GASTROENTEROLOGY ARTICLE OF THE WEEK
August 17, 2006
ASGE Guideline. Esophageal Dilation. Gastrointest Endosc 2006;63:755-760.
1. Complex esophageal strictures are characterized by:
a. diameter >12 mm
b. inability to pass the stricture with the upper endoscope
c. asymmetric strictures
d. strictures located in the upper 1/3 of the esophagus
2. The size of the largest dilator passed to dilate a stricture is determined by:
a. the attending’s testosterone level
b. the fellow’s degree of inexperience
c. no more than 3 consecutive dilators in increments of 1mm after moderate
resistance is encountered
d. until blood covers the dilator
3. To obtain relief of dysphagia in most patients, the target esophageal diameter should be:
a. 30 mm
b. 8-10 mm
c. 10-12 mm
d. >13 mm
4. Dilation for achalasia
a. should be performed with 3 to 4 cm diameter balloons
b. 1/3 of patients will have recurrence of symptoms
c. Perforation rate is 3% to 4%
d. Initial balloon size should be 40mm to assure good results
True or False
5. An UGIS should be obtained prior to performing an EGD in patients presenting with dysphagia
6. Patients with suspected eosinophilic esophagitis should undergo biopsies only of the distal esophagus even if the endoscopy is normal.
7. There is no convincing data stating that balloon dilators must be inflated for a specified period of time (i.e. 1 minute) to achieve best results
8. After an achalasia dilation complicated by perforation, surgical Heller myotomy can be performed at the time of the repair of the perforation, but it must be done with an open rather than laparoscopic approach.
9. Through-the-scope balloon dilators have a lower perforation rate than bougie-type dilators because they do not exert longitudinal-type forces.
10. Esophageal dilation should not be performed immediately after obtaining endoscopic biopsies of the strictured area.
11. Perforation rates for dilation of all types of esophageal strictures averages 0.1 to 0.4%
12. A 25 y/o male presenting with his second episode of food impaction in 1.5 years has an otherwise normal endoscopy. The best next step in his management is dilation with a large-diameter dilator to treat a suspected Schatzki’s ring.
13. PPI therapy may delay recurrence of symptoms after dilating a Schatzki’s ring.
14. Botulinum toxin injection for the treatment of achalasia is as effective as balloon dilation