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Bush N, Bhattacharjee S, Sachan A, Gupta R, Rana S. Perforations from Endoscopic Dilation of Corrosive Strictures in Adults: A Systematic Review and Meta-Analysis. Dig Dis Sci 2022; 67:3200-3209. [PMID: 34739625 DOI: 10.1007/s10620-021-07295-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Endoscopic dilation is an important therapeutic option for treatment of corrosive strictures. Its safety is unclear with variable perforation rates in previous studies. We aimed to evaluate its safety with regard to perforations and the effect of dilator type to perforation risk. METHODS A systematic review of published literature from inception to April 24, 2021, using PubMed and EMBASE databases was conducted. Studies in adult subjects (mean age ≥ 18 years) reporting perforation rates of endoscopic dilation of corrosive esophageal and/or gastric strictures were included. Pooled cumulative perforation rates were computed as primary outcome. Secondary outcomes included, perforation with each dilator subtypes, surgical or conservative modes of management and mortality. Random effect meta-analysis was used to estimate the frequency of each of these outcomes. Variables were reported as percentages with 95% CI. RESULTS A total of 712 subjects (N) who underwent 4840 dilations (n) were noted in the 15 studies that were included. Of which, eight were retrospective, while the remaining seven were prospective. On meta-analysis, the cumulative pooled perforation rate was 1% (1-2%) of the number of dilations (n%). The perforation rates with SG (1%, 0-3%) and balloon (1%, 0-5%) dilators were similar (p value < 0.01). 45/64 (59%, 11-94%) perforations were subjected to surgery while the remaining 14/64 (41%, 6-89%) was managed conservatively. Choice of management strategy was biased to the norms of the treating team. About 3/712 patients (0%, 0-2%) succumbed following perforation. CONCLUSION Perforation from endoscopic dilation of corrosive strictures occurs rarely, and there is no significant difference in perforation risk related to the type of dilator.
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Affiliation(s)
- Nikhil Bush
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Samiksha Bhattacharjee
- Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Anurag Sachan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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3
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Kobayashi Y, Nishikawa K, Akasaka T, Kato S, Hamakawa T, Yamamoto K, Kobayashi N, Kitakaze M, Maeda S, Uemura M, Miyake M, Hama N, Miyamoto A, Kato T, Miyazaki M, Nakamori S, Mita E, Sekimoto M, Mano M, Hirao M. Retrograde endoscopic submucosal dissection for early thoracic esophageal carcinoma. Clin J Gastroenterol 2021; 14:434-438. [PMID: 33689125 DOI: 10.1007/s12328-021-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 12/01/2022]
Abstract
Although the standard treatment for intramucosal esophageal cancer without lymph node metastasis is endoscopic submucosal dissection (ESD), we sometimes encounter patients who are not able to undergo a transoral endoscopic examination. Here, we report a surgical procedure consisting of transgastric retrograde ESD to treat early esophageal cancer (T1a-EP, N0, M0) because of a stricture after hypopharyngeal cancer surgery. This retrograde ESD procedure can be a safe and effective treatment option for early esophageal cancer. This is the first report of a surgical retrograde ESD method for esophageal cancer.
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Affiliation(s)
- Yuta Kobayashi
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Kazuhiro Nishikawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Tomofumi Akasaka
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Seiya Kato
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan.,Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Kei Yamamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Noboru Kobayashi
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Masatoshi Kitakaze
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Sakae Maeda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji, Sakai, Osaka, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Naoki Hama
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Digestive Surgery, Ikeda City Hospital, 3-1-18 Jonan, Ikeda, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Shoji Nakamori
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Eiji Mita
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
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4
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Mullen MB, Witt MA, Stromberg AJ, Fritz MA. National Database Outcomes of Esophageal Dilations. Laryngoscope 2020; 131:2436-2440. [PMID: 33305828 DOI: 10.1002/lary.29322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes. STUDY DESIGN Observational, retrospective cohort study. METHODS We queried a national database of insurance claims for Current Procedural Terminology (CPT) codes representing esophageal dilation performed between 2011 and 2017. Patients aged 18 to 100 who were continuously enrolled with their insurance provider were included. Demographic information, additional CPT codes, concomitant diagnoses, and anticoagulant medication data were collected for all patients included. Postoperative mortality was assessed and International Classification of Diseases (ICD)9/10 codes for complications, including esophageal perforation, hemorrhage, mediastinitis, and sepsis were flagged. RESULTS We identified 202,965 encounters for esophageal dilation. Of these procedures, 193 were performed on a patient who underwent percutaneous endoscopic gastrostomy (PEG) during the study period and was analyzed separately. Another 244 dilations were excluded due to repeat entries. Of the remaining 202,528 procedures remaining, 42,310 were repeat dilations in the same patient. Data analysis was confined to each patient's initial dilation. 160,218 initial dilations remained. Of these, 62,107 were performed on male patients and 98,111 were performed on female patients. The average age was 57.7 years. There were 12 mortalities within 30 days postoperatively, representing 0.0075% of all dilations. Esophageal perforation and esophageal hemorrhage were the most common reported complications, with 139 and 110 occurrences, respectively. The overall per-dilation complication rate was 0.215%. CONCLUSIONS Evidence from a national insurance claim database suggests that esophageal dilation is a safe procedure with a low rate of serious complications and a 30-day all-cause mortality rate of less than 1 per 10,000 dilations. LEVEL OF EVIDENCE IV Laryngoscope, 2020.
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Affiliation(s)
- Michael B Mullen
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Michael Andrew Witt
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Arnold J Stromberg
- Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Mark A Fritz
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
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5
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Zhou WZ, Song HY, Park JH, Shin JH, Kim JH, Cho YC, Kim PH, Kim SC. Incidence and management of oesophageal ruptures following fluoroscopic balloon dilatation in children with benign strictures. Eur Radiol 2016; 27:105-112. [PMID: 27048529 DOI: 10.1007/s00330-016-4342-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the incidence and management of oesophageal ruptures following fluoroscopic balloon dilatation (FBD) in children with benign oesophageal strictures. METHODS Sixty-two children with benign oesophageal strictures underwent FBDs. Oesophageal rupture was categorized as intramural (type 1), transmural (type 2), or transmural with free leakage (type 3). The possible risk factors for oesophageal ruptures were analyzed. RESULTS One hundred and twenty-nine FBDs were performed in these patients. The oesophageal rupture rate was 17.1 % (22/129). The majority (21/22) of ruptures were type 1 and type 2, both were treated conservatively. Only one patient had a type 3 rupture and underwent oesophagoesophagostomy. The patient gender, age, and the length and cause of the stricture showed no significant effect on the rupture (P > 0.05). However, for the patients ≤2 years old, the initial balloon with a diameter ≥10 mm showed a higher oesophageal rupture rate than those <10 mm during the first session (P = 0.03). CONCLUSIONS Although the oesophageal rupture rate in children was 17.1 %, the type 3 rupture rate was 0.8 %, which usually requires aggressive treatment. For children ≤2 years old, the initial balloon diameter should be <10 mm in the first session for decreasing the risk of oesophageal rupture. KEY POINTS • The oesophageal rupture rate following balloon dilatation in children was 17.1 %. • The incidence of transmural rupture with free leakage is very low. • Only transmural rupture with free leakage needs aggressive treatment. • For children ≤2 years, the initial balloon diameter should be <10 mm.
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Affiliation(s)
- Wei-Zhong Zhou
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.,Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Young Chul Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Seong-Chul Kim
- Pediatric Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
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6
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Khokhar HA, Azeem B, Bughio M, Bass GA, Elfadul A, Salih M, Fahmy W, Walsh TN. Trans-Balloon Visualisation During Dilatation (TBVD) of Oesophageal Strictures: a Novel Innovation. J Gastrointest Surg 2016; 20:674-9. [PMID: 26585885 DOI: 10.1007/s11605-015-3024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/09/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hydrostatic balloon dilatation of upper gastrointestinal strictures is associated with a risk of perforation that varies with the underlying pathology and with the technique employed. We present a technique of trans-balloon visualisation of the stricture during dilatation (TBVD) that allows direct 'real-time' observation of the effect of dilatation on the stricture, facilitating early recognition of mucosal abruption, thereby reducing the perforation rate. PATIENTS AND METHODS We retrospectively analysed 100 consecutive patients, undergoing balloon dilatation of oesophageal strictures between 1st of January 2011 and 1st of July 2014. RESULTS One hundred patients underwent 186 dilatations, with 34 having multiple procedures (mean 1.86). All had oesophageal strictures (mean diameter 8.49 mm, range 5-11 mm) and most underwent dilatation up to a maximum of 17 mm (mean 14.7 mm). Fifty-six percent were male and the average age was 62.5 years (17-89 years). Only one patient (0.5% of all procedures) had a full-thickness perforation requiring intervention while just one further patient had a deep mucosal tear that did not require intervention. CONCLUSIONS TBVD is a safe technique with a short learning curve and is one of the important factors that allow potentially difficult dilatations to be performed safely with an exceptionally low rate of adverse events of less than 1%.
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Affiliation(s)
- Haseeb A Khokhar
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland.
- , 9 The Avenue, Highfield Park, Ballincollig, County Cork, Ireland.
| | - Beenish Azeem
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Mumtaz Bughio
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Gary A Bass
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Amr Elfadul
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Monim Salih
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Waleed Fahmy
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Thomas N Walsh
- Upper GI Surgical Department, Connolly Hospital Blanchardstown, Dublin 15, Ireland
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