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Interventional radiology
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
These techniques are based on bronchography. Balloon dilation of acquired tracheobronchial stenoses is easy and effective. The procedure is analogous to esophageal dilation. The airway can be accessed through an endotracheal or tracheostomy tube, or a laryngeal mask airway. The measurement facilities on modern angiographic equipment are helpful because accurate assessment of the diameter and length of the balloon to be used is very important. Fluoroscopic guidance is useful because it allows accurate positioning of the balloon, and abolition of the waist confirms that complete inflation has been achieved. A description of stenting and other pediatric airway intervention is beyond the scope of this chapter.
Eosinophilic Esophagitis
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Raghu U. Varier, Molly A. O’Gorman
Esophageal dilatation can be performed for patients who have symptomatic esophageal strictures; however, use of this procedure carries a risk of mucosal laceration and perforation. It is generally recommended that diagnostic endoscopy with biopsy be performed, followed by medical therapy, prior to esophageal dilatation in patients with EoE.
Bacteremia
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Spyridon Fortis, Greg J. Beilman
Bacteremia, the presence of bacteria in the bloodstream, was described more than a century ago by Libman, in 1897. Transient bacteremia can occur in daily activities such as tooth brushing with no clinical sequelae because the host immune system eliminates the bacteria. Bacteremia may occur after tooth brushing up to 50% depending on the intensity, while periodontal surgeries may be associated with an incidence rate of bacteremia as high as 90% [1]. Up to 16% of the patients may develop bacteremia after intubation or bronchoscopy, while bacteremia can occur in an average of 16% of patients in ICU after nasotracheal suctioning [1]. Gastrointestinal procedures may be associated with transient bacteremia in a rate that ranges from 0% to 17%, while the incidence of bacteremia after esophageal dilation can be as high as 45% [1]. Urinary tract interventions may be complicated with transient bacteremia in a rate of 11%–86% depending on the sterility of the urine and the intensity of the procedure [1]. The rate of transient bacteremia after a simple urinary catheterization is about 13%, while the incidence of bacteremia after a vaginal birth is about 3% [1]. When the host immune system fails to clear the bacteria, bacteremia can lead to blood stream infection (BSI) and sepsis. Since transient bacteremia is not associated with clinically significant conditions, the term bacteremia is reserved for bacteremia associated with clinical signs and is often used instead of BSI. Bacteremia and BSI can be further classified as primary or secondary. Primary BSI is a BSI without a known source [2]. In the presence of an indwelling catheter, a primary bacteremia is considered a catheter-related BSI [2]. The incidence of hospital-àcquired BSI in United States is 189 per 100,000 person-years and BSI accounts for 2.2% of total admissions [3]. Half of the BSI take place in the ICU [4] and 5% of all ICU patients develop BSI [5]. BSI is a leading cause of death with a case fatality rate ranging from 10% to 60% [2]. In addition to being an important cause of death, BSIs lead to prolonged length of hospitalizations and higher cost of care [4,6].
Efficacy of bougie dilation for normal diet in benign esophageal stricture
Published in Scandinavian Journal of Gastroenterology, 2023
Jun Young Park, Jae Myung Park, Ga-Yeong Shin, Joon Sung Kim, Yu Kyung Cho, Tae Ho Kim, Byung-Wook Kim, Myung-Gyu Choi
There is no consensus on how many times the dilation should be repeated. A previous study has reported that symptoms show improvement in 98% of patients when the dilatation is more than 15 mm and that the dilation-free period is prolonged when the dilation is more than 16 mm [21,22]. Another study has reported that dilation of the esophagus by more than 12 mm is appropriate for alleviating dysphagia [7]. In the present study, we confirmed that the likelihood of eating a normal diet was significantly increased when the patient was dilated by at least 13 mm. Most patients who were able to eat a normal diet showed an effect in less than three procedures. Only one patient was able to eat a normal diet with the session repeated four times or more. In refractory patients who do not expand sufficiently after five sessions, the response to endoscopic treatment is poor. There is no established additional treatment currently [23]. There were four cases that corresponded to the definition of refractory stricture proposed by Kockman. They did not reach clinical success even after repeated bougie dilations. Among 24 patients who underwent four or more bougie dilation including post-operative and post-radiation etiology, only 1 (4.2%, postoperative) patient achieved clinical success. Results of our study confirmed that repeated bougie dilation was ineffective in patients who did not improve symptoms even after repeating bougie dilation three times. Therefore, it is advisable to consider other esophageal dilatation methods in these patients.
Drug treatment strategies for eosinophilic esophagitis in adults
Published in Expert Opinion on Pharmacotherapy, 2022
Due to the above, the pharmacological treatment of EoE has gained popularity in recent years, and despite specifically approved drugs to treat patients with EoE still not being available in many settings, this is one of the areas of more intense development in the understanding of this disease. Firstly used to treat EoE in 1998 [27], swallowed topical corticosteroids (STC) are currently used to induce histological remission of the disease [28], and novel formulations designed to coat the esophageal inner surface also provide long-term benefit [29]. By acting through anti-inflammatory effects, independent of their activity on gastric acid secretion [30,31], proton pump inhibitors (PPIs) have been also shown an effective first-line therapy for EoE [32] able to achieve [33] and maintain [34–36] clinical and histological remission in around 50% of patients. Finally, esophageal dilation may provide symptom relief up to 95% of patients with a reduced esophageal caliber [37]. As endoscopic dilation is a mechanical procedure with no effect on the mucosal inflammation, it usually needs to be used together with effective diet or drug-based anti-inflammatory therapies in patients with fibrostenotic esophageal features (such as esophageal rings of narrow caliber esophagi) or persistent dysphagia/food impaction, even though they are under an effective drug- or diet-based anti-inflammatory therapy [38].
Current options and investigational drugs for the treatment of eosinophilic esophagitis
Published in Expert Opinion on Investigational Drugs, 2022
Sonsoles Tamarit-Sebastian, Francisco Miguel Ferrer-Soler, Alfredo J Lucendo
Being a unique form of non-IgE-mediated food allergy triggered mainly by food antigens [10], strategies based on the elimination of food triggers have been shown to be the only therapy that targets the cause of EoE, inducing and maintaining its remission [11]. There are no current food allergy tests that accurately predict food triggers for EoE [12], so empirical elimination of foods more commonly involved in triggering food allergy achieves the most consistent results [13]. Swallowed topic corticosteroids (STC) have been shown to be effective in inducing histological remission of the disease [14–16], and novel formulations targeted at coating the esophageal mucosa also provide symptomatic relief [17–19]. Proton pump inhibitors (PPIs) are an effective first-line therapy [20] able to achieve [21] and maintain [22–24] histological and symptomatic remission in a half of patients. This is due to their anti-inflammatory effect, independent of their action on gastric acid secretion [25,26]. Finally, up to 95% of patients have shown symptom relief following esophageal dilation [27]. This should be considered in patients with fibrostenotic esophageal complications and persistent dysphagia/food impaction, despite them being under an effective anti-inflammatory treatment [28].