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Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Eric M. Pauli, Robert E. Cilley
Esophageal dilation is performed using prograde sequential dilators, with or without guidewires, and balloon dilators. Large-caliber balloon dilation is used to treat achalasia. Fluoroscopy to confirm proper guidewire position and to monitor the passage of each dilator is a useful adjunct for more complex strictures; however, it may not reduce the risk of perforation. Traditionally, mechanical (bougie) dilators of progressively larger size are passed to the point of maximal dilation. Clear end-points for dilation are difficult to determine (e.g. blood on dilator, subjective increase in difficulty). Balloon dilators apply force to the stricture in a radial fashion and may be safer than mechanical dilators that have both radial and longitudinal force vectors. Esophageal injury and perforation can occur with any technique. Strictures refractory to dilation may require additional endoscopic management including intralesional steroid or mitomycin C injection, stent placement, and endoscopic incisional therapy.
Anorectal malformation: Definitive repair and surgical protocol
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Belinda Dickie, Taiwo Lawal, Paola Midrio
The most common schedule of calibrations is: bi-daily calibration (30–60 seconds each calibration) with weekly increases in size until 13–14 mm is reached (Table 4.1). Once the adequate anal size is reached, the colostomy can be closed, but calibrations are recommended, daily, for a couple of more months. Calibrations should not be painful, except for the first few days, nor should blood be noted. There is some speculation as to whether dilators are needed at all and this is currently being prospectively studied. If a good anoplasty is done and a patient does not dilate, a skin level stricture many result, which can be easily solved using a Heineke–Mikulicz plasty in four quadrants.
Benign oesophageal obstruction
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Alternative techniques using other dilators are essentially similar. The important points are that the dilator be of fixed size, and that it be precisely placed in the LOS. With the Witzel dilator, this can be ensured by X-ray screening if desired, or by retroverting the endoscope in the stomach to view the position of the dilating balloon from below.
Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria
Published in Journal of Obstetrics and Gynaecology, 2022
Oluwasomidoyin Olukemi Bello, Imran Oludare Morhason-Bello, Olatunji Okikiola Lawal, Rukiyat Adeola Abdus-Salam, Ayodele Olukayode Iyun, Oladosu Akanbi Ojengbede
The management of AG may be non-surgical or surgical depending on the extent of tissue damage and degree of vaginal scarring. The non-surgical technique involves serial vaginal dilation with graded dilators. Surgical procedures like neovaginoplasty, flap or skin graft, buccal mucosa graft, oxidative cellulose and amnion membrane allografts have been used with varying degrees of success (Unuigbe et al.1984; Arowojolu et al. 2001; Kapoor et al. 2006; Ugburo et al. 2011). Pudendal thigh flap allows for robust tissue mobilisation that can be used to construct a neovagina while maintaining the natural angle and sensation. However, this may be complicated with hair growth and numbness of the vagina (Ugburo et al. 2011). Sigmoid vaginoplasty gives good results with the achievement of a good vaginal length and width because of its large lumen and adequate lubrication with a decreased need for postoperative dilation and a short recovery period. Its disadvantages include excess mucus production, prolapse of a neovagina, postoperative shrinking, and occurrence of colon diseases like ulcerative colitis and adenocarcinoma in the neovagina (Kapoor et al. 2006; Rawat et al. 2010; Kondo et al. 2012; Alsaleh et al. 2014; Ruegner et al. 2014; Kölle et al. 2019).
Pneumatic dilation for esophageal achalasia: patient selection and perspectives
Published in Scandinavian Journal of Gastroenterology, 2022
Abdul Mohammed, Rajat Garg, Neethi Paranji, Aneesh V. Samineni, Prashanthi N. Thota, Madhusudhan R. Sanaka
Levine et al. first proposed PD as a safe and effective technique for treating achalasia in 1987 [6]. Since then, the technique has been modified, improved, and perfected for optimal use. There are several types of dilators commercially available now. The Rider-Moeller device and the Brown-McHardy dilators are the older dilation systems utilizing high-compliance balloons [7]. The modern dilation systems, such as the Rigiflex dilator (Boston Scientific, Marlborough, MA), comprise a low-compliance balloon. The newer models are designed to achieve no further than the maximum desired diameter; further inflation can only increase the pressure but not the diameter. On the contrary, a high-compliance balloon may increase esophageal wall tension due to increasing balloon diameter resulting in esophageal perforation [8].
Efficacy of empiric esophageal dilation in patients with non-obstructive dysphagia: systematic review and meta-analysis
Published in Scandinavian Journal of Gastroenterology, 2021
Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Dawit Jowhar, Umer Farooq, Ashu Acharya, Abdul Kouanda, Zaid Imam, Nazneen Ahmed, Collin Henry, Nasir Saleem, Craig Munroe, Colin W. Howden
We also found evidence of clinical heterogeneity among studies. The methods of assessing response to dilation varied across studies. Colon et al. [6] used a dysphagia score and diet score; their dysphagia score was mainly based on symptom frequency. Scolapio et al. used a different questionnaire than Colon et al. to calculate their dysphagia score and also used a visual analog scale ranging from 0 (no problems with swallowing) to 10 (total inability to swallow). The types of dilators used also differed among studies. While Colon et al. [6] used Maloney dilators, Scolapio et al. [10] used through-the-scope balloon dilators. Since balloon dilators were only used to dilate the distal esophagus, it is possible that subtle lesions such as mucosal rings in the upper esophagus may have been responsible for dysphagia in patients with otherwise normal endoscopic appearances. The number of patients on PPIs or H2RAs varied across studies. All patients were on acid-suppressant medicines in two [11,12]. However, in the study by Scolapio et al., fewer than 20% of patients were on acid suppression. These differences may be important since reflux symptoms are common in patients with dysphagia and such patients may respond at least partially to acid suppression.