tailieunhanh - Practical Pediatric Gastrointestinal Endoscopy - part 6

Ba điều kiện mãn tính là chịu trách nhiệm về chít hẹp thực quản lành tính trong phần lớn các bệnh nhân nhi khoa: viêm thực quản trào ngược nghiêm trọng bao gồm cả thực quản Barrett, viêm thực quản ăn mòn, và hẹp thực quản. Nghiêm khắc liên quan đến viêm thực quản ăn mòn được lâu dài và thường không thích hợp cho nong nội soi. | 102 Practical Pediatric Gastrointestinal Endoscopy George Gershman Marvin Ament Copyright 2007 by Blackwell Publishing Ltd 6 Therapeutic Upper GI Endoscopy BENIGN ESOPHAGEAL STRICTURE Three chronic conditions are responsible for benign esophageal strictures in the majority of pediatric patients severe reflux esophagitis including Barrett s esophagus corrosive esophagitis and esophageal atresia. Strictures related to corrosive esophagitis are long and usually are not suitable for endoscopic dilatation. However esophageal stricture secondary to reflux esophagitis or repaired esophageal atresia is short and can be treated endoscopically. The technique of endoscopic dilation is quite simple. The procedure does not require fluoroscopy. The length of narrowed esophagus in children with a tight stricture is estimated by a prior esophagram. Esophageal balloon dilators are available in three different sizes 3 5 and 8 cm in length. The short one is more vulnerable to slip from the stricture during dilation. A 5-cm dilator is the most convenient for positioning in pediatric patients. Each dilator can be distended with water to the designed diameter of 6-8-10 mm 10-12-15 mm and 12-15-18 mm with recommended pressure. The procedure is started with proper sedation and intubation of the esophagus in the standard fashion. The size of the stricture is estimated visually. The length of the stricture is measured endoscopically or radiologically. Some corrections should be made for x-ray magnification and edema or spasm of adjacent esophagus. The diameter of the balloon chosen for the first dilation should be equal to or less than that of the stricture. A guidewire is inserted into the biopsy channel and advanced 10-15 cm beyond the stricture to secure an intraluminal position of the balloon. The dilator is lubricated with silicone spray. Additional 1 or 2 ml of silicone oil can be injected into the biopsy channel. A dilator is threaded along the guidewire and slid through the .