Dilation Of Esophageal Strictures Research Articles

Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial.

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. 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. Secondary outcomes through 12 months included safety, time to first dilation for recurrent stricture, dysphagia, and level of activity. At 3 months, the biodegradable stent group (n = 32) underwent significantly fewer endoscopic dilations for recurrent stricture compared with the dilation group (n = 34; P < 0.001). By 6 months, the groups were similar. The number of patients experiencing adverse events was similar between the groups. Two patients in the biodegradable stent group died after developing tracheoesophageal fistulas at 95 and 96 days post-placement; no deaths were attributed to the stent. Median time to first dilation of recurrent stricture for the biodegradable stent group was significantly longer (106 vs. 41.5 days; P = 0.003). Dysphagia scores improved for both groups. Patients in the biodegradable stent group had a significantly higher level of activity through 12 months (P < 0.001). Biodegradable stent placement is associated with temporary reduction in number of repeat dilations and prolonged time to recurrent dysphagia compared with dilation. Additional studies are needed to better define the exact role of biodegradable stent placement to treat recurrent BES.

Endoscopic dilation in pediatric esophageal strictures: a literature review.

Background: Esophageal strictures in pediatric age are a quite common condition due to different etiologies. Esophageal strictures can be divided in congenital, acquired and functional. Clinical manifestations are similar and when symptoms arise, endoscopic dilation is the treatment of choice. Our aim was to consider the efficacy of this technique in pediatric population, through a wide review of the literature. Method: A search on PubMed/Medline was performed using “esophageal strictures”, “endoscopic dilations” and “children” as key words. Medline, Scopus, PubMed publisher and Google Scholar were searched as well. As inclusion criteria, we selected clinical studies describing dilations applied to all type of esophageal strictures in children. Papers referred to single etiology strictures dilations or to adult population only were excluded, as well as literature-review articles. Results: We found 17 studies from 1989 to 2018. Overall, 738 patients in pediatric age underwent dilation for esophageal strictures with fixed diameter push-type dilators (bougie dilators) and/or radial expanding balloon dilators. Severe complications were observed in 33/738 patients (4,5%) and perforation was themost frequent (29/33). Conversion to surgery occurred only in 16 patients (2,2%). Conclusions: Endoscopic dilation is the first-choice treatment of esophageal strictures, it can be considered a safe procedure in pediatric age. Both, fixed diameter push-type dilators and radial expanding balloon dilators, showed positive outcomes in term of clinical results and cases converted to surgery. However, it’s essential to perform these procedure in specialized Centers by an experienced team, in order to reduce complications. (www.actabiomedica.it)

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.

Diagnostic yield of gastrointestinal endoscopy in North West Region Cameroon and trends in diagnosis over time.

IntroductionGastrointestinal endoscopy is an important modality for diagnosis and treatment of gastrointestinal disease, but there are limited data regarding the diagnostic yield of endoscopy in Cameroon and changes in the prevalence of endoscopic findings over time. Our aims were to describe the diagnostic utility of esophagogastroduodenoscopy (EGD) and colonoscopy, the impact of periodic on-site mentorship on cecal intubation rate and changes in the prevalence of common upper gastrointestinal findings when compared to a similar report from our region published in 1990.MethodsRetrospective review of all EGD and colonoscopy procedures performed during 2015 at a regional referral hospital in North West Region, Cameroon, with comparison to EGD findings reported by Dent and colleagues in 1990. During the year 3 endoscopists provided periodic colonoscopy mentorship.ResultsAmong 1,371 EGDs, abnormalities were found in 59.7% and therapeutic interventions (most commonly esophageal stricture dilation or band ligation of varices) were performed in 137 (10%). When compared to 25 years previously, peptic ulcer disease was less common and esophagitis was more common (p < 0.0001; p < 0.0001). The prevalence of malignancy (2.2%) was similar. Among 380 colonoscopies diagnostic findings were seen in 60.5%, including colorectal malignancies in 5.8%. Cecal intubation rate improved from 32% to 89% during the one-year study period.ConclusionEGD and colonoscopy have a diagnostic yield of about 60% in symptomatic patients in North West Region, Cameroon. When compared to 1990 peptic ulcer disease was less common and esophagitis was more common. Periodic on-site mentorship was associated with improved physician performance of colonoscopy.

Dilation of a Complex High-Grade Esophageal Stricture Without Fluoroscopy

Esophageal lumen dilation is performed to relieve dysphagia caused by esophageal strictures. Most commonly, high grade esophageal strictures are dilated using fluoroscopy to monitor the placement of guidewires and dilators. Here, we present a video on esophageal dilation using an esophageal lumen patency string. The lumen patency string helps guide the dilation of the esophagus; thus, avoiding the use of fluoroscopy. The procedure involves using an esophageal lumen patency string (placed during previous endoscopic lumen restoration), bare metal wire, guidewire, gastric stoma, and plastic sheath to safely establish access inside the patient's esophagus. Then, serial dilators are used to dilate the esophagus. At the end of the procedure the lumen patency string is replaced for future dilations. This method of esophageal dilation is more cost effect than using an esophageal stent to dilate the lumen. Further, patients find the string more comfortable than a stent. Finally, this method does not expose patients to radiation since fluoroscopy is avoided. Watch the video: https://goo.gl/dXY3Mv

Safety of Endoscopic Dilation in Eosinophilic Esophagitis

Although endoscopic dilation of esophageal strictures in patients with eosinophilic esophagitis (EoE) is a mainstay of treatment, significant mucosal

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.

Management of Benign Esophageal Strictures in Children.

Esophageal strictures are seldom in children. In many countries, accidental ingestion of corrosives is a major cause of risk for stricture formation. Therefore, their management is a challenge. Safety and long-term efficacy of esophageal dilation for benign esophageal strictures has been confirmed in children. Because most children with structures are toddlers or younger, balloon dilatation is often preferred over bouginage. There is increasing evidence that short duration administration of high doses steroids may be of benefit in some specific situation (IIb esophagitis according to Zargar classification). Mytomycin-C application needs to be further evaluated. Stenting was reported to be successful in some refractory cases.

Clinical Outcomes of Dilation Therapy for Anastomotic Esophageal Stricture.

Benign esophageal stricture after esophagectomy is not an infrequent complication. Anastomotic esophageal stricture requires frequent multiple dilations. We aimed to evaluate the clinical outcomes of dilation therapies using an endoscopic balloon or bougie dilator and analyzed the risk factors associated with refractory stricture. Between January 2009 and May 2016, the medical records of 21 patients treated with endoscopic balloon dilation or bougie dilation for esophageal anastomotic strictures were retrospectively reviewed. During the study periods, a total of 21 patients were diagnosed with esophageal anastomotic stricture and included for analysis (17 male; mean age, 68.2±7.2 years at the first procedure). The mean stricture length was 6.4±8.1 mm. The refractory stricture was found in 28.6% of patients, and successful relief of dysphagia was achieved in 71.4% of patients. The major complication associated with dilations was absent. Factors associated with refractory stricture were stricture length (> 10 mm, p<0.049) and diabetes mellitus (p=0.035). Additive bougie dilations achieved clinical success in 4 out of 7 patients. Dilation with endoscopic balloon or bougie dilator was an effective and safe procedure for benign anastomotic esophageal strictures of less than 10 mm in length.

A 型食道閉鎖症の一例 : 先天性食道閉鎖症術後吻合部狭窄に対する食道拡張法,及び摂食習慣確立

A 型食道閉鎖症の一例 : 先天性食道閉鎖症術後吻合部狭窄に対する食道拡張法,及び摂食習慣確立

One-shot balloon dilation of esophageal stricture due to unusual lichen planus localization

One-shot balloon dilation of esophageal stricture due to unusual lichen planus localization

Swiss Cheese Esophagus: A Case of Esophageal Intramural Pseudodiverticulosis

Diverticula can be seen throughout the gastrointestinal tract including the Esophagus. Esophageal Intramural Pseudodiverticulosis (EIPD) is a rare condition characterized by the presence of multiple pinhead-sized outpouchings of the esophageal wall, giving the esophagus the appearance of Swiss cheese on endoscopy. We present a case of EIPD in a patient with eosinophilic esophagitis (EoE). To our knowledge, this is the first case describing EIP with concomitant EoE. A 72 year old Caucasian male presents to a gastroenterology clinic for evaluation of dysphagia. He underwent endoscopy as part of his evaluation, which revealed multiple esophageal diverticula as well as distal esophageal strictures. The patient underwent successful esophageal stricture dilation and was advised to follow up for a repeat endoscopy. He followed with another gastroenterologist for the next 3 years where he was diagnosed with Eosinophilic Esophagitis (EoE). He was treated with oral budesonide slurry but continued to have recurrent dysphagia. He presented with a complaint of “macaroni stuck” in his throat. The food bolus passed spontaneously and on endoscopy he had multiple esophageal rings as well as pseudodiverticulosis. The patient underwent Savary dilation, followed by multiple repeat stricture dilatation sessions in the following months. He subsequently had complete resolution of his dysphagia, while on budesonide, and had a satisfactory endoscopic appearance on the most recent endoscopy, except for the pseudodiverticulosis. EIPD was first described in 1960 by the British Institute of Radiology. To date a little over 200 cases of EIP have been described in the literature. Unlike colonic diverticula, the exact mechanism by which EIPD forms is unclear. It seems, however, to be affected by chronic inflammation whereby the structural integrity of the esophageal lining, especially at the excretory ducts of the submucosal glands, is compromised leading to the formation of diverticula. This rare entity represents a unique challenge, especially in the presence of other concomitant conditions. In our patient, both EoE and EIPD can lead to dysphagia and stricture formation. This raises an interesting question: Are the strictures a result of EIPD or EoE or both? Also, if EIPD is associated with chronic inflammatory states then why is it not more commonly seen with conditions such as reflux esophagitis?Figure 1

Breaking the “Rule of Three” for Esophageal Dilation

The “rule of three” in dilation of esophageal strictures suggests that in a single session, no more than three bougie dilators of sequentially larger size should be passed once moderate or greater resistance is evident. (Dilators passed with no or mild resistance do not count toward this total.) Despite its ubiquity in guideline and expert recommendations, this “rule” has never been validated. In a retrospective chart review, researchers assessed the effect of the …

Balloon versus bougie for dilatation of benign oesophageal strictures

This is the protocol for a review and there is no abstract. The objectives are as follows: To undertake a systematic review comparing the safety and efficacy of balloon dilatation with bougienage for dilatation of benign oesophageal strictures.

Endoscopic dilation of benign esophageal anastomotic strictures over 16\xa0mm has a longer lasting effect

BackgroundThe optimal target of endoscopic dilation of postsurgical esophageal strictures is unknown. Our aim was to compare the dilation-free period of patients who underwent dilation up to 16 mm with patients who were dilated up to 17 or 18 mm.MethodsWe retrospectively analyzed adult patients who received bougie/balloon dilation for a benign anastomotic stricture after esophagectomy. An anastomotic stricture was defined as dysphagia in combination with a luminal diameter of ≤13 mm at endoscopy. We analyzed the dilation-free period using Kaplan–Meier and multivariable Cox regression analysis.ResultsEighty-eight patients were dilated up to a maximum diameter of 16 mm and 91 patients to a diameter >16 mm. The stricture recurrence rate was 79.5 % in the 16 mm group and 68.1 % in the >16 mm group (p = 0.083). The overall dilation-free period had a median of 41.5 (range 8–3233) days and 92 (range 17–1745) days, respectively (p < 0.001). For patients who developed a stricture recurrence, the median dilation-free period was 28 (range 8–487) days and 63 (range 17–1013) days, respectively (p = 0.001). Cox regression analysis showed a reduced risk of stricture recurrence for patients who were dilated up to >16 mm: crude hazard ratio (HR) 0.57 (95 % confidence interval (CI) 0.41–0.81) and adjusted HR 0.48 (95 % CI 0.33–0.70).ConclusionsEndoscopic dilation over 16 mm resulted in a significant prolongation of the dilation-free period in comparison with dilation up to 16 mm in patients with benign anastomotic strictures after esophagectomy.

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.

Dilatation of esophageal strictures in epidermolysis bullosa patients: a single center experience

Esophageal stricture is one of the most common gastrointestinal complication in epidermolysis bullosa patients. We describe the technique of esophageal stricture dilatation, with a focus on safety and procedural modifications. Case series of 6 patients diagnosed with epidermolysis bullosa who underwent esophageal dilatation in our unit. Type of epidermolysis bullosa, patient’s age, dilatation technique, dysphagia free interval and complications were recorded. Four females and two males underwent a total of 31 dilatations during a 4-year follow-up. Most common dilatation technique was “through-the-scope” with three-stage baloons without radiology control, and in one case Savary bougi. Dilatation is usually done as an outpatient procedure with patients being discharged 3–4 h after the procedure. Mean dysphagia free interval is 7 months, longer is older patients. “Through-the-scope” baloons could be the best way to perform esophageal dilatation in epidermolysis bullosa patients. The procedure is short, safe with high success rate and dysphagia free interval and minimal complications.

Factors affecting dilation force in balloon dilation of severe esophageal strictures: an experiment using an artificial stricture model.

The multidiameter balloon catheter is used widely for severe esophageal stricture dilation. However, the relationships between inflation pressure, balloon size, and radial dilation force at the stricture site have not been examined fully. We performed an experiment using phantom models to investigate the relationships between inflation pressure, balloon size, and radial dilation force. The balloon dilation procedure was performed for each stricture model using three sizes of balloon: 10-11-12, 12-13.5-15, and 15-16.5-18mm. A positive association between inflation pressure and dilation force was observed for each balloon size. In balloons inflated by targeting the same diameter, the dilation force was higher for smaller balloons than for larger balloons. An inverse association between stricture size and dilation force was observed in the 12-13.5-15mm balloon (3 vs 5mm, P=.002; 5 vs 7mm, P<.001). We found relationships between inflation pressure, balloon size, severity of strictures, and dilation force. To perform safe and effective esophageal balloon dilation, the inflation pressure and balloon size should be selected after considering the stricture size and target diameter.

Cerebral Abscess Complicating Esophageal Stricture Dilation in a Patient with Down’s Syndrome

Cerebral Abscess Complicating Esophageal Stricture Dilation in a Patient with Down’s Syndrome

Our approach to esophageal perforation secondary to dilatation of caustic esophageal stricture in children

Our approach to esophageal perforation secondary to dilatation of caustic esophageal stricture in children