e-ISSN: 1302-5422
Ağustos 2011
- Ana Sayfa
- Sayılar
- Ağustos 2011
- Sigmoid özofaguslu bir olguda akalazya balon dilatasyonu
Ağustos 2011 / (19 - 2)
Sigmoid özofaguslu bir olguda akalazya balon dilatasyonu
Sayfa Numaraları
71-72
Yazarlar
Mete AKIN, Mehmet İŞLER, Yıldıran SONGÜR, Gökhan AKSAKAL
Kurumlar
Süleyman Demirel Üniversitesi Tıp Fakültesi, Gastroenteroloji Bilim Dalı, Isparta
Özet
Bu yazıda, sigmoid özofagus gelişimi ile komplike olmuş akalazyalı bir hastada, standart yöntemle balon dilatasyonu yapılamadığı için kullandığımız bir yöntemi bildiriyoruz.
Anahtar Kelimeler
Balon dilatasyonu, sigmoid özofagus, akalazya
Giriş
Achalasia is a primary motility disorder of the esophagus characterized by incomplete relaxation of the lower esophageal
sphincter (LES) and aperistalsis of the esophagus. Pneumatic
dilatation and surgical myotomy are effective methods for treatment (1). Pneumatic dilatation may be difficult via standard
methods in patients complicated with sigmoid esophagus.
An 83-year-old woman was admitted with complaints of dysphagia and postprandial vomiting. The esophagus was detected as tortuous and dilated on barium esophagography, which was described as sigmoid esophagus (Figure 1). The esophageal lumen was extremely wide and tortuous and contained food residues on endoscopic examination. The endoscope was forwarded with difficulty to the distal part of the esophagus, and the LES level could only be passed with some difficulty. The stomach and duodenum were normal. A guidewire was left in the stomach; however, the attempt to pass a 30 mm balloon over the wire was not possible because of the extremely tortuous and dilated esophagus. In the next step, a balloon was attached to the endoscope with plaster and both were passed into the stomach successfully. Pneumatic dilatation was performed with endoscopic and scopic guidance, after the balloon reached the mid-LES level, which was observed endoscopically in the retroflex position (Figure 2).
Endoscopic control was possible in the same process, and no complications were observed except mucosal hemorrhage.
Different methods have been reported previously for pneumatic dilatation in patients with sigmoid esophagus. Holloway and McCallum (2) attached the pneumatic dilator with internal stiffener to the guidewire, while Bernstein and Barkin (3) used an overtube, and Kerr et al. (4) attached the pneumatic dilator to an endoscope using a string.
In conclusion, in patients with sigmoid esophagus, the pneumatic dilator can be attached to the endoscope, and dilatation can be performed more easily and safely with endoscopic and fluoroscopic guidance.
An 83-year-old woman was admitted with complaints of dysphagia and postprandial vomiting. The esophagus was detected as tortuous and dilated on barium esophagography, which was described as sigmoid esophagus (Figure 1). The esophageal lumen was extremely wide and tortuous and contained food residues on endoscopic examination. The endoscope was forwarded with difficulty to the distal part of the esophagus, and the LES level could only be passed with some difficulty. The stomach and duodenum were normal. A guidewire was left in the stomach; however, the attempt to pass a 30 mm balloon over the wire was not possible because of the extremely tortuous and dilated esophagus. In the next step, a balloon was attached to the endoscope with plaster and both were passed into the stomach successfully. Pneumatic dilatation was performed with endoscopic and scopic guidance, after the balloon reached the mid-LES level, which was observed endoscopically in the retroflex position (Figure 2).
Endoscopic control was possible in the same process, and no complications were observed except mucosal hemorrhage.
Different methods have been reported previously for pneumatic dilatation in patients with sigmoid esophagus. Holloway and McCallum (2) attached the pneumatic dilator with internal stiffener to the guidewire, while Bernstein and Barkin (3) used an overtube, and Kerr et al. (4) attached the pneumatic dilator to an endoscope using a string.
In conclusion, in patients with sigmoid esophagus, the pneumatic dilator can be attached to the endoscope, and dilatation can be performed more easily and safely with endoscopic and fluoroscopic guidance.
Kaynaklar
1. Moawad FJ, Wong RKh. Modern management of achalasia. Curr Opin
Gastroenterol 2010; 26: 384-8.
2. Holloway RH, McCallum RW. Technique for pneumatic dilatation in achalasia complicated by ?sigmoid? esophagus. J Clin Gastroenterol 1982; 4: 123-5.
3. Bernstein D, Barkin JS. Pneumatic dilatation of a sigmoid esophagus in achalasia using an overtube. Gastrointest Endosc 1993; 39: 549-50.
4. Kerr RM, Ott DJ, Wu WC, Ward BW. Pneumatic dilatation of the achalasic esophagus requiring the aid of an endoscope. Am J Gastroenterol 1987; 82: 74-7.
2. Holloway RH, McCallum RW. Technique for pneumatic dilatation in achalasia complicated by ?sigmoid? esophagus. J Clin Gastroenterol 1982; 4: 123-5.
3. Bernstein D, Barkin JS. Pneumatic dilatation of a sigmoid esophagus in achalasia using an overtube. Gastrointest Endosc 1993; 39: 549-50.
4. Kerr RM, Ott DJ, Wu WC, Ward BW. Pneumatic dilatation of the achalasic esophagus requiring the aid of an endoscope. Am J Gastroenterol 1987; 82: 74-7.
