Balloon Dilatation Of Esophageal Strictures Research Articles

Endoscopic Balloon Dilation of Esophageal Strictures in Children with Esophageal Atresia: 19 Years’ Experience

Endoscopic Balloon Dilation of Esophageal Strictures in Children with Esophageal Atresia: 19 Years’ Experience

Usefulness of a novel narrow-diameter endoscope for endoscopic balloon dilation of esophageal strictures.

Usefulness of a novel narrow-diameter endoscope for endoscopic balloon dilation of esophageal strictures.

Sealing of esophageal perforation with a fully covered biliary stent in a pediatric patient

Conservative treatment for esophageal perforations can cause problems related to both nutrition and wound healing in pediatric patients due to its long duration. This case report presents a 14-month-old female patient who underwent endoscopic balloon dilatation for esophageal stricture. The patient had been operated on for esophageal atresia in the neonatal period. Eight hours after discharge, the patient was hospitalized again due to esophageal perforation. Although conservative treatment lasting three weeks was the preferred method, it was unsuccessful. Therefore, a fully covered biliary stent was used instead of an esophageal stent, as the appropriate size stent could not be found. The stent sealed the perforation, and the patient started to be fed orally on the third day. The esophageal stent was removed on the 17th day, and no leakage was observed on the esophagogram. Although conservative methods are the first-line treatment for esophageal perforations in children, their long duration and the inability to feed for a long time are significant disadvantages. Fully covered self-expandable esophageal stents may be a reliable alternative for sealing esophageal perforations in pediatric patients, as they are in adults.

AORTOESOPHAGEAL FISTULA PRESENTING AS HEMATEMESIS AFTER UPPER ENDOSCOPY

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aortoesophageal fistulas (AEFs) are a rare and deadly cause of upper gastrointestinal bleeds. Prior repair of the thoracic aorta, primary aortic aneurysms, foreign body ingestion and thoracic cancer account for more than 90% of AEFs. Here we present the case of a patient developing AEF after a diagnostic esophagogastroduodenoscopy (EGD). CASE PRESENTATION: A 72-year-old male smoker with a history lung cancer status post right lobectomy presented with months of progressive solid dysphagia. In the past months he underwent two EGDs with balloon dilation of esophageal strictures, of which the most recent one was complicated by a distal esophageal perforation requiring an esophageal stent. Weeks after stent removal his dysphagia returned, prompting a repeat EGD to obtain biopsies of his stricture [Figure 1A-B]. The post-operative course was complicated by a small episode of hematemesis, for which the patient was offered admission for observation but declined. After eating his first meal at home, the patient had a second episode of hematemesis which prompted him to present to the emergency department. On admission, the patient was noted to have hematemesis necessitating a rapid response activation. He underwent emergent endotracheal intubation for airway protection and was started on pantoprazole and octreotide infusions. A massive transfusion protocol was initiated, and the patient was transferred to the intensive care unit where he was started on multiple vasopressors for his hypovolemic shock. A stat computed tomography angiogram (CTA) of the chest was suspicious for an underlying aorto-esophageal fistula [Figure 2A-C]. Thoracic surgery was consulted and given the patient’s age and complexity of the procedure; he was deemed a poor surgical candidate. Ultimately the patient’s family decided to pursue comfort care and the patient passed shortly thereafter. DISCUSSION: The presentation of AEF is characterized by a triad of midthoracic pain, sentinel arterial hemorrhage, and massive hemorrhage after a symptom-free interval. While initial clot formation tamponades the fistula, GI contents rapidly weaken this clot. Evaluation for AEF should done with a CTA-Chest as it has been found to be more sensitive than EGD. Initial therapy should focus on achieving hemodynamic stability via thoracic endovascular aneurysm repair or aortic graft replacement. AEF outcomes are improved when the esophageal pathology can be addressed with esophagectomy, stenting, or fistula repair, and with use of post-operative broad-spectrum antibiotics. Prompt surgical intervention increases one-year survival up to 50%. CONCLUSIONS: AEF should be included in the differential of hematemesis after instrumentation for an EGD. Limited time exists between the herald bleed and massive hemorrhage to confirm the diagnosis and plan for a surgical approach. CTA-Chest should be obtained first, followed by an EGD when imaging is inconclusive. Reference #1: Takeno S, Ishii H, Nanashima A, Nakamura K. Aortoesophageal fistula: review of trends in the last decade. Surg Today. December 2019:1-9. Reference #2: Uittenbogaart M, Sosef MN, van Bastelaar J. Sentinel bleeding as a sign of gastroaortic fistula formation after oesophageal surgery. Case Rep Surg. 2014;2014:614312. Reference #3: Vu QDM, Menias CO, Bhalla S, Peterson C, Wang LL, Balfe DM. Aortoenteric fistulas: CT features and potential mimics. Radiographics. 2009;29(1):197-209. DISCLOSURES: No relevant relationships by Hareen Chela, source=Web Response No relevant relationships by Ethan Karle, source=Web Response No relevant relationships by Adam Letvin, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by Shyam Shankar, source=Web Response

MODERN METHODS OF THE TREATMENT OF ESOPHAGEAL STRICTURES IN BULLOUS EPIDERMOLYSIS CHILDREN

The review presents modern approaches to the treatment and prevention of the benign esophageal stenosis in epidermolysis bullosa (EB) children. There are discussed advantages and disadvantages of such main methods as conservative, intraluminal recanalization, and surgical operations used in the treatment of esophageal strictures in EB patients. The features of anesthesia in BE patients are described. Balloon dilatation of esophageal strictures under endoscopic or fluoroscopic control has been shown to be the optimal method of treating patients. In severe BE children with refractory esophageal stenosis, developmental delay, and nutritional status disorders, to perform hyperalimentation by virtue of the percutaneous endoscopic gastrostomy (PEG) tube is recommended.

Efficacy and safety of endoscopic balloon dilatation of esophageal strictures without fluoroscopy: a pilot study

IntroductionEsophageal strictures can be caused by malignancy, congenital stenosis, motility disorders or benign strictures. Endoscopic balloon dilatation is a simple procedure with low complication rates to treat gastrointestinal strictures. This study aims to analyze indications and results of balloon dilatation without fluoroscopy.Material and methodsThe patients who underwent pneumatic balloon dilatation (PBD) for esophageal stricture were included in the study. The demographic characteristics of the patients, indications for PBD, number of operations and complications were recorded.ResultsTwelve patients were included in this pilot study. The most common cause of esophageal strictures was malignancy. In this group, PBD was performed before stenting in the patients who were planned to receive neoadjuvant therapy, had locally advanced esophageal cancer or inoperable esophageal cancer, and complained of difficulty swallowing. Three patients underwent PBD due to achalasia. One of these patients underwent PBD 3 times due to recurrence of symptoms during the follow-up period. The success rate of PBD in this study was 91.6%. The success rate for the patients who underwent PBD for the first time was 83.3%. None of the patients who underwent endoscopic balloon dilatation had major complications (such as massive bleeding and perforation) or procedural mortality.ConclusionsEndoscopic balloon dilatation without fluoroscopy performed by experienced endoscopists is an effective and safe method for the treatment of esophageal strictures. Successful results are obtained with low complication rates in experienced centers.

Balloon Dilatation of Esophageal Strictures in Children With Bullous Epidermolysis: Description of Case Series

Esophageal strictures are the most common complications of bullous epidermolysis in children. Strictures cause the development of dysphagia that prevents oral alimentation and receipt of an adequate amount of nutrients that is accompanied by a violation of nutritional status, weight loss, and delayed physical development of a child. Disturbed swallowing can also cause aspiration syndrome, pneumonia, and airway obstruction. To eliminate dysphagia and reduce the risk of complications, it is necessary to restore esophageal patency. The article describes the results of X-ray with assisted balloon dilatation in 19 children with bullous epidermolysis and dysphagia. It is shown that this method of esophagus recanalization allows to effectively and safely restore oral alimentation of children already in the first day after intervention with a gradual expansion of the diet.

Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture.

This study aimed to evaluate the effectiveness of intravenous steroid pulse therapy following balloon dilatation for esophageal stenosis and stricture in children. The study enrolled six children, including three with congenital esophageal stenosis and three with anastomotic strictures after surgery for esophageal atresia, all of whom were treated by balloon dilatation combined with high-dose intravenous methylprednisolone pulse therapy. Methylprednisolone was injected intravenously at a dose of 20mg/kg/day for 2days, starting from the day of dilatation, followed by 10mg/kg/day for 2days, for a total of 4days. Esophageal stricture recurred in all three patients with congenital esophageal stenosis despite repeated balloon dilatation without methylprednisolone. However, the symptoms of dysphagia improved and did not recur after systemic steroid pulse therapy following balloon dilatation. Symptoms also resolved in all three patients with anastomotic strictures following balloon dilatation with systemic steroid pulse therapy. All six patients remained asymptomatic after 6-21months follow-up, with no complications. Intravenous methylprednisolone pulse therapy following balloon dilatation is safe and effective for the treatment of esophageal stenosis and strictures in children.

Trans-Balloon Visualisation During Dilatation (TBVD) of Oesophageal Strictures: a Novel Innovation

BackgroundHydrostatic balloon dilatation of upper gastrointestinal strictures is associated with a risk of perforation that varies with the underlying pathology and with the technique employed. We present a technique of trans-balloon visualisation of the stricture during dilatation (TBVD) that allows direct ‘real-time’ observation of the effect of dilatation on the stricture, facilitating early recognition of mucosal abruption, thereby reducing the perforation rate. Patients and MethodsWe retrospectively analysed 100 consecutive patients, undergoing balloon dilatation of oesophageal strictures between 1st of January 2011 and 1st of July 2014. ResultsOne hundred patients underwent 186 dilatations, with 34 having multiple procedures (mean 1.86). All had oesophageal strictures (mean diameter 8.49 mm, range 5–11 mm) and most underwent dilatation up to a maximum of 17 mm (mean 14.7 mm). Fifty-six percent were male and the average age was 62.5 years (17–89 years). Only one patient (0.5 % of all procedures) had a full-thickness perforation requiring intervention while just one further patient had a deep mucosal tear that did not require intervention. ConclusionsTBVD is a safe technique with a short learning curve and is one of the important factors that allow potentially difficult dilatations to be performed safely with an exceptionally low rate of adverse events of less than 1 %.

Endoscopic Balloon Dilation of Esophageal Strictures in 9 Horses.

BackgroundMedical treatment of esophageal strictures in horses is limited and the use of balloon dilatation is described in few cases. Long‐term follow up after balloon dilatation and the use of intralesional corticosteroids has not been evaluated.ObjectivesTo describe the use of endoscopic guided, esophageal balloon dilatation in horses for cervical and thoracic esophageal strictures and administration of intralesional corticosteroids at the time of dilatation.AnimalsNine horses from the hospital population with benign esophageal strictures.MethodsRetrospective study: Medical records were reviewed from horses presented to the William R. Pritchard, Veterinary Medical Teaching Hospital at UC Davis from 2002 to 2013. Records were searched using the key words: equine, horse, balloon dilatation, bougienage, and esophageal stricture.ResultsNine horses with esophageal strictures were treated with esophageal balloon dilatation. Five horses survived (survival at writing ranged from 2 to 11 years after discharge) and all nonsurvivors were <1 year of age and presented with concurrent problems or developed complications including megaesophagus, unresolved esophageal obstruction requiring esophagostomy, or severe aspiration pneumonia. Four horses were treated with intralesional corticosteroids with no adverse effects noted in the survivors (n = 3). Four horses available for long‐term follow up were alive at 2, 5, 6, and 11 years after presentation and 3 of these horses were being fed a hay‐based diet.ConclusionsResolution of esophageal strictures in the horse can be performed successfully, safely, and under standing sedation using balloon dilatation. Intralesional corticosteroids might reduce the incidence of recurrent strictures.

The role of endoscopy in the evaluation and management of dysphagia

The role of endoscopy in the evaluation and management of dysphagia

Tu1293 Endoscopic Balloon Dilatation for Esophageal Stricture After Endoscopic Submucosal Dissection for Early Esophageal Neoplasms

The use of esophageal endoscopic submucosal dissection (ESD) to remove superficial esophageal neoplasms is gradually becoming more common as an alternative to surgery recently these years. However, postoperative esophageal stricture is frequently observed after the removal of large lesions by ESD.Though there were a few studies reported some new methods for esophageal strictures, esophageal dilatation is still the most preferred choice in clinical practice. Endoscopic balloon dilatation (EBD) has been widely reported for dealing with benign stricture after esophagectomy and several studies had reported the effect and complications.

Clinical value of preventive balloon dilatation for esophageal stricture

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) were developed for the treatment of benign lesions and early superficial esophageal cancers in the gastrointestinal (GI) tract. However, esophageal strictures frequently develop in patients who undergo EMR/ESD. Therefore, we aimed to investigate the clinical value of preventive balloon dilatation (BD) for esophageal diseases following endoscopic therapy. A total of 30 patients who had received EMR or ESD were enrolled in the study. Preventive BD was carried out for 12 cases within 1 week following EMR/ESD. The remaining 18 cases were not subjected to preventive BD and were used as an historic control. The results revealed that no complications, including esophageal stenosis and dysphagia, were observed in the patients who received preventive BD. In the control group, seven cases experienced dysphagia, of which two were released without clinical treatment and the other five were released following two or three BD procedures. The results indicate that preventive BD is an effective treatment for patients with esophageal diseases following EMR and should be considered at an early stage when the mucosal injury exceeds two-thirds of the esophageal lumen.

Systemic Air Embolism With Hepatic Portal Venous Gas (HPVG) Following Endoscopic Balloon Dilatation of Esophageal Stricture

Systemic Air Embolism With Hepatic Portal Venous Gas (HPVG) Following Endoscopic Balloon Dilatation of Esophageal Stricture

Fluoroscopically Guided Dilation of Esophageal Strictures in Patients With Dystrophic Epidermolysis Bullosa: Long-Term Results

The purpose of this study was to investigate the immediate and long-term outcomes after fluoroscopically guided balloon dilation of esophageal strictures in a series of patients with dystrophic epidermolysis bullosa (DEB). Between 2005 and 2011, the medical records of all patients with DEB treated with fluoroscopically guided balloon dilation of esophageal strictures were included in the study and retrospectively analyzed. The indication for treatment was dysphagia attributed to at least one radiologically verified esophageal stricture. The primary endpoints of the study included procedural technical success, clinical improvement assessed with a 0-4 dysphagia score, and major complication rate. Secondary endpoints were patient survival and reintervention rates. Nineteen consecutively registered patients with DEB (age range, 10-51 years; mean, 30 ± 12.2 years) and dysphagia due to esophageal strictures were treated with fluoroscopically guided balloon dilation. In total, 90 procedures and 121 dilations were performed to manage 28 lesions. Balloon diameter ranged from 8 to 18 mm. The mean follow-up time was 47.51 ± 16.64 months (range, 17-73 months). The technical success rate was 96.7% (87/90). There were no major complications. The mean reintervention rate was 1.19 dilations per patient per year, and the postprocedural dysphagia score (0.72 [95% CI, 0.56-0.87]) was significantly lower than baseline (2.50 [95% CI 2.35-2.65]) (p < 0.001). Repeated fluoroscopically guided balloon dilation is safe and effective for the management of dysphagia caused by esophageal strictures in DEB. Use of this technique was associated with marked clinical improvement in dysphagia and satisfactory long-term reintervention rates with no major complications.

Endoscopic balloon dilatation of esophageal strictures in children

Aim of the study To assess the efficacy and safety of endoscopic balloon dilatation of esophageal strictures in children. Material and methods Design: retrospective case series; population: 49 patients under 18 years of age referred to our center for esophageal strictures; treatment: endoscopic balloon dilatation; outcome parameters: residual dysphagia, weight gain, iatrogenic esophageal perforation, assessment of the esophageal lumen by endoscopy or esophagogram. Results The three main etiologies were esophageal atresia (49%; n = 24), corrosive injury (25%; n = 12), and epidermolysis bullosa (14%; n = 7), followed by a heterogeneous group of rarer causes (12%; n = 6). The number of dilatations ranged from 1 to 8 sessions per patient (median ± SEM: 2 ± 0.3). The length of the follow-up period ranged from 20 to 109 months (median ± SEM: 40 ± 4 months). Treatment was successful in 86% of cases ( n = 42). Twelve percent of patients ( n = 6) had a residual stenosis requiring surgery, and a further one still experienced swallowing difficulties requiring enteral nutrition via gastrostomy in spite of the absence of significant residual stricture. Results were less satisfactory in cases of corrosive injury than with other etiologies. Three esophageal perforations were observed (6% of patients; 2% of procedures). All were medically treated. Conclusions Endoscopic balloon dilatation is a simple, safe and efficacious treatment of esophageal strictures in children.

Efficacy of Preventive Endoscopic Balloon Dilation for Esophageal Stricture After Endoscopic Resection

We earlier reported that mucosal defect involving over three-fourths of the circumference of the esophagus after endoscopic mucosal resection (EMR) is a risk factor for the development of the stricture. Although endoscopic balloon dilation (EBD) is a useful procedure to relieve the stricture, there is no standard strategy for preventing development of the stricture. The aim of this study was to evaluate the efficacy and the safety of preventive EBD. From 1993 to 2008, 41 consecutive patients with extensive mucosal defect involving over three-fourths of the esophageal circumference after EMR or endoscopic submucosal dissection (ESD) were investigated. Preventive EBD was carried out for 29 cases within 1 week just after EMR/ESD and was repeated once a week until the mucosal defect was completely healed. The remaining 12 cases were not underwent preventive EBD and used as a historic control. If postEMR/ESD stricture developed regardless of preventive EBD, conventional EBD was given repeatedly until the stricture was completely relieved. Preventive EBD decreased the incidence of stricture (59% vs. 92%, P =0.04), reduced the severity of stricture [(≤2 mm; >2 mm and ≤5 mm; >5 mm)=(1; 2; 14) vs. (4; 4; 3), P = 0.01] and shortened the duration required for resolving the stricture (29 d vs. 78 d, P =0.04) even when stricture developed. There was no complication associated with preventive EBD procedure. Preventive EBD is an effective procedure to prevent postEMR/ESD stricture. Preventive EBD should be considered when EMR/ESD results in a mucosal defect with a circumference greater than three-fourths of the esophageal lumen.

Anesthesia for balloon dilatation of esophageal strictures in children with epidermolysis bullosa dystrophica: from intubation to sedation

Dystrophic epidermolysis bullosa is a rare disease mainly affecting small children. They often have to undergo different surgical procedures, for example balloon dilatation following esophageal strictures to maintain oral intake and prevent malnutrition. So far, no specific treatment is available for patients with any forms of epidermolysis bullosa. However, more and more minimal invasive surgical techniques are used to manage symptoms of the disease, for example endoscopic balloon dilatation for severe esophageal strictures. In this article implications for the anesthetic management of children with dystrophic epidermolysis bullosa are described. General anesthesia and sedation techniques are feasible if specific prerequisites are fulfilled. The team providing anesthesia and endoscopy must be familiar with the nature and disabilities of this disease. Coordinated care of the involved disciplines is crucial for all planned procedures regarding perioperative management.

Esophageal balloon dilation in children: prospective analysis of hemodynamic changes and complications during general anesthesia

Study Objective To investigate hemodynamic changes and complications in children during balloon dilation of esophageal strictures. Design Prospective, controlled study. Setting University teaching hospital. Patients 5 ASA physical status I and II pediatric patients with benign esophageal stricture related to ingestion of caustic substances. Interventions Anesthesia was induced with intravenous propofol two mg/kg and cisatracurium 0.2 mg/kg and maintained with 66% nitrous oxide and one minimum alveolar concentration of sevoflurane in oxygen . In each session, balloon size was increased until the stricture was opened. Measurements and Results A total of 18 sessions and 99 dilations in 5 children performed over a one-year period were included in the study. In 8 of 18 sessions, esophageal stricture was located in the middle one third of the esophagus; and in the others, in the upper one third. Four cases experienced bleeding; two cases, inability to ventilate due to obstruction of the endotracheal tube tip by the inflated balloon; and two cases, postextubation bronchospasm. In 95 of the 99 dilations, while the balloon was inflated, heart rate was faster and blood pressure increased significantly. Conclusion Anesthesiologists should keep in mind the possibility of hemodynamic instability and possible endotracheal tube tip obstruction by the inflated balloon and safeguard the airway against bleeding, secretions, and radio-opaque fluid during esophageal balloon dilation.

What are the Gastrointestinal Endoscopic Requirements of a Cancer Centre?

Aims To describe the elective endoscopy requirements of a cancer centre. Materials and methods A prospective register of all patients referred from a cancer centre to our unit over a period of 1 year was maintained. Emergency procedures out of hours were not included. Results The Endoscopic Unit at the Chelsea and Westminster Hospital provides a service to the local population of southwest London and the Fulham Road branch of the Royal Marsden Hospital. Between 1 January and 31 December 2003, 3720 new National Health Service patients with cancer were seen at the Royal Marsden Hospital; 1423 of these patients were seen at the Fulham Road branch. In the same period, the Endoscopy Unit at the Chelsea and Westminster Hospital investigated 5270 patients. Of these, 426 patients (8.1%) were referred from the Royal Marsden Hospital. In total, these patients underwent 491 procedures. Two hundred and fifty-three patients were men, with a median age of 65 years (range 22–100), and 173 were women, with a median age of 58 years (range 18–100). The diagnostic procedures carried out included colonoscopy ( n = 125), upper gastrointestinal endoscopy ( n = 136), flexible sigmoidoscopy ( n = 90), endoscopic ultrasound ( n = 24), anorectal physiology measurement ( n = 5) and endoscopic retrograde cholangio-pancreatography (ERCP) ( n = 1). Therapeutic procedures included ERCP (biliary stents/sphincterotomy/stone extraction) ( n = 38), placement of percutaneous endoscopic gastrostomy ( n = 29), balloon dilatation of oesophageal strictures ( n = 25), oesophageal, gastric, duodenal or colonic stent insertion or laser therapy ( n = 16), naso-jejunal tube insertion ( n = 1) and banding of oesophageal varices ( n = 1). All patients were treated as day cases. Four patients were admitted for observation after their investigation. All others were discharged home or back to the Royal Marsden Hospital. Conclusions Cancer centres increasingly require diagnostic, palliative and therapeutic endoscopic support as part of the acute and follow-up management of patients. Many procedures are urgent. This study suggests that a significant number of patients being managed in a cancer centre will require endoscopic intervention and the range of procedures, equipment and skills required is wide.