Esophageal Dilatation.  El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Peptic Stenosis due to a Reflux Esophagitis. This 57 year-old man with longstanding 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.

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.

 For more endoscopic details, download the video clip by
 clicking on the endoscopic image. Wait to be downloaded
 complete then Press Alt and Enter for full screen. All
 endoscopic images shown in this Atlas contain video clips.
 We recommend seeing the video clips in full screen mode

 

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%.

Video Endoscopic Sequence 2 of 23.

 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.

TThe 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.

Video Endoscopic Sequence 3 of 23.

 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.

 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 .

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 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

Video Endoscopic Sequence 5 of 23.

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.

 

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

Video Endoscopic Sequence 6 of 23.

 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.

 

In this image and the video clip display the overcome of the stenosis with the balloon. esophageal dilation is often considered as the primary treatment option. Balloon dilation is done directly through an endoscope

Video Endoscopic Sequence 7 of 23.

 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.

 

A hiatal hernia is displayed in  retroflexed maneuver. Esophageal dilatation is the technique used to stretch or open the blocked portion of the esophagus. Usually hydrostatic dilating balloon is straddled across the stricture but there are a number of dilating techniques available.

Video Endoscopic Sequence 8 of 23.

 A hiatal hernia is displayed in retroflexed maneuver.
 Esophageal dilatation is the technique used to stretch or
 open the blocked portion of the esophagus. Usually
 hydrostatic dilating balloon is straddled across the stricture
 but there are a number of dilating techniques available.

A close-up.

Video Endoscopic Sequence 9 of 23.

A close-up

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

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.

Again, repeated dilation are performed. Pass the balloon through the endoscope channel while it's still deflated.

Video Endoscopic Sequence 11 of 23.

Again, repeated dilation are performed.

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

 

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

Video Endoscopic Sequence 12 of 23.

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

 

Dilation of more than 17 mm in diameter was performed

Video Endoscopic Sequence 13 of 23.

Dilation of more than 17 mm in diameter was performed.

 

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

Video Endoscopic Sequence 14 of 23.

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

 

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

Video Endoscopic Sequence 15 of 23.

 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.

 

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.

Video Endoscopic Sequence 16 of 23.

 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.

Technique of balloon dilation of esophageal stricture under direct endoscopic visualization

Video Endoscopic Sequence 17 of 23.

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 is an acceptable modality for the dilation of stenoses at various sites in the gastrointestinal tract

Video Endoscopic Sequence 19 of 23.

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

 

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.

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.

Status post dilation , Balloon esophageal dilatation is an effective and safe first-line therapy. Complications are quite rare and manageable

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.

Chromatoscopy with lugolīs stain. Fundicalīs cell are observed.

Video Endoscopic Sequence 22 of 23.

Chromatoscopy with lugolīs stain.

Fundicalīs cell are observed.

The biopsies did not reveal Barrett s esophagus.

Video Endoscopic Sequence 23 of 23.

The biopsies did not displayed, Barrettīs esophagus.

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..

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.

Video Endoscopic Sequence 2 of 16.

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.
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.

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.

Video Endoscopic Sequence 5 of 16.

 

Video Endoscopic Sequence 6 of 16.

Esophageal stenosis that required balloon dilatation

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

 

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

Video Endoscopic Sequence 7 of 16.

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

Video Endoscopic Sequence 8 of 16.

Endoscopy of Balloon Dilatacion of the Stricture of the lower third

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

Video Endoscopic Sequence 9 of 16.

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

Video Endoscopic Sequence 10 of 16.

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

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.

 

Video Endoscopic Sequence 12 of 16.

Retroflexed image, seen the endoscope emerging from the esophagus.

Video Endoscopic Sequence 13 of 16.

 

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.

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.

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.

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.

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.

 

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.

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.

To rule out malignancy some biopsies were taken.

Video Endoscopic Sequence 2 of 7.

 To rule out malignancy some biopsies were taken.       

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

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.

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.

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. 

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

Video Endoscopic Sequence 5 of 7.

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

A hiatus hernia is observed.

              Video Endoscopic Sequence 6 of 7.

 A hiatus hernia is observed.

 

The fundus in retroflexion the hiatus hernia is appreciated.

Video Endoscopic Sequence 7 of 7.

 The fundus in retroflexion the hiatus hernia is appreciated.

Esophageal Dilatation. 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 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.