Techniques in Gastrointestinal Endoscopy最新文献_第6页

Techniques in endoscopy: Esophageal motility disorders 内镜技术：食管运动障碍

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.07.003

John E. Pandolfino, Dustin A. Carlson

引用次数: 0

Treatment of idiopathic achalasia with per-oral esophageal myotomy 经口食管肌切开术治疗特发性贲门失弛缓症

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.07.006

Ryan A.J. Campagna, Eric S. Hungness

{"title":"Treatment of idiopathic achalasia with per-oral esophageal myotomy","authors":"Ryan A.J. Campagna, Eric S. Hungness","doi":"10.1016/j.tgie.2018.07.006","DOIUrl":"10.1016/j.tgie.2018.07.006","url":null,"abstract":"<div>Achalasia is a rare esophageal motility disorder that necessitates the disruption of the lower esophageal sphincter. Patients with achalasia should be evaluated in a systematic, multidisciplinary fashion. Workup should include upper endoscopy, esophagography, and high-resolution manometry. The gold standard for surgical treatment is laparoscopic Heller myotomy with partial fundoplication. Per-oral esophageal myotomy is a novel endoscopic technique that has gained considerable traction over the past decade. The procedure includes the creation of a submucosal tunnel and a selective circular myotomy of the lower esophageal sphincter. Common intra-operative hazards include bleeding within the submucosal tunnel and capnoperitoneum. Significant complications are rare. Patients experience excellent dysphagia relief that is on par with laparoscopic Heller myotomy at moderate-term follow up. Post-operative gastroesophageal reflux disease occurs in greater than one-third of patients, and the vast majority of cases are readily controlled with an anti-secretory medication. Although data is sparse, there is a growing body of literature that supports the long-term durability of per-oral esophageal myotomy.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37057393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

The role of endoscopic ultrasound for the evaluation and treatment of esophageal motility disorders 内镜超声在食管运动障碍评估和治疗中的作用

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.07.002

Kumar Krishnan MD

{"title":"The role of endoscopic ultrasound for the evaluation and treatment of esophageal motility disorders","authors":"Kumar Krishnan MD","doi":"10.1016/j.tgie.2018.07.002","DOIUrl":"10.1016/j.tgie.2018.07.002","url":null,"abstract":"<div>Esophageal motor disorders constitute a heterogeneous group of diseases that result in symptoms of dysphagia and chest pain. The primary diagnostic tool in the evaluation of patients with esophageal motor disorders is high resolution esophageal manometry. While manometric findings provide the sine qua non for the diagnosis of achalasia, they are limited in that they cannot provide meaningful anatomic correlates. Endoscopic ultrasound (EUS) has a key role in the evaluation of patients with esophageal motor disorders. Both probe-based ultrasound systems and echoendoscopes can provide high resolution imaging of the esophageal wall and surrounding structures. Due to a variety of factors, EUS has demonstrated clear variability in esophageal and muscle thickness. This may also reflect further anatomic heterogeneity among esophageal motor disorders. The benefit of EUS in the evaluation of alternative causes for outflow obstruction and pseudoachalasia is clear and should be considered in patients with atypical presentations. Novel indications for EUS include advanced imaging techniques and EUS directed treatments to the lower esophageal sphincter. EUS alone is not a replacement for standard diagnostic tests, it remains a helpful tool in the overall management of patients with esophageal motor disorders.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47682830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endoscopic dilation for treatment of esophageal motility disorders 内镜下扩张治疗食管运动障碍

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.06.002

Michael F. Vaezi MD, PhD, MSc, FACG , Joel E. Richter MD, FACP, MACG

{"title":"Endoscopic dilation for treatment of esophageal motility disorders","authors":"Michael F. Vaezi MD, PhD, MSc, FACG , Joel E. Richter MD, FACP, MACG","doi":"10.1016/j.tgie.2018.06.002","DOIUrl":"10.1016/j.tgie.2018.06.002","url":null,"abstract":"<div>Esophageal dilation is an important therapeutic strategy in patients with esophageal motility disorders. Patients with achalasia have for many years benefited from pneumatic dilation as a definitive form of therapy, which is superior to botulinum toxin injection and equivalent in efficacy to surgical myotomy. Optimal performance of pneumatic dilation ensures maximum efficacy and reduced complication of perforation. Esophageal dilation also plays a crucial role in esophagogastric junction outflow obstruction due to strictures or prior surgical interventions as well as in esophageal hypercontractile states such as spastic disorders or in those with nonobstructive dysphagia. In this section, we will review the clinical evidence of esophageal dilation in achalasia, esophagogastric junction outflow obstruction, esophageal spastic disorders and in patients with dysphagia and nonobstructive dysphagia. We will outline specific techniques currently recommended and employed in esophageal dilations for these disorders and provide relative efficacy to other forms of therapy.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46010863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Esophageal motility disorders 食道运动障碍

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.06.001

Albert J. Bredenoord MD , C. Prakash Gyawali MD

{"title":"Esophageal motility disorders","authors":"Albert J. Bredenoord MD , C. Prakash Gyawali MD","doi":"10.1016/j.tgie.2018.06.001","DOIUrl":"10.1016/j.tgie.2018.06.001","url":null,"abstract":"<div>Esophageal symptoms are most often related to gastroesophageal reflux disease and other mucosal or structural processes in the tubular esophagus. When these have been appropriately ruled out with careful endoscopy, or when motility disorders are suspected based on persistent symptoms or endoscopic findings, esophageal motility testing is performed. High resolution manometry has been shown to be superior and has largely replaced conventional esophageal manometry, as it provides more detailed evaluation of esophageal motor function and results in an accurate diagnosis more often. Using innovative and intuitive software tools applied to the electronic pressure data from high resolution manometry, esophageal outflow obstruction (including achalasia spectrum disorders), major motor disorders (hypercontractile esophagus, distal esophageal spasm, and absent contractility), and minor disorders (ineffective esophageal motility and fragmented peristalsis) can be diagnosed. Provocative testing (multiple rapid swallows, rapid drink challenge, and solid test meal) can provide additional gain in motor diagnoses in symptomatic patients with normal or inconclusive standard manometry, but the clinical value is still controversial. New metrics have been introduced to characterize the esophagogastric junction in terms of barrier function and morphology, which are relevant in the context of gastroesophageal reflux disease. Barium radiography has a complementary role in the evaluation and follow-up in patients with symptoms suggestive of esophageal motility disorders. Symptomatic patients with minor motor disorders or normal motility, especially when response to provocative testing is normal, may have a functional basis for symptoms.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43912775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Endoscopic atlas of motility disorders 运动障碍内镜图谱

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.06.003

Anand S. Jain MD , Peter J. Kahrilas MD

引用次数: 0

Evaluation of esophageal motility during endoscopy with the functional luminal imaging probe 功能性管腔成像探头在内镜检查中对食管运动的评价

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.07.004

Dustin A. Carlson MD, MS

{"title":"Evaluation of esophageal motility during endoscopy with the functional luminal imaging probe","authors":"Dustin A. Carlson MD, MS","doi":"10.1016/j.tgie.2018.07.004","DOIUrl":"10.1016/j.tgie.2018.07.004","url":null,"abstract":"<div>The functional luminal imaging probe (FLIP) provides a novel method to evaluate the esophageal response to distension. The comprehensive evaluation of esophageal function that includes esophagogastric junction (EGJ) distensibility and distension-induced contractility, i.e. FLIP panometry, provides an appealing method to evaluate esophageal motility at the time of sedated endoscopy. Abnormal EGJ distensibility is a consistently observed finding among patients with achalasia and EGJ outflow obstruction, while the normal contractile response to esophageal distension involves repetitive, antegrade contractions. Thus, the esophageal motility assessment with FLIP panometry was reported to effectively detect abnormal motility, including achalasia, and also may identify functional abnormalities that are not detected on manometry. Ultimately, FLIP panometry offers a well-tolerated method to potentially enhance the clinical evaluation of esophageal motility. This review aims to discuss the evaluation of esophageal motility at the time of endoscopy with FLIP panometry.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46260375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Endoscopic injection therapy for achalasia and other esophageal motilitydisorders 内镜注射治疗贲门失弛缓症及其他食道运动障碍

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.07.001

Sabine Roman , David A. Katzka

{"title":"Endoscopic injection therapy for achalasia and other esophageal motilitydisorders","authors":"Sabine Roman , David A. Katzka","doi":"10.1016/j.tgie.2018.07.001","DOIUrl":"10.1016/j.tgie.2018.07.001","url":null,"abstract":"<div>Botulinum toxin (BT) injections have been proposed to treat achalasia and hypertensive esophageal motility disorders. They affect lower esophageal sphincter (LES) and esophageal muscle function by inhibiting acetylcholine release and thus preventing neuromuscular conduction. BT injection in the LES is effective to treat achalasia but the improvement is limited to few months. As a consequence, recent guidelines recommend BT in achalasia patients who are not good candidates for more definitive therapy with pneumatic dilation or myotomy. BT might be a good option for patients with esophago-gastric junction obstruction without a firm diagnosis of achalasia. However, response to BT injection is not predictive of response to a more invasive therapy. BT injection in both the LES and the esophageal body might have a short-term efficacy to relieve dysphagia in patients with diffuse esophageal spasm or nutcracker esophagus. Usually BT is administrated as 1 cc aliquots with 20 units of toxin per milliliter into the LES and/or the esophageal body for a total dose of 100 unit international. BT injections are usually safe. Moderate chest pain might be reported following the injection. Three cases of death were reported due to acute mediastinitis and pseudoaneurysm. Finally, there is a theoretical risk of increased difficulty to perform esophageal myotomy in patients who previously received BT therapy due to the potential risk of fibrosis.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48175880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Peroral endoscopic myotomy (POEM) for esophageal motility disorders other than achalasia 经口内窥镜肌切开术(POEM)治疗贲门失弛缓症以外的食管运动障碍

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.08.001

Nasim Parsa , Mouen A. Khashab

{"title":"Peroral endoscopic myotomy (POEM) for esophageal motility disorders other than achalasia","authors":"Nasim Parsa , Mouen A. Khashab","doi":"10.1016/j.tgie.2018.08.001","DOIUrl":"10.1016/j.tgie.2018.08.001","url":null,"abstract":"<div>Peroral endoscopic myotomy (POEM) is a novel minimally invasive procedure that has demonstrated excellent results in patients with all achalasia subtypes. In patients with non-achalasia disorders, POEM is more complex both in terms of preoperative evaluation and surgical technique. There are multiple studies that reported the results of POEM in patients with diffuse esophageal spasm and Jackhammer esophagus. POEM can potentially be the ideal endoscopic therapy for these motility disorders as it not only allows myotomy of the lower esophageal sphincter but also of the esophageal body, where the hypertensive contractions occur. In these patients, manometric diagnosis should be clear on careful review of their motility tracing. There have been promising reports of POEM in patients with esophago-gastric junction outflow obstruction, however, the data are still limited. In general, non-achalasia esophageal motility disorders are very rare and multicenter collaboration is required to develop an evidence-based methodology for POEM application in these disorders. The key to performa successful POEM is based on careful patient selection and complete pre-operative evaluation. GERD after POEM is common and management, goals of therapy, and long-term outcomes of GERD after POEM are unclear. Candidates should be appropriately counseled on expected outcomes and the need for long-term surveillance.</div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46318705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Endoscopic diagnosis and treatment of disorders of upper esophageal sphincter function 食管上括约肌功能紊乱的内镜诊断与治疗

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-07-01 DOI: 10.1016/j.tgie.2018.07.005

Ronak V. Patel MD, Ikuo Hirano MD

引用次数: 1