Esophageal Balloon Dilatation Research Articles

Caustic oesophagitis in children

Caustic substance ingestion (CSI) remains a major health issue, particularly in developing countries, where laws are not effectively enforced. This review offers a thorough analysis of the current epidemiology, clinical features, management, treatment, and long-term complications of CSI in children. Strong alkalis sold in liquid and granular forms, particularly crystalline grease cleaners (concentrated sodium hydroxide), are the principal causes of severe oesophageal damage. Currently, early endoscopy to assess the gastro-oesophageal mucosa is not considered necessary for all CSI cases. Oesophageal stricture is a major complication developing after CSI, and should be diagnosed and treated earlier, 10-14 days after CSI via commencement of a dilation program. Fluoroscopically guided oesophageal balloon dilatation seems to be safe, with a low frequency of complications and a high success rate. However, it should commence earlier than is currently the case, and should be performed gently, using balloons of gradually increasing diameter. If dilation fails after a few months, oesophageal replacement surgery should be performed. Unfortunately, neither dilatation treatment nor oesophageal bypass surgery can prevent the development of oesophageal carcinoma, the incidence of which is high after CSI. The continuing unacceptably high incidence of CSI accidents would be reduced if corrosive materials were sold in their original childproof containers, highlighting the need for preventive and adult education programmes.

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.

Paediatric laparoscopic Heller’s cardiomyotomy: A single centre series

BackgroundThe optimal management of oesophageal achalasia remains unclear in the paediatric population due to the rarity of the disease. This study reviews the institutional experience of the laparoscopic Heller’s cardiomyotomy (HC) procedure and attempts to define the most appropriate treatment. MethodsA retrospective review of children undergoing HC at a single institution was performed. Demographics, pre-operative investigations, and interventions were reviewed. Post-operative outcomes and follow up were evaluated. Data is expressed as median (range). ResultsTwenty-eight children were included (13 male, 15 female) whose median age was 13 (3.2–17.4) years. Nine children underwent a pre-operative oesophageal balloon dilatation (OBD) a median of 1(1–6) times. Others included botulinum toxin injection (n=1) and Nifedipine (n=1). All had a pre-operative upper gastrointestinal contrast series, and twenty-five had upper gastrointestinal endoscopy and manometry. All had laparoscopic HC with no conversions, and ten had a concomitant fundoplication. Post-operative intervention occurred in eight (28%) incorporating OBD (n=7), of whom four required a redo HC. One patient underwent a redo without intervening OBD. Follow-up was for a median of 0.83 (0–5) years with fourteen children discharged from surgical follow-up. Twenty-seven have thus far had a good outcome. ConclusionThis study comprises the largest series of paediatric laparoscopic HC reported to date. It is effective with or without a fundoplication and is the best long term treatment modality available. OBD for persisting symptoms following HC may obviate the need for redo myotomy.

A case of secondary achalasia caused by scar tissue formation after distal gastrectomy

A 64-year-old man underwent distal gastrectomy for gastric cancer. His postoperative recovery was uneventful until he suddenly started complaining of difficulty swallowing. Fluoroscopy revealed narrowing of the abdominal esophagus into a spindle-like shape. Endoscopic esophageal balloon dilatation was performed with no improvement in his condition. We concluded that the patient could not eat because of mechanical stenosis of the gastroesophageal junction. Reoperation was performed via laparotomy. The abdominal esophagus and gastroesophageal junction were found to have become stiff with adhesions, probably as a result of surgical scarring. We incised the esophageal muscle layer and dissected adhesions around the abdominal esophagus to relieve esophageal stenosis. After reoperation, the patient was able to eat. We recommend that in cases of sudden onset dysphagia after distal gastrectomy, the possibility of secondary achalasia because of scar tissue formation should be considered.

Spleen rupture complicating upper endoscopy

An 81-year-old woman with history of chronic lymphocytic leukemia and recent diagnosis of Clostridium difficile colitis, and maintained on oral vancomycin, presented for generalized weakness, persistent nausea, and a long history of difficulty swallowing (food hangs in her chest and does not move down to her stomach). Workup revealed low potassium and white blood cell count of 41 000/mm with lymphocytes predominance. Renal function and liver enzyme levels were within normal. The patient received intravenous fluids and electrolytes replacement. A diagnostic upper endoscopy was done to delineate the cause of the dysphagia, and the findings were tortuous esophagus, slight narrowing of the esophageal sphincter, and an enormous intrathoracic stomach. Most of the stomach except for the antrum was above the diaphragm. The scope was passed through the hiatus entering the antrum. Below the hiatus, there was acute angulation into the antrum and fair maneuverings were required to reach the pylorus and into the duodenum. Biopsies were taken and esophageal sphincter balloon dilatation was done. Shortly after the procedure, the patient became diaphoretic, hypotensive, and tachycardic, requiring fluid resuscitation and vasopressors. She also developed abdominal pain and marked tenderness, predominantly at the right upper quadrant.

Clinico-epidemiological Study of Caustic Substance Ingestion Accidents in Children in Anatolia: The DROOL Score as a New Prognostic Tool

Background : To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study.Methods : We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10–14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10–14 days) and late (> 21 days) dilatation patients who were referred for OBD by other hospitals. Results : In total, 144 (71%) incidents occurred within the parents’ home and 44 (22%) occurred at another individual’s home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients’ parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10–14 days. Timely endoscopy was performed within 10–14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS < 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients.Conclusions : Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10–14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (> 21 days). OBD can then also be started earlier in these patients.

Evaluation of the Incidence of Esophageal Complications Associated With Balloon Dilation and Their Management in Patients With Malignant Esophageal Strictures

The objective of this study was to investigate the incidence of esophageal complications associated with balloon dilation and their management in patients with malignant esophageal strictures. Fluoroscopically guided esophageal balloon dilation was performed in 89 patients with malignant esophageal strictures during a period of 15 years. Inclusion criteria were patients with unresected esophageal or gastric carcinoma showing short-segment stricture (≤4 cm) at the esophagogastric junction; patients who had previously received chemotherapy, radiation therapy, or both to manage malignant strictures; or patients who were scheduled for chemotherapy or radiation therapy to manage malignant strictures. Of these patients, 72 had esophageal cancer and 17 had stomach cancer. Esophageal rupture was categorized as intramural, transmural, or transmural with mediastinal leakage. A total of 120 procedures were performed, with each patient undergoing one to four procedures. Esophageal rupture occurred in 13 patients (15%): eight with intramural rupture, four with transmural rupture, and one with transmural rupture with mediastinal leakage. Improvements in dysphagia score were observed in 76 of 89 patients (85%) after balloon dilation. All esophageal ruptures were detected immediately after the procedure. Intramural and transmural ruptures were treated conservatively, whereas transmural rupture with mediastinal leakage was treated by temporary stent placement. The overall prevalence of esophageal rupture was 15%. All intramural and transmural ruptures were successfully managed conservatively, whereas transmural rupture with mediastinal leakage was treated by temporary stent placement. We found no relationship between rupture incidence and balloon diameter.

The Reduviid Bug Travels North: An Impressive Presentation of Megaesophagus

Purpose: Introduction: Symptomatic Chagas' disease has been generally confined to South and Central America. Given the Latin American immigration pattern, it is hypothesized that at least 350,000 individuals with seropositivity for Trypanosoma cruzi are living in the U.S. today and only a small number of these individuals have emigrated from Mexico. This case represents an interesting presentation of megaesophagus in a Mexican-American patient. Case Report: A 30 year old Mexican-American male with no past medical history presented to the Emergency Department after a motor vehicle accident. A computed tomography (CT) scan of the chest revealed that the esophagus was markedly dilated and narrowed at the level of the gastroesophageal junction. Further history revealed the patient was experiencing intermittent dysphagia to solids and liquids, regurgitation of undigested foods, and heartburn on occasion for most of his life. He denied odynophagia and the remainder of review of systems was unremarkable. Physical exam was normal, including a benign abdomen. Labs were also unremarkable. An esophagogastroduodenoscopy (EGD) revealed a markedly dilated esophagus with a large amount of retained food. Subsequent upper gastrointestinal (UGI) series with small bowel follow through revealed massive dilatation of the thoracic esophagus extending from T1 to the gastroesophageal junction, with the largest diameter measuring around 8 cm. Chagas disease was suspected and serum antibodies returned with a positive IgG titer of 1:16, consistent with past infection of Chagas disease. Repeat EGD was done and showed a markedly dilated esophagus (9 cm) with retained food. No motility was noted in the esophagus consistent with achalasia. A successful esophageal balloon dilation was performed and the patient noted immediate improvement of dysphagia symptoms. Discussion: Although the patient did not present for evaluation of GI symptoms, megaesophagus was found incidentally. The CT, UGI, and EGD images are very impressive. With the increase in travel and immigration to the U.S., Chagas' disease is becoming more prevalent in this country. This patient had immigrated to the U.S. in 1998, frequents Mexico often, and even recalled childhood dysphagia. Myocardial disease is the most common manifestation of Chagas' disease and megaesophagus and megacolon are the most common intestinal manifestations. Initial symptoms usually present with atypical chest pain which can be secondary to cardiac or esophageal disease. It is important to consider the diagnosis of Chagas in the differential when abnormal imaging or a history of chest pain, dysphagia, or viral respiratory illness is present.

Use of a continuing medical education course to improve fellows' knowledge and skills in esophageal disorders

Advanced esophageal endoscopic procedures such as stricture dilation, hemostasis tools, and stent placement as well as high-resolution manometry (HRM) interpretation are necessary skills for gastroenterology fellows to obtain during their training. Becoming proficient in these skills may be challenging in light of higher complication rates compared with diagnostic procedures and infrequent opportunities to practice these skills. Our aim was to determine if intensive training during a continuing medical education (CME) course boosts the knowledge and skills of gastroenterology fellows in esophageal diagnostic test interpretation and performance of therapeutic procedures. This was a pretest-posttest design without a control group of a simulation-based, educational intervention in esophageal stricture balloon dilation and HRM interpretation. The participants were 24 gastroenterology fellows from 21 accredited US training programs. This was an intensive CME course held in Las Vegas, Nevada from August 7 to August 9, 2009. The research procedure had two phases. First, the subjects were measured at baseline (pretest) for their knowledge and procedural skill. Second, the fellows received 6 hours of education sessions featuring didactic content, instruction in HRM indications and interpretation, and deliberate practice using an esophageal stricture dilation model. After the intervention, all of the fellows were retested (posttest). A 17-item checklist was developed for the esophageal balloon dilation procedure using relevant sources, expert opinion, and rigorous step-by-step procedures. Nineteen representative HRM swallow studies were obtained from Northwestern's motility lab and formed the pretest and posttest in HRM interpretation. Mean scores on the dilation checklist improved 81% from 39.4% (standard deviation [SD]= 33.4%) at pretest to 71.3% (SD = 29.5%) after simulation training (P < 0.001). HRM mean examination scores increased from 27.2% (SD = 16.4%) to 46.5% (SD = 15.8%), representing a 71% improvement (P < 0.001). Pearson's correlations indicated there was no correlation between pretest performance, medical knowledge measured by United States Medical Licensing Examination examinations, prior clinical experience, or procedural self-confidence and posttest performance of esophageal dilation or HRM interpretation. The education program was rated highly. This study demonstrated that a CME course significantly enhanced the technical skills and knowledge of gastroenterology fellows in esophageal balloon dilation and HRM interpretation. CME courses such as this may be a valuable adjunct to standard fellowship training in gastroenterology.

Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia

Achalasia is a rare, but well-defined primary esophageal motor disorder. Classic therapeutic approaches include botulinum toxin injection, balloon dilation, and surgical myotomy of the lower esophageal sphincter. This report summarizes our experience with different treatment modalities for achalasia. Forty-three patients with achalasia treated in our hospital were subdivided according to therapeutic strategy: endoscopic botulinum toxin injection into the lower esophageal sphincter (EBTI; n = 7), endoscopic esophageal balloon dilation (EBD; n = 16), surgical myotomy after failed esophageal balloon dilation (EBD-HM; n = 14), and first-line surgical myotomy (HM; n = 6). Therapeutic efficiency was evaluated comparing standardized symptom scores preoperatively and at follow-up. There was no mortality and no significant difference between the groups for age, sex, or morbidity. The mean follow-up was at 9, 35, 38, and 17 months. At follow-up, recurrent or persistent symptoms were found in 71.4%, 6.3%, 35.7%, and 16.7% in EBTI, EBD, EBD-HM, and HM, respectively. Considering EBD-HM patients as failures of esophageal dilation, the total rate of recurrent or persistent symptoms after EBD was 50%. Poor symptomatic outcome was correlated to a low esophageal sphincter pressure during pretherapeutic manometry (p = 0.03) and to sigmoid-shaped esophageal dilatation (p = 0.06). Surgical myotomy is the most reliable first-line therapy for achalasia, particularly in patients with a high sphincter pressure and moderate esophageal dilatation. Botox injection has a high failure rate and should be reserved for exceptional cases. Endoscopic dilation provides about 50% of patients with long-term symptomatic relief; in most cases, failure can be successfully treated surgically.

A comparative study between temporary esophageal stenting and balloon dilatation for achalasia

Objective To compare the short- and long- term effects and safety of endoscopic balloon dilatation vs. placement of specially designed reclaimable self-expanding anti-reflux esophageal stents for achalasia. Methods A total of 129 patients with achalasia were divided into 2 groups to receive either endoscopic scopic balloon dilatation（,l=63）or endoscopic placement of specially designed reclaimable self-expandinganti-reflux esophageal stents （n = 66）. The dysphagia symptom scores were recorded before and 1-month,6-month and 12-month after the procedure, respectively. The change in width of esophagus, procedure related complications, length and costs of hospitalization were also analyzed. Results Dysphagia symptom score was significantly decreased after the treatment in both groups （P 〈 0.05）. The effective rates evaluated at 1-month, 6-month and 12-month after the procedure in balloon dilatation group were 100. 0% , 96. 7% and 91.5% , respectively, which in stenting group were 100.0% , 98. 0% and 97.1% , respectively. There was no significant difference in changes of symptom score at 1-month and 6-month after treatment between the 2 groups （P 〉 0.05） , while at 12-month after treatment, the decrease of symptom score in stenting group was significantly higher than that in balloon dilatation group （P〈0. 05）. After the treatment, the significant widening of the stricture and narrowing of the dilated esophagus were achieve in both groups （P 〈 0.05）,while no significant difference between these 2 groups was observed in changes of width （P 〉 0. 05）. Procedure related complications in balloon dilatation group included esophageal perforation （n =1） and upper gastrointestinal bleeding （n=4） , which was not occurred in stenting group, but complications included hyperplasia of granulation tissue （n = 1）, stent dislocation （n =2） and defulvium （n = 1） was observed inthe latter group. The length of hospitalization was similar in 2 groups （P 〉 0. 05） , and the cost of hospitalization in stenting group was significantly higher than that of balloon dilatation group （P 〈 0. 05）. Conclusion Compared with endoscopic balloon dilatation, the specially designed reclaimable self-expanding antireflux stents is a more ideal method for achalasia, with similar short-term effect, but better long-term effect and safety. Key words: Esophageal achalasia; Endoscopes; Balloon dilation; Stents

Fluoroscopically Guided Balloon Dilation of the Esophagus

Balloon dilation has become a common method for treating a variety of esophageal conditions. When properly performed, it is an effective procedure with a high rate of success. Fluoroscopically guided balloon dilation offers distinct advantages over endoscopically performed balloon dilation or blindly performed bougienage, as it allows for better visual control of the procedure and morbidity is low. In our experience, fluoroscopically guided esophageal balloon dilation is safe and easy to perform, provided that the operators are aware of the potential complications and the procedure is properly tailored to the patient's underlying condition. At our institution, over the course of 25 years we have performed more than 2300 fluoroscopically guided esophageal balloon dilations to treat a multitude of disorders including strictures of benign and malignant etiology, anastomotic strictures, radiation-induced strictures, tight gastric fundoplication wraps, esophageal webs and rings, achalasia, and anastomotic leaks. Over the years that we have performed the procedure, we have adapted our technique to maximize postprocedural outcomes and utilize available technology. In this article, we describe our current technique, present the various conditions amenable to balloon dilation, and emphasize modifications for each condition. We also discuss potential problems and complications that we have experienced in our practice.

Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features

Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed.

Long-term management of corrosive esophageal stricture with balloon dilation in children

There are only a few studies focused on efficacy and safety of balloon dilation in corrosive esophageal stricture in children. The aim of this study is to assess the long-term clinical results of balloon dilation in the treatment of corrosive esophageal stricture in children. We retrospectively analyzed the management of 18 children (median age 3 years) who were treated with balloon dilation because of caustic esophageal stricture between January 2001 and December 2008. A total of 295 sessions of balloon dilation were performed in all patients over an 8-year period. Technical success was achieved in all patients, whereas clinical success was achieved only in eight (44.4%) patients after first dilation. Eight (44.4%) of all patients showed recovery within the first year and another six (33.3%) patients recovered within 2 years. Esophageal perforation occurred in one (5%) patient, during one dilation session (0.33%). The average number of dilation sessions was 12.7, 2.8, and 1, respectively, in the first, second, and third year. There was significant difference between the mean number of dilation sessions in the first and second year, and second and third year (p < 0.01 and p = 0.043). Short-segment esophageal strictures, improvement of food intake capacity, and increase in intervals of dilation sessions are good patient indicators. We suggest that esophageal balloon dilatation is a safe and effective method of treatment in caustic esophageal strictures and recommend that balloon dilation program be performed for at least 2 years before deciding that dilation has failed and preferring other treatment modalities which have higher risk of complications.

Balloon Dilatation for Corrosive Esophageal Strictures in Children: Radiologic and Clinical Outcomes

ObjectiveWe retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture.Materials and MethodsThe study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5).ResultsA total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD.ConclusionOnly a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.

Minimally invasive management of children with caustic ingestion: less pain for patients

Management of caustic ingestion in children is still controversial. In this study, we evaluate a minimally invasive management consisting of flexible endoscopy, balloon dilatation and intralesional steroid injection in children, with a history of caustic ingestion. Between April 2002 and January 2009, 350 (206 males and 144 females) children with a history of caustic ingestion were admitted. Enteral feeding was discontinued for 24 h. Parenteral feeding was started in patients with inadequate oral intake. No patient underwent an early esophagoscopy or gastrostomy. A contrast study of upper gastrointestinal tract was performed in all patients with persistent dysphagia within 3 weeks after injury. In case of an esophageal stricture, a dilatation program was initiated. For this purpose, a flexible esophagoscopy was performed. A guidewire was placed through the narrowed segment into the stomach and a balloon dilatator was inserted with the assistance of the guidewire. Balloon dilatations were performed every 1-3 weeks. In intractable strictures, triamcinolone acetonide (TAC) was injected into the narrowed segment via flexible endoscopy. Seventeen patients (8 males, 9 females, median 3 years old) required esophageal dilatation. All of the patients completed dilatation program with complete relief of symptoms. None of the patients required any stent application nor esophageal replacement or gastrostomy. Ten patients underwent intralesional TAC injection. No patient had an esophageal perforation or any other complication related to dilatation. In all patients, the symptoms have been alleviated completely and no further dilatation was necessary after a median of five dilatation sessions (1-19 dilatations). Minimally invasive management of caustic ingestion consisting of flexible endoscopy, guidewire-assisted esophageal balloon dilatation and intralesional TAC injection without any gastrostomy or esophageal stent/placement is effective and leads to relief of dysphagia in almost all patients. This method of dilatation is also safe and iatrogenic esophageal perforation is very unlikely.

Transnasal Balloon Dilation of the Esophagus

To describe the safety of transnasal balloon dilation of the esophagus. Retrospective case series. Two tertiary care institutions. All patients undergoing transnasal balloon dilation of the esophagus. Complications. Fifty-four transnasal esophageal balloon dilations were performed in 38 patients. The mean age of the cohort was 65 years (range, 13-88 years). Twenty-nine patients were male (76%). Twenty procedures were performed using only topical anesthesia in the office setting. Seven patients (18%) were postlaryngectomy, and 15 patients (39%) had a history of head and neck radiation therapy. The upper esophageal sphincter (UES) was the most frequent dilation site (63%), followed by proximal/mid esophagus (26%), lower esophageal sphincter (LES) (7.4%), and both the UES and LES (3.7%). Indications included cricopharyngeal dysfunction, benign stricture, web, and Schatzki ring. Two procedures (3.7%) were aborted secondary to self-limited laryngospasm or gagging. There were no clinically significant complications. Transnasal esophageal balloon dilation can be performed in unsedated or sedated patients with a very low complication rate. The procedure is well tolerated in 96% of patients. This technique, formerly available only through larger caliber oral gastroscopes and under sedation, allows for office-based esophageal balloon dilation in an otolaryngology practice.

Pseudoachalasia From Gastric Cancer

A 59-year-old woman was referred from another hospital for esophageal balloon dilatation, with the impression of idiopathic achalasia. She developed progressive dysphagia of 3-month duration associated with weight loss of about 5 kg. She did not have abdominal pain, odynophagia, tarry stool, or hematemesis. Her previous medical history was unremarkable. She denied tobacco use or alcohol consumption. Physical examination centered on abdominal findings of mild tenderness at the epigastric area. There was no palpable lymphadenopathy.

Oesophageal strictures caused by the ingestion of corrosive agents: effectiveness of balloon dilatation in children

To evaluate the safety and clinical effectiveness of balloon dilatation in children for oesophageal strictures caused by the ingestion of corrosive agents. The study comprised 11 children (median age 6 years; range 1-14 years) with oesophageal strictures caused by corrosive agents, who underwent a total of 36 balloon dilatation sessions. The technical and clinical success, recurrence of dysphagia, complications, and primary and secondary patency rates were retrospectively evaluated. Technical success was achieved in 91% of patients and in 97% of balloon dilatation sessions. Clinical success (defined as improved food intake and reduced dysphagia within 1 month of the first balloon dilatation session) was achieved in 64% of patients (7/11). During the mean 35-month follow-up period (range 1-89 months), 10 (91%) patients experienced recurrence. Oesophageal rupture (types 1 or 2) occurred in 45% of patients and in 31% of balloon dilatation sessions. Primary patency rates at 6 months and 1, 2, 3, 4, and 5 years were 36, 27, 14, 14, 14, and 14%, respectively. Secondary patency rates at 6 months and 1, 2, 3, 4, and 5 years were 82, 82, 82, 56, 42, and 42%, respectively. The secondary patency rate was higher than the primary patency rate (p<0.05). The present study examined oesophageal balloon dilatation for paediatric oesophageal strictures caused by the ingestion of corrosive agents. Although the technical success rate was high and there were no deaths, the clinical success rate was low owing to a high recurrence rate. However, repeated balloon dilatations resulted in an acceptable secondary patency rate.

Esophageal Balloon Dilation in Children Prospective Analysis of Hemodynamic Changes and Complications During General Anesthesia

Survey of Anesthesiology: April 2008 - Volume 52 - Issue 2 - p 85-86 doi: 10.1097/SA.0000296406.72327.23