alexa

GET THE APP

Dersleri yüzünden oldukça stresli bir ruh haline sikiş hikayeleri bürünüp özel matematik dersinden önce rahatlayabilmek için amatör pornolar kendisini yatak odasına kapatan genç adam telefonundan porno resimleri açtığı porno filmini keyifle seyir ederek yatağını mobil porno okşar ruh dinlendirici olduğunu iddia ettikleri özel sex resim bir masaj salonunda çalışan genç masör hem sağlık hem de huzur sikiş için gelip masaj yaptıracak olan kadını gördüğünde porn nutku tutulur tüm gün boyu seksi lezbiyenleri sikiş dikizleyerek onları en savunmasız anlarında fotoğraflayan azılı erkek lavaboya geçerek fotoğraflara bakıp koca yarağını keyifle okşamaya başlar
The Efficacy Of Balloon Dilation In Achalasia Is The Result Of Stretching Of The Lower Esophageal Sphincter, Not Muscular Disruption | 81867
ISSN: 2161-069X

Journal of Gastrointestinal & Digestive System
Open Access

Like us on:

Our Group organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations
700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)
Google Scholar citation report
Citations : 1439

Journal of Gastrointestinal & Digestive System received 1439 citations as per Google Scholar report

Journal of Gastrointestinal & Digestive System peer review process verified at publons
Indexed In
  • Index Copernicus
  • Google Scholar
  • Sherpa Romeo
  • Open J Gate
  • Genamics JournalSeek
  • China National Knowledge Infrastructure (CNKI)
  • Electronic Journals Library
  • RefSeek
  • Hamdard University
  • EBSCO A-Z
  • OCLC- WorldCat
  • SWB online catalog
  • Virtual Library of Biology (vifabio)
  • Publons
  • Geneva Foundation for Medical Education and Research
  • Euro Pub
Share This Page

The efficacy of balloon dilation in achalasia is the result of stretching of the lower esophageal sphincter, not muscular disruption

11th World Gastroenterologists Summit

Fathali Borhan-Manesh, Mohammad J Kaviani and Ali R Taghavi

Shiraz University of Medical Sciences-Nemazee Hospital, Iran

Posters & Accepted Abstracts: J Gastrointest Dig Syst

DOI: 10.4172/2161-069X-C1-062

Abstract
Background: Pneumatic dilation (PD) of the lower esophageal sphincter (LES) is a major palliative treatment in achalasia. It is generally believed and frequently stated in the Gastroenterology Textbooks and Journals, that the beneficiary effect of PD in achalasia, is the result of rupture of the circumferential muscular layer of the LES, as done in Heller surgical procedure. However, the effectiveness of PD, contrary to that of Heller myotomy, is often short lived, and recurrence of dysphagia necessitates repeat PD with a larger balloon diameter (35-40 mm). Aims: The lack of durability of effectiveness of PD in achalasia and the lack of any previous study in support of the presumptive mechanism of action of PD to explain the effectiveness of this procedure, prompted the author to investigate the state and the integrity of the LES, 24 hours after PD and clarify the most likely mechanism for symptomatic relief after PD in achalasic patients. Method: To look for and detect the occurrence and the extent of any muscular disruption at the LES, 43 eligible and consenting patients with definite diagnosis of achalasia, underwent endoscopy ultra-sound, using Olympus GF-UE160 echoendoscope with an Aloka prosound probe at 7.5 MHZ, 24 hours after PD. Results: Out of 43 patients, 36 (83.7%) revealed an intact LES, 5 (11.6%) demonstrated small area of muscular disruption and 2 (4.6%) showed small hematoma. None of the investigated patients developed symptoms or signs of esophageal perforation. Conclusion: Our results convincingly demonstrate that clinical improvement from PD in achalasia is not related to rupture of the muscular layer of the LES, but is the result of circumferential stretching of the LES. One may also conclude from this study that any muscular disruption from PD in achalasia should be considered a complication of the procedure and not the intended result.
Biography
Top