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Ando Y, Hashimoto K, Sano A, Fujita N, Yanagawa R, Ono Y, Obuchi Y, Tatsushima D, Watanabe S, Tomifuji M, Tanaka Y. Frequent occurrence of postbreakfast syncope due to carotid sinus syndrome after surgery for hypopharyngeal cancer: A case report. Medicine (Baltimore) 2021; 100:e25959. [PMID: 34011078 PMCID: PMC8137094 DOI: 10.1097/md.0000000000025959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of frequent syncopal episodes after laryngopharyngectomy for hypopharyngeal cancer. As all syncopal episodes were observed during the forenoon, we also evaluated the heart rate variability using ambulatory electrocardiography to determine why the syncopal episodes occurred during a specified period of the day. PATIENT CONCERNS A 73-year-old Japanese man who underwent laryngopharyngectomy for recurrent hypopharyngeal cancer started experiencing frequent episodes of loss of consciousness that occurred during the same time period (10:00-12:00). He had never experienced syncopal episodes before the operation. From 23 to 41 days postoperatively, he experienced 9 syncopal episodes that occurred regardless of his posture. DIAGNOSES Pharyngo-esophagoscopy revealed an anastomotic stricture between the free jejunum graft and the upper esophagus. Swallowing videofluoroscopy confirmed the dilatation of the jejunal autograft and a foreign body stuck on the oral side of the anastomosis. Contrast-enhanced computed tomography revealed that the carotid artery was slightly compressed by the edematous free jejunum. The patient was diagnosed with carotid sinus syndrome (CSS) as the free jejunum was dilated when consuming breakfast, which may have caused carotid sinus hypersensitivity and induced a medullary reflex. INTERVENTIONS Administration of disopyramide was effective in preventing syncope. Heart rate variability analysis using ambulatory electrocardiography showed that parasympathetic dominancy shifted to sympathetic dominancy during 10:00 to 12:00. The significant time regularity of the syncopal episodes may have been affected by modified diurnal variation in autonomic tone activity. OUTCOMES After the surgical release and re-anastomosis of the pharyngoesophageal stenosis via an open-neck approach, no recurrent episodes of syncope were reported. LESSONS We reported a case of frequent syncopal episodes limited to the forenoon due to CSS after surgery for hypopharyngeal carcinoma. The patient was treated with anticholinergics followed by the release and re-anastomosis of the pharyngoesophageal stenosis. When syncope occurs after surgery for head and neck lesions, CSS due to postoperative structural changes should be considered as a differential diagnosis of syncope.
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Affiliation(s)
- Yuya Ando
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Azusa Sano
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Naoya Fujita
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Rempei Yanagawa
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Yasuhiro Obuchi
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Daisuke Tatsushima
- Department of Otolaryngology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Shun Watanabe
- Department of Otolaryngology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
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Savarino E, di Pietro M, Bredenoord AJ, Carlson DA, Clarke JO, Khan A, Vela MF, Yadlapati R, Pohl D, Pandolfino JE, Roman S, Gyawali CP. Use of the Functional Lumen Imaging Probe in Clinical Esophagology. Am J Gastroenterol 2020; 115:1786-1796. [PMID: 33156096 PMCID: PMC9380028 DOI: 10.14309/ajg.0000000000000773] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The functional lumen imaging probe (FLIP) measures luminal dimensions using impedance planimetry, performed most often during sedated upper endoscopy. Mechanical properties of the esophageal wall and opening dynamics of the esophagogastric junction (EGJ) can be objectively evaluated in esophageal motor disorders, eosinophilic esophagitis, esophageal strictures, during esophageal surgery and in postsurgical symptomatic states. Distensibility index, the ratio of EGJ cross sectional area to intraballoon pressure, is the most useful FLIP metric. Secondary peristalsis from balloon distension can be displayed topographically as repetitive anterograde or retrograde contractile activity in the esophageal body, similar to high-resolution manometry. Real-time interpretation and postprocessing of FLIP metadata can complement the identification of esophageal outflow obstruction and achalasia, especially when findings are inconclusive from alternate esophageal tests in symptomatic patients. FLIP can complement the diagnosis of achalasia when manometry and barium studies are inconclusive or negative in patients with typical symptoms. FLIP can direct adequacy of disruption of the EGJ in achalasia when used during and immediately after myotomy and pneumatic dilation. Lumen diameter measured using FLIP in eosinophilic esophagitis and in complex strictures can potentially guide management. An abbreviated modification of the Grading of Recommendations Assessment, Development, and Evaluation was used to determine the quality of available evidence and recommendations regarding FLIP utilization. FLIP metrics that are diagnostic or suggestive of an abnormal motor pattern and metrics that define normal esophageal physiology were developed by consensus and are described in this review.
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Affiliation(s)
| | | | | | | | | | | | | | - Rena Yadlapati
- University of California in San Diego, La Jolla, California, USA
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Jo YS, Cha JH, Kim YK, Kim SY, Lee HS. Simultaneous double balloon dilatation using double channel therapeutic endoscope in patients with cricopharyngeal muscle dysfunction: An observative study. Medicine (Baltimore) 2020; 99:e21793. [PMID: 32871899 PMCID: PMC7458264 DOI: 10.1097/md.0000000000021793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (β = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.
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Affiliation(s)
- Yong Seob Jo
- Department of Physical Medicine and Rehabilitation, Myongji Hospital
| | - Jung Hyun Cha
- Department of Physical Medicine and Rehabilitation, Myongji Hospital
| | - Yong Kyun Kim
- Department of Physical Medicine and Rehabilitation, Myongji Hospital
| | - Sun Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang
| | - Hong Sub Lee
- Department of Internal medicine, Inje University Busan Paik Hospital, Busan, Korea
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium; Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
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Triggs JR, Carlson DA, Beveridge C, Jain A, Tye MY, Kahrilas PJ, Pandolfino JE. Upright Integrated Relaxation Pressure Facilitates Characterization of Esophagogastric Junction Outflow Obstruction. Clin Gastroenterol Hepatol 2019; 17:2218-2226.e2. [PMID: 30708108 PMCID: PMC6663640 DOI: 10.1016/j.cgh.2019.01.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Under the Chicago Classification of esophageal motility disorders, esophagogastric junction outflow obstruction (EGJOO) includes a varied clinical spectrum that results in diagnostic and management difficulties. We aimed to demonstrate that including upright swallows during high-resolution manometry (HRM) helps identify patients with clinically significant EGJOO. METHODS We performed a retrospective study of consecutive patients diagnosed with EGJOO on HRM from January 2015 through July 2017. HRM studies included 10 supine and 5 upright 5-ml liquid swallows. HRM values, esophagrams, and patient-reported outcomes were evaluated to identify factors associated with objective EGJOO (defined by esophagram) and symptomatic dysphagia (brief esophageal dysphagia questionnaire scores, >10). RESULTS Of the 1911 patients who had HRM during the study period, 16.2% (310) were diagnosed with EGJOO; 155 patients completed an esophagram and 227 completed the brief esophageal dysphagia questionnaire. Of these patients, 30.3% (47/155) had radiographic evidence of EGJOO and 52.4% (119/227) had symptomatic dysphagia. The median upright integrated relaxation pressure for patients with radiographic evidence of EGJOO or symptomatic dysphagia was higher than for patients without. An upright integrated relaxation pressure >12 mmHg identified patients with radiographic evidence of EGJOO with 97.9% sensitivity and 15.7% specificity; for symptomatic dysphagia these values were 88.2% and 23.1%, respectively. CONCLUSION An upright integrated relaxation pressure of >12 mmHg identifies patients with clinically significant esophageal outflow obstruction or dysphagia with a high level of sensitivity. This simple manometric maneuver (upright swallows) should be added to the standard manometric protocol.
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Affiliation(s)
- Joseph R Triggs
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Dustin A Carlson
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Claire Beveridge
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anand Jain
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Y Tye
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter J Kahrilas
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John E Pandolfino
- Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Yoneyama F, Sato F, Tokunaga C, Sakamoto H, Enomoto Y, Watanabe Y, Hiramatsu Y. Postoperative Dysphagia in Debranching Thoracic Endovascular Aortic Repair with Retroesophageal Carotid-Carotid Bypass. Ann Vasc Surg 2017; 43:315.e1-315.e4. [PMID: 28479429 DOI: 10.1016/j.avsg.2017.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/15/2016] [Accepted: 01/12/2017] [Indexed: 11/18/2022]
Abstract
A carotid-carotid bypass is commonly used in debranching thoracic endovascular aortic repair. When the bypass graft is placed in the retroesophageal position, the esophagus may be compressed by the graft from behind. Therefore, dysphagia may occur postoperatively as a serious complication. To avoid this issue, we recommend placing the bypass graft below the cricoid cartilage.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Fujio Sato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiharu Enomoto
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yutaka Watanabe
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Abstract
Purpose: The purpose was to investigate the manometric characteristics in patients with lower esophageal rings or strictures with special reference to food impaction. Material and Methods: The material comprised 344 patients (158 female and 186 male). Lower esophageal rings or strictures were diagnosed radiologically by the full column technique. Manometry was performed with triple lumen catheters connected to a hydraulic capillary system and external transducers. Results: Forty patients had rings, and 21 patients strictures. The reference group comprised 283 patients. Dysphagia was seen most frequently in patients with rings. Food impaction was seen only in patients with rings or strictures, whereas chest pain and heartburn appeared with the same incidence in all 3 groups. Non-specific motor disorders were seen most frequently in patients with strictures, but as delayed esophageal emptying with no influence on the tendency to food impaction. Only ring diameter, but not stricture diameter, was of any significance with a higher incidence of food impaction in patients with narrow rings. Conclusion: Radiology rather than manometry should be the first diagnostic step in patients with benign dysphagia suffering from food impaction.
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Affiliation(s)
- L Røhl
- Department of Radiology R, Aarhus University Hospital, Denmark
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8
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Colizzo JM, Clayton SB, Richter JE. Intrabolus pressure on high-resolution manometry distinguishes fibrostenotic and inflammatory phenotypes of eosinophilic esophagitis. Dis Esophagus 2016; 29:551-7. [PMID: 25913144 DOI: 10.1111/dote.12360] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this investigation was to determine the motility patterns of inflammatory and fibrostenotic phenotypes of eosinophilic esophagitis (EoE) utilizing high-resolution manometry (HRM). Twenty-nine patients with a confirmed diagnosis of EoE according to clinicopathological criteria currently being managed at the Joy McCann Culverhouse Swallowing Center at the University of South Florida were included in the retrospective analysis. Only patients who completed HRM studies were included in the analysis. Patients were classified into inflammatory or fibrostenotic subtypes based on baseline endoscopic evidence. Their baseline HRM studies prior to therapy were analyzed. Manometric data including distal contractile integral, integrated relaxation pressure, and intrabolus pressure (IBP) values were recorded. HRM results were interpreted according to the Chicago Classification system. Statistical analysis was performed with SPSS software (Version 22, IBM Co., Armonk, NY, USA). Data were compared utilizing Student's t-test, χ(2) test, Pearson correlation, and Spearman correlation tests. Statistical significance was set at P < 0.05. A total of 29 patients with EoE were included into the retrospective analysis. The overall average age among patients was 40 years. Male patients comprised 62% of the overall population. Both groups were similar in age, gender, and overall clinical presentation. Seventeen patients (58%) had fibrostenotic disease, and 12 (42%) displayed inflammatory disease. The average IBP for the fibrostenotic and inflammatory groups were 18.6 ± 6.0 mmHg and 12.6 ± 3.5 mmHg, respectively (P < 0.05). Strictures were only seen in the fibrostenotic group. Of the fibrostenotic group, 6 (35%) demonstrated proximal esophageal strictures, 7 (41%) had distal strictures, 3 (18%) had mid-esophageal strictures, and 1 (6%) patient had pan-esophageal strictures. There was no statistically significant correlation between the level of esophageal stricture and degree of IBP. Integrated relaxation pressure, distal contractile integral, and other HRM metrics did not demonstrate statistical significance between the two subtypes. There also appeared no statistically significant correlation between patient demographics and esophageal metrics. Patients with the fibrostenotic phenotype of EoE demonstrated an IBP that was significantly higher than that of the inflammatory group.
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Affiliation(s)
- J M Colizzo
- Department of Internal Medicine, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
| | - S B Clayton
- Department of Internal Medicine, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
- Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
| | - J E Richter
- Department of Internal Medicine, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
- Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, Tampa, Florida, USA
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Bertolini R, Meyenberger C, Putora PM, Albrecht F, Broglie MA, Stoeckli SJ, Sulz MC. Endoscopic dilation of complete oesophageal obstructions with a combined antegrade-retrograde rendezvous technique. World J Gastroenterol 2016; 22:2366-2372. [PMID: 26900299 PMCID: PMC4735011 DOI: 10.3748/wjg.v22.i7.2366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/03/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the combined antegrade-retrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome.
METHODS: This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation (CARD) within the last 10 years. The patients’ demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy (PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale (FOIS) (≥ level 3).
RESULTS: The cohort consisted of six patients [five males; mean age 71 years (range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up (median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing (two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery.
CONCLUSION: The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow.
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Dhar A, Close H, Viswanath YK, Rees CJ, Hancock HC, Dwarakanath AD, Maier RH, Wilson D, Mason JM. Biodegradable stent or balloon dilatation for benign oesophageal stricture: Pilot randomised controlled trial. World J Gastroenterol 2014; 20:18199-18206. [PMID: 25561787 PMCID: PMC4277957 DOI: 10.3748/wjg.v20.i48.18199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/07/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To undertake a randomised pilot study comparing biodegradable stents and endoscopic dilatation in patients with strictures.
METHODS: This British multi-site study recruited seventeen symptomatic adult patients with refractory strictures. Patients were randomised using a multicentre, blinded assessor design, comparing a biodegradable stent (BS) with endoscopic dilatation (ED). The primary endpoint was the average dysphagia score during the first 6 mo. Secondary endpoints included repeat endoscopic procedures, quality of life, and adverse events. Secondary analysis included follow-up to 12 mo. Sensitivity analyses explored alternative estimation methods for dysphagia and multiple imputation of missing values. Nonparametric tests were used.
RESULTS: Although both groups improved, the average dysphagia scores for patients receiving stents were higher after 6 mo: BS-ED 1.17 (95%CI: 0.63-1.78) P = 0.029. The finding was robust under different estimation methods. Use of additional endoscopic procedures and quality of life (QALY) estimates were similar for BS and ED patients at 6 and 12 mo. Concomitant use of gastrointestinal prescribed medication was greater in the stent group (BS 5.1, ED 2.0 prescriptions; P < 0.001), as were related adverse events (BS 1.4, ED 0.0 events; P = 0.024). Groups were comparable at baseline and findings were statistically significant but numbers were small due to under-recruitment. The oesophageal tract has somatic sensitivity and the process of the stent dissolving, possibly unevenly, might promote discomfort or reflux.
CONCLUSION: Stenting was associated with greater dysphagia, co-medication and adverse events. Rigorously conducted and adequately powered trials are needed before widespread adoption of this technology.
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Novikov VN, Lozhkina NV. [Stenting of the oesophagus and oesophageal anastomoses in the case of neoplastic stenosis]. Vestn Khir Im I I Grek 2014; 173:14-17. [PMID: 25055527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors aimed to optimize the strategy and technology of regeneration of oesophagus patency and oesophageal anastomosis in a case of tumor stenosis. Results of endoscopic correction of neoplastic stenosis of the oesophagus were studied in 244 patients, the cases of oesophagocolic anastomosis--in 12 patients and outcomes of oesophagogastric--in 8, respectively. A protection of self-expandable stents is an effective method of regeneration of enteral feeding in patients with manifested dysphagia, which is specified by the growth of malignant tumor of the oesophagus or oesophageal anastomosis. A possibility of formation of broncho-esophageal communications limits the usage of silicone tubular and steel self-expandable stents with partial coating of a funnel by special indications: a disposition of proximal border of tumor stenosis less than 3 cm from esophageal--pharyngeal passage--for the first; a necessity of fast recovery of oesophagus patency in rigid stenosis and an impossible single-stage dilatation of constriction zone--for the second. An optimal device for oesophagus and anastomosis protection is a fiber-nitinol self-expandable stent with coating. The stents with antireflux valve should be used in the case of oesophagogastric passage lesions.
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Khat'kov IE, Izrailov RE, Domrachev SA, Kononets PV, Vasnev OS, Koshkin MA. [Thoracolaparoscopic simultaneous operations on esophagus]. Khirurgiia (Mosk) 2014:45-51. [PMID: 25484150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Extirpation or subtotal resection of esophagus was performed in 14 patients by using of thoracolaparoscopic technique in terms from November 2011 to March 2014. The mean patients' age was 56 years old (27-67 years). In 10 patients indications for surgery included benign esophagus diseases such as cardiospasm stage IV (2 cases), peptic stricture (5 cases) and burn stricture (3 cases). 4 patients were operated for esophagus cancer including middle one-third cancer in 1 patient, lower one-third cancer in 3 cases. 10 patients underwent extirpation of esophagus with peristaltic gastric tube plasty. 1 patient had esophagus substituted by segment of the left colon. Esophageal anastomoses were formed on the neck (interrupted sutures were applied in 7 patients; staplers - in 3 cases). Lewis operation with intrapleural esophageal-gastric anastomosis forming was performed in 3 patients. The mean surgery duration was 579 minutes (305-710 min), mean blood loss - 141 ml (from 50 to 300 ml). Postoperative period had not complications in 8 of 14 patients. Different complications including partial failure of the anastomosis on the neck (5 cases), intrapleural anastomosis failure (1 case) were observed in 6 patients. Partial failure of the anastomosis on the neck was treated by using of therapy. All patients recovered. Patient with intrapleural anastomosis failure required additional surgery which included uncoupling of anastomosis, esophagostomy on the neck and gastrostomy forming. This patient died from recurrent myocardial infarction. Thus the authors consider that complete thoracolaparoscopic technique provides precise preparation of esophagus and stomach, adequate lymphadenectomy with minimal blood loss and operative trauma. The results after these operations are comparable with those after open interventions. Thoracolaparoscopic simultaneous operations must be applied in clinics having sufficient experience in esophagus surgery and thoracolaparoscopic technique.
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Albayrak I, Bağcacı S, Sallı A, Kucuksen S, Uğurlu H. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis. Korean J Intern Med 2013; 28:614-8. [PMID: 24009460 PMCID: PMC3759770 DOI: 10.3904/kjim.2013.28.5.614] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/23/2012] [Accepted: 09/17/2012] [Indexed: 01/18/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.
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Affiliation(s)
- Ilknur Albayrak
- Department of Physical Therapy and Rehabilitation, Beysehir Public Hospital, Konya, Turkey.
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15
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Ivanov AP, Miroshnikov BI, Iakunin SI, Pavlov PV, Kopiakov AL, Galkina NV. [Esophagoplasty in combined scarry lesions of the esophagus, laryngopharynx and the trachea in children]. Vestn Khir Im I I Grek 2013; 172:59-65. [PMID: 24640751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The experience of plasty of the pharynx and esophagus with graft of the free small intestine segment was presented in 12 children after burn stricture by the potassium permanganate. The technical aspects of operation using methods of the reconstructive vascular surgery were described. Good short-term result was obtained in all the patients. The long-term results were investigated during 15 years. It was observed, that the graft diverticulum developed by 4-7 years in 3 patients, whom repeated operation should be performed. According to the authors, the regional plasty of the esophagus by free revasculizated small intestine graft was really effective surgical supply and could be considered as the method of choice in limited scarry lesions of the pharynx and cervical esophagus, but the method should be improved.
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16
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Belevich VL, Ovchinnikov DV. [Treatment of benign esophageal stricture]. Vestn Khir Im I I Grek 2013; 172:111-114. [PMID: 24640761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The article presents an analysis of long-term experience of treatment of 128 patients with benign esophagus and esophageal anastomosis strictures in Kirov Military Medical Academy. This significant data included all possible variations of scarry esophageal strictures according their etiology, localization and the extension. The wide range of methods, which involved the different variants of bouginage, balloon dilation, stenting, electrosurgical dissection and resection of the stomach, were applied in treatment of the patients. The analysis of immediate and long-term results allowed detecting the criteria of choice and indication for use of the methods or their combination. Practical recommendations reflect the strategy of each variant of treatment and have the specific character. Possible complications and negative results of irrational application of different methods were presented. The immediate and long-term results gave evidence of the successful treatment of the patients with scarry esophagus and esophageal anastomosis strictures.
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17
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Gibadulin NV, Gibadulina IO. [The regurgitation prophylaxis after the distal esophagus resection]. Khirurgiia (Mosk) 2012:59-64. [PMID: 22678539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The clinical use of esophagogastroplasty with antireflux gastroesophageal anastomosis was analyzed basing on the data of 11 operated patients. All patients had benign strictures of the esophagus were operated on transhiatally. The long-term and early results demonstrated the efficacy of the sphincter-valve gastroesophageal anastomosis in prevention of reflux after distal esophagus resection and primary esophagogastroplasty.
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Abstract
INTRODUCTION The incidence of cicatricial carcinoma of the scarred esophagus in patients with corrosive injuries is relatively high. Therefore, the necessity to resect the diseased oesophagus was raised as opposed to carry out a simple by-pass reconstruction only. CASE REPORT A 56-year-old female patient with a past medical history of lye consumption presented with a stricture of the esophagus. She underwent resection of the diseased esophagus with mediastinal colon interposition. 28 years after surgery the patient had symptoms of progressive dysphagia and loss of weight caused by scar cancer of the esophagus. After neoadjuvant chemo-radiotherapy, resection of the remainder oesophagus was performed with free jejunal transplantation. On postoperative day 14 the patient had been discharged with no complications and good swallowing function. CONCLUSION In our case, scar cancer developed 28 years after oesophageal resection and more than 50 years after the corrosive injury. This case is another argument for simple bypass.
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MESH Headings
- Adult
- Anastomosis, Surgical
- Burns, Chemical/complications
- Burns, Chemical/etiology
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/physiopathology
- Carcinoma, Squamous Cell/surgery
- Caustics/adverse effects
- Cell Transformation, Neoplastic
- Chemotherapy, Adjuvant
- Child, Preschool
- Cicatrix/pathology
- Cicatrix/surgery
- Colon/transplantation
- Deglutition
- Esophageal Neoplasms/etiology
- Esophageal Neoplasms/physiopathology
- Esophageal Neoplasms/surgery
- Esophageal Stenosis/etiology
- Esophageal Stenosis/pathology
- Esophageal Stenosis/physiopathology
- Esophageal Stenosis/surgery
- Esophagectomy
- Female
- Humans
- Jejunum/transplantation
- Middle Aged
- Neoadjuvant Therapy/methods
- Radiotherapy, Adjuvant
- Tomography, X-Ray Computed
- Transplantation, Autologous
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Affiliation(s)
- Melinda Szabó
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika, Pécs, Hungary.
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19
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Zani A, Morini F, Paolantonio P, Cozzi DA. Not all symptoms disappear after vascular ring division: a pathophysiological interpretation. Pediatr Cardiol 2008; 29:676-8. [PMID: 17851633 DOI: 10.1007/s00246-007-9041-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 06/18/2007] [Indexed: 11/28/2022]
Abstract
Vascular rings are a group of cardiovascular lesions due to faulty embryological development derived from an abnormality of neural crest cells (cephalic neurocristopathy). In addition to peculiar symptoms due to compression on the trachea and/or the esophagus, patients with vascular rings might present further features of neural crest-related defects. We report on a case of a child with complete vascular ring, affected both by compressive symptoms and by autonomic disturbances and minor facial anomalies. The autonomic disturbances are clinical features of maturational dysautonomia and tend to disappear with aging, whereas major compressive symptoms are solved by surgery.
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Affiliation(s)
- Augusto Zani
- Pediatric Surgery Unit, University of Rome La Sapienza, Rome, Italy
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20
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Contini S, Tesfaye M, Picone P, Pacchione D, Kuppers B, Zambianchi C, Scarpignato C. Corrosive esophageal injuries in children. A shortlived experience in Sierra Leone. Int J Pediatr Otorhinolaryngol 2007; 71:1597-604. [PMID: 17716749 DOI: 10.1016/j.ijporl.2007.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/03/2007] [Accepted: 07/04/2007] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Children with caustic ingestions in developing countries are often treated at home, sometimes by traditional healers, or are referred, frequently late, to tertiary hospitals, which only seldom offer adequate endoscopic and dilatation facilities. Therefore, when dilatations are performed, the stricture is often already well established, making dilatation more difficult. The aim of this paper is to report our experience in the management of corrosive injuries in a group of children of Sierra Leone, all complaining accidental ingestion of caustic soda, many of them treated months after the ingestion. METHOD We considered all children admitted after corrosive ingestion, from November 2001 to November 2005, to the "Emergency" Surgical Center in Goderich-Freetown, Sierra Leone. In December 2005 the hospital was supplied with endoscopes and dilatation devices. The children still followed up clinically were recalled to submit them to an endoscopic follow-up and to a dilatation, if needed. RESULTS Forty children were admitted (mean age: 4.5 years): 16 (group A) after an esophageal perforation during dilatation performed elsewhere (death rate: 56%). Twenty-four children (group B) were observed after ingestion, 58% being submitted to a surgical gastrostomy. Death rate after ingestion was nil. The mean interval between ingestion and endoscopy was 8.8 months. Fifty-three dilatations were carried out in 17 children over a 3 months period. We report three perforations (17.6%) and a death rate of 5.8% (1/17). Two patients were lost to follow-up. Three patients (17.6%) did not show any improvement. Four children complained recurrent dysphagia after the first dilatation cycle. Overall, 10 children (58.8%) showed a clear-cut improvement at 6 months. CONCLUSIONS The majority of treated strictures were late, therefore difficult to dilate and at higher risk of perforation. Dilatation with Savary bougies seems safer than with balloon catheters. Recurrent strictures and a long-term dilatation treatment should be expected. Retrograde dilatations through gastrostomies should be the preferred method of treatment and surgical gastrostomies should be performed without hesitation. Esophageal replacement is unlikely in these countries, except in very few referral centres. Therefore, any effort should be made to treat caustic strictures by timely dilatation programs.
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Affiliation(s)
- Sandro Contini
- Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy.
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21
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Randjelovic T, Dikic S, Filipovic B, Gacic D, Bilanovic D, Stanisavljevic N. Short-segment jejunoplasty: the option treatment in the management of benign esophageal stricture. Dis Esophagus 2007; 20:239-46. [PMID: 17509121 DOI: 10.1111/j.1442-2050.2007.00679.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A non-dilatable benign stricture of the esophagus is a problem for the patient and always a challenge for the surgeon. The present study is intended to provide some details of surgical technique and the physiological concept that constitutes the basis for patient selection for short-segment jejunoplasty. In this study, out of 98 patients, 91 had complex stricture of the lower, and seven of the cervical esophagus. The main cause of stenosis in 60 patients (61.2%) was gastroesophageal reflux, in 34 (34.7%) post-corrosive damage, and in three (3.0%) it was other causes. All patients were treated by three methods of jejunoplasty: group I (n=54 patients) short-segment of the jejunum; group II (n=37 pts) Roux-en-Y double tract; and group III (n=7 patients) short jejunal segment on the long vascular pedicle. Intraoperative complications occurred in 17 (17.34%) of the patients. An anastomotic leak occurred only in three (3.29%) in group I and II, and 1/98 patients (1.02%) died from mediastinitis. Follow-up of functional results for up to 36 months (average 18 months) was available in 77/97 (79.3%) hospital survivors. Fifty-seven (74%) patients are satisfied with their ability to take food, postoperative reflux was completely denied by 72 (93.5%) patients. Postvagotomy diarrhea was transient and gradually subsided over the course of the first 6 months.
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Affiliation(s)
- T Randjelovic
- Department of Gastrointestinal Surgery, University Hospital Center Bezanijska Kosa, Belgrade, Serbia.
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22
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Patsilinakos SP, Antonatos DG, Spanodimos S, Nikolaou NI, Sotirellos K, Korkonikitas PI, Tsingas D. Swallow syncope in a patient with esophageal stenosis caused by an ascending aorta aneurysm: differential diagnosis from postprandial hypotension: a case report. Angiology 2007; 58:126-9. [PMID: 17351170 DOI: 10.1177/0003319706295514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Swallow syncope is usually caused by organic or functional disorders of the esophagus due to abnormal vasovagal reflex. In elderly patients this situation could be confused with postprandial hypotension. We present a case of an elderly patient who presented with swallow syncope that was caused by a waist in the midportion of esophagus induced by an ascending aorta aneurysm.
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Affiliation(s)
- S P Patsilinakos
- Cardiology Department, Konstantopoulio-Ag. Olga General Hospital, N. Ionia, Athens.
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23
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Price T, Jones SEM, Montgomery PQ. Is current UK management of oesophageal food bolus obstruction evidence based? An e-mail survey and literature review. Eur Arch Otorhinolaryngol 2007; 264:329-35. [PMID: 17333232 DOI: 10.1007/s00405-007-0260-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Accepted: 12/09/2006] [Indexed: 12/18/2022]
Abstract
There is a great deal of variation in individual management of non-sharp oesophageal food bolus obstruction in the United Kingdom. An e-mail survey of consultants and specialist registrars in ENT was carried out to establish current UK practice. A review of the published literature was under-taken to establish whether current practice is evidence based. The majority of practitioners (95%) do not proceed immediately to rigid oesophagoscopy but use antispasmodic drugs (83%), most commonly hyoscine butylbromide (Buscopan) and diazepam, to try to induce spontaneous passage of the obstruction. There is currently no evidence in the published literature to support the use of these drugs. The use of Buscopan seems to have been encouraged by a misquoted reference in a prominent ENT textbook. Better evidence is needed to establish the best form of treatment for this relatively common problem.
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Affiliation(s)
- T Price
- Norfolk and Norwich University Hospital, Norwich, UK.
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24
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Abakumov MM, Pinchuk TP, ll'iashenko LG. [Is antisecretory therapy of patients with chemical burn of the esophagus mandatory?]. Khirurgiia (Mosk) 2007:20-4. [PMID: 17426684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Intragastric pH-metry and esophagogastroduodenoscopy has been performed in 64 patients with chemical burn of the esophagus. It has been revealed that 51.6% patients had hyperacidity, 25% - normacidity, and 23.4% - hypoacidity. Gastroesophageal reflux has been diagnosed in 50% patients according to pH-metry examination and in 80-100% patients according to esophagogastroduodenoscopy, duodenogastric reflux - in 25 and 34.4% cases, respectively. A direct correlation exists between gastroesophageal reflux and basal gastric acidity, severity of chemical burn of the esophagus. It is concluded that antisecretory therapy is mandatory in complex treatment of patients with chemical burn of the esophagus.
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25
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Moyer MT, Stack BC, Mathew A. Successful recovery of esophageal patency in 2 patients with complete obstruction by using combined antegrade retrograde dilation procedure, needle knife, and EUS needle. Gastrointest Endosc 2006; 64:789-92. [PMID: 17055876 DOI: 10.1016/j.gie.2006.06.081] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Accepted: 06/20/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Esophageal occlusion is typically caused by cancer or postradiation changes; it is difficult to treat, with poor surgical outcomes. The combined antegrade retrograde dilation (CARD) method has been used to endoscopically restore the esophageal lumen after complete occlusion by cancer or postradiation changes, with good preliminary results. Reproducing this technique and improving its speed and convenience would be advances in treating this difficult clinical problem. OBJECTIVE A demonstration of 2 alternative endoscopic techniques for treating complete esophageal obstructions. DESIGN The CARD method was performed in 2 patients with unresectable cancer and complete esophageal occlusion. In the first patient, a needle knife was used to cut through the obstruction, instead of removing it piecemeal with biopsy forceps before over-the-wire dilation. In the second patient, an EUS needle was used to cross a particularly long obstruction, which allowed subsequent dilation and recanalization. SETTING A tertiary referral center. PATIENTS Two patients with complete esophageal obstruction secondary to head and neck cancer, with associated radiation therapy. RESULTS In both cases, this method resulted in successful recanalization of the occluded lumen in a relatively short amount of time, without complications. LIMITATIONS The small number of patients in this series. CONCLUSIONS The CARD needle-knife method may be a safe, effective, and efficient approach to complete esophageal occlusion. In addition, the CARD-EUS needle method may be an preferable technique to cross long obstructions quickly; however, more experience will be required.
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Affiliation(s)
- Matthew T Moyer
- Division of Gastroenterology and Hepatology, Pennsylvania State University Hospital, Hershey Medical Center, Hershey, Pennsylvania 17078, USA
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26
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Seidl RO, Todt I, Ernst A. Esophagus atresia after cervical spine surgery: case report and literature review. Eur Arch Otorhinolaryngol 2006; 264:291-3. [PMID: 17021777 DOI: 10.1007/s00405-006-0171-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 08/03/2006] [Indexed: 10/24/2022]
Abstract
We report on a case of esophageal atresia following cervical spine surgery. A swallowing examination was performed using fibre-optic endoscopy and videofluoroscopy. There was scar tissue fixation of the larynx and esophagus to the cervical spine. Operative mobilization of the larynx and esophagus and formation of a sliding layer using a platysma-fascia flap was done. The PEG and tracheal cannula were removed; oral nutrition was initiated after 3 months. Swallowing disorders following operations on the upper cervical spine should be investigated. Careful preparation that preserves the layers should be carried out. Fixation of tissues as a result of scarring should be treated with a sliding layer.
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Affiliation(s)
- Rainer O Seidl
- Department of Otolaryngology, Head and Neck Surgery at UKB, Free University of Berlin, 12683, Berlin, Germany.
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Abstract
Short esophagus and peptic esophageal stricture are complications of chronic severe GERD. Short esophagus is properly diagnosed by an objective,intraoperative assessment after appropriate dissection of the GEJ. A laparoscopic Collis gastroplasty combined with an antireflux procedure comprises effective therapy. Peptic stricture should be addressed with an initial course of dilator therapy and optimization of antiacid medication. Consideration is given to an antireflux procedure if conservative therapy fails. Laparoscopic techniques have proven to be safe and effective in treating short esophagus and peptic stricture.
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Affiliation(s)
- Chuong D Hoang
- Section of General Thoracic Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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28
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Shim CS, Jung IS, Cheon YK, Ryu CB, Hong SJ, Kim JO, Cho JY, Lee JS, Lee MS, Kim BS. Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endoscopy 2005; 37:335-9. [PMID: 15824943 DOI: 10.1055/s-2005-861113] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND STUDY AIMS When stents are placed across the esophagogastric junction for palliative treatment of malignant strictures, they may lead to esophagogastric reflux. The aim of this study was to compare the effectiveness of a newly designed antireflux stent with that of a standard open stent and a currently available antireflux stent (Dostent) in preventing gastroesophageal reflux symptoms in patients with inoperable cancer at the esophagogastric junction. PATIENTS AND METHODS Thirty-six consecutive patients with cancer at the esophagogastric junction were randomly assigned to undergo placement of a newly designed antireflux stent (n = 12), a Dostent (n = 12), or a standard open stent (n = 12). Technical and clinical success, dysphagia score, reflux symptoms, complications and ambulatory 24-h esophageal pH monitoring were assessed. RESULTS The technical success rates were 100 %. After 1 week, dysphagia had improved in all patient groups ( P < 0.05), but the degree of improvement did not differ between the three groups. The DeMeester score was significantly lower in the group with the newly designed antireflux stent than in the other groups. The fraction of the total recording time during which esophageal pH was below 4 was 3.14 +/- 5.78 % using the newly designed antireflux stent, in comparison with 29.25 +/- 15.41 % in the Dostent group and 15.01 +/- 11.72 % in the standard open stent group ( P < 0.001). Fewer reflux episodes occurred with the newly designed antireflux stent than with the Dostent or standard open stent. There were no complications with any of the three stents. CONCLUSIONS The newly designed antireflux stent is effective in relieving dysphagia caused by malignant cancer at the esophagogastric junction. The newly designed antireflux stent is significantly more effective in preventing gastroesophageal reflux than currently available antireflux stents.
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Affiliation(s)
- C S Shim
- Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, South Korea
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29
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Abstract
In the first part of the article we described diagnostic methods aiming to resolve the individual underlying pathomechanism of chronic swallowing disorders (dysphagia). From these, we deducted different therapeutic measures that can be applied either alone or in combination. Weakening of the upper esophageal sphincter with botulinum toxin is reserved for patients with structural stenosis or a relative hyperfunction of the sphincter. It can be tried to use the "Passy-Muir Valve" for tracheostomized patients that aspirate. Most cases benefit from a therapy that consists of specific exercises. "Restitution" relies on exercises to practice new movement patterns as well as improvement of muscle strength. "Compensation" is based on exercises to counteract structural and/or functional deficits. Through "adaptation" residual, therapy resistant disease can be alleviated through dietary planning of consistency, temperature, and nutrient content of food. In many cases it is necessary to combine "restitution", "compensation", and "adaptation".
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Affiliation(s)
- R Schönweiler
- Abteilung für Phoniatrie und Pädaudiologie (in der HNO-Klinik), Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
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30
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Abstract
Ingestion of corrosive substances can lead to strictures of the esophagus and stomach. Cicatrization of the lower part of the esophagus can entrap vagal fibers in the process of fibrosis. The aim of the present study was to evaluate gallbladder dysfunction as a sequel to vagal damage in patients with corrosive-induced esophageal strictures. The cephalic phase of gallbladder emptying was stimulated by modified sham feeding according to the chew-and-spit method. Gallbladder volume was measured by ultrasonography using the ellipsoid method after an overnight fast and every 15 min for a period of 90 min after sham feeding in 22 patients and 10 controls. Mean fasting gallbladder volume was significantly greater in patients than in controls (22.09 +/- 9.78 vs. 14.61 +/- 4.42 ml; P = 0.025). After sham feeding the gallbladder ejection fraction was significantly lower in patients than in controls (32.86 +/- 17.21 vs. 49.40 +/- 7.86%; P = 0.007). Patients with cicatrization in the distal one-third of the esophagus had a greater basal gallbladder volume (24.57 +/- 9.2 ml) and significantly lower ejection fraction (20.47 +/- 8.9%) than patients with strictures at other sites (gallbladder volume, 18.50 +/- 10.69 ml; ejection fraction, 47.48 +/- 13.3%; P = 0.001). In conclusion, patients with corrosive-induced esophageal strictures, especially those in the distal one-third, had an increased fasting gallbladder volume and decreased cephalic phase of gallbladder emptying, pointing to impaired vagal cholinergic transmission, possibly due to vagal entrapment in the cicatrization process.
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Affiliation(s)
- Bilal A Khan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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31
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Da-Costa-Pinto EAL, Dorsa TK, Altimani A, Andreollo NA, Cardoso SR, Morais DJ, Bustorff-Silva JM. A functional study of caustic strictures of the esophagus in children. Braz J Med Biol Res 2004; 37:1623-30. [PMID: 15517076 DOI: 10.1590/s0100-879x2004001100005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to assess esophageal motor function in 21 children (7.5 +/- 2.9 years) with caustic strictures. Esophageal manometry was performed using a water-infusion system interfaced with a polygraph and displayed on a computer screen. The data were compared with those obtained from 9 healthy children. Radionuclide transit was determined by studying deglutition of a single bolus of 99mTc pertechnetate in 10 ml of water. Non-peristaltic low-amplitude and long-duration waves were the most common findings detected in patients with strictures longer than 20% of esophageal length (N = 11). Compared with the control group, these patients presented lower mean amplitude and longer mean duration of waves (24.4 +/- 11.2 vs 97.9 +/- 23.7 mmHg, P < 0.05, and 6.7 +/- 2.4 vs 1.6 +/- 0.1 s, P < 0.05, respectively). Six patients presented low-amplitude waves just below the constricted site. Ten children presented delayed esophageal transit. There was an association between dysphagia and abnormalities on manometry (P = 0.02) and between symptoms and scintigraphy data (P = 0.01). Dysphagia in caustic strictures is due to esophageal motility abnormalities, which are closely related to the scarred segment.
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Affiliation(s)
- E A L Da-Costa-Pinto
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de CampinasCampinas, SP, Brasil.
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32
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Abstract
Cicatricial pemphigoid is a rare, autoimmune, blistering disorder affecting the mucous membranes and skin. Esophageal involvement affects a small proportion of affected individuals and may present up to 10 years after the initial onset of the disease. We present a case of esophageal cicatricial pemphigoid that presented initially as linear IgA disease. We describe the successful treatment of dysphagia by graded esophageal dilatations.
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Affiliation(s)
- W-K Syn
- Gastroenterology Department, Department of Medicine, Good Hope Hospital, Birmingham, UK.
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33
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Abstract
Eosinophilic esophagitis (EE) is a rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa The hallmark of this condition is intermittent and often painful dysphagia that may become constant as the disease progresses. It was initially included within the more general condition known as eosinophilic gastroenteritis but it is now considered an independent entity. Attwood et al. called attention to eosinophilic esophagitis as a distinct clinical condition in 1993. Although eosinophilic esophagitis was thought to occur primarily in children, a significant body of evidence suggests that it affects adults as well. We describe a clinical case of a young woman with a long-standing history of dysphagia affected of this rare entity.
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Affiliation(s)
- Maria L Ruiz-Rebollo
- Gastroenterology Unit, Hospital Comarcal de Medina del Campo, Valladolid, Spain.
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34
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Abstract
OBJECTIVE We evaluated the ability of endoscopic ultrasonography to predict likelihood of stricture formation in patients with corrosive esophagitis. METHODS Consecutive patients with esophagitis resulting from alkaline or acid chemical ingestion (n = 11) were evaluated prospectively by endoscopic ultrasonography between hospital days 4 and 12. Findings for the most severe lesion were classified according to the appearance of the muscular layers: distinct muscular layers without thickening (grade 0); distinct muscular layers with thickening (grade I); obscured muscular layers with indistinct margins (grade II); and muscular layers that could not be differentiated (grade III). Findings were also classified according to whether apparent damage to muscular layers in the worst-appearing image involved part of the circumference (type a) or the whole circumference (type b). Implications of these findings for subsequent stricture formation were then evaluated. RESULTS Stricture formation did not occur in patients with grade 0 or grade I images; transient stricture formation occurred in a patient showing grade IIa. Stricture requiring repeated bougie dilation occurred in a patient showing grade IIIb. CONCLUSIONS Endoscopic ultrasonographic images presumed to reflect the destruction of muscular layers (grades II to III), as opposed to only edema (grade I), may be associated with stricture formation. This modality can accurately visualize deep lesions in corrosive esophagitis, making it prognostically useful.
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Affiliation(s)
- Yoshito Kamijo
- Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine, Kanagawa, Japan
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35
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Abstract
BACKGROUND/PURPOSE Congenital esophageal stenosis (CES) is a rare condition that is associated with various foregut symptoms. The aim of the current study was to investigate esophageal motor function in pediatric patients with isolated CES. METHODS Four boys with CES (age, 3 weeks to 4 years old) were studied before treatment. The initial symptoms were dysphagia or stridor. The CES was caused by fibromuscular stenosis (FMS) in 2, tracheobronchial remnants (TBR) in 1, and membranous diaphragm (MD) in 1. An esophagram, endoscopy, 24-hour esophageal pH monitoring, and manometry were conducted. RESULTS The esophagram showed the stasis of contrast medium proximally to the distal esophageal narrowing in FMS/TBR patients. Endoscopic esophagitis was not found in any patients. Three patients were documented with pathologic esophageal acid exposure by 24-hour esophageal pH monitoring. Manometry showed that esophageal contractions predominantly were synchronous in FMS/TBR patients but were peristaltic in an MD patient. Basal lower esophageal sphincter (LES) pressure was at least 20 mm Hg in all. Swallow-induced LES relaxations were incomplete in FMS/TBR patients. CONCLUSIONS The presence of gastroesophageal reflux and impaired esophageal motility are common in patients with CES.
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Affiliation(s)
- Hisayoshi Kawahara
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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36
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Belafsky PC, Speirs J. Postswallow aspiration secondary to stenosis of the upper esophageal sphincter. Ear Nose Throat J 2003; 82:838-9. [PMID: 14661430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
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37
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Abstract
Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral stenosis and the development of esophageal carcinoma. Endoscopy should be attempted and can be safely performed in most cases to assess the extent of damage. Procedure-related perforation is rare. Stricture formation is more common in patients with second and third degree burns. Corticosteroids may help prevent stricture formation. Esophageal carcinoma may develop beginning 30 to 40 years after the time of injury.
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Affiliation(s)
- Kovil Ramasamy
- The Department of Medicine, Mount Sinai Services, City Hospital Center at Elmhurst, New York, New York, USA
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38
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Abstract
OBJECTIVE In the era of liberal proton pump inhibitor (PPI) use, benign esophageal strictures remain a significant management problem, with 30-40% of patients experiencing symptomatic recurrence within 1 yr of successful dilation. We therefore sought to examine predictors of early recurrence of benign esophageal strictures after endoscopic dilation. METHODS Predictors for stricture recurrence were examined in 87 consecutive outpatients undergoing initial dilation over a 1-yr period. Patients with symptomatic recurrence of dysphagia requiring repeat dilation within 1 yr of initial successful dilation (cases) were compared to patients who did not require redilation (controls). Predictors were assessed by univariate and multivariate analysis. Kaplan-Meier analysis of significant predictors using time to first redilation was also performed. RESULTS Of the patients, 36 required repeat dilation within 1 yr, whereas 51 did not (median follow-up, 33 months). Of all strictures, 67 (77%) were peptic, with the remainder caused by radiation, drug-related injury, or congenital stenosis, among other causes. In multivariate analysis, nonpeptic strictures were significant predictors for early recurrence, as was a narrower stricture diameter. For peptic strictures, the persistence of heartburn after dilation and the presence of a hiatal hernia were significant predictors. Of all peptic strictures, 84% of patients were on PPIs after dilation, with no difference between cases and controls. Of all patients with persistent heartburn after dilation, 90% were on PPIs. CONCLUSIONS The persistence of heartburn after dilation is a strong predictor for early symptomatic recurrence of benign esophageal peptic strictures, despite a high rate of PPI use. This may suggest persistent acid reflux requiring optimization of acid reduction therapy. Alternatively, combined acid and alkaline reflux may account for progressive injury despite PPI therapy. Esophageal pH studies may be invaluable in making the distinction between acid and non-acidic (alkaline) reflux. Nonpeptic strictures are also more likely to have early recurrences and are therefore more difficult to manage.
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Affiliation(s)
- Adnan Said
- Section of Gastroenterology and Hepatology, Department of Medicine, The University of Wisconsin Hospital, Madison, Wisconsin, USA
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39
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Shimao H. [Endoscopic stent insertion for malignant esophageal stenosis]. Nihon Naika Gakkai Zasshi 2003; 92:92-8. [PMID: 12652709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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40
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Abstract
The lower esophageal mucosal ring, or Schatzki's ring, was first described by Templeton. Anatomically, it represents the lower end of the esophagus. Patients classically present with intermittent dysphagia to solids. Diagnosis is made by endoscopy or a barium esophagram. Gastroesophageal reflux disease has been suggested as an etiology. It can usually be treated by passing a large dilator. Further controlled studies are needed to study its cause.
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Affiliation(s)
- Sajid Jalil
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Cherleston. South Carolina, USA
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41
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Koltuksuz U, Mutuş HM, Kutlu R, Ozyurt H, Cetin S, Karaman A, Gürbüz N, Akyol O, Aydin NE. Effects of caffeic acid phenethyl ester and epidermal growth factor on the development of caustic esophageal stricture in rats. J Pediatr Surg 2001; 36:1504-9. [PMID: 11584397 DOI: 10.1053/jpsu.2001.27032] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE An experimental study was performed to modify the healing response in caustic esophageal burns to prevent stricture development. Two different agents with different modes of actions, caffeic acid phenethyl ester (CAPE) and epidermal growth factor (EGF), were studied. CAPE has antiinflammatory, immunomodulatory, antioxidant, and antimitotic properties. EGF has known properties in supporting wound healing and in protecting esophagus from injuries. METHODS The model described by Gehanno and its modification by Liu was used to create standard esophageal burns with 50% NaOH. The study was performed with 76 rats in 4 main groups (sham, CAPE, EGF, and control) and 2 subgroups in each for 5 and 28 days of observation. Efficacy of treatment was assessed in 28-day subgroups by measuring weight gain, contrast esophagograms on day 27, histologic evaluation by measuring stenosis index (wall thickness/lumen diameter), and collagen deposition, and biochemically by determining tissue hydroxy proline (OHP) content. RESULTS In the end of the study, increase rates of mean body weights of the animals in the 28-day subgroups were as follows: sham, 30%; CAPE, 23%; EGF, 22%; and control, 14%. Although all the animals in subgroups significantly gained weight, the mean weight gain was significantly low in controls when compared with sham, CAPE, and EGF groups (P <.05). Contrast esophagograms on day 27 showed no stenosis in the sham, mild stenosis in CAPE and EGF, and severe stenosis with proximal dilatation in controls. Stenosis indices of the subgroups were as follows: sham, 0.29; CAPE, 0.41; EGF, 0.41; control, 0.84. Index was significantly higher in controls (P <.05). Collagen accumulation scores in the esophageal wall were as follows: Sham, 0.0; CAPE, 0.87; EGF, 0.30; control, 2.70. Scores also were significantly higher in controls (P <.05). Tissue (OHP) levels were as follows (mg/g dry tissue): Sham, 1.48; CAPE, 1.53; EGF, 1.90; control, 4.01. Production of OHP was significantly higher in controls. CONCLUSIONS The results of the parameters in the study indicate that administration of CAPE and EGF has beneficial effects in the prevention of caustic esophageal strictures. Those effects of CAPE may occur through its antiinflammatory, immunomodulatory, and antioxidant properties, and EGF may occur through its induced proliferative properties on the esophagus.
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Affiliation(s)
- U Koltuksuz
- Departments of Pediatric Surgery, Radiology, Biochemistry, and Pathology, Inönü University, School of Medicine, Malatya, Turkey
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42
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Abstract
OBJECTIVE The aim of this study was to review the long-term results of treating benign esophageal fistula and stenosis using self-expanding metal stents. METHODS We treated four patients using covered mesh or coiled stents. We removed the stents electively in two patients (one endoscopically and one during planned partial esophagectomy) and unexpectedly in one patient who developed bleeding. One stent migrated and required laparotomy for removal. RESULTS Placement of self-expanding metal stents successfully sealed the benign fistula in two patients and reestablished swallowing in two other patients with complicated achalasia. Two patients were swallowing normally on long-term follow-up, one died of the underlying disease, and one required gastrostomy. CONCLUSION Temporary use of self-expanding metal stents as a feasible option for treating benign esophageal stenosis and fistula in patients who have failed other conventional treatments.
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Affiliation(s)
- J G Lee
- Division of Gastroenterology, UC Davis Medical Center, Sacramento, California 95817, USA
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43
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Kimber RD, Roberts-Thomson IC. Gastrointestinal: Crohn's disease of the oesophagus. J Gastroenterol Hepatol 2000; 15:959. [PMID: 11022841 DOI: 10.1046/j.1440-1746.2000.02301.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- R D Kimber
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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44
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Makutani S, Yoshioka T, Uchida H, Tanaka T, Yoshimura H, Ohishi H, Iwasaki S, Ide K, Ueda K, Maeda M. [Experimental study of esophageal covered stent for prevention of migration: use of clay to simulate stenosis of the esophagogastric junction or anastomosis site]. Nihon Igaku Hoshasen Gakkai Zasshi 2000; 60:434-8. [PMID: 10965749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE An inner-covered Spiral Z-stent (IC-SZ) developed by our group was examined for its effectiveness in preventing migration by experimental comparison with commercially available esophageal covered stents. MATERIALS AND METHODS The following six types of stents were used: inner-covered Spiral Z-stents with diameters of 16 mm (small IC-SZ) and 19 mm (large IC-SZ), outer-covered Spiral Z-stent (OC-SZ), covered Wallstent, covered Ultraflex stent, and Cook Z-stent. Experimental models were prepared using clay to simulate stenosis of the esophagogastric junction or anastomosis site due to tumor, and each stent was placed in the clay. After the stent had been fully expanded with a balloon catheter, one of its ends was pulled until the stent migrated out of the clay, and the traction force was measured. The inner cavity of the stent placed in the clay was observed using an endoscope. RESULTS The mean maximal traction force required to pull the stents out of the clay were as follows, in decreasing order: 4.14 +/- 0.39 kg for the large IC-SZ, 4.12 +/- 0.83 kg for the small IC-SZ, 3.64 +/- 0.44 kg for the Cook Z-stent (p < 0.05), 3.34 +/- 0.62 kg for the covered Ultraflex stent (p < 0.05), 1.53 +/- 0.43 kg for the OC-SZ (p < 0.01), and 0.56 +/- 0.16 kg for the covered Wallstent (p < 0.01). The force required to pull out the large IC-SZ stent was the greatest, showing a significant difference from the values for the other four types of stents (excluding the small IC-SZ). Observation using an endoscope revealed that the wire of the IC-SZ stent was almost entirely embedded in the clay, whereas the wires of other stents were not. CONCLUSION The IC-SZ stent may be less likely to migrate than other esophageal covered stents.
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Affiliation(s)
- S Makutani
- Department of Radiology, Higashiosaka City General Hospital
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45
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Abstract
BACKGROUND Traditionally, mercury-filled rubber bougies are used for dilation of simple or mild-to-moderate esophageal strictures, whereas through-the-scope balloon dilators and wire-guided polyvinyl bougies have become standard for more complex strictures. Because few comparative trials are available, the choice of dilator and technique is largely based on the training and experience of the operator. METHODS We reviewed 348 esophageal dilation procedures performed on a total of 142 patients over a 4-year period (January 1, 1993, to January 1, 1997). The location and cause of stricture, the maximum diameter of the instrument used per session, the rate of perforation, and the rate of fluoroscopy use were recorded. RESULTS Maloney, balloon (hydrostatic and pneumatic type), and Savary dilations were performed in 102, 156, and 90 sessions, respectively. Perforations occurred in 4 patients. All of these perforations occurred when Maloney dilators were passed blindly into complex strictures (Fisher's exact test, p = 0.011, two-tailed). Three of these four patients had undergone endoscopy with conscious sedation immediately before the dilation. The immediate outcome of surgery was good in all 4 patients with no deaths. CONCLUSION Perforation was most commonly associated with the blind passage of Maloney bougies into complex strictures.
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Affiliation(s)
- L V Hernandez
- Department of Medicine, Section of Gastroenterology, University of Wisconsin Medical School, Milwaukee Clinical Campus, Sinai-Samaritan Medical Center, Milwaukee, Wisconsin, USA
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Dorlöchter L, Kolsrud E, Olafsdottir E, Fluge G, Rosendahl K, Hatlebakk J. [Esophageal stricture as a complication of gastroesophageal reflux in children]. Tidsskr Nor Laegeforen 2000; 120:187-9. [PMID: 10851913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
General practitioners and paediatricians often get in contact with children who present with regurgitation and vomiting. To some extent, regurgitation is a normal situation in infants during their first months of life. Abnormal gastrooesophageal reflux, however, should be diagnosed and treated adequately, as there is a risk of complications. At the Department of Paediatrics, Haukeland Hospital, Bergen we have diagnosed oesophageal strictures due to undiagnosed gastrooesophageal reflux in six children. One patient had previously been treated for gastrooesophageal reflux during infancy. The main reasons for admitting the children were dysphagia and weight loss. When the correct diagnosis had been established, the patients were treated with cisapride and omeprazole orally. Several dilatations of the strictures were performed by upper endoscopy. A Nissen's fundoplication has been performed in two patients and is probably necessary to undertake in the remaining four. Clinical awareness of gastrooesophageal reflux is important, since undiagnosed reflux carries a risk of oesophagitis and stricture formation.
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47
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Abstract
OBJECTIVE In contrast to the well-recognized Schatzki's ring, the lower esophageal muscular ring remains a poorly defined entity. The purpose of this study is to report on the clinical features of three patients with lower esophageal muscular rings and review the literature on this disorder, to better understand its importance as a cause of dysphagia. METHODS Three patients presenting to the West Roxbury VA Medical Center were identified as having a contractile, focal narrowing in the distal esophagus by upper GI series. Clinical histories were obtained and endoscopic and manometric evaluations were performed. RESULTS The three patients had symptoms consisting of chronic, intermittent dysphagia for both liquids and solids. The results of barium swallows and upper endoscopic examinations were similar and revealed a focal, thick constriction of variable luminal diameter located a few centimeters above the squamocolumnar junction. Esophageal motility testing revealed peristaltic, high-amplitude, long-duration, and multiple peaked contractions. Lower esophageal sphincter function was normal. The patients derived partial or only temporary relief of dysphagia with esophageal dilation with rigid dilators. All three patients had significant symptomatic responses to anticholinergic agents. CONCLUSIONS Lower esophageal muscular rings are an uncommon but important cause of dysphagia. Significant esophageal motility abnormalities can be found in symptomatic patients. Distinguishing the lower esophageal muscular ring from the Schatzki's ring is important because of differences in the treatment and outcome of the two conditions.
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Affiliation(s)
- I Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Medical School, Chicago, Illinois 60611, USA
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48
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Monda LA. Diagnosis and treatment of esophageal strictures. Radiol Technol 1999; 70:361-72. [PMID: 10101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Difficulty swallowing due to narrowing of the esophagus has many causes, both benign and malignant. This article examines the causes of esophageal stricture as well as its diagnosis and treatment. Radiographic examination, and in particular fluoroscopy, is key to a positive outcome for patients with this condition.
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Affiliation(s)
- L A Monda
- Diagnostic Imaging Department, United Hospital Center, Clarksburg, WVa., USA
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49
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Yoshioka K, Ando T, Inoue K, Hiraoka N, Kasamatsu Y, Yoshida T, Kondo M. Esophageal stenosis and Graves disease in brittle type 1 diabetes mellitus. Arch Intern Med 1998; 158:1380-1. [PMID: 9645838 DOI: 10.1001/archinte.158.12.1380-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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50
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Ganga-Zandzou PS, Devulder C, Michaud L, Ategbo S, Gottrand F, Debeugny P, Leclerc F, Turck D. [Long-term follow-up of children with esophageal caustic stenosis]. Arch Pediatr 1998; 5:610-6. [PMID: 9759204 DOI: 10.1016/s0929-693x(98)80162-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Long term follow-up of children with esophageal caustic stenosis is not well known. The aim of the present study was to describe functional, organic and psychological, as well as social consequences. PATIENTS AND METHODS Thirty-four children with a mean age of 3 years and 7 months +/- 3 years and 2 months (ranges: 1 month-14 years and 3 months) were included in a longitudinal study. Various parameters have been studied: treatment, functional symptoms, nutritional status (weight/height, body composition) and psychological and social consequences. chi 2 and Mann-Whitney tests were used for statistical analysis. RESULTS Twenty-one patients have been treated by mechanical dilatations whereas surgery was performed in 12 children; the mean number of dilatations per child was higher in patients treated by dilatations (21 +/- 17 vs 14 +/- 16; P < 0.05). The frequency of dysphagia was not different in patients with colon interposition or not (69% vs 53%; P = 0.1). Nutritional status was not affected by the presence of esophageal caustic stenosis. Psychological and social consequences were characterized by scholastic difficulties, anxiety and severe depression. One case of suicide was observed. CONCLUSION Children with caustic stenosis should be followed for a long period of time. A multidisciplinary approach is necessary, taking into account medical, social and psychological consequences.
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Affiliation(s)
- P S Ganga-Zandzou
- Unité de gastroentérologie, hépatologie et nutrition, Hôpital Jeanne-de-Flandre, CHRU, Lille, France
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