journal of Gastroenterology: WJG
Carolyne Morcos Ghobrial, A E Eskander
BACKGROUND: Esophageal strictures resulting from caustic ingestion in children are usually difficult to be managed, and surgical replacement is usually required for cases refractory to frequent dilatation sessions. Topical Mitomycin C (MMC) has been recently used in the management of resistant strictures. We evaluated the efficacy of MMC application in treatment of long refractory caustic esophageal strictures. METHODS: This prospective study included 120 patients of both sexes with refractory caustic long esophageal strictures (> 3 cm in length)...
June 4, 2018: Surgical Endoscopy
Abed Al Lehibi, Areej Al Balkhi, Abdullah Al Mtawa, Nawaf Al Otaibi
Background and aims:  Postoperative leak is one of the most feared complications after bariatric surgery. Endoscopic stenting is used to manage leaks by decreasing the gastrointestinal intraluminal pressure. The main advantage of endoscopic management is providing healing while still allowing for oral nutrition. However, limited literature exists on whether biodegradable stents can be used to control leaks when conventional metallic stents fail. Methods:  Our series consists of four patients who were found to have a leak as a complication of bariatric surgery...
June 2018: Endoscopy International Open
Masaya Uesato, Kentarou Murakami, Yoshihiro Nabeya, Kazunori Fugo, Hisahiro Matsubara
Aim: To show our unique strategy of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma larger than the subcircumference. Methods: From April 2011, we used a mucosal preservation method called the log bridge (LB) method for the lesion larger than the subcircumference. The patients in whom the circumference of the mucosal defect was 5/6 to <1 were classified into the LB group; those who underwent whole circumferential ESD were classified into the non-LB group...
2018: Gastroenterology Research and Practice
Alfredo J Lucendo, Javier Molina-Infante
PURPOSE OF REVIEW: For patients with eosinophilic esophagitis (EoE), endoscopic dilation has been used primarily to provide immediate symptomatic relief of dysphagia. This report reviews the current position of esophageal dilation in the therapeutic algorithm for EoE, including effectiveness and safety issues. RECENT FINDINGS: Esophageal strictures in EoE develop as a consequence of long-lasting esophageal eosinophilia, with patient age and diagnostic delay as well established risk factors...
July 2018: Current Opinion in Gastroenterology
Francisco Schlottmann, Marco G Patti
Esophageal achalasia is a primary esophageal motility disorder of unknown origin, characterized by lack of peristalsis and by incomplete or absent relaxation of the lower esophageal sphincter in response to swallowing. The goal of treatment is to eliminate the functional obstruction at the level of the gastroesophageal junction Areas covered: This comprehensive review will evaluate the current literature, illustrating the diagnostic evaluation and providing an evidence-based treatment algorithm for this disease Expert commentary: Today we have three very effective therapeutic modalities to treat patients with achalasia - pneumatic dilatation, per-oral endoscopic myotomy and laparoscopic Heller myotomy with fundoplication...
May 27, 2018: Expert Review of Gastroenterology & Hepatology
M M Szczesniak, P I Wu, J Maclean, T I Omari, I J Cook
INTRODUCTION: Restrictive defects of the pharyngo-esophageal junction (PEJ) are common in both structural and neurological disorders and are amenable to therapies aiming to reduce outflow resistance. Intrabolus pressure (IBP) acquired with high-resolution manometry and impedance (HRMI) is an indicator of resistance and a marker of reduced PEJ compliance. Constraints and limitations of IBP as well as the optimal IBP parameter remain undefined. AIMS: To determine: (i) the impact of peak pharyngeal pressure (PeakP) on the diagnostic accuracy of IBP for the detection of a restrictive defect at the PEJ and (ii) the optimal IBP parameter for this purpose...
May 24, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Jan Martínek, Stefan Juhas, Radek Dolezel, Barbora Walterová, Jana Juhasova, Jiri Klima, Zuzana Rabekova, Zuzana Vacková
Endoscopic submucosal dissection or widespread endoscopic resection allow the radical removal of circumferential or near-circumferential neoplastic esophageal lesions. The advantage of these endoscopic methods is mini-invasivity and low risk of major adverse events compared to traditional esophagectomy. The major drawback of these extensive resections is the development of stricture - the risk is 70-80% if more than 75% of the circumference is removed and almost 100% if the whole circumference is removed. Thus, an effective method to prevent post-ER/ESD esophageal stricture would be of major benefit, because treatment of strictures requires multiple sessions of endoscopic dilatation and may carry a risk of perforation...
May 24, 2018: Minerva Chirurgica
Chun-Hsiang Chang, Hsun-Chin Chao, Man-Shan Kong, Shih-Yen Chen, Chien-Chang Chen, Ming-Wei Lai
AIM: The present study evaluates the long-term clinical and nutritional effect to endoscopic balloon dilatation (EBD) in pediatric esophageal stricture. METHODS: This was a 15-year retrospective study involving pediatric patients with esophageal stricture treated with EBD. Outcome parameters included the number of dilatations, procedural success rates, nutritional status, and complications. EBD was performed in patients with a dysphagia score greater than 2. The nutritional status was assessed by weight-for-age z-score...
May 3, 2018: Pediatrics and Neonatology
Diego Soares Coca, Carolina Manna Santos, Osmar Silvio Garcia de Oliveira, Dayse Aparício Pereira, Carlos Jr Kiyoshi Furuya, Everson L A Artifon
OBJECTIVE: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. MATERIAL AND METHODS: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them...
January 2018: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
C Gambardella, A Allaria, G Siciliano, C Mauriello, R Patrone, N Avenia, A Polistena, A Sanguinetti, S Napolitano, G Conzo
BACKGROUND: Corrosive esophageal strictures are common. The severity of the strictures depends on type, quantity, duration of contact and concentration of the caustic substance ingested. Endoscopic balloon dilation and endoscopic bougienage are a cornerstone in the management of the benign esophageal strictures and are the most widely used treatments, but are expensive and invasive procedures. CASE PRESENTATION: We report the case of an 82-year-old patient with a corrosive esophageal stricture treated for over 40 years by means of home self-bougienage...
May 22, 2018: BMC Gastroenterology
Akihiko Kida, Koichiro Matsuda, Akito Sakai
A 29-day-old girl who was born by Cesarean section in Week-27 of pregnancy due to pregnancy-induced-hypertension, with a height and body weight of 30-cm and 556-g was referred to our hospital with frequent vomiting. As esophagogastroduodenoscopy revealed upper esophageal stenosis, gastrostomy was performed. Five months after birth, esophagogastroduodenoscopy showed membranous obstruction of upper esophagus (Figure.1A). This article is protected by copyright. All rights reserved.
May 21, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Ruchir Puri, C Daniel Smith, Steven P Bowers
AIM: To evaluate outcomes of surgical remediation for symptomatic or anatomic failure after a transoral incisionless fundoplication (TIF). METHODS: This retrospective study was performed on 11 patients who underwent a remedial operation following TIF failure between June 2011 and September 2016 at the Mayo Clinic in Florida for persistent foregut symptoms. Upper gastrointestinal workup characterized 1 patient as having normal post-TIF anatomy and 10 as having anatomic failure...
May 16, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Hans Gregersen, Kar Man Lo
This review provides a biomechanical perspective on the pathophysiology and treatment of achalasia. The esophagus is efficient in transporting ingested material to the stomach in healthy subjects. A fine balance exists between the peristaltic forces generated in the esophageal body (which herein is defined as the preload) and the resistance in the outlet, the esophago-gastric junction (which is defined as the afterload). Achalasia is a rare esophageal disease that progressively over many years challenges esophageal efficacy...
May 14, 2018: Annals of the New York Academy of Sciences
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