Balloon is a much more controlled dilation. You're going to get equal pressure as you dilate the balloon. You can do it under fluoroscopic guidance to see how the neck changes with that dilation.
The colon does not peristals like the rest of the esophagus or the bowel. So when we go antiperistaltic, it's really just gravity that's pulling food down and they become dilated over time.
Management of Esophageal Stenosis and Strictures in Children | Congenital & Acquired w/ Dr. Walther
▶Ep 3 · 0:22
clinicalThere are both congenital and acquired esophageal stenosis↗
▶Ep 3 · 0:34
clinicalFibromuscular hypertrophy is the most common type of congenital esophageal stenosis↗
▶Ep 3 · 0:34
quoteFibromuscular hypertrophy is the most common.↗
▶Ep 3 · 0:36
clinicalCongenital esophageal stenosis can also present as tracheal bronchial remnants or mucosal webs↗
▶Ep 3 · 0:45
clinicalCongenital esophageal stenosis is associated with EATEF, esophageal duplications, congenital heart disease, anorectal malformations, and VACTERL↗
▶Ep 3 · 0:57
clinicalFibromuscular hypertrophy occurs in the middle to lower third of the esophagus↗
▶Ep 3 · 0:57
clinicalTracheal bronchial remnants occur in the lower third of the esophagus↗
▶Ep 3 · 1:10
quoteSo acquired is going to be like your strictures, right? A peptic stricture from GEERD, a caustic congestion, or an iatrogenic stricture, like from a perforation.↗
▶Ep 3 · 1:10
clinicalAcquired esophageal stenosis includes peptic stricture from GERD, caustic ingestion, or iatrogenic stricture from perforation↗
▶Ep 3 · 1:23
guidelineWorkup for esophageal stenosis starts with an esophagram↗
▶Ep 3 · 1:42
guidelineThe first treatment attempted is usually dilation↗
▶Ep 3 · 1:45
clinicalThere are two types of dilators: bougie dilation and balloon dilators↗
▶Ep 3 · 1:55
quoteBalloon is a much more controlled dilation. You're going to get equal pressure as you dilate the balloon. You can do it under fluoroscopic guidance to see how the neck changes with that dilation.↗
▶Ep 3 · 1:55
clinicalBalloon dilation provides more controlled dilation with equal pressure and can be done under fluoroscopic guidance↗
▶Ep 3 · 2:17
clinicalResection of congenital esophageal stenosis can be performed thoracoscopically↗
▶Ep 3 · 2:28
clinicalThree main esophageal replacement techniques are gastric pull-up, jejunal interposition, and colonic interposition↗
▶Ep 3 · 2:41
clinicalGastric pull-ups carry long-term risks of dilation and redundancy, creating a space-occupying lesion in the chest over time↗
▶Ep 3 · 3:03
quoteJejunal interpositions is a very complex surgery. If you're going to do it, you should do it at a major center that has all of the important people in place.↗
▶Ep 3 · 3:03
opinionJejunal interposition is a very complex surgery that should be performed at a major center with all important personnel in place↗
▶Ep 3 · 3:30
clinicalColonic interposition uses pieces of transverse or descending colon, performed either isoperistaltic or antiperistaltic depending on mesenteric blood supply↗
▶Ep 3 · 3:48
clinicalThe colon does not peristalse like the esophagus or bowel, so with antiperistaltic placement gravity pulls food down and the colon becomes dilated over time↗
▶Ep 3 · 3:48
quoteThe colon does not peristals like the rest of the esophagus or the bowel. So when we go antiperistaltic, it's really just gravity that's pulling food down and they become dilated over time.↗
▶Ep 3 · 3:59
clinicalColonic interpositions sometimes become stretched out and redundant, requiring revision↗
▶Ep 3 · 4:12
quoteA peptic stricture, you don't necessarily have to go after the stricture, you just have to treat the reflux.↗
▶Ep 3 · 4:12
guidelineFor peptic strictures, treatment should address the underlying reflux rather than the stricture itself↗
▶Ep 3 · 4:30
clinicalEndoscopic options for strictures include needle knife stricturoplasty, which uses a thin device to score the strictured area in multiple places↗
▶Ep 3 · 4:54
clinicalEOE strictures are related to a disease process and are different from other stricture types↗
▶Ep 3 · 5:08
clinicalDupixent, a monoclonal antibody given via weekly injection, is a medication for EOE↗
▶Ep 3 · 5:14
guidelineIf EOE persists despite medical treatment, dilation is performed↗
Ashley's statements about Esophageal Stricture29 statements
Management of Esophageal Stenosis and Strictures in Children | Congenital & Acquired w/ Dr. Walther
▶Ep 4 · 0:22
clinicalThere are both congenital and acquired esophageal stenosis↗
▶Ep 4 · 0:34
clinicalFibromuscular hypertrophy is the most common type of congenital esophageal stenosis↗
▶Ep 4 · 0:34
quoteFibromuscular hypertrophy is the most common.↗
▶Ep 4 · 0:36
clinicalCongenital esophageal stenosis can also present as tracheal bronchial remnants or mucosal webs↗
▶Ep 4 · 0:45
clinicalCongenital esophageal stenosis is associated with EATEF, esophageal duplications, congenital heart disease, anorectal malformations, and VACTERL↗
▶Ep 4 · 0:57
clinicalFibromuscular hypertrophy occurs in the middle to lower third of the esophagus↗
▶Ep 4 · 0:57
clinicalTracheal bronchial remnants occur in the lower third of the esophagus↗
▶Ep 4 · 1:10
quoteSo acquired is going to be like your strictures, right? A peptic stricture from GEERD, a caustic congestion, or an iatrogenic stricture, like from a perforation.↗
▶Ep 4 · 1:10
clinicalAcquired esophageal stenosis includes peptic stricture from GERD, caustic ingestion, or iatrogenic stricture from perforation↗
▶Ep 4 · 1:23
guidelineWorkup for esophageal stenosis starts with an esophagram↗
▶Ep 4 · 1:42
guidelineThe first treatment attempted is usually dilation↗
▶Ep 4 · 1:45
clinicalThere are two types of dilators: bougie dilation and balloon dilators↗
▶Ep 4 · 1:55
clinicalBalloon dilation provides more controlled dilation with equal pressure and can be done under fluoroscopic guidance↗
▶Ep 4 · 1:55
quoteBalloon is a much more controlled dilation. You're going to get equal pressure as you dilate the balloon. You can do it under fluoroscopic guidance to see how the neck changes with that dilation.↗
▶Ep 4 · 2:17
clinicalResection of congenital esophageal stenosis can be performed thoracoscopically↗
▶Ep 4 · 2:28
clinicalThree main esophageal replacement techniques are gastric pull-up, jejunal interposition, and colonic interposition↗
▶Ep 4 · 2:41
clinicalGastric pull-ups carry long-term risks of dilation and redundancy, creating a space-occupying lesion in the chest over time↗
▶Ep 4 · 3:03
quoteJejunal interpositions is a very complex surgery. If you're going to do it, you should do it at a major center that has all of the important people in place.↗
▶Ep 4 · 3:03
opinionJejunal interposition is a very complex surgery that should be performed at a major center with all important personnel in place↗
▶Ep 4 · 3:30
clinicalColonic interposition uses pieces of transverse or descending colon, performed either isoperistaltic or antiperistaltic depending on mesenteric blood supply↗
▶Ep 4 · 3:48
quoteThe colon does not peristals like the rest of the esophagus or the bowel. So when we go antiperistaltic, it's really just gravity that's pulling food down and they become dilated over time.↗
▶Ep 4 · 3:48
clinicalThe colon does not peristalse like the esophagus or bowel, so with antiperistaltic placement gravity pulls food down and the colon becomes dilated over time↗
▶Ep 4 · 3:59
clinicalColonic interpositions sometimes become stretched out and redundant, requiring revision↗
▶Ep 4 · 4:12
guidelineFor peptic strictures, treatment should address the underlying reflux rather than the stricture itself↗
▶Ep 4 · 4:12
quoteA peptic stricture, you don't necessarily have to go after the stricture, you just have to treat the reflux.↗
▶Ep 4 · 4:30
clinicalEndoscopic options for strictures include needle knife stricturoplasty, which uses a thin device to score the strictured area in multiple places↗
▶Ep 4 · 4:54
clinicalEOE strictures are related to a disease process and are different from other stricture types↗
▶Ep 4 · 5:08
clinicalDupixent, a monoclonal antibody given via weekly injection, is a medication for EOE↗
▶Ep 4 · 5:14
guidelineIf EOE persists despite medical treatment, dilation is performed↗
