RESUMEN
BACKGROUND AND STUDY AIMS: Esophagrams are often obtained routinely after pneumatic balloon dilation for achalasia, even in asymptomatic patients, as there is a risk of postprocedure esophagogastric perforation, which is a potentially life-threatening complication. The aim of this study was to determine whether the combination of a clinical suspicion of perforation and endoscopic re-examination after pneumatic dilation for achalasia can detect esophagogastric perforation, and thereby preclude the need for routine esophagrams in all patients. PATIENTS AND METHODS: All patients who underwent pneumatic dilation between January 2002 and June 2012âat our single tertiary referral center were identified retrospectively. Procedures were categorized into two groups: Group 1 underwent routine esophagograms after pneumatic dilation, and Group 2 underwent esophagograms only if there was a clinical suspicion of perforation. The detection rate of esophageal perforation after pneumatic dilation was compared between the two groups. RESULTS: A total of 119 achalasia dilation procedures were performed in 70 patients. Group 1 included 49/119 procedures (41.2â%), all of which were followed by routine esophagograms. Group 2 included 70/119 procedures (58.8â%), 12 of which were followed by esophagograms based on a clinical suspicion of perforation. No esophageal perforations were found in Group 1, whereas three were found in Group 2.âNo perforations occurred in the 58 procedures that were not followed by esophagograms. The overall rate of perforation was 3/119 (2.5â%). CONCLUSIONS: Esophagrams obtained routinely after pneumatic dilation for achalasia did not reveal unsuspected esophagogastric perforations. No esophageal perforations were missed after procedures that were not followed by esophagograms. Obtaining an esophagram only in cases of clinical suspicion of perforation and endoscopic evaluation may be an alternative to routine esophagograms in patients undergoing pneumatic dilation for achalasia.
Asunto(s)
Cateterismo/métodos , Dilatación/efectos adversos , Acalasia del Esófago/terapia , Perforación del Esófago/diagnóstico , Esofagoscopía/métodos , Rotura Gástrica/diagnóstico , Estómago/lesiones , Perforación del Esófago/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Presión , Estudios Retrospectivos , Rotura Gástrica/etiologíaRESUMEN
In the rapidly evolving field of endoscopic gastrointestinal imaging, Optical Coherence Tomography (OCT) has found many diverse applications. We present the current status of OCT and its practical applications in imaging normal and abnormal mucosa in the esophagus, stomach, small and large intestines, and biliary and pancreatic ducts. We highlight technical aspects and principles of imaging, assess published data, and suggest future directions for OCT-guided evaluation and therapy.
RESUMEN
PURPOSE: Intraoperative ultrasound is commonly used during standard transabdominal surgery. The feasibility of endoscopic ultrasound (EUS) through Natural Orifice Translumenal Endoscopic Surgery (NOTES) for identification of abdominal lesions with a flexible echoendoscope has not been studied. AIM: To test the feasibility of NOTES-EUS for abdominal exploration and identification of mock hepatic lesions. METHODS: Five pigs underwent transvaginal or transcolonic NOTES and endosonographic exploration. In 3 anesthetized pigs, mock hepatic lesions were created and NOTES-EUS was then performed to identify these mock lesions. Necropsy was performed in all cases. RESULTS: All target organs were consistently identified by NOTES-EUS in all animals. Mock hepatic lesions were successfully created in 3 animals and were able to be located by NOTES-EUS. No complications were observed at necropsy. CONCLUSIONS: Abdominal exploration and localization of mock lesions by NOTES-EUS is technically feasible. As natural orifice surgery evolves, intraoperative NOTES-EUS would be an essential addition to the NOTES armamentarium.