CONTACTS
SUBJECTS
Endoscopy Endoscope Gastroendoscopy Achalasia Dysphagia Swallowing V
0703 -
0703 - ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 3 0000, ref SDS 1 Q36L.
070502 -
070503 -
070504 -
070505 -
070506 -
070507 -
070509 - ..
0706 -
0707 -
0708 - Progress
0709 -
070901 - Research found today...
070902 -
070903 - Intech
070904 - Science, Technology and Medicine open access publisher
070905 - Publish, read and share novel research
070907 - ..
070908 - September 2, 2015 under CC BY 3.0 license.
070910 - ..
070911 - Endoscopy for Diseases with Esophageal Dysphagia
070913 - ..
070914 - Hiroshi Makino1, Hiroshi Yoshida1 and Eiji Uchida2
070915 - [1] Department of Surgery, Nippon Medical School,
070916 - Tama-Nagayama Hospital, Japan
070917 - [2] Department of Surgery, Nippon Medical School, Japan
070918 -
070919 - http://www.intechopen.com/books/seminars-in-dysphagia/endoscopy-for-diseases-with-esophageal-dysphagia
070920 -
070921 -
070922 - 1. Introduction
070923 -
070924 - The Standards of Practice Committee of the ASGE prepared
070925 - the data to update the previous ASGE guidelines [1].
070926 - Guidelines for the appropriate use of endoscopy are based
070927 - on critical reviews of the available data and the expert
070928 - consensus on the guidelines when they are drafted.
070930 - ..
070931 - Esophagogastroduodenoscopy (EGD) is an effective tool for
070932 - the diagnostic evaluation and management of patients with
070933 - dysphagia. Varadarajulu reported a diagnostic yield of 54%
070934 - with EGD in the initial evaluation of patients aged >40
070935 - years who presented with dysphagia and concomitant
070936 - heartburn, odynophagia, and weight loss [2].
070938 - ..
070939 - The American Gastroenterological Association (AGA)
070940 - previously reviewed the treatment of patients with
070941 - dysphagia, which is caused by benign disorders of the
070942 - distal esophagus [3,4]. The most important examination for
070943 - these diseases is endoscopy. Specimens of esophageal
070944 - lesions obtained by biopsy and brush cytology may be used
070945 - to establish a diagnosis of neoplasms or specific
070946 - infections [5]. Malignant esophageal tumors are also
070947 - diagnosed by biopsy on endoscopy. Endoscopic evaluation is
070948 - recommended for most patients with dysphagia of the
070949 - esophageal origin as an effective means of establishing or
070950 - confirming a diagnosis, seeking evidence of esophagitis
070951 - (excluding malignancies), and implementing therapy when
070952 - appropriate.
070954 - ..
070955 - The AGA has recommended endoscopic dilation by both bougie
070956 - and balloon for the endoscopic management of diseases
070957 - involving dysphagia [3,4], but more recent reports also
070958 - describe therapy by...
070959 -
070960 - 1. endoscopic injection of corticosteroid, triamcinolone,
070961 - or botulinum, or
070962 -
070963 - 2. endoscopic fundoplication for GERD.
070965 - ..
070966 - 3. Peroral endoscopic myotomy (POEM) is another new
070967 - endoscopic procedure used for the treatment of achalasia.
070969 - ..
070970 - In this review we report the usefulness of endoscopy for
070971 - the evaluation and management of diseases involving
070972 - dysphagia.
070973 -
070975 - ..
070976 - This research extends the report of contaminated gastroscope causing
070977 - illness and death on 160726 1117. ref SDS 3 WR8I
070979 - ..
070980 - Research on 160621, following discharge from hospital after suffering
070981 - stroke symptoms on 160617 following EGD, found sedation issues can
070982 - cause myocardial infarction problems. ref SDS 2 0J4M
070984 - ..
070985 - On 160621, infectious complications related to diagnostic endoscopy
070986 - result either from the procedure itself or from the use of
070987 - contaminated equipment. Transient bacteremia may occur during a
070988 - diagnostic endoscopic procedure and is found more often for
070989 - therapeutic procedures. The incidence is relatively low and the rate
070990 - of bacterial endocarditis or other complications in patients not at
070991 - risk for endocarditis (e.g. normal cardiac valves) is extremely low
070992 - and estimated to be 1 in 5 to 10 million. ref SDS 2 UQ8O
070994 - ..
070995 - Article continues...
070996 -
070997 - 2. EVALUATION
070998 -
070999 - The most common causes of esophageal dysphagia are listed
071000 - in Table 1.
071001 -
071003 - ..
071004 - Endoscopic dilation Other endoscopic
071005 - treatments
071007 - ..
071008 - Bougie Balloon
071010 - ..
071011 - Benign diseases Yes
071012 -
071014 - ..
071015 - Peptic stricture Yes Transoral incisionless
071016 - fundoplication
071017 -
071018 -
071019 - Radiofrequency ablation
071020 -
071021 -
071022 - Injection of corticosteriods
071023 - of triamcinolone
071024 -
071026 - ..
071027 - Schatzki ring Yes Electrocautery incision with
071028 - a needle-knive papillotome
071029 -
071031 - ..
071032 - Esophageal web Yes
071033 -
071035 - ..
071036 - Eosinophilic Yes
071037 - esophagitis
071038 -
071040 - ..
071041 - Caustic injury Yes
071042 -
071044 - ..
071045 - Anastomotic Yes Biodegradable stent
071046 - structure
071047 -
071049 - ..
071050 - Radiation injury Yes
071051 -
071053 - ..
071054 - Drug-induced Yes
071055 - stricture
071056 -
071058 - ..
071059 - Postendoscopic Yes
071060 - therapy stricture
071061 -
071063 - ..
071064 - Malignant
071065 - diseases
071066 -
071068 - ..
071069 - Head and neck No Self-expanding metal stents
071070 - tumor (SEMS)
071071 -
071073 - ..
071074 - Esophageal No Self-expanding metal stents
071075 - carcinoma (SEMS)
071076 - (adeno and
071077 - squamous cell)
071078 -
071080 - ..
071081 - Extrinsic No Self-expanding metal stents
071082 - compression (SEMS)
071083 -
071085 - ..
071086 - Motility
071087 - disorders
071088 -
071090 - ..
071091 - Achalasia Yes Peroral endoscopic
071092 - myotomy (POEM)
071093 -
071094 - Injection of botulinum toxin
071096 - ..
071097 - Diffuse No
071098 - esophageal
071099 - spasm
071100 -
071101 -
071103 - ..
071104 - The acceptance of endoscopy as a gold standard for testing
071105 - for mucosal disease may bias evaluations of the
071106 - sensitivity of other diagnostic modalities. Given that
071107 - endoscopy was used as the gold standard for mucosal
071108 - disease, the sensitivity of radiology could not have
071109 - exceeded that of endoscopy [3].
071111 - ..
071112 - If the patient history, barium swallow, or both suggest
071113 - achalasia, manometry to confirm the diagnosis should
071114 - generally precede the endoscopic evaluation, to better
071115 - prepare for endoscopic therapy.
071116 -
071117 -
071118 - 1. GERD: PEPTIC ESOPHAGEAL STRICTURE
071119 -
071120 - White light endoscopy is now the standard investigation
071121 - procedure for identifying esophageal injury. An
071122 - experienced endoscopist who takes the time to
071123 - methodically inspect the esophagus is generally
071124 - expected to succeed in diagnosing reflux esophagitis.
071126 - ..
071127 - There has been evidence, however, of interindividual
071128 - variability in the endoscopic diagnosis of erosive
071129 - reflux esophagitis and other lesions of the upper
071130 - gastrointestinal tract. Krugmann reported detailed
071131 - endoscopic findings for GERD [4].
071133 - ..
071134 - Peptic esophageal stricture as a consequence of
071135 - gastroesophageal reflux disease is the most frequent
071136 - among benign esophageal strictures [6]. The typical
071137 - case of peptic esophageal stricture is shown in Figure
071138 - 1. There are multiple etiologies for benign esophageal
071139 - stricture or stenosis, but the most frequent is the
071140 - peptic stricture resulting from pathologic acid
071141 - exposure in GERD.
071143 - ..
071144 - Dysphagia is a common symptom.
071146 - ..
071147 - When dysphagia is encountered, accurate diagnostic
071148 - procedures (barium esophagogram, upper endoscopy with
071149 - biopsies) have to be performed to exclude malignant
071150 - causes first. Strictures can be divided into two
071151 - categories anatomically: ?simplex? or ?complex.? The
071152 - former are short, focal, nonangulated, and wide enough
071153 - to allow an endoscope to easily pass through. The
071154 - latter are long and angulated, with a severely narrowed
071155 - diameter. The strictures are also sometimes scored
071156 - based on three parameters to optimize the therapeutic
071157 - decisions: the...
071158 -
071159 - 1. stricture diameter,
071160 - 2. stricture length, and
071161 - 3. degree of difficulty of stricture dilation [7].
071163 - ..
071164 - After this scoring, the stricture can be classified as
071165 - type I (mild), type II (moderate), or type III (severe
071166 - or critical). This classification is also useful for
071167 - predicting the most appropriate therapeutic option.
071169 - ..
071170 - 2. NERD (NONEROSIVE REFLUX DISEASE)
071171 -
071172 - NERD is a subcategory of GERD characterized by
071173 - troublesome reflux-related symptoms in the absence of
071174 - esophageal mucosal erosions or breaks on conventional
071175 - endoscopy, without recent acid-suppressive therapy [8].
071176 - Most patients with typical reflux symptoms show no
071177 - evidence of erosive esophagitis on endoscopy. Upper
071178 - gastrointestinal endoscopy is required to establish a
071179 - diagnosis of NERD. Further investigation is required
071180 - when alarming symptoms are present. Routine random
071181 - biopsy is not currently recommended for the diagnosis
071182 - of NERD. Additional diagnostic information is provided
071183 - by ambulatory 24-hour intraesophageal pH-metry and
071184 - impedance measurement with reflux-related symptom
071185 - correlation.
071187 - ..
071188 - 3. SCHATZKI RING AND ESOPHAGEAL WEB
071189 -
071190 - Narrowing of the esophagus can be due to either a
071191 - benign or malignant stricture formation, webs (mucosa
071192 - or submucosa alone), or rings (mucosa, submucosa, and
071193 - muscle). Esophageal rings and webs are both membranous
071194 - structures in which a thin fold of tissue creates at
071195 - least a partial obstruction of the esophageal lumen.
071196 - Esophageal webs usually measure 2?3 mm wide. The
071197 - obstruction is a smooth extension of normal esophageal
071198 - tissue made up of mucosa or submucosa alone. Webs can
071199 - be found anywhere along the esophagus, but classically
071200 - they appear in the anterior postcricoid area of the
071201 - upper esophagus. A web at this site constitutes the
071202 - Paterson Brown?Kelly syndrome, otherwise known as
071203 - Plummer?Vinson syndrome in the USA [9].
071205 - ..
071206 - Esophageal rings are concentric, smooth, thin
071207 - extensions of normal esophageal tissue, usually 3?5 mm
071208 - thick. They consist of mucosa, submucosa, and muscle.
071209 - Rings are often detected incidentally at barium
071210 - studies or endoscopy. There is no sex difference in
071211 - the incidence of rings overall, though multiple rings
071212 - are usually found in young men. Rings are classified
071213 - as types A, B, and C [9]. The A ring, an uncommon type
071214 - located a few centimeters proximal to the
071215 - esophagogastric squamocolumnar junction, is thought to
071216 - be caused by normal physiologic smooth muscle
071217 - contractions. The B ring (more commonly known as
071218 - Schatzki ring) is actually a web, as it involves only
071219 - mucosa and submucosa and tends to appear in the distal
071220 - esophagus and as the proximal part of a hiatus hernia.
071221 - The B ring is nonprogressive and usually presents in
071222 - patients aged over 50 who experience intermittent
071223 - dysphagia to solid food over periods spanning months
071224 - or years. The C ring, another rare type, is found in
071225 - the most distal portion of the esophagus. On X-ray,
071226 - the C ring manifests as an indentation caused by
071227 - diaphragmatic crural pressure. A and C rings are both
071228 - unlikely to be readily seen on upper endoscopy. Hence,
071229 - the B ring (Schatzki ring) is the most common
071230 - esophageal ring found on either esophagogram or
071231 - endoscopy. Schatzki rings rarely cause symptoms.
071232 - Overall, esophageal rings with luminal narrowing
071233 - significant enough to cause symptoms (13 mm or less)
071234 - are seen in only about 0.5% of all esophagograms.
071236 - ..
071237 - 4. HEAD AND NECK TUMOR AND ESOPHAGEAL TUMOR
071238 -
071239 - A core cancer-specific symptom of head and neck tumors
071240 - is difficulty in swallowing [10]. Most patients with
071241 - tumors of the head and neck or esophagus present for
071242 - medical attention because of dysphagia.
071244 - ..
071245 - Among the many symptoms of esophageal cancer,
071246 - dysphagia may have an especially adverse effect on
071247 - quality of life (QOL) [11]. Dysphagia is the
071248 - predominant symptom in more than 70% of patients with
071249 - esophageal cancer. The optimum management of dysphagia
071250 - caused by advanced primary EC has not yet been
071251 - established, although continued progress toward this
071252 - goal has been achieved in recent years.
071254 - ..
071255 - Apart from the weight loss that may result, an
071256 - inability to swallow comfortably or a tendency to
071257 - regurgitate food may spoil meals shared with families
071258 - and friends or induce patients to withdraw from social
071259 - situations.
071261 - ..
071262 - Granular cell tumors and solitary fibrous tumors of
071263 - the cervical esophagus also cause dysphagia [12, 13].
071265 - ..
071266 - 5. EOSINOPHILIC ESOPHAGITIS AND INFECTION
071267 -
071268 - The incidence of eosinophilic esophagitis (EoE) is
071269 - registering an increase in adults. An allergic
071270 - reaction to food is now established to play an
071271 - important role in its etiology, and dietary
071272 - interventions and biologic agents to block the
071273 - inflammatory cascade are thought to hold promise as
071274 - novel fields of clinical research. Biopsies should be
071275 - obtained from the proximal and distal esophagus to
071276 - evaluate for eosinophilic esophagitis in patients who
071277 - present with dysphagia together with endoscopic
071278 - findings suggestive or not suggestive of EoE, and also
071279 - in patients without esophageal mechanical obstruction.
071280 - Patients usually present with dysphagia, food
071281 - impaction, and/or reflux-like symptoms, and biopsy of
071282 - the esophagus typically shows more than 15 eosinophils
071283 - per high-power field [14]. The dysphagia predominantly
071284 - seen in EoE has been attributed to both organic and
071285 - nonorganic (i.e., motility) disorders. Endoscopically,
071286 - a normal-appearing esophagus is usually incompatible
071287 - with a diagnosis of EE, although the findings can be
071288 - subtle.
071290 - ..
071291 - EGD findings implicative of EoE include an attenuation
071292 - of the subepithelial vascular pattern, linear furrowing
071293 - (possibly extending along the whole length of the
071294 - esophagus), surface exudates composed of eosinophils,
071295 - or abscesses or strictures [15,16].
071297 - ..
071298 - Endoscopic evaluation of the gastrointestinal tract
071299 - remains a cornerstone of diagnosis, especially in
071300 - patients with advanced immunodeficiency who are at risk
071301 - for opportunistic infections (OIs) [17]. Infectious
071302 - esophagitis may be caused by fungal, viral, bacterial,
071303 - or even parasitic agents [18]. Acute onset of symptoms
071304 - such as dysphagia and odynophagia is typical of this
071305 - condition. Candida esophagitis most commonly appears
071306 - in patients with hematologic malignancies or AIDS, or
071307 - who use steroids for the treatment of disorders.
071308 - Candida esophagitis is usually diagnosed when white
071309 - mucosal plaque-like lesions are seen on
071310 - esophagogastroduodenoscopy. HSV esophagitis occurs
071311 - most frequently in solid organ and bone marrow
071312 - transplant recipients.
071314 - ..
071315 - The diagnosis of herpes simplex virus esophagitis is
071316 - usually based on endoscopic findings confirmed by
071317 - histopathological examination. Well-circumscribed
071318 - ulcerous lesions with a "volcano-like" appearance may
071319 - appear in the mucosa of the distal esophagus, typically
071320 - with diameters of less than 2 cm. Diffuse erosive
071321 - esophagitis may also be present.
071323 - ..
071324 - Cytomegalovirus esophagitis is observed in patients who
071325 - have undergone transplantation, are on long-term
071326 - dialysis, are infected with HIV, or are receiving
071327 - chronic steroid therapy. Esophagogastroduodenoscopy
071328 - usually reveals large solitary ulcers or erosions in
071329 - the distal esophagus.
071331 - ..
071332 - 6. ESOPHAGITIS INDUCED BY CAUSTIC INJURY, RADIATION
071333 - INJURY, OR DRUGS
071335 - ..
071336 - A patient with a usual history of caustic substance
071337 - ingestion and prolonged hospitalization for severe
071338 - caustic damage was hospitalized again because of an
071339 - increase in dysphagia and odynophagia [19]. The gold
071340 - standard of safely assessing the depth, extent of
071341 - caustic ingestion injury, and appropriate therapeutic
071342 - regimen is EGD. The patients underwent EGD within 24
071343 - hours of admission and mucosal damage was graded using
071344 - Zagar's modified endoscopic classification scheme [19].
071346 - ..
071347 - Radiation therapy (RT), the primary modality for
071348 - patients with tumors of the upper aero-digestive tract,
071349 - allows larynx preservation [20]. Proximal esophageal
071350 - strictures occur in 2?16% of patients after radiation
071351 - therapy for cancers of the lung or head and neck.
071352 - RT-induced laryngeal edema (due to inflammation and
071353 - lymphatic disruption) is a common and expected side
071354 - effect. Progressive edema and associated fibrosis
071355 - detected by endoscope or barium swallowing can lead to
071356 - long-term problems with phonation and swallowing.
071357 - Aspiration pneumonia associated with dysphagia after
071358 - intensive chemo radiation therapy has recently been
071359 - reported at a growing frequency.
071361 - ..
071362 - Drug-induced esophagitis mainly presents as chest pain,
071363 - odynophagia, and dysphagia. In the agents known to
071364 - induce esophagitis, antibiotics are the most common
071365 - culprit. Other causative agents include nonsteroidal
071366 - anti-inflammatory drugs, antihypertensive drugs,
071367 - acetaminophen, oral hypoglycemic agents (glimepiride),
071368 - bisphosphonates (alendronate, ibandronate), ascorbic
071369 - acid, and warfarin [21]. The most frequent endoscopic
071370 - site of drug-induced esophagitis is the middle third of
071371 - the esophagus. On endoscopy, drug-induced esophagitis
071372 - manifests as ulcers of various forms such as kissing
071373 - ulcers, erosions, or ulcers with bleeding, as patchy
071374 - sections coated with drug materials or impacted pill
071375 - fragments, or sometimes as strictures.
071377 - ..
071378 - 7. ACHALASIA
071379 -
071380 - Achalasia is regarded as a disease exclusively
071381 - involving the smooth muscle. About 70?80% of patients
071382 - have absent or incomplete lower esophageal sphincter
071383 - (LES) relaxation with wet swallows, while the remainder
071384 - have complete but shortened relaxation [22]. The
071385 - typical endoscopic findings are shown in Figure 2A,B.
071386 - Patients with esophageal stasis are often unaware of
071387 - this condition. Heartburn, though not infrequent,
071388 - bears little relationship to the esophageal acid
071389 - exposure in achalasia, regardless of whether heartburn
071390 - is elicited by GER or esophageal stasis. Endoscopic
071391 - examination can readily differentiate these disorders
071392 - in most cases, although manometry may sometimes be
071393 - required to make the distinction in equivocal cases.
071394 - Readers may find interest in the AGA?s recent technical
071395 - review of the clinical uses of esophageal manometry and
071396 - detailed descriptions of the procedure. Esophageal
071397 - manometry is the gold standard test for esophageal
071398 - motility disorders [23]. Esophageal manometry has been
071399 - shown to be especially useful for definitively
071400 - diagnosing achalasia or diffuse esophageal spasm and
071401 - for detecting esophageal motor abnormalities associated
071402 - with collagen-vascular disease.
071404 - ..
071405 - 8. DIFFUSE ESOPHAGEAL SPASM
071406 -
071407 - Diffuse esophageal spasm (DES) is an uncommon disorder
071408 - characterized by an impairment of ganglionic inhibition
071409 - in the distal esophagus. Upper endoscopy should be
071410 - performed as an initial evaluation of esophageal
071411 - symptoms consistent with spastic disorders [24]. No
071412 - specific endoscopic abnormality appears in most cases,
071413 - but the endoscopist may notice disordered esophageal
071414 - contractions. DES is defined by the presence of
071415 - simultaneous contractions on conventional manometry.
071416 - In higher resolution recordings by HRM with EPT,
071417 - however, the propagation velocity varies greatly along
071418 - the length of the esophagus and often progresses
071419 - rapidly in some regions. Esophageal manometry, the
071420 - putative gold standard in the diagnosis of achalasia,
071421 - classically shows aperistalsis and failure of
071422 - relaxation of the lower esophageal sphincter.
071424 - ..
071425 - 9. EXTRINSIC COMPRESSION
071426 -
071427 - Dysphagia is also caused by extrinsic compression of
071428 - the esophagus associated with mediastinal diseases,
071429 - tumors such as lung cancer and lymphoma, or infections
071430 - such as tuberculosis or histoplasmosis [1,3].
071431 -
071433 - ..
071434 - 3. Treatment method for diseases with dysphagia
071435 -
071436 - A general approach to the treatment of adult patients with
071437 - dysphagia caused by benign disorders of the distal
071438 - esophagus is outlined in the ?Medical Position Statement on
071439 - Treatment of Patients with Dysphagia Caused by Benign
071440 - Disorders of the Distal Esophagus? from the American
071441 - Gastroenterological Association (AGA) [3]. The review
071442 - describes the management of dysphagia, peptic stricture,
071443 - lower esophageal mucosal rings, and achalasia. More
071444 - recently, the Standards of Practice Committee of the
071445 - American Society for Gastrointestinal Endoscopy (ASGE)
071446 - updated its previous guideline. In sections covering the
071447 - role of endoscopy in evaluation and management, the uses of
071448 - endoscopy evaluating dysphagia and dilation techniques for
071449 - various dysphagic diseases are discribed [1.3]. The
071450 - endoscopic management of esophageal dysphagia is summarized
071451 - in Table 1.
071452 -
071453 - 1. PREPARATION AND DILATION TECHNIQUE
071454 -
071455 - Patients who have esophageal stasis because of
071456 - underlying achalasia, diverticula, or tight strictures
071457 - may require a prolonged nasogastric tube placement to
071458 - minimize the risk of aspiration and are instructed to
071459 - refrain from intake of solids for 6 hours and clear
071460 - liquids for 2 hours before the procedure in the
071461 - outpatient setting. The esophageal dilation procedure
071462 - carries a high risk of adverse bleeding events. In
071463 - patients considered low risk for thromboembolic events,
071464 - oral anticoagulation with warfarin should be withheld
071465 - for 5?7 days before the procedure. Bridging therapy
071466 - with heparin before restarting warfarin is often
071467 - recommended for patients at high risk for
071468 - thromboembolic events. Thienopyridines (e.g.,
071469 - clopidogrel) are usually withheld for 7?10 days before
071470 - the procedure.
071472 - ..
071473 - Bougie dilators exert both radial and axial forces
071474 - along the entire length of the stricture. In the
071475 - technique of wire-guided bougie dilation, a guidewire
071476 - is passed through the esophagus and its tip is
071477 - positioned in the antrum.
071479 - ..
071480 - Balloon dilators exert only a radial force along the
071481 - length of the stricture. This circumferential
071482 - pressure, called hoop stress, is a product of the
071483 - diameter and pressure within the balloon.
071485 - ..
071486 - 2. GERD: PEPTIC STRICTURES
071487 -
071488 - Various methods for endoscopic management of peptic
071489 - stricture were reported [25]. The AGA recommend
071490 - progressive dilatation to 40?60 F using polyvinyl
071491 - bougies or balloons for both simple (diameter<10 mm,
071492 - not tortuous) and complicated (diameter >10 mm,
071493 - tortuous) strictures, and mercury bougies for only
071494 - simple strictures [3]. The ASGE reported that patients
071495 - with peptic strictures may be treated with Maloney,
071496 - push-type dilators and balloon dilators with similar
071497 - efficacy. The degree of dilation in a session should
071498 - be based on the severity of the stricture [1]. The
071499 - first dilator that causes resistance to passage is
071500 - counted as 1. The ?rule of three? states that only two
071501 - additional dilators of sequential size should be passed
071502 - (three dilators in total). The ?rule of three? for
071503 - bougie dilation has been accepted but not formally
071504 - studied for safety. The initial dilator is selected
071505 - based on the stricture diameter. This is estimated to
071506 - be about the same size as the lumen of the stricture,
071507 - or not more than 1?2 mm larger than the lumen.
071508 - Sequential dilation is then performed.
071510 - ..
071511 - The AGA described the endoscopic therapy for GERD and
071512 - concluded that radiofrequency ablation is generally
071513 - effective for the treatment of GERD [26].
071515 - ..
071516 - Endoscopic fundoplication is also successfully
071517 - performed in many institutes [27]. Transoral
071518 - incisionless fundoplication (TIF) with the EsophyX TM
071519 - device is effective for creating a continent
071520 - gastroesophageal valve and obtaining good functional
071521 - results, as measured by pH impedance in patients with
071522 - gastroesophageal reflux disease (GERD). TIF
071523 - significantly improved both atypical and typical
071524 - symptoms in patients: the corresponding GERD
071525 - health-related quality of life (HRQL) and reflux
071526 - symptom index (RSI) score was reduced by 50% or more
071527 - compared to baseline on proton pump inhibitors (PPIs).
071529 - ..
071530 - Several reports confirmed the beneficial effect of
071531 - intralesionally administered corticosteroids or
071532 - triamcinolone in benign esophageal strictures of
071533 - different etiologies [6].
071535 - ..
071536 - 3. LOWER ESOPHAGEAL MUCOSAL RING
071537 -
071538 - Large-bore endoscopic dilation or bougienage (15 mm/45
071539 - Fr or larger) is the mainstay therapy for both upper
071540 - and lower esophageal lesions. The AGA recommends
071541 - progressive dilatation to 45?60 F using mercury or
071542 - polyvinyl bougies or balloons [3]. This procedure is
071543 - frequently performed with either Savary or Maloney
071544 - dilators, though balloon dilation has also been
071545 - reported. The ASGE pointed out that dilation with a
071546 - single large (16?20 mm) dilator leads to rupture of the
071547 - Schatzki ring and symptomatic relief in almost all
071548 - patients. Electrocautery incision with a needle-knife
071549 - papillotome and four-quadrant biopsies of the ring has
071550 - been performed together with dilation as adjunctive
071551 - methods.
071553 - ..
071554 - 4. HEAD AND NECK AND ESOPHAGEAL TUMORS: EXTRINSIC
071555 - COMPRESSION
071556 -
071558 - ..
071559 - 5. EOSINOPHILIC ESOPHAGITIS AND INFECTION
071560 -
071562 - ..
071563 - 6. POSTRADIATION STRICTURE
071564 -
071566 - ..
071567 - 7. ACHALASIA
071568 -
071569 - Esophageal dilation for achalasia involves forceful
071570 - disruption of the lower esophageal sphincter. This is
071571 - usually accomplished with 30- to 40-mm-diameter
071572 - pneumatic balloon dilators. Dilation is generally
071573 - performed over a wire under fluoroscopic guidance,
071574 - although nonfluoroscopically guided dilation using
071575 - endoscopic visualization alone has been reported.
071577 - ..
071578 - POEM is a new endoscopic procedure used for the
071579 - treatment of achalasia [29]. This novel endoscopic
071580 - esophagomyotomy method was first reported by Pasricha
071581 - et al. in porcine models and then by Inoue et al. in
071582 - humans. POEM is performed by dissection and division of
071583 - the inner circular muscle layer of the esophagus
071584 - through a submucosal tunnel created endoscopically by a
071585 - small proximal opening of the esophageal mucosa. A
071586 - study evaluating the role of POEM reported a
071587 - significant improvement in dysphagia scores.
071589 - ..
071590 - A further option is endoscopic botulinum toxin
071591 - injection into the lower esophageal sphincter. This
071592 - technique offers good short-term results.
071594 - ..
071595 - Ham et al. identified the currently available
071596 - biodegradable stents for benign esophageal strictures
071597 - [30]. This technique will also be available for the
071598 - treatment of achalasia.
071600 - ..
071601 - 8. POSTESOPHAGECTOMY ANASTOMOTIC STRICTURES
071602 -
071604 - ..
071605 - 4. Conclusion
071606 -
071607 - This chapter is based on the ASGE guidelines and
071608 - recommendations by AGA. Endoscopy is more sensitive than
071609 - radiology for identifying subtle mucosal lesions of the
071610 - esophagus such as mild esophagitis caused by
071611 - gastroesophageal reflux or infection. A cost analysis also
071612 - showed that EGD with therapeutic intent is more cost
071613 - effective than an initial diagnostic approach with barium
071614 - swallow in patients with histories suggestive of benign or
071615 - malignant esophageal obstruction.
071617 - ..
071618 - Various endoscopic treatments are useful for diseases with
071619 - dysphagia and minimally invasive compared to surgical
071620 - procedures.
071622 - ..
071623 - 5. Acknowledgements
071624 -
071625 - The authors wish to thank Dr. Hiroshi Maruyama and Dr.
071626 - Ichiro Akagi for their clinical support.
071627 -
071628 -
071629 -
071630 -
071631 -
0717 -
SUBJECTS
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0803 -
080401 - ..
080402 - Endoscope Endoscopy
080403 -
080404 -
080405 - Wikipedia
080406 -
080407 - Endoscopy
080408 -
080409 - https://en.wikipedia.org/wiki/Endoscopy
080410 -
080411 - 1. Endoscopy means looking inside and typically refers to
080412 - looking inside the body for medical reasons using an
080413 - endoscope,[1] an instrument used to examine the interior of
080414 - a hollow organ or cavity of the body. Unlike most other
080415 - medical imaging techniques, endoscopes are inserted
080416 - directly into the organ.
080418 - ..
080419 - 2. There are many different types of endoscope, and depending
080420 - on the site in the body and the type of procedure,
080421 - endoscopy may be performed by a doctor or a surgeon, and
080422 - the patient may be fully conscious or anaesthetised. Most
080423 - often the term endoscopy is used to refer to an examination
080424 - of the upper part of the gastrointestinal tract, known as
080425 - an esophagogastroduodenoscopy.[2]
080427 - ..
080428 - 3. For non-medical use, similar instruments are called
080429 - borescopes.
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