Fluoroscopy-guided balloon dilatation of benign esophageal strictures in children: 11-year experience.

BACKGROUND: The esophageal stricture is an important clinical problem in children, and the treatment is difficult. OBJECTIVE: To evaluate the results of fluoroscopy-guided balloon dilatation of benign pediatric esophageal strictures and to suggest a safety range for balloon diameters. MATERIALS AND METHODS: We retrospectively reviewed the medical records of children who underwent fluoroscopy-guided esophageal balloon dilatation for treatment of benign esophageal stricture from February 2008 to July 2019. We recorded the demographic data of the children, technical details of each procedure, balloon diameter, number of repeated procedures, clinical and technical success rates, complications and follow-up period. Technical success was defined as the disappearance of the waist formation on the balloon catheter, and clinical success was defined as no need for re-dilation or other treatment methods during the 1-year follow-up after the procedure. These children were divided into groups and evaluated according to esophageal stricture etiology. RESULTS: Technically successful procedures included 375 balloon dilatations in 116 patients (67 boys; age range: 1 month to 18 years; mean age: 4.3 ± 4.8 standard deviation [SD] years at the initial dilatation). The follow-up period was 1-138 months (median: 41 months; mean: 44 months) since the last dilatation. In this study, the clinical success rate was 34% per procedure (120 of 353 procedures) and 85% per patients (91 of 107 patients). The total complication rate per procedure was 0.5%, and the perforation rate was 0.25% per session. CONCLUSION: Fluoroscopy-guided esophageal balloon dilatation is an effective and reliable method for treating benign esophageal strictures in children.

Fluoroscopy-guided percutaneous antegrade approach for ureteral stent placement in children: a single-center experience.

BACKGROUND: Although there are many studies on percutaneous nephrostomy in urinary obstruction management in pediatric patients, there is a limited number of studies on percutaneous antegrade ureteral stenting (PAUS) on this issue. PURPOSE: To evaluate the results of fluoroscopy-guided percutaneous antegrade approach for ureteral stent placement through the nephrostomy route in children. MATERIAL AND METHODS: Between October 2005 and June 2019, the medical records of children who underwent PAUS through the nephrostomy route were reviewed retrospectively. Demographic data of the patients, technical and clinical success rates, technical details, and complications of the procedure were recorded. Patients were divided and evaluated into groups according to etiology. Categorical data were analyzed by using the Pearson chi-square test. RESULTS: In total, 31 patients (19 boys, 12 girls; age range = 2 months-18 years; mean age = 7.4 ± 6.01 years) and 42 procedures were included in the study. The most common underlying diseases were ureteropelvic junction obstruction (16 stents, 38.1%) and vesicoureteral reflux (13 stents, 31%). The technical and clinical success rates were 97.6% and 90%, respectively. Clinical failure (10%) was not related to gender, underlying diseases, and stent size (P > 0.05). Mean stent dwelling time was 96.43 ± 58.1 days. Complications were urinary tract infection (two procedures), stent migration (two procedures), early occlusion (one procedure), and contrast material leak after balloon dilation (one procedure). The complication rate was 14.6%. No procedure-related death was observed. CONCLUSION: PAUS through the nephrostomy route in children is an effective and reliable method when surgical treatment is not feasible.

Percutaneous antegrade ureteral stent placement: single center experience.

PURPOSE: We aimed to present our clinical experience with percutaneous antegrade ureteral stent placement in a single center. METHODS: Electronic records of patients who underwent percutaneous image-guided ureteral stent placement between September 2005 and April 2017 were reviewed. A total of 461 patients (322 males, 139 females; age range, 19-94 years; mean age, 61.4±15 years) were included in the study. Patients were classified into two main groups: those with neoplastic disease and those with non-neoplastic disease. Failure was defined as persistence of high level of serum creatinine or an inability to place stents percutaneously. Postprocedural complications were grouped as percutaneous nephrostomy and stent placement related complications. RESULTS: A total of 727 procedures in 461 patients were included in the study: 654 procedures (90%) in 407 patients (88.3%) were in the neoplastic group and 73 procedures (10%) in 54 patients (11.7%) were in the non-neoplastic group. Our technical success rates were 97.7% and 100% and complication rates were 3.1% and 4.1% in neoplastic and non-neoplastic groups, respectively. Seven stents retrievals and 112 balloon dilatations were performed successfully. CONCLUSION: Percutaneous antegrade ureteral stent placement is a safe and effective method for management of ureteral injuries and obstructions due to both malignant and benign causes when the retrograde approach has failed.

The association between gallstone disease and plaque in the abdominopelvic arteries.

BACKGROUND: The aim of this study was to assess the atheromatous plaque, in the abdominopelvic arteries as a marker of cardiac risk in patients with or without gallstone disease (GD). MATERIALS AND METHODS: A total of 136 patients were enrolled in this cross-sectional study. Forty-eight patients had GD and the remaining 88 patients did not. The presence or absence of gallstones was noted during abdominal ultrasonography while vascular risk factors such as plaque formation, intima-media thickness, plaque calcification, mural thrombus, stenosis, aneurysm, and inflammation were recorded during an abdominopelvic computed tomography scan. In addition, percentage of the abdominopelvic aorta surface covered by atheromatous plaque was calculated. RESULTS: The mean age of patients with GD and without GD was 50.81 ± 16.20 and 50.40 ± 12.43, respectively. Patients with GD were more likely to have diabetes mellitus, a higher body mass index (BMI) (P < 0.001), and higher cholesterol (P < 0.01), and low-density lipoprotein-cholesterol (P < 0.02) levels. No significant differences were found between the groups regarding other atherosclerotic risk factors. Patients with GD had significantly higher rates of the vascular risk factors as intima-media thickness, plaque formation, calcification, aneurysm, mural thrombosis, stenosis, and inflammation in all abdominal arterial segments other than aneurysm in the femoral arteries. In addition, patients with GD had severe atheromatous plaques in the abdominal aorta, common iliac, external iliac, and common femoral artery (CFA). In patients with GD, parameters of age, BMI, and systolic and diastolic blood pressure were all correlated with the severity of the atheromatous plaque in abdominal aorta, common iliac, external iliac, and CFA. CONCLUSION: We demonstrated a direct relationship between GD and abdominopelvic atheromatous plaque, which is a marker for increased cardiovascular risk, for the first time in the literature. Patients with GD exhibit greater abdominopelvic atherosclerosis and therefore, have a higher risk of cardiovascular disease.