scholarly journals The Use of a Cutting Balloon for Dilation of a Fibrous Esophageal Stricture in a Cat

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Alexander E. Gallagher ◽  
Andrew J. Specht
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Stricture ◽  
Balloon Dilation ◽  
The Novel ◽  
Success Rates ◽  
Cutting Balloon ◽  
Esophageal Strictures ◽  
Variable Success ◽  
Ingestion Of Caustic Substances

Esophageal strictures are uncommon in cats with causes including medications, ingestion of caustic substances, or gastroesophageal reflux under anesthesia. Bougienage and balloon dilation are the main treatments for strictures but have variable success rates. This paper describes the novel use of a cutting balloon for dilation of a fibrous stricture in a cat that was previously refractory to treatment with traditional balloon dilation.

Esophageal Stricture in a Patient with Epidermolysis Bullosa Acquisita: Endoscopic and Medical Management

1997 ◽  
Vol 1 (3) ◽  
pp. 162-166 ◽  
Author(s):  
Donald J. Lazas ◽  
William D. James ◽  
Kim B. Yancey ◽  
James W. Kikendall ◽  
Roy K. H. Wong
Keyword(s):  
Epidermolysis Bullosa ◽  
Esophageal Stricture ◽  
Balloon Dilation ◽  
Epidermolysis Bullosa Acquisita ◽  
Nutritional Intake ◽  
Endoscopic Balloon Dilation ◽  
Esophageal Strictures ◽  
Radial Forces ◽  
Bullous Diseases ◽  
Endoscopic Balloon

Background: This 40-year-old man with extensive and severe epidermolysis bullosa acquisita (EBA) developed an esophageal stricture that caused dysphagia and limited his nutritional intake. Objective: The purpose of the evaluation and management was to relieve the symptomatic obstruction so that he could better swallow food and medications. Methods: Endoscopic visualization of the stricture allowed for balloon dilation to be effected. The radial forces applied probably allowed for a less traumatic intervention than the linear shearing forces of bougienage. Results: The stricture widened and immediately provided less dysphagia and better tolerance in ingesting food. Medical treatment with sucralfate, known to bind to and protect ulcer bases, also improved his symptoms. Conclusions: Esophageal strictures are relatively uncommon in patients with EBA; however, when faced with a stricture in this or other scarring bullous diseases that affect the esophagus, endoscopic balloon dilation combined with postprocedure sucralfate offers improvement with advantages over older methods of intervention.

DOZ047.16: Rules are made to be broken: examining the rule of 3 in pediatric esophageal strictures

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S J Clark ◽  
P D Ngo ◽  
S J Staffa ◽  
J L Yasuda ◽  
M A Manfredi
Keyword(s):  
Esophageal Stricture ◽  
Pediatric Patients ◽  
Balloon Dilation ◽  
Retrospective Chart Review ◽  
Caustic Ingestion ◽  
Perforation Rate ◽  
Roc Curve Analysis ◽  
Extrinsic Compression ◽  
Esophageal Strictures ◽  
Initial Starting

Abstract Background The ‘rule of 3’ holds that bougie dilation of an esophageal stricture should not progress beyond 3 mm in a single session. Despite the existence of this ‘rule’ for at least 40 years, one recent study found that nonadherence to the rule for balloon and bougie dilations did not increase the risk of perforation. All these studies were done in adult populations; no studies have examined the rule of 3 in pediatric patients. In addition, no study has suggested a maximum dilation size that can be safely performed in one session. Methods A retrospective chart review of patients with esophageal strictures caused by surgery (esophageal atresia or congenital esophageal stricture repair), foreign body or caustic ingestion, or extrinsic compression was performed. Between January 2016 and May 2018, 275 patients underwent 1581 balloon dilations. Delta diameter increase was calculated for 1453 endoscopies by subtracting the initial stricture diameter as determined by the endoscopist prior to dilation from the diameter of the largest balloon used. Perforations were defined as any contrast extravastion outside of the esophagus or hospital readmission for delayed onset of perforation. Perforation rate by delta diameter increase was analyzed using logistic regression modeling, receiver operating characteristic (ROC) curve analysis, and Fisher's exact test. Results There were 8 perforations in 1093 dilations with delta diameter <6 mm (0.7%) and 18 perforations in 360 dilations with delta diameter ≥6 mm (5.0%). ROC analysis demonstrated good discriminatory ability of delta dilation in predicting perforation (area under ROC = 0.753; 95% CI: 0.665–0.841; P < 0.001). The optimal cutoff as determined by Youden's J index was a delta dilation ≥6 mm (sensitivity = 68%, specificity = 76%). The initial starting diameter at the time of dilation did not influence the perforation rate (P = 0.126). Conclusion Nonadherence to the rule of 3 with dilation up to 5.5 mm in a single balloon dilation session appears safe in pediatric patients.

PS01.095: BENIGN ESOPHAGEAL STRICTURE: A RECAP OF OUR EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 76-76
Author(s):  
Keat How Teoh ◽  
Kelvin Voon ◽  
Shyang Yee Lim ◽  
Premnath Nagalingam
Keyword(s):  
Endoscopic Treatment ◽  
Esophageal Stricture ◽  
Endoscopic Dilatation ◽  
Line Treatment ◽  
First Line ◽  
Benign Esophageal Stricture ◽  
Anastomotic Strictures ◽  
Esophageal Strictures ◽  
The Mean ◽  
First Line Treatment

Abstract Background Caustic injury remains the commonest cause of benign esophageal strictures in Asia. Others include gastroesophageal reflux, iatrogenic, radiation, autoimmune or idiopathic causes. Treatment goals are relief of dysphagia and prevention of recurrence. This study aims to evaluate the experience with benign esophageal stricture in Penang Hospital, a tertiary hospital in Northern region of Malaysia. Methods A retrospective review of 12 patients with benign esophageal strictures between year 2012 - 2017. Results The mean age was 53.5 and two thirds were female. Half of these patients were of Chinese ethnicity while the other half were Indian. The commonest cause was caustic ingestion (41.7%), followed by reflux stricture (25%) and anastomotic stricture (25%). There was one case of dystrophic epidermolysis bullosa. More than half of the patients had complex and multiple strictures. 41.7% of patients had proximal strictures that were located within 20cm from the incisors. Endoscopic dilatation was the first line treatment with either Savary Gilliard or balloon dilators. A total of 97 dilatation sessions were done with a mean dilatation frequency of 2.3 ± 1.5 times for anastomotic strictures, 8 ± 8.2 times for reflux strictures and 8.0 ± 6.6 times for corrosive strictures. The mean dilatation interval was 2.5 ± 1.2 weeks. 58.3% of patients had successful endoscopic treatment. The success rate was higher in non-corrosive stricture (83% vs 40%). There was one dilatation related complication in which the patient had pneumomediastinum without overt mediastinitis. This however, resolved with conservative management. 41.7% of patients had refractory strictures that failed endoscopic dilatation. Surgery including esophagectomy (40%), revision of anastomosis (20%) and gastrostomy (40%) were done for this group of patients. Proximal strictures, complex strictures and multiple strictures were associated with failed endoscopic dilatation (P < 0.05). Conclusion Endoscopic dilatation is the first line treatment for benign esophageal strictures. Surgery is reserved for refractory strictures with failed endoscopic treatment. Predictor scoring systems for refractory stricture and individualized approaches are the key to success. Disclosure All authors have declared no conflicts of interest.

scholarly journals “Peptic Esophageal Stricture In A Patient With Parkinson’s Disease”

2020 ◽  
Vol 7 (06) ◽  
pp. 4832-4836
Author(s):  
M. Kovacheva Slavova ◽  
Magdalena Aleksieva ◽  
Victoria Ilieva ◽  
Plamen Gecov ◽  
Borislav Vladimirov
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Esophageal Stricture ◽  
Distal Part ◽  
Esophageal Resection ◽  
Early Postoperative Period ◽  
Antiparkinsonian Drug ◽  
Successful Management ◽  
Ivor Lewis ◽  
Esophageal Strictures

Benign esophageal strictures are uncommon and their management remains challenging. Herein, we present a rare both functional and organic esophageal stricture in a patient with Parkinson’s disease and reflux esophagitis. The patient was diagnosed with severe complex stricture in the distal part of the esophagus, requiring surgical treatment. We performed subtotal esophageal resection and Ivor-Lewis gastroesophagoplasty. The successful management of antiparkinsonian drug therapy with adequate parenteral substitution in the early postoperative period is of great importance to avoid any further complications.

scholarly journals Management of Chronic Fistula Using the Cardiac Septal Defect Occluder

2021 ◽  
Vol 01 (01) ◽  
pp. 001-002
Author(s):  
Guilherme Henrique Peixoto de Oliveira
Keyword(s):  
Endoscopic Treatment ◽  
Septal Defect ◽  
Critical Role ◽  
Therapeutic Endoscopy ◽  
Treatment Modalities ◽  
Success Rates ◽  
Off Label Use ◽  
Chronic Fistula ◽  
Off Label ◽  
Variable Success

Therapeutic endoscopy plays a critical role in the management of gastrointestinal (GI) fistulas. Innovative endoscopic approaches have revolutionized the treatment of GI fistulas; however, current endoscopic treatment modalities require multiple sessions and are associated with highly variable success rates and safety profi les. Due to these currently limitations, the off -label use of cardiac septal defect occluders (CSDOs) has emerged as a promising device to treatment GI fi stulas, with early studies suggesting it to be a technically feasible, effective, and safe treatment. Therefore, we believe CSDO devices may be a preferred option for the management of refractory GI fistulas.

scholarly journals Aspergillus flavus NRRL 35739, a Poor Biocontrol Agent, May Have Increased Relative Expression of Stress Response Genes

2019 ◽  
Vol 5 (2) ◽  
pp. 53 ◽  
Author(s):  
Kayla K. Pennerman ◽  
Guohua Yin ◽  
Joan W. Bennett ◽  
Sui-Sheng T. Hua
Keyword(s):  
Stress Response ◽  
Aspergillus Flavus ◽  
Genetic Basis ◽  
Biocontrol Agent ◽  
Success Rates ◽  
Lower Stress ◽  
Relative Expression ◽  
Stress Response Genes ◽  
Variable Success ◽  
Aflatoxin Accumulation

Biocontrol of the mycotoxin aflatoxin utilizes non-aflatoxigenic strains of Aspergillus flavus, which have variable success rates as biocontrol agents. One non-aflatoxigenic strain, NRRL 35739, is a notably poor biocontrol agent. Its growth in artificial cultures and on peanut kernels was found to be slower than that of two aflatoxigenic strains, and NRRL 35739 exhibited less sporulation when grown on peanuts. The non-aflatoxigenic strain did not greatly prevent aflatoxin accumulation. Comparison of the transcriptomes of aflatoxigenic and non-aflatoxigenic A. flavus strains AF36, AF70, NRRL 3357, NRRL 35739, and WRRL 1519 indicated that strain NRRL 35739 had increased relative expression of six heat shock and stress response proteins, with the genes having relative read counts in NRRL 35739 that were 25 to 410 times more than in the other four strains. These preliminary findings tracked with current thought that aflatoxin biocontrol efficacy is related to the ability of a non-aflatoxigenic strain to out-compete aflatoxigenic ones. The slower growth of NRRL 35739 might be due to lower stress tolerance or overexpression of stress response(s). Further study of NRRL 35739 is needed to refine our understanding of the genetic basis of competitiveness among A. flavus strains.

Tu1382 Esophageal Episiotomy - a Combination of Needle Knife Cautery and Balloon Dilation - Improves the Outcome of Highly Refractory and Recurrent Benign Esophageal Strictures

2014 ◽  
Vol 79 (5) ◽  
pp. AB519
Author(s):  
Kristina Seeger ◽  
Michael J. Bartel ◽  
Michael B. Wallace ◽  
Massimo Raimondo ◽  
Timothy a. Woodward
Keyword(s):  
Balloon Dilation ◽  
Esophageal Strictures ◽  
Needle Knife

scholarly journals Safety and effectiveness of a novel generator algorithm for bipolar vessel sealing: a randomised controlled chronic animal study

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bernhard Kraemer ◽  
Christos Tsaousidis ◽  
Stephan Kruck ◽  
Martin Schenk ◽  
Marcus Scharpf ◽  
...  
Keyword(s):  
Animal Study ◽  
Clinical Success ◽  
Lateral Spread ◽  
Histological Evaluation ◽  
Vascular Bundles ◽  
The Novel ◽  
Success Rates ◽  
Vessel Sealing ◽  
Thermal Spread

Abstract Background Electrosurgical vessel sealers are gradually replacing conventional techniques such as ligation and clipping. Algorithms that control electrosurgical units (ESU), known as modes, are important for applications in different surgical disciplines. This chronic porcine animal study aimed to evaluate the safety and effectiveness of the novel thermoSEAL electrosurgical vessel sealing mode (TSM). The BiClamp® mode (BCM) of the renowned VIO® 300 D ESU served as control. BCM has been widely available since 2002 and has since been successfully used in many surgical disciplines. The TSM, for the novel VIO® 3 ESU, was developed to reduce sealing time and/or thermal lateral spread adjacent to the seal while maintaining clinical success rates. The primary aim of this study was to investigate the long-term and intraoperative seal quality of TSM. Methods The BiCision® device was used for vessel sealing with TSM and BCM in ten German Landrace pigs which underwent splenectomy and unilateral nephrectomy during the first intervention of the study. The seals were cut with the BiCision® knife. Ninety-nine arteries, veins and vascular bundles were chronically sealed for 5 or 21 days. Thereafter, during the second and terminal intervention of the study, 97 additional arteries and veins were sealed. The carotid arteries were used for histological evaluation of thermal spread. Results After each survival period, no long-term complications occurred with either mode. The intraoperative seal failure rates, i.e. vessel leaking or residual blood flow after the first sealing activation, were 2% with TSM versus 6% with BCM (p = 0.28). The sealing time was significantly shorter with TSM (3.5 ± 0.69 s vs. 7.3 ± 1.3 s, p < 0.0001). The thermal spread and burst pressure of arteries sealed with both modes were similar (p = 0.18 and p = 0.61) and corresponded to the histological evaluation. The measured tissue sticking parameter was rare with both modes (p = 0.33). Tissue charring did not occur. Regarding the cut quality, 97% of the seals were severed in the first and 3% in the second attempt (both with TSM and BCM). Conclusions The novel TSM seals blood vessels twice as fast as the BCM while maintaining excellent tissue effect and clinical success rates. Trial registration Not applicable.

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