Background: Pneumatic balloon dilation is the most effective nonsurgical treatment to relieve functional obstruction of the gastroesophageal junction in achalasia. Since its inception, the conventional technique has b...Background: Pneumatic balloon dilation is the most effective nonsurgical treatment to relieve functional obstruction of the gastroesophageal junction in achalasia. Since its inception, the conventional technique has been performed under direct fluoroscopic control with or without a guidewire. To overcome the impediments of the conventional technique and radiation exposure, we have devised a novel technique of achalasia dilation without fluoroscopy. The aim of the study was to evaluate the efficacy, the safety, and the outcome of the new method. Methods: Fifty-six patients (34 men, 22 women) (mean age 32 years) with achalasia cardia were subjected, over a span of 2 years, to dilation with a Gruntzig-type (Rigiflex balloon) pneumatic dilator with the new technique. Clinical response and complications were assessed. Observations: Excellent improvement in dysphagia, pain, and regurgitation was observed in 92.9% , 89.3% , and 89.3% patients at 24 hours, 6 weeks, and 6 months after dilation, respectively. The mean time to maneuver the Rigiflex balloon to the antrum was 30 seconds. The procedure was successfully done in all patients, and there were no procedural failures. The mean time of the procedure was 8 minutes. There were no complications or mortality during the study. Conclusions: Achalasia dilation with this new technique has excellent results and is devoid of the side effects of radiation. It can be done as an office procedure, without the need of a fluoroscopy setup.展开更多
十二指肠镜下行十二指肠乳头括约肌切开术（EST）或气囊扩张术（EPBD）治疗肝外胆管结石，由于其微创性、安全性、有效性以及并发症少等优势，得到了人们的广泛认可。但是 EST 治疗胆总管结石所引起的并发症，如出血、穿孔、胰腺炎、胆...十二指肠镜下行十二指肠乳头括约肌切开术（EST）或气囊扩张术（EPBD）治疗肝外胆管结石，由于其微创性、安全性、有效性以及并发症少等优势，得到了人们的广泛认可。但是 EST 治疗胆总管结石所引起的并发症，如出血、穿孔、胰腺炎、胆管炎和十二指肠乳头括约肌受损导致的反流性胆管炎和结石复发等，发病率仍较高。而 EPBD 虽可以保护十二指肠乳头括约肌功能，具有较高的取石成功率，术后并发症如出血、穿孔等亦较 EST 少，但因气囊压迫胰管开口，术后急性胰腺炎的发生率相对较高［1］，使其应用受到一定限制。如何在胆总管结石内镜取石中取得更好的疗效，并减少术后并发症已经成为广大临床工作者的研究重点。本文采用内镜下乳头括约肌小切开联合 EPBD 治疗胆总管结石，旨在探讨该方法的应用价值。展开更多
文摘Background: Pneumatic balloon dilation is the most effective nonsurgical treatment to relieve functional obstruction of the gastroesophageal junction in achalasia. Since its inception, the conventional technique has been performed under direct fluoroscopic control with or without a guidewire. To overcome the impediments of the conventional technique and radiation exposure, we have devised a novel technique of achalasia dilation without fluoroscopy. The aim of the study was to evaluate the efficacy, the safety, and the outcome of the new method. Methods: Fifty-six patients (34 men, 22 women) (mean age 32 years) with achalasia cardia were subjected, over a span of 2 years, to dilation with a Gruntzig-type (Rigiflex balloon) pneumatic dilator with the new technique. Clinical response and complications were assessed. Observations: Excellent improvement in dysphagia, pain, and regurgitation was observed in 92.9% , 89.3% , and 89.3% patients at 24 hours, 6 weeks, and 6 months after dilation, respectively. The mean time to maneuver the Rigiflex balloon to the antrum was 30 seconds. The procedure was successfully done in all patients, and there were no procedural failures. The mean time of the procedure was 8 minutes. There were no complications or mortality during the study. Conclusions: Achalasia dilation with this new technique has excellent results and is devoid of the side effects of radiation. It can be done as an office procedure, without the need of a fluoroscopy setup.
文摘十二指肠镜下行十二指肠乳头括约肌切开术（EST）或气囊扩张术（EPBD）治疗肝外胆管结石，由于其微创性、安全性、有效性以及并发症少等优势，得到了人们的广泛认可。但是 EST 治疗胆总管结石所引起的并发症，如出血、穿孔、胰腺炎、胆管炎和十二指肠乳头括约肌受损导致的反流性胆管炎和结石复发等，发病率仍较高。而 EPBD 虽可以保护十二指肠乳头括约肌功能，具有较高的取石成功率，术后并发症如出血、穿孔等亦较 EST 少，但因气囊压迫胰管开口，术后急性胰腺炎的发生率相对较高［1］，使其应用受到一定限制。如何在胆总管结石内镜取石中取得更好的疗效，并减少术后并发症已经成为广大临床工作者的研究重点。本文采用内镜下乳头括约肌小切开联合 EPBD 治疗胆总管结石，旨在探讨该方法的应用价值。
