Successful pneumatic dilation of achalasia in pregnancy

Pulanić, Ronald; Kalauz, Miro; Opačić, Milorad; Rustemović, Nadan; Brkić, Tomislav

doi:10.1016/j.dld.2008.02.038

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…Data on endoscopic therapies for achalasia during pregnancy consist of one case report of botulinum injec tion 101 and three case reports of balloon dilatation (Supple mentary Table 4 online). [102][103][104] In one pregnancy, botulinum injection for severe weight loss due to progressive dysphagia was successfully performed without maternal complications. The mother rapidly gained weight after the procedure and a healthy baby was born near term with no evident neuromuscular blockade.…”

Section: Weak Indicationsmentioning

confidence: 99%

Risks versus benefits of gastrointestinal endoscopy during pregnancy

Cappell

2011

Nat Rev Gastroenterol Hepatol

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Although gastrointestinal endoscopy is generally safe, its safety must be separately analyzed during pregnancy with regard to fetal safety. Fetal risks from endoscopic medications are minimized by avoiding FDA category D drugs, minimizing endoscopic medications, and anesthesiologist attendance at endoscopy. Esophagogastroduodenoscopy seems to be relatively safe for the fetus and may be performed when strongly indicated during pregnancy. Despite limited clinical data, endoscopic banding of esophageal varices and endoscopic hemostasis of nonvariceal upper gastrointestinal bleeding seems justifiable during pregnancy. Flexible sigmoidoscopy during pregnancy also appears to be relatively safe for the fetus and may be performed when strongly indicated. Colonoscopy may be considered in pregnant patients during the second trimester if there is a strong indication. Data on colonoscopy during the other trimesters are limited. Therapeutic endoscopic retrograde cholangiopancreatography seems to be relatively safe during pregnancy and should be performed for strong indications (for example, complicated choledocholithiasis). Endoscopic safety precautions during pregnancy include the performance of endoscopy in hospital by an expert endoscopist and only when strongly indicated, deferral of endoscopy to the second trimester whenever possible, and obstetric consultation.

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Section: Weak Indicationsmentioning

confidence: 99%

Risks versus benefits of gastrointestinal endoscopy during pregnancy

Cappell

2011

Nat Rev Gastroenterol Hepatol

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“…La dilatation pneumatique endoscopique est le traitement le plus souvent proposé. Son but est de dilacérer les fibres musculaires du SIO [9,10]. Dans 80 % des cas, une seule séance est suffisante.…”

Section: Discussionunclassified

“…La dilatation endoscopique se fait à l'aide de ballonnets calibrés avec augmentation progressive de diamètre (de 30 à 40 mm). Cette dilatation se fait sous un contrôle scopique, ce qui limite cette technique chez la femme enceinte [8,10]. La cardiomyotomie extramuqueuse de Heller représente le traitement chirurgical de l'achalasie de l'oesophage dans le but de diminuer la pression du SIO.…”

Section: Discussionunclassified

“…La cardiomyotomie extramuqueuse de Heller représente le traitement chirurgical de l'achalasie de l'oesophage dans le but de diminuer la pression du SIO. Il s'agit de sectionner longitudinalement les fibres musculaires au niveau du cardia jusqu'à 1 à 2 cm vers l'estomac [10]. Quelques cas de récidive d'achalasie durant les grossesses ultérieures sont rapportés dans la littérature, même après traitement chirurgical de l'achalasie durant la première grossesse [5,6].…”

Section: Discussionunclassified

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et al. 2012

Feuillets de Radiologie

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“…Pneumatic dilation has been a viable option for the treatment of achalasia at any gestational age. 5 This modality does not pose any risk to the fetus. However, it could be complicated by esophageal rupture, which may require an open surgery.…”

Section: Discussionmentioning

confidence: 99%

Treatment of severe achalasia during pregnancy with esophagoscopic injection of botulinum toxin A: a case report

et al. 2009

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A pregnant Thai woman presented with progressive dysphagia starting from the gestational age of 18 weeks. Total parenteral nutrition was administered at 33 weeks of gestation due to severe malnutrition. The fetus was found to be growth restricted. Preliminary diagnosis was esophageal achalasia. Diagnostic and treatment options, including early delivery followed by surgical intervention, temporizing pneumatic dilation and intrasphincteric botulinum toxin injection, were discussed before endoscopic examination. The patient preferred temporizing treatments to prolong the pregnancy and to allow for an improvement of her nutritional status to facilitate postpartum recovery. Marked dilatation of the esophagus was found during esophagoscopy. Therefore, local injection of 80 U of botulinum toxin A was chosen over balloon dilation. The swallowing function improved soon after the treatment. The patient and the fetus started to gain weight. Subsequent sonographic examinations did not show any evidence of botulinum toxicity in the fetus. The baby was born at 36 weeks of gestation with an active respiration and preserved muscle tones. Breast-feeding was withheld. The patient remained asymptomatic for at least 6 weeks after delivery. There have been reports of an intentional use of botulinum toxin in selected cases of unremitting movement disorder during pregnancy. No deleterious effects to the mothers or the babies were found in local injection with limited dosage after the first trimester. The authors cannot encourage the routine administration of this neurotoxin for the treatment of achalasia during pregnancy. However, this report provides additional information of botulinum toxin use in pregnant women. Journal of Perinatology (2009) 29, 637-639; doi:10.1038/jp.2009 Keywords: achalasia; botulinum toxin; pregnancy Case report A 39-year-old Thai pregnant woman, G5P2-0-2-2, was referred to our hospital at 33 weeks of gestation due to progressive dysphagia. The symptom started from 18 weeks of gestation. Her first two children were delivered by low transverse Cesarean section. On admission, she had lost 9 kg, and severe malnutrition and dehydration were observed. Fetal weight estimation was 1400 g, which indicates fetal growth restriction (10th percentile).1 Her symptoms were suggestive of esophageal achalasia. Total parenteral nutrition was administered immediately. Diagnostic and treatment options were discussed before endoscopic examination. This included an early delivery of the growth-restricted fetus after steroids administration. The patient could have either definitive or palliative surgical treatments afterward. Temporizing interventions to improve the nutritional status of the fetus and herself were also discussed. The options were pneumatic dilation and intrasphincteric botulinum toxin injection. The temporizing options could prolong the pregnancy, so that the baby would be less likely to suffer from the complications of prematurity. As the route of delivery would be by Cesarean section, the improved nutritional sta...

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Successful pneumatic dilation of achalasia in pregnancy

Cited by 8 publications

References 6 publications

Risks versus benefits of gastrointestinal endoscopy during pregnancy

Risks versus benefits of gastrointestinal endoscopy during pregnancy

Vomissement gravidique

Treatment of severe achalasia during pregnancy with esophagoscopic injection of botulinum toxin A: a case report

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