scholarly journals Successful Management of Esophageal Perforation with Self-Expandable Metal Stent following Pneumatic Dilation for Achalasia Cardia

2019 ◽  
Vol 10 (03) ◽  
pp. 183-185
Author(s):  
Abhai Verma ◽  
Samir Mohindra ◽  
Vivek Anand Saraswat ◽  
Uday Chand Ghoshal
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Perforation ◽  
Esophageal Stent ◽  
Pneumatic Dilation ◽  
Metal Stent ◽  
Successful Management ◽  
Common Cause ◽  
Achalasia Cardia ◽  
Esophageal Sphincter ◽  
Self Expandable Metal Stent

AbstractAchalasia cardia is the most common cause of motor dysphagia. Pneumatic dilation (PD) of lower esophageal sphincter remains the cornerstone of treatment. However, it is associated with esophageal perforation in some cases. We present a case of esophageal perforation following PD of achalasia cardia which was successfully managed with esophageal stent.

scholarly journals Evaluation of Short-term Outcomes of Laparoscopic Heller Cardiomyotomy with Dor Fundoplication Versus Pneumatic Dilatation for Treatment of Achalasia

2020 ◽  
Author(s):  
Islam Khaled ◽  
Gad M. Behairy ◽  
Mohamed Saeed ◽  
Sara Abdulaziz ◽  
Leena S. Omar ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Pneumatic Dilatation ◽  
Pneumatic Dilation ◽  
Dor Fundoplication ◽  
Therapeutic Success ◽  
Esophageal Motility Disorder ◽  
Eckardt Score ◽  
Esophageal Sphincter ◽  
Dor’S Fundoplication

Abstract Background: Achalasia is a rare esophageal motility disorder of unknown cause. However, the best treatment modality for achalasia is controversial. Treatment consists of disruption of the lower esophageal sphincter, classically either by endoscopic pneumatic dilation or laparoscopic Heller’s myotomy combined with an anti-reflux procedure. The study aim was to compare laparoscopic Heller cardiomyotomy plus Dor Fundoplication with pneumatic dilatation for treatment of achalasia.Methods: In this interventional study, we included 50 adult patients diagnosed as having achalasia by performing either a barium study or by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter on esophageal manometry. The patients were randomly classified into two groups according to the intervention performed: pneumatic dilation or laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication(LHCM). Follow-up evaluations were performed after 8 and 16 months.Results: In total, 50 patients with achalasia and an Eckardt symptom score > 3 were managed by two different interventions according to their groups.After 16 months of follow up the height of a barium-contrast column after 5 min was significantly lower in the LHCM group than in the pneumatic dilation group. There were no other statistically significant differences in the primary or secondary outcomes(Eckardt score, lower esophageal sphincter, and quality of life) between the two groups.Conclusion: After 16 months of follow-up, the rates of therapeutic success and number of complications were nearly similar between LHCM and pneumatic dilation. We conclude that either treatment is suitable as an initial treatment for achalasia.

Outcome of Pneumatic Balloon Dilatation in Achalasia Cardia

2021 ◽  
Vol 10 (1) ◽  
pp. 8-13
Author(s):  
Shankar Baral ◽  
Bidhan NIdhi Paudel ◽  
Ajit Khanal ◽  
Jiwan Thapa ◽  
Bhuwneshwer Yadhav ◽  
...  
Keyword(s):  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Poor Response ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilatation ◽  
Response To Treatment ◽  
Sphincter Pressure ◽  
Achalasia Cardia ◽  
Type Iii ◽  
Esophageal Sphincter

Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p<0.001). None of the patients had major complications. Younger age (23±6.377 years) had poor response to treatment, while predilatation Lower Esophageal Sphincter pressure, gender and type of achalasia did not affect the treatment outcome. Conclusion: PD is safe and effective treatment modality for Achalasia. Younger patients have poor response to treatment with Pneumatic Dilatation.  

Endotherapy for a 5-cm mid-esophageal perforation with tandem stenting above the lower esophageal sphincter (with videos)

2009 ◽  
Vol 23 (12) ◽  
pp. 2836-2841 ◽  
Author(s):  
Shou-jiang Tang ◽  
Shailender Singh ◽  
Michael A. Wait ◽  
Mary A. Mullican ◽  
Daniel J. Scott
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Perforation ◽  
Esophageal Sphincter

scholarly journals Temporary Insertion of a Covered Self-Expandable Metal Stent to Treat Esophageal Perforation due to Endoscopic Submucosal Dissection

2015 ◽  
Vol 54 (9) ◽  
pp. 1049-1052 ◽  
Author(s):  
Kazuhiro Ota ◽  
Toshihisa Takeuchi ◽  
Haruhiko Ozaki ◽  
Satoshi Harada ◽  
Yuichi Kojima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Esophageal Perforation ◽  
Metal Stent ◽  
Submucosal Dissection ◽  
Self Expandable Metal Stent

scholarly journals Advances in the diagnosis and treatment of achalasia of the cardia: A review

2021 ◽  
Vol 9 (1) ◽  
pp. 24-31
Author(s):  
Baozhen Zhang ◽  
Yidan Wang ◽  
Ye Liao ◽  
Jingjing Zhang ◽  
Yufan Wu ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Peroral Endoscopic Myotomy ◽  
Diagnosis And Treatment ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Sphincter Pressure ◽  
Idiopathic Achalasia ◽  
Retrosternal Pain ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Abstract Idiopathic achalasia is an esophageal motor disorder characterized by the loss of the lower esophageal sphincter ganglion, resulting in impaired lower esophageal relaxation and absence of esophageal peristalsis. Patients commonly present with progressive dysphagia accompanied by reflux, heartburn, retrosternal pain, and severe weight loss. Diagnosis is primarily based on the patient’s chief complaints, barium esophagography, and the most recent high-resolution manometry. Endoscopic assessment and endoscopic ultrasonography also have significant value with regard to the exclusion of esophageal anatomical lesions, neoplastic diseases, and pseudoachalasia. However, as most patients with achalasia demonstrate a gradual onset, early diagnosis is difficult. Currently, treatment of idiopathic achalasia, including pneumatic dilation, stent placement, and surgical myotomy, is aimed at reducing lower esophageal sphincter pressure and relieving the symptoms of dysphagia. Peroral endoscopic myotomy has gradually become the mainstream treatment because it causes less trauma and has a rapid recovery rate. This article reviews the main methods of diagnosis and treatment of achalasia, with an emphasis on the potential of peroral endoscopic myotomy and the advancements of immunotherapy for achalasia.

Achalasia: Diagnosis, Management, and Clinical Course in 16 Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 798-805
Author(s):  
William E. Berquist ◽  
William J. Byrne ◽  
Marvin E. Ament ◽  
Eric W. Fonkalsrud ◽  
Arthur R. Euler
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilation ◽  
Sphincter Pressure ◽  
School Aged Children ◽  
Retrosternal Pain ◽  
Esophageal Sphincter

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.

Endoscopic removal of a migrated esophageal self-expandable metal stent after compression with detachable snares through an intact esophageal stent

2010 ◽  
Vol 71 (1) ◽  
pp. 205-207 ◽  
Author(s):  
Ho-Jung An ◽  
Hae-Yon Lee ◽  
Byung-Wook Kim ◽  
Sun-Mee Park ◽  
Jeong-Seon Ji ◽  
...  
Keyword(s):  
Esophageal Stent ◽  
Endoscopic Removal ◽  
Metal Stent ◽  
Self Expandable Metal Stent
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