Endoscopy of Peptic Stenosis due to a Reflux Esophagitis

Video Endoscopic Sequence 1 of 23.

Endoscopy of Peptic Stenosis due to a Reflux Esophagitis

This 57 year-old man with long-standing reflux disease.

Peptic strictures are sequelae of gastroesophageal reflux–induced esophagitis, and they usually originate from the squamocolumnar junction and average 1-4 cm in length.


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Endoscopy of Peptic Stenosis due to a Reflux Esophagitis

Video Endoscopic Sequence 2 of 23.

Endoscopy of Peptic Stenosis due to a Reflux Esophagitis

The image and the video clip displayed a reduction of the
diameter of the gastroesophageal junction.


Gastroesophageal reflux disease accounts for approximately 70 -80% of all cases of esophageal stricture. Postoperative strictures account for about 10%, and corrosive strictures account for less than 5%.

Although dilation of gastrointestinal strictures has been limited historically to the esophagus and anorectum, the development of polyethylene balloons has expanded the endoscopist’s therapeutic horizons.

Passed over a guidewire or directly through an endoscope, such balloons allow access to stenotic lesions of the stomach, small intestine, colon, and pancreaticobiliary tract.

Endoscopy of Peptic Stenosis due to a Reflux Esophagitis

Video Endoscopic Sequence 3 of 23.

Endoscopy of Peptic Stenosis due to a Reflux Esophagitis

The patient was managed with PPI during three months. Patient did not get improving of his symptoms needing to perform a esophageal dilation.
Treatment usually involves dilation combined with acid suppressive therapy.

Consequently, these expanded capabilities have led endoscopists into widespread dilation therapy for a variety of stenoses, despite the absence of data or contradictory studies regarding the risks and benefi ts of dilation compared with more conventional therapy such as surgery. Similarly, as pharmacological and radiation therapies evolve, it is unclear whether dilation provides a desirable alternative or adjuvant to these treatments.

For example, stenoses with deep ulcerations caused by Crohn’s disease, which would have historically necessitated surgery, are increasingly being dilated by endoscopists. Whether these dilations may be made more successful, or even obviated, by new immunomodulatory treatments for inflammatory bowel disease (IBD) remains unknown.



Endoscopy of Esophageal Dilation

Video Endoscopic Sequence 4 of 23.

  Endoscopy of Esophageal Dilation.

Balloon Dilators, Flexible endoscopy allows the physician to directly view the stricture.

Deflated balloons are placed through the scope and across the stricture. When inflated they become sausage shaped, stretch and break the stricture.

BALLOON DILATORS Deflated balloons are placed through the endoscope and across the stricture. When inflated, they become sausage-shaped, stretch, and break the stricture.

Under direct endoscopic observation, the balloon is then inflated Once the stricture is dilated, with either single or multiple balloons, the balloon is withdrawn through the endoscope, after emptying the water.

The image and video clip display maneuver of dilatio

Video Endoscopic Sequence 5 of 23.

  Endoscopy of Esophageal Dilation.

The image and video clip display maneuver of dilation.

The goals of therapy for benign esophageal strictures are the relief of dysphagia and the prevention of stricture recurrence.

The majority of benign strictures that are found in the esophagus result from long standing gastroesophageal reflux
.

Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 6 of 23.

  Endoscopy of Esophageal Dilation.

Once the balloon has been inflated to the desired diameter, it is kept in place for a short time before deflating.
Actually use three minutes at a time and then deflate it.

The caliber of the balloon catheter was increased gradually over subsequent dilations, up to a diameter that allowed patients to swallow solid foods.


Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 7 of 23.

  Endoscopy of Esophageal Dilation.

In this image and the video clip display the overcome the stenosis with the balloon.

Esophageal dilation is often considered as the primary treatment option. Balloon dilation is done directly through an endoscope.

Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 8 of 23.

  Endoscopy of Esophageal Dilation.

A hiatal hernia is displayed in retroflexed maneuver.

Esophageal dilatation is the technique used to stretch or open the blocked portion of the esophagus.

Usuall hydrostatic dilating balloon is straddled across the stricture but there are a number of dilating techniques available.



Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 9 of 23.

A close-up

 

 

 

Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 10 of 23.

This image and the video clip display clearly the diameter
of the peptic stricture above of the hiatal hernia.


Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 11 of 23.

Again, repeated dilation are performed.

Pass the balloon through the endoscope channel while it’s
still deflated.


Endoscopy of Esophageal Dilation

Video Endoscopic Sequence 12 de 23.

  Endoscopy of Esophageal Dilation

A balloon dilator passed through the endoscope is often
inflated within the confines of the stricture, thus opening th
area and relieving the patient's symptoms.




Endoscopy of Esophagusl Dilation

Video Endoscopic Sequence 13 of 23.

  Endoscopy of Esophagusl Dilation

Dilation of more than 17 mm in diameter was performed.

 

Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 14 of 23.

Keeping the stricture in the middle of the balloon and then we inflate it to a given diameter.

Endoscopy of Esophageal Dilation

Video Endoscopic Sequence 15 of 23.

  Endoscopy of Esophageal Dilation

The ability to control and monitor the balloon makes it reliable procedure. That is the most common type of dilation and it has a very low complication rate with a good success rate.

Endoscopy of Esophageal Dilation

Video Endoscopic Sequence 16 of 23.

  Endoscopy of Esophageal Dilation

Flexible endoscopy allows the physician to directly view the stricture.
Deflated balloons are placed through the endoscope and across the stricture.

When inflated, they become sausage shaped, stretch, and break the stricture.

Endoscopy of Esophageal Dilation

Video Endoscopic Sequence 17 of 23.

  Endoscopy of Esophageal Dilation

Technique of balloon dilation of esophageal stricture under direct endoscopic visualization.

 

Balloon Dilation of Esophageal Stricture.

Video Endoscopic Sequence 18 of 23.

Balloon Dilation of Esophageal Stricture.

 



Balloon Dilation of Esophageal Stricture.

Video Endoscopic Sequence 19 of 23.

Balloon Dilation of Esophageal Stricture.

Balloon dilation is an acceptable modality for the dilation of stenosis at various sites in the gastrointestinal tract.

 

 


Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 20 of 23.

In this image as well as the video clip shows the Hiatal Hernia, above of the hernia is display the stricture.

The physician can almost always uncover the specific cause of the stricture. And there are a variety of treatment options available for the physician.

Complications are rare and, in most instances, a satisfactory outcome occurs with complete clearing of or improvement in the swallowing problem..

Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 21 of 23.

Status Post Dilation.

Balloon esophageal dilatation is an effective and safe
first-line therapy.

Complications are quite rare and manageable.


Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 22 of 23.

Chromatoscopy with lugol´s stain.




Endoscopy of Esophageal Dilation.

Video Endoscopic Sequence 23 of 23.

The biopsies did not displayed, Barrett´s esophagus.

Endoscopy of Esophageal Stenosis after total gastrectomy and chemoradiation.

Video Endoscopic Sequence 1 of 16.

Endoscopy of Esophageal Stenosis after total gastrectomy and chemoradiation.

This 62 year-old male, was reffered to us to evalute a disphagia, one year previous, undergone total gastrectomy due a gastric cancer, one month after the gastrectomy, radiation therapy was iniciated, an upper endoscopy was done. The stenosis of esophagus was found and balloon dilatation was performed.

Endoscopy of Esophageal Stenosis with web formation

Video Endoscopic Sequence 2 of 16.

Endoscopy of Esophageal Stenosis with web formation



Endoscopy of Esophageal Stenosis with web formation

Video Endoscopic Sequence 3 of 16.

Endoscopy of Esophagus Stenosis with web formation.

Stage III Gastric Cancer.
Standard treatment options:

Radical surgery. Curative resection procedures are confined to patients who at the time of surgical exploration do not have extensive nodal involvement.

Postoperative chemoradiation therapy.

Perioperative chemotherapy.

Perioperative chemotherapy


Endoscopy of Esophagus Stenosis with web formation.

Video Endoscopic Sequence 4 of 16.

The endoscope is advanced trying to pass to the stomach but the resistance exerted by fibrosis was quite strong therefore we decided to perform dilatation.

Endoscopy of Esophagus Stenosis with web formation.

Video Endoscopic Sequence 5 of 16.

 

 

Esophageal stenosis that required balloon dilatation

Video Endoscopic Sequence 6 of 16.

Esophageal stenosis that required balloon dilatation.

One week after the diagnosis, balloon dilatacion of the stricture was performed.





 

 

Esophageal stenosis that required balloon dilatation.

Video Endoscopic Sequence 7 of 16.

Bougienage was first utilized for the treatment of
esophageal stenosis in 1821.





Endoscopy of Balloon Dilatacion of the Stricture of the lower third.

Video Endoscopic Sequence 8 of 16.

Endoscopy of Balloon Dilatacion of the Stricture of the lower third.

 

 

 

Endoscopic balloon dilation Chemotherapy- and radiation

Video Endoscopic Sequence 9 of 16.

Endoscopic balloon dilation Chemotherapy- and radiation
induced esophageal stenosis under direct visualization
.

Esophageal stenosis that required balloon dilatation.

Video Endoscopic Sequence 10 of 16.

 

 

 

Esophageal stenosis that required balloon dilatation.

Video Endoscopic Sequence 11 of 16.

Many esophageal cancer patients present with recurrent
dysphagia after treatment with radiotherapy and are
considered at high risk for further endoscopic intervention
.

Retroflexed image, seen the endoscope emerging from the esophagus.

Video Endoscopic Sequence 12 of 16.

Retroflexed image, seen the endoscope emerging from the esophagus.

 

 

Esophageal stenosis that required balloon dilatation.

Video Endoscopic Sequence 13 of 16.





 

 

 

 

Treatment of a radiation-induced esophageal web

Video Endoscopic Sequence 14 of 16.

Treatment of a radiation-induced esophageal web

Mitomycin C is applied in drops to the site of the injury.

Mitomycin C is an antiproliferative agent that has been used successfully as an adjunct treatment in ophthalmological procedures,in the management of laryngeal and tracheal stenosis,and more recently to prevent the recurrence of caustic esophageal strictures.


Topical mitomycin C over the esophageal mucosa after

Video Endoscopic Sequence 15 of 16.

Topical mitomycin C over the esophageal mucosa after
 dilation.

Mitomycin C: An Alternative Conservative Treatment for
Refractory Esophageal Stricture.

Local application of mitomycin C is a potential alternative to iterative dilations, surgery, or stent placement for the treatment of refractory esophageal stricture in children.

However,prospective, long-term assessment of outcomes is needed before any efinitive conclusion can be drawn about the usefulness of mitomycin C in these patients.

Esophageal stenosis that required balloon dilatation.

Video Endoscopic Sequence 16 of 16.

Final Status after the procedure.

Below the Esophagojejunostomy after total gastrectomy.

Adequate palliation of dysphagia can be achieved by dilation of patients with radiation therapy-induced strictures of the esophagus.
Dilation of these strictures is relatively simple and safe if performed with care
.


Esophageal Dilation.

Video Endoscopic Sequence  1 of 7.

Esophageal Dilation.

A 56 year-old female who presented severe dysphagia, nauseas, vomiting and weight loss of more than 20 pounds. An upper endoscopy was performed, reflux esophagitis grade IV was found with severe peptic stenosis.

Esophageal Dilation.

Video Endoscopic Sequence  2 of 7.

To rule out malignancy some biopsies were taken.

 

Esophageal Dilation.

Video Endoscopic Sequence 3 of 7.

Starting the Esophageal Dilation.

A hydrostatic dilating balloon straddled across the
stricture. Under direct observation, the stricture will be
dilated..

Video Endoscopic Sequence  4 of 7.

To observe the procedure download the video clip.

The goals of therapy for benign esophageal strictures are the relief of dysphagia and the prevention of stricture recurrence.

The majority of benign strictures that are found in the esophagus result from long-standing gastroesophageal reflux.

Esophageal Dilation.

  Video Endoscopic Sequence 5 of 7.

The stenosis was overcome, a hiatal hernia is seen
below.


Hiatus Hernia

Video Endoscopic Sequence 6 of 7.

Hiatus Hernia is observed.

Esophageal Dilatation.

Esophageal Dilatation.

Caustic Ingestion.

A 72 year-old male with esophageal stricture due to a
corrosive substance containing acetone. Patient refers to
have accidentally ingested acetone thinking it was an
alcoholic drink.

.

 

 

 

 

Esophageal stricture of the lower third

Video Endoscopic Sequence 1 of 5.

Esophageal stricture of the lower third

A 54 year-old male, who for esophageal adenocarcinoma received therapy with linear accelerator, subsequently after two months developed refractory stenosis of the lower third.

 


dilation with hydrostatic balloon

Video Endoscopic Sequence 2 of 5.

It starts dilation with hydrostatic balloon

 

Esophageal dilation

Video Endoscopic Sequence 3 of 5.

It observed that the dilatation has been completed


Esophageal dilation

Video Endoscopic Sequence 4 of 5.

 

Esophageal dilation

Video Endoscopic Sequence 5 of 5.

The post status to hydrostatic balloon dilation is observed. There is enough fibrosis which is the cause of the recurrence.

 

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