1
|
Zhang M, Mao J, Xue K, Zhang Y, Ma J, Li Y, Lyu Y, Yan X. A Novel Deformable Self-Assembled Magnetic Anastomosis Ring (DSAMAR) for Esophageal Stenosis Recanalization without Temporary Gastrostomy in Beagle Dogs. J Pediatr Surg 2024; 59:1204-1209. [PMID: 37968150 DOI: 10.1016/j.jpedsurg.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/28/2023] [Revised: 09/28/2023] [Accepted: 10/14/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND To assess the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR) in the treatment of esophageal stenosis in beagle dogs via transoral access without temporary gastrostomy. METHODS Experimental esophageal stenosis was created in 10 beagle dogs by partial cervical esophageal ligation. The DSAMAR was inserted into the distal esophagus via the narrow section of the esophagus using a gastroscope. A circular DSAMAR was placed in the proximal esophagus. The magnetic rings on both sides of the experimental stenosis automatically attracted each other. We then recorded the operation time, postoperative complications, anastomotic formation time, and magnetic ring discharge time. The dogs were euthanized 4 weeks postoperatively; subsequently, we obtained the esophageal anastomotic specimens and observed the anastomotic formation via the naked eye and by light microscopy. RESULTS Our esophageal stenosis model produced reproducible stenoses in all dogs, which was confirmed via endoscopy and esophagography. DSAMAR was successfully implanted in all experimental animals under endoscopic and X-ray monitoring, and all linear DSAMARs were successfully transformed into rings. The magnets at both ends of the esophageal stenosis were automatically attracted. All animals survived until euthanasia. No complications, including esophageal perforation, bleeding, and gastrointestinal obstruction, were noted during the perioperative period. The mean operation time of endoscopic magnetic anastomosis was 15.6 ± 2.41 (range, 12-19) min. The mean esophageal anastomotic formation time was 8.8 ± 1.03 (range, 7-10) days, and the mean expulsion time of DSAMAR was 13.94 ± 2.88 (range, 10-19) days. Gastroscopy and esophagography were performed at 4 weeks postoperatively; the esophageal patency was good. Macroscopic observation of the esophageal anastomotic specimens revealed that the esophageal mucosal layer of the anastomosis had good continuity and the anastomosis was smooth. CONCLUSION DSAMAR is a feasible option for magnetic recanalization of esophageal stricture via transoral access without temporary gastrostomy.
Collapse
Affiliation(s)
- Miaomiao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China
| | - Jianqi Mao
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Kaihua Xue
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuhan Zhang
- Qide College, Xi'an Jiaotong University, Xi'an, China
| | - Jia Ma
- Department of Surgical Oncology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.
| |
Collapse
|
2
|
Tantisarasart T, Tantichamnankul T, Kitsiripant C, Choochuen P. Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report. Korean J Anesthesiol 2024; 77:278-281. [PMID: 38029795 PMCID: PMC10982525 DOI: 10.4097/kja.23722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) is vital for the diagnosis and treatment of various gastrointestinal conditions but carries a low risk of venous air embolism (VAE). We report a case of VAE during EGD, confirmed by computed tomographic pulmonary angiography (CTPA). CASE A 56-year-old male with a history of hypopharyngeal cancer underwent EGD for dysphagia-related esophageal dilation. Signs of VAE were noted, prompting swift interventions, including oxygen therapy, positional changes, and CTPA. CTPA revealed the Mercedes-Benz sign, pneumomediastinum, and a minimal pneumothorax. The patient's oxygen saturation improved within 30 min before undergoing CTPA, and he was discharged on postoperative day 4. CONCLUSIONS Timely recognition of VAE, resulting in appropriate interventions supported by CTPA, resulted in favorable patient outcomes.
Collapse
Affiliation(s)
| | | | | | - Panjai Choochuen
- Department of Radiology, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
3
|
Duan Y, Jia W, Liang Y, Zhang X, Yang Z, Yang Q. Progress in the treatment and prevention of esophageal stenosis after endoscopic submucosal dissection. Clin Res Hepatol Gastroenterol 2024; 48:102290. [PMID: 38311060 DOI: 10.1016/j.clinre.2024.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/07/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
The primary treatment for early esophageal cancer and precancerous lesions is endoscopic submucosal dissection (ESD). However, this approach leads to a high incidence of postoperative esophageal stenosis, which can significantly impact a patient's quality of life. While various methods are available to prevent post-ESD esophageal stenosis, their effectiveness varies. Therefore, this study aims to provide an overview of the currently employed methods for preventing post-ESD esophageal stenosis in clinical practice in view of assisting clinical practitioners.
Collapse
Affiliation(s)
- Yangyang Duan
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Wenxiu Jia
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Ying Liang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Xiuning Zhang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China
| | - Zhufeng Yang
- Department of Digestive Endoscopy, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China.
| | - Qian Yang
- Department of Spleen and Stomach Diseases, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, 050011, China; Hebei Key Laboratory of Turbidity Toxin Syndrome, Hebei, China; Hebei Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research, Hebei, China.
| |
Collapse
|
4
|
Mizuno J, Urabe Y, Oka S, Konishi H, Ishibashi K, Fukuhara M, Tanaka H, Tsuboi A, Yamashita K, Hiyama Y, Kotachi T, Takigawa H, Yuge R, Hiyama T, Tanaka S. Predictive factors for esophageal stenosis in patients receiving prophylactic steroid therapy after endoscopic submucosal dissection for esophageal squamous cell carcinoma. BMC Gastroenterol 2024; 24:41. [PMID: 38245690 PMCID: PMC10799525 DOI: 10.1186/s12876-024-03135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/02/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Methods to prevent esophageal stenosis (ES) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) have received increasing attention. Although steroid administration is a prophylactic treatment, the risk factors for ES during prophylactic steroid therapy remain unknown. Therefore, this study aimed to retrospectively evaluate the risk factors for refractory ES in patients administered prophylactic steroids after ESD for ESCC. METHODS Among 795 patients with ESCC (854 lesions), 180 patients (211 lesions) administered local triamcinolone acetonide (TrA) and/or oral prednisolone were recruited for this study. We compared the total number of endoscopic balloon dilatation (EBD) procedures performed for post-ESD ES and clinical findings (tumor size, ESD history or chemoradiation therapy [CRT], entire circumferential resection, muscle layer damage, supplemental oral prednisolone administration, EBD with TrA injection, and additional CRT) between patients with refractory and non-refractory ES. EBD was continued until dysphagia resolved. We categorized cases requiring ≥ 8 EBD procedures as refractory postoperative stenosis and divided the lesions into two groups. RESULTS Multivariate logistic regression analysis revealed that factors such as ESD history, CRT history, tumor size, and entire circumferential resection were independently associated with the development of refractory ES. The withdrawal rates of EBD at 3 years were 96.1% (52/53) and 58.5% (39/59) in the non-refractory and refractory groups, respectively. CONCLUSIONS Our data suggest that entire circumferential resection and CRT history are risk factors for refractory post-ESD ES in ESCC, even with prophylactic steroid administration.
Collapse
Affiliation(s)
- Junichi Mizuno
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Hirona Konishi
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Kazuki Ishibashi
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Motomitsu Fukuhara
- Department of Gastroenterology, Graduate School of Biomedical & Science, Hiroshima University, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiyoshi Tsuboi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuichi Hiyama
- Department of Hiroshima Clinical Research and Development Support Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryo Yuge
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
5
|
Wang QX, Shi RH. Prospects of polyglycolic acid sheets for the treatment of esophageal stricture after esophageal endoscopic submucosal dissection. World J Gastrointest Endosc 2024; 16:1-4. [PMID: 38313459 PMCID: PMC10835476 DOI: 10.4253/wjge.v16.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
Esophageal cancer is the seventh most common type of cancer and the sixth leading cause of cancer -related mortality worldwide. Endoscopic submucosal dissection (ESD) is widely used for the resection of early esophageal cancer. However, post-ESD esophageal stricture is a common long-term complication, which requires attention. Patients with post-ESD esophageal stricture often experience dysphagia and require multiple dilatations, which greatly affects their quality of life and increases healthcare costs. Therefore, to manage post-ESD esophageal stricture, researchers are actively exploring various strategies, such as pharmaceutical interventions, endoscopic balloon dilation, and esophageal stenting. Although steroids-based therapy has achieved some success, steroids can lead to complications such as osteoporosis and infection. Meanwhile, endoscopic balloon dilatation is effective in the short term, but is prone to recurrence and perforation. Additionally, esophageal stenting can alleviate the stricture, but is associated with discomfort during stenting and the complication of easy displacement also present challenges. Tissue engineering has evolved rapidly in recent years, and hydrogel materials have good biodegradability and biocompatibility. A novel type of polyglycolic acid (PGA) sheets has been found to be effective in preventing esophageal stricture after ESD, with the advantages of a simple operation and low complication rate. PGA membranes act as a biophysical barrier to cover the wound as well as facilitate the delivery of medications to promote wound repair and healing. However, there is still a lack of multicenter, large-sample randomized controlled clinical studies focused on the treatment of post-ESD esophageal strictures with PGA membrane, which will be a promising direction for future advancements in this field.
Collapse
Affiliation(s)
- Qing-Xia Wang
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Medical School, Nanjing 210009, Jiangsu Province, China
| | - Rui-Hua Shi
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Medical School, Nanjing 210009, Jiangsu Province, China
| |
Collapse
|
6
|
Kim SH, Kim JW, Park SY, Kim HS, Lim CJ, Lee GH, Lim JW, Seo YE, Park SY, Lee YH, Jung YW, Kang WR, You HS, Kim DH. Successful Simultaneous Treatment of Benign Stricture and Colonic Neoplasm Arising from Colonic Interposition after Esophagectomy: A Case Report. Korean J Gastroenterol 2023; 82:140-144. [PMID: 37743813 DOI: 10.4166/kjg.2023.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/07/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session. Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.
Collapse
Affiliation(s)
- Seung Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Jin Won Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Seon-Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Chae June Lim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Gang Han Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Jae Woong Lim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Young Eun Seo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Shin Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Yo Han Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Yong-Wook Jung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Woo Rim Kang
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Hye-Su You
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Korea
| |
Collapse
|
7
|
Oldakovskiy V, Murashkin N, Lokhmatov M, Gusev A, Tupylenko A, Budkina T, Yatzik S, Dyakonova E, Abaykhanov R, Fisenko A. Our experience of using Losartan for esophageal stenosis in children with dystrophic form of congenital epidermolysis bullosa. J Pediatr Surg 2023; 58:619-623. [PMID: 36566169 DOI: 10.1016/j.jpedsurg.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dystrophic epidermolysis bullosa (DEB) is one of the most severe forms of congenital epidermolysis bullosa and characterized by the formation of many surgical complications. Esophageal stenosis is a common complication of DEB and occurs in almost 76% of cases. Balloon dilatation (BD) under X-ray control is the main therapeutic technique, however conservative treatment is necessary to prevent restenosis. The use of the drug losartan is promising due to its antifibrotic effect through the suppression of transforming growth factor-β1 (TGF-β1). PURPOSE To evaluate the efficacy of losartan in the prevention of restenosis after BD of esophageal stenosis in children with DEB. MATERIALS AND METHODS The study included 19 children from 2 to 16 years old (mean age 9.2 ± 3.58 years) with DEB and X-ray confirmed esophageal stenosis. All children underwent BD. In the main group 9 children after BD have received losartan, in the control group of 10 children - only standard therapy. The observation period was 12 months. RESULTS In the main group, 1 child (11.1%) required repeated dilatation, in the control group - 4 children (40%). Indicators of nutritional deficiency (THINC scale) and the disease severity index (EBDASI) were significantly lower in the group of children treated with losartan. No undesirable actions of the drug were recorded. CONCLUSIONS In this study losartan showed its safety, contributed to a decrease in the restenosis frequency and an improvement in the nutritional status of children with DEB after BD. However, further studies are required to confirm its effectiveness. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Vladislav Oldakovskiy
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Nikolay Murashkin
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Maksim Lokhmatov
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Aleksey Gusev
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia; Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya str. 6, 117198, Moscow, Russia.
| | - Artem Tupylenko
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Tatiana Budkina
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Sergey Yatzik
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Elena Dyakonova
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Rasul Abaykhanov
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Andrey Fisenko
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| |
Collapse
|
8
|
Park JY, Park JM, Shin GY, Kim JS, Cho YK, Kim TH, Kim BW, Choi MG. Efficacy of bougie dilation for normal diet in benign esophageal stricture. Scand J Gastroenterol 2023; 58:199-207. [PMID: 35996943 DOI: 10.1080/00365521.2022.2111227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Bougination is one of the first-line treatments in benign esophageal stricture (BES). The aim of the study was to identify clinical and endoscopic factors affecting the achievement of a normal diet with only bougie dilation in patients with BES. PATIENTS AND METHODS Patients treated with only bougination for BES at three hospitals were retrospectively investigated. Data including patient demographics, stricture and procedural characteristics were collected. Clinical success was defined as normal diet without additional procedures for two months after bougination. Clinical success rate and associated factors were assessed. RESULTS A total of 121 patients with BES were included. The most common cause of BES was post-operative stricture (n = 55). Finally, 43 (36%) patients were able to eat a normal diet with only bougination. Of these patients, 42 (97.7%) achieved clinical success in the first three sessions or less. Among causes of stenosis, corrosive injury had the lowest success rate (9/40, 22.5%). Clinical success rate was significantly higher for those with the length of stricture of less than 2 cm (47.2%), those with pre-procedural dysphagia of semi-solid or soft diet (51.3%) and those with dilation of 13 mm or more (46.1%). However, the duration of symptom, the number of previous endoscopic treatments and the location of stenosis were not related to clinical success. CONCLUSIONS Normal diet is possible in one-third of BES after bougination alone. Predictable factors for achieving a normal diet were less than four sessions of dilation, short length of stricture, pre-procedural dysphagia status and diameter of dilator.
Collapse
Affiliation(s)
- Jun Young Park
- Seoul St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Seoul St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ga-Yeong Shin
- Seoul St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Inchoen St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Kyung Cho
- Seoul St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Kim
- Bucheon St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wook Kim
- Inchoen St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Seoul St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
9
|
Shah SN, Chehade NEH, Tavangar A, Choi A, Monachese M, Chang KJ, Samarasena JB. Hybrid argon plasma coagulation in Barrett's esophagus: a systematic review and meta-analysis. Clin Endosc 2023; 56:38-49. [PMID: 36733989 PMCID: PMC9902689 DOI: 10.5946/ce.2022.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS Patients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC. METHODS We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM. RESULTS Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%). CONCLUSION Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.
Collapse
Affiliation(s)
- Sagar N. Shah
- Department of Internal Medicine, Los Angeles Medical Center, University of California, Los Angeles, CA, USA
| | - Nabil El Hage Chehade
- Division of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Amirali Tavangar
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Alyssa Choi
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Marc Monachese
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Kenneth J. Chang
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Jason B. Samarasena
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA,Correspondence: Jason B. Samarasena H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine 333 City Blvd West Suite 400, Orange, CA 92868, USA E-mail:
| |
Collapse
|
10
|
Kim MJ, Ryu DG, Park SB, Choi CW, Kim HW, Kim SJ. Esophageal Stricture after Endoscopic Drainage of Esophageal Abscess as a Complication of Acute Phlegmonous Esophagitis: A Case Report. Korean J Gastroenterol 2022; 80:262-266. [PMID: 36567439 DOI: 10.4166/kjg.2022.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 12/27/2022]
Abstract
Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.
Collapse
Affiliation(s)
- Min Ji Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
11
|
Barros LCTRD, Santos BMRTD, Ferreira GDSA, Gomes VMDS, Vieira LPB. Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report. World J Surg Proced 2022; 12:13-19. [DOI: 10.5412/wjsp.v12.i2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition, characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery (SMA). Most cases of SMAS are associated with weight loss, and the most frequent clinical manifestations are nausea, vomiting, postprandial fullness, and abdominal pain. Treatment of SMAS is usually conservative, consisting mainly of adequate nutritional support, but in refractory cases surgery may be necessary, with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.
CASE SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion, who suffered significant weight loss after replacement of his jejunostomy tube. He was admitted to the hospital due to pain and abdominal distension. A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery, thus establishing the diagnosis of SMAS. Due to the presence of the esophageal stricture, the patient was incapable of emesis; however, passage of a nasogastric tube for decompression was not possible. Considering the risk of gastric perforation due to distention, we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.
CONCLUSION Diagnosis of SMAS can be challenging in patients with esophageal stenosis, and risk of gastric perforation may preclude conservative treatment.
Collapse
Affiliation(s)
| | | | - Gustavo de Sousa Arantes Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70658-700, Distrito Federal, Brazil
- Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
| | - Vitoria Mikaelly da Silva Gomes
- Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
| | - Lorenna Paulinelli Bahia Vieira
- Department of General Surgery, Hospital de Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte 31710350, Minas Gerais, Brazil
- Department of General Surgery, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte 30620090, Minas Gerais, Brazil
| |
Collapse
|
12
|
Tintinago LF, Victoria W, Velez-Esquivia MA, Arias JJ, Candelo E. Cricoid Cartilage Hypertrophy as the Cause of Larynx Stenoses: Case Report and Updated Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:2595-2598. [PMID: 36452584 PMCID: PMC9702115 DOI: 10.1007/s12070-020-02253-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/31/2020] [Indexed: 11/24/2022] Open
Abstract
Aerodigestive obstruction due to cricoid hypertrophy is a rare and potentially life-threatening condition. We present a two-year-old female patient who displayed repetitive respiratory infections, swallowing disorder, and malnutrition without any eye signs or symptoms of airway alterations. We described a patient with aerodigestive obstruction generating a marked narrowing of the trachea immediately below the larynx due to severe thickening of the cricoid cartilage. She was successfully treated with surgery, and the clinical and radiological features of this condition are presented here with a review of the literature.
Collapse
Affiliation(s)
- Luis F. Tintinago
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- School of Health Science, Universidad ICESI, Cali, Colombia
| | - William Victoria
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- School of Health Science, Universidad ICESI, Cali, Colombia
| | - Maria A. Velez-Esquivia
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | | | - Estephania Candelo
- Head and Neck and Airway Surgery, Fundación Valle del Lili, Avenida Simón Bolívar - Cra. 98 # 18-49, Cali, Colombia
- School of Health Science, Universidad ICESI, Cali, Colombia
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| |
Collapse
|
13
|
Ishioka M, Yoshio T, Sasaki T, Tamashiro A, Yoshizawa N, Suzuki K, Tokura J, Namikawa K, Tokai Y, Yoshimizu S, Horiuchi Y, Ishiyama A, Hirasawa T, Chin K, Ogura M, Sasahira N, Fujisaki J. Safety and Efficacy of Self-Expandable Metallic Stent Placement Using Low Radial Force Stent for Malignant Dysphagia after Radiotherapy. Digestion 2022; 103:261-268. [PMID: 35184058 DOI: 10.1159/000522007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We aimed to investigate the safety and efficacy of self-expandable metallic stent (SEMS) placement in patients with prior radiotherapy (RT) using the Niti-S stent, which is characterized by low radial force, in comparison to patients without prior RT. METHODS A consecutive series of 83 patients who were treated by SEMS placement using Niti-S stent for severe malignant esophageal obstruction or fistula were enrolled. The adverse event rates and efficacy were retrospectively compared between patients with/without prior RT before SEMS placement (RT group [n = 32] versus non-RT group [n = 51]). RESULTS The incidence rate of major adverse events in the RT group was 6.3% and was not significantly different from that in the non-RT group (5.9%, p = 0.95). Among the RT group, 84.4% were able to resume oral intake within a median of 2 days. Among the patients with fistula, 78.6% could resume oral intake and survive for 73 days after SEMS placement. Cox proportional hazard regression analysis identified significant factors affecting overall survival to be prior RT (hazard ratio [HR]: 1.96), low performance status (HR: 3.87), and subsequent anticancer treatment after SEMS placement (HR: 0.41). However, compared to the non-RT group, the RT group had received longer duration of anticancer treatment before SEMS placement and a lower rate of subsequent anticancer treatment after SEMS placement. CONCLUSIONS With the Niti-S stent, the incidence of major adverse events was sufficiently low even for patients after RT. SEMS with low radial force would be an effective palliative treatment option for patients, regardless of prior RT.
Collapse
Affiliation(s)
- Mitsuaki Ishioka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan,
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Sasaki
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsuko Tamashiro
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Gastroenterology, Matsumoto Kyoritsu Hospital, Nagano, Japan
| | - Natsuko Yoshizawa
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Gastroenterology, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Keigo Suzuki
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junki Tokura
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Namikawa
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshitaka Tokai
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keisho Chin
- Department of Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mariko Ogura
- Department of Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Sasahira
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
14
|
Yano T, Yoda Y, Nonaka S, Abe S, Kawata N, Yoshio T, Sasaki T, Tanaka S, Sasaki F, Maekita T, Kitano M, Matsumoto K, Isayama H, Ono H. Pivotal trial of a biodegradable stent for patients with refractory benign esophageal stricture. Esophagus 2022; 19:516-524. [PMID: 35106667 DOI: 10.1007/s10388-022-00909-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 10/08/2021] [Accepted: 01/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Benign esophageal strictures (BES) cause dysphagia and decrease patients' quality of life. Although mechanical dilation is the standard of care for BES, in some patients, dysphagia is unrelieved despite repeated procedures. The biodegradable stent was developed to resolve refractory BES, with reported favorable outcomes, but it is unapproved in Japan. Thus, we evaluated the safety and efficacy of the biodegradable stent (BDS) for patients with refractory BES for regulatory approval. METHODS This was a nonrandomized single-arm prospective trial conducted at eight institutions. We included patients with BES after ≥ 5 times of dilation or ≥ one time of radial incision and cutting whose dysphagia score (DS) was 2 or worse and an endoscope could not admit. The primary endpoint was the proportion of patients whose DS improvement of ≤ 1 was maintained at 3 months. RESULTS Thirty patients (median age: 69 years, male/female: 27:3) were enrolled and treated; BDS placement failed in 1 patient. Fourteen patients maintained their DS improvement until 3 months after placement (proportion of DS improvement at 3 months 46.7% [95% CI: 28.3-65.7]), and the median dysphagia-free survival was 98 days [95% CI: 68-123]. Most adverse events could be managed conservatively; however, a patient with BES after chemoradiotherapy (CRT) developed an esophago-left atrium fistula and died approximately 4 months after stent placement. CONCLUSION The BDS was effective for refractory BES and the safety was acceptable. However, the indication for this procedure in patients RECEIVING CRT for esophageal cancer should be carefully considered.
Collapse
Affiliation(s)
- Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 288-8577, Japan.
| | - Yusuke Yoda
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 288-8577, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Takashi Sasaki
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Shinwa Tanaka
- Department of Endoscopic Internal Medicine, Kobe University Hospital, Hyogo, Japan
| | - Fumisato Sasaki
- Department of Endoscopic Internal Medicine, Kagoshima University Hospital, Kagoshima, Japan
| | - Takao Maekita
- Department of Gastroenterology, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Department of Gastroenterology, Wakayama Medical University, Wakayama, Japan
| | - Kenshi Matsumoto
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| |
Collapse
|
15
|
Zhu B, Song B, Wang Y, Bao M, Cheng W, Zhang W, Liu M, Gong Y. Protective effect of rosuvastatin against the formation of benign esophageal stricture. Esophagus 2022; 19:343-50. [PMID: 34800196 DOI: 10.1007/s10388-021-00895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Benign esophageal strictures result from caustic or radiation injury or surgical procedures. Statins have anti-inflammatory and anti-fibrotic activities. We examined the role of rosuvastatin in preventing benign esophageal fibrosis and stricture formation in a rabbit model. METHODS Twenty-six rabbits were assigned to control and rosuvastatin groups. The rabbits in the rosuvastatin group were administered rosuvastatin 5 mg/day, 2 weeks prior to the esophageal stricture phase. Esophageal strictures were established by applying 4% sodium hydroxide solution to the middle esophagus. Esophagography was performed to evaluate the degree of esophageal stenosis, and histopathologic assessment of esophageal tissue damage was performed with hematoxylin-eosin and Masson staining. The expressions of transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), and α-smooth muscle actin (α-SMA) were examined by immunohistochemistry. RESULTS The incidence of strictures was significantly lower in the rosuvastatin group. Esophagography demonstrated mild stenosis in the narrowest inner esophageal diameter in the rosuvastatin group than in the control group, and Masson staining demonstrated significantly less collagen deposition in the rosuvastatin group. In addition, immunohistochemistry results showed that the expressions of TGF-β1, CTGF, and α-SMA significantly reduced in the rosuvastatin group. CONCLUSIONS The present study demonstrated that rosuvastatin prevents benign esophageal stricture formation. This effect may be exerted through the anti-fibrotic activity of rosuvastatin, which may be exerted by the inhibition of CTGF and α-SMA production induced by TGF-β1.
Collapse
|
16
|
Kılıç ŞS, Serdar İskit H. Management and clinical outcomes of congenital esophageal stenosis in pediatric patients: Experience of a tertiary referral center. J Pediatr Surg 2022; 57:518-25. [PMID: 34229876 DOI: 10.1016/j.jpedsurg.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to retrospectively investigate congenital esophageal stenosis (CES) cases managed at our institution using a non-aggressive strategy based on a step-up approach from esophageal balloon dilatations to surgery. METHODS Patients' charts with CES managed in a tertiary pediatric surgery department were retrospectively evaluated. Demographic characteristics, clinical features, pH-monitoring, imaging, and esophagoscopy results were recorded together with their treatments and outcomes. RESULTS Nineteen patients, confirmed with radiologic and endoscopic investigations, were managed. Complete symptom resolution was achieved in 14 patients by a median of five (2-15) recurrent esophageal balloon dilatations lasting for 7.5 (2-108) months. Two more patients, after 7 and 15 dilatations, had mild dysphagia, not interfering with their daily living. One patient, in whom the initial dilatation attempt with 3 atm was unsuccessful, and two patients with persistent symptoms and growth retardation despite ongoing dilatation treatment, underwent surgery. After 48 (12-132) months of follow-up, 17 patients were symptom-free. CONCLUSION Conservative treatment with esophageal balloon dilatations is an efficient and reliable modality that can be used as a first-line treatment in CES. Surgical treatment option should be used when dilatation attempt is unsuccessful, or symptoms and growth retardation persist despite dilatation treatment.
Collapse
|
17
|
Almanza-Miranda E, Blanco-Rodríguez G, Penchyna-Grub J, Teyssier-Morales G, Peña-Vélez R. Importance of early endoscopic and clinical evaluation of children with caustics ingestion. Bol Med Hosp Infant Mex 2021; 78:544-548. [PMID: 34934210 DOI: 10.24875/bmhim.20000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Accidental ingestion of caustics in pediatrics continues to be a frequent problem that can lead to severe injuries and permanent sequelae that require esophageal rehabilitation programs. This study aimed to describe the medical care experience of children who ingested caustic substances in a tertiary hospital in Mexico City. METHODS We conducted a descriptive and analytical study. We described age, sex, type of caustics, clinical and endoscopic findings, and the radiological evolution of 284 patients who arrived during the acute phase. RESULTS The records of 336 children with a history of caustic ingestion were reviewed. The median age was 1.7 years, and the predominant sex was male. Caustic soda was the most accidentally ingested substance. We found an association between the severity of the esophageal injury with the presence of more than four symptoms at diagnosis (χ², p < 0.001) and with the finding of oral lesions, sialorrhea, and vomiting (χ², p < 0.05). Forty percent (n = 114) showed normal gastrointestinal endoscopy. CONCLUSIONS In children with caustic ingestion, upper gastrointestinal endoscopy should be performed within 72 hours to evaluate the extent of the lesions. In this study, we found that more than four symptoms at admission, and oral lesions, sialorrhea, and vomiting are associated with the severity of the esophageal injury.
Collapse
Affiliation(s)
- Enory Almanza-Miranda
- Servicio de Cirugía de Tórax y Endoscopia, Hospital Infantil de México Federico Gómez
| | | | - Jaime Penchyna-Grub
- Servicio de Cirugía de Tórax y Endoscopia, Hospital Infantil de México Federico Gómez
| | | | - Rubén Peña-Vélez
- Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico
| |
Collapse
|
18
|
Millán M, Parra MW, Sanchez-Restrepo B, Caicedo Y, Serna C, González-Hadad A, Pino LF, Herrera MA, Hernández F, Rodríguez-Holguín F, Salcedo A, Serna JJ, García A, Ordoñez CA. Primary repair: damage control surgery in esophageal trauma. Colomb Med (Cali) 2021; 52:e4094806. [PMID: 34908621 PMCID: PMC8634275 DOI: 10.25100/cm.v52i2.4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 06/18/2021] [Indexed: 11/11/2022] Open
Abstract
Esophageal trauma is a rare but life-threatening event associated with high morbidity and mortality. An inadvertent esophageal perforation can rapidly contaminate the neck, mediastinum, pleural space, or abdominal cavity, resulting in sepsis or septic shock. Higher complications and mortality rates are commonly associated with adjacent organ injuries and/or delays in diagnosis or definitive management. This article aims to delineate the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia, on the surgical management of esophageal trauma following damage control principles. Esophageal injuries should always be suspected in thoracoabdominal or cervical trauma when the trajectory or mechanism suggests so. Hemodynamically stable patients should be radiologically evaluated before a surgical correction, ideally with computed tomography of the neck, chest, and abdomen. While hemodynamically unstable patients should be immediately transferred to the operating room for direct surgical control. A primary repair is the surgical management of choice in all esophageal injuries, along with endoscopic nasogastric tube placement and immediate postoperative care in the intensive care unit. We propose an easy-to-follow surgical management algorithm that sticks to the philosophy of "Less is Better" by avoiding esophagostomas.
Collapse
Affiliation(s)
- Mauricio Millán
- Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Boris Sanchez-Restrepo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | | | - Alexander Salcedo
- Universidad Icesi, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alberto García
- Universidad Icesi, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad Icesi, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| |
Collapse
|
19
|
Ravich WJ. The Art of Endoscopic Dilation: Lessons Learned Over 4 Decades of Practice. Gastroenterol Clin North Am 2021; 50:737-750. [PMID: 34717868 DOI: 10.1016/j.gtc.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The author offers his approach to esophageal dilation based on 40 years of a practice specializing in swallowing disorders and esophageal disease. He discusses general concepts in the management of esophageal strictures and then provides an approach to dilation of different types of esophageal stenotic lesions.
Collapse
Affiliation(s)
- William J Ravich
- Section of Digestive Diseases, Yale School of Medicine, 40 Temple St., Suite !A, New Haven, CT 06510, USA.
| |
Collapse
|
20
|
Nishibuchi I, Murakami Y, Kubo K, Imano N, Takeuchi Y, Urabe Y, Oka S, Tanaka S, Nagata Y. Temporal changes and risk factors for esophageal stenosis after salvage radiotherapy in superficial esophageal cancer following non-curative endoscopic submucosal dissection. Radiother Oncol 2021; 166:65-70. [PMID: 34838886 DOI: 10.1016/j.radonc.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy (RT) has recently received increasing attention as an additional treatment for organ preservation after non-curative endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer. Esophageal stenosis is an adverse event related to RT after ESD that is not widely studied. The aim of this study was to investigate esophageal stenosis related to salvage RT in superficial esophageal cancer after non-curative ESD. MATERIALS AND METHODS Fifty patients who received salvage RT after non-curative ESD at a single institution between 2011 and 2018 were included in this study. The Common Terminology Criteria for Adverse Events, version 5.0, was used to assess esophageal stenosis. Data were compared using Fisher's exact test. Statistical significance was set at P < 0.05. RESULTS Median follow-up time was 48 months (range, 12-95 months). Grade 2 and 3 esophageal stenosis were observed in 17 (34%), and 3 patients (6%), respectively. The frequency of grade 2 or worse esophageal stenosis decreased over time (before RT, 6 months, 1 year, and 2 years after RT: 16 (32%), 13 (26%), 10 (20%), and 6 (12%) patients, respectively). Only one patient required endoscopic balloon dilation (EBD) 1 year after RT. All grade 3 esophageal stenosis improved grade 2 or less by EBD. In univariate analysis, only tumor location was a significant risk factor for grade 3 esophageal stenosis. CONCLUSIONS Esophageal stenosis, after salvage RT in patients with esophageal cancer who received non-curative ESD, improved naturally or after EBD; only a few cases required long-term EBD.
Collapse
|
21
|
Seong YW, Kim JH, Ok YJ, Oh SJ, Choi JS, Lee JS, Moon HJ. Is Hypertrophic or Keloid Wound Scar a Risk Factor for Stricture at Esophagogastric Anastomosis Site after Esophageal Cancer Operation? Korean J Gastroenterol 2021; 78:213-218. [PMID: 34697275 DOI: 10.4166/kjg.2021.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/19/2021] [Accepted: 08/09/2021] [Indexed: 11/03/2022]
Abstract
Background/Aims Anastomotic stricture at the esophagus and the conduit anastomosis site after the surgical resection of esophageal cancer is relatively common. This study examined whether a hypertrophic scar or keloid formation at a surgical wound is related to an anastomotic stricture. Methods From March 2007 to July 2017, 59 patients underwent curative surgery for esophageal cancer. In 38 patients, end-to-end anastomosis (EEA) of the esophagus and the conduit was performed using EEA 25 mm. A hypertrophic wound scar was defined when the width of the midline laparotomy wound scar exceeded 2 mm. The relationship between the hypertrophic scar and stricture and the other risk factors for anastomotic stricture in these 38 patients was analyzed. Results Of the 38 patients, eight patients (21.1%) had an anastomotic stricture, and a hypertrophic skin scar was observed in 14 patients (36.8%). Univariate analysis revealed lower BMI and hypertrophic scars as risk factors (p=0.032, p=0.001 respectively). Multivariate analysis revealed a hypertrophic scar as an independent risk factor for an anastomotic stricture (p=0.010, OR=27.06, 95% CI 2.19-334.40). Conclusions Hypertrophic wound scars can be a risk factor for anastomotic stricture after surgery for esophageal cancer. An earlier prediction of anastomotic stricture by detecting hypertrophic wound healing in patients undergoing esophagectomy may improve the patients' quality of life and surgical outcomes by earlier treatments.
Collapse
Affiliation(s)
- Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Kim
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - You Jung Ok
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Se Jin Oh
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Sung Choi
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Sang Lee
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jong Moon
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Hayashi T, Asahina Y, Nakanishi H, Terashima T, Okamoto K, Yamada S, Takatori H, Kitamura K, Mizukoshi E, Ninomiya I, Kaneko S. Evaluation of the efficacy and safety of salvage photodynamic therapy by talaporfin sodium for cervical esophageal cancers and lesions larger than 3 cm. Esophagus 2021; 18:645-654. [PMID: 33201316 DOI: 10.1007/s10388-020-00799-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Salvage photodynamic therapy with talaporfin sodium has a high local control rate for esophageal cancer after definitive chemoradiotherapy. The eligibility criteria for photodynamic therapy include the absence of invasion to the cervical esophagus and a 3 cm maximum longitudinal lesion length. There is little evidence regarding the efficacy and safety of lesions outside the eligibility criteria. This retrospective cohort study evaluated the efficacy and safety of photodynamic therapy of such lesions. METHODS Patients with consecutive lesions between February 2016 and May 2020 (n = 36) were enrolled. The local complete response rates and adverse events were compared between patients with cervical and non-cervical lesions and those with lesions larger and smaller than 3 cm. RESULTS The local complete response rate was 77.8% and was significantly lower in cervical than in non-cervical lesions (20.0% vs 80.6%, p = 0.005). Esophageal stricture, laryngeal pain, and fever were significantly higher in the cervical than in the non-cervical lesion group; however, the detected adverse events were up to grade 2. Laser exposure dose was high in lesions larger than 3 cm (median, 650 vs 400 J; p < 0.001). No significant differences in local complete response rates and adverse effects were noted. One case involving a lesion larger than 3 cm needed balloon dilations for esophageal stricture. CONCLUSIONS Although salvage esophageal photodynamic therapy was effective for local control with acceptable safety after definitive chemoradiotherapy failure, photodynamic therapy toward cervical lesions had a statistically lower local complete response rate. Lesions larger than 3 cm may be considered treatable.
Collapse
Affiliation(s)
- Tomoyuki Hayashi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshiro Asahina
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Terashima
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Koichi Okamoto
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinya Yamada
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hajime Takatori
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Itasu Ninomiya
- Department of Gastrointestinal Surgery, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| |
Collapse
|
23
|
Bolia R, Sarma MS, Biradar V, Sathiyasekaran M, Srivastava A. Current practices in the management of corrosive ingestion in children: A questionnaire-based survey and recommendations. Indian J Gastroenterol 2021; 40:316-25. [PMID: 33991312 DOI: 10.1007/s12664-021-01153-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Corrosive ingestion causes significant morbidity in children with no standard guidelines regarding management. This survey aimed to understand practices adopted by gastroenterologists, identify lacunae in evaluation and management and suggest a practical algorithm. METHODS Indian gastroenterologists participated in an online survey (65 questions) on managing corrosive ingestion. When ≥ 50% of respondents agreed on a management option, it was considered as 'agreement'. RESULTS Ninety-eight gastroenterologists (72 pediatric) who had managed a total of ~ 2600 corrosive ingestions in the last 5 years responded. The commonest age group affected was 2-5 years (61%). Majority of ingestion was accidental (89%) with 80% due to improper corrosive storage. Ingestion of alkali and acid was equally common (alkali 41%, acid 39%, unknown 20%). History of inducing-vomiting after ingestion by community physicians was present in 57%. There was an agreement on 77% of questions. The respondents agreed on endoscopy (70%) and chest X-ray (67%) in all, irrespective of symptoms. Endoscopy was considered safe on days 1-5 after ingestion (91%) and relatively contraindicated thereafter. The consensus was to use acid suppression, always (59%); steroids, never (68%) and antibiotics, if indicated (59%). Feeding was based on endoscopic findings: oral in mild injuries and nasogastric (NG) in others. Eighty percent placed a NG tube under endoscopic guidance. Stricture dilatation was considered safe after 4 weeks of ingestion. Agreement on duration of acid suppression and stricture management (dilatation protocol and refractory strictures) was lacking. CONCLUSION Corrosive ingestion mostly affects 2-5-year olds and is accidental in majority. It can be potentially prevented by proper storage and labelling of corrosives. An algorithm for management is proposed.
Collapse
|
24
|
Kinowaki S, Shimizu Y, Ono M, ZiJian Y, Tanaka I, Shimoda Y, Inoue M, Ishikawa M, Yamamoto K, Ono S, Ohnishi S, Sakamoto N. Experiment on endoscopic balloon dilation for esophageal stenosis after endoscopic submucosal dissection in pigs. J Gastroenterol 2021; 56:527-536. [PMID: 33899159 DOI: 10.1007/s00535-021-01791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Endoscopic balloon dilation (EBD) is effective for esophageal stenosis caused by ESD. However, an efficient EBD method has not been established. We, therefore, conducted EBD experiments on porcine esophageal stenosis models. METHODS Study 1: in dilation models (day 22 after ESD), the thickness of the outer muscle layer (as an index of the extension effect) and the area of muscle fiber bundle necrosis in the inner muscle layer (as an index of thermal damage) were evaluated. Study 2: in restenosis models (day 43 after ESD), the thickness of the fibrous plexus (as an index of restenosis) was evaluated. In total, 12 porcine models were created. RESULTS Study 1: the thickness of the outer muscle layer was 1243 ± 322 μm in surrounding locations and it was 803 ± 145 μm beneath the laceration (p = 0.005). In cases of muscular layer injury, the area of necrosis was 15,500 ± 10400 μm2 in surrounding locations and it was 40,200 ± 12900 μm2 at the laceration site (p < 0.001). Study 2: the thickness of the fibrous plexus was 1359 ± 196 μm in surrounding locations and it was 1322 ± 136 μm2 in the laceration scar site (p = 0.74). CONCLUSION Since thermal damage persists until the completion of stenosis, EBD in the initial stage should be carefully performed. An extension effect was observed only at the laceration site and it later returned to a status similar to that of surrounding locations. Additional intervention would be required for preventing restenosis.
Collapse
Affiliation(s)
- Sayoko Kinowaki
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Kita 14 jo Nishi 5 chome, Kitaku, Sapporo, 060-8648, Japan.
| | - Masayoshi Ono
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Yang ZiJian
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Ikko Tanaka
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Yoshihiko Shimoda
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Masaki Inoue
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Marin Ishikawa
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan.,Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Keiko Yamamoto
- Division of Endoscopy, Hokkaido University Hospital, Kita 14 jo Nishi 5 chome, Kitaku, Sapporo, 060-8648, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Kita 14 jo Nishi 5 chome, Kitaku, Sapporo, 060-8648, Japan
| | - Shunsuke Ohnishi
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15 jo Nishi 7 chome, Kitaku, Sapporo, 060-8638, Japan
| |
Collapse
|
25
|
Hamada K, Itoh T, Kawaura K, Kuno H, Kamai J, Kobayasi R, Azukisawa S, Kitakata H, Ishisaka T, Igarashi Y, Kodera K, Okuno T, Morita T, Himeno T, Yano H, Higashikawa T, Iritani O, Iwai K, Morimoto S, Matoba M, Okuro M. A Case of Refractory Esophageal Ulcer Caused by Radiotherapy for Hepatocellular Carcinoma. World J Oncol 2021; 12:67-72. [PMID: 34046101 PMCID: PMC8139740 DOI: 10.14740/wjon1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
A 77-year-old man who underwent radiotherapy for hepatocellular carcinoma 6 months prior consulted for esophageal obstruction. Esophagogastroduodenoscopy revealed an esophageal ulcer caused by radiotherapy for hepatocellular carcinoma. He was treated with dietary counseling and vonoprazan. After 9 months, the ulcer improved but a moderate stenosis remained. Several factors such as high fraction size, history of chemotherapy, and stress associated with food intake might involve in the development of a radiation-associated ulcer. Opportunities to choose radiotherapy for hepatocellular carcinoma may increase, so we hypothesize that esophageal ulcers might be a complication that should be noted associated with this therapy.
Collapse
Affiliation(s)
- Kazu Hamada
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.,Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Tohru Itoh
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Ken Kawaura
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Kuno
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Junji Kamai
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Rika Kobayasi
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Sadahumi Azukisawa
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Hidekazu Kitakata
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Taishi Ishisaka
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Yuta Igarashi
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Kumie Kodera
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Tazuo Okuno
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Takuro Morita
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Tarou Himeno
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroshi Yano
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | | | - Osamu Iritani
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Kunimitsu Iwai
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Shigeto Morimoto
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Munetaka Matoba
- Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| |
Collapse
|
26
|
Baili E, Davakis S, Syllaios A, Boura M, Meropouli A, Charalabopoulos A. An extraordinary rare anastomotic band causing food bolus obstruction following uneventful minimally invasive esophagectomy: endoscopic treatment. J Surg Case Rep 2021; 2021:rjab212. [PMID: 34055298 PMCID: PMC8159199 DOI: 10.1093/jscr/rjab212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
The most common long-term complication post esophagectomy implicating the esophagogastric anastomosis is stricture-induced stenosis leading to late postoperative dysphagia. Herein, we present a case of a male patient readmitted to our Upper Gastrointestinal Department due to a food bolus obstruction through an anastomotic epithelial band arisen from a prior esophagogastric anastomosis performed 5 months earlier. A band transection in between two hemostatic clips placed on both sides of the band, followed by a release and fragmentation of the foreign body into several pieces led to its final transoral removal endoscopically. The patient experienced a direct resolution of his dysphagia and discharged on the same day. At 6 months follow-up, he remains symptom-free. In conclusion, endoscopic state-of-the-art techniques when combined with standard hemostatic surgical principles in a minimally invasive manner are excellent tools for the management of post-esophagectomy syndromes.
Collapse
Affiliation(s)
- Efstratia Baili
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Spyridon Davakis
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Athanasios Syllaios
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Maria Boura
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Antonia Meropouli
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Alexandros Charalabopoulos
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| |
Collapse
|
27
|
Na HK, Lee JH, Shim IK, Jung HY, Kim DH, Kim CJ. Allogeneic epithelial cell sheet transplantation for preventing esophageal stricture after circumferential ESD in a porcine model: preliminary results. Scand J Gastroenterol 2021; 56:598-603. [PMID: 33764846 DOI: 10.1080/00365521.2021.1897669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Circumferential endoscopic submucosal dissection (ESD) for large lesions induces severe stricture, requiring subsequent treatment. We aimed to evaluate the efficacy of allogeneic epithelial cell sheet transplantation in preventing esophageal stricture after circumferential ESD in a porcine model. MATERIALS AND METHODS A total of 15 conventional pigs underwent a 4 cm long circumferential ESD in the mid-esophagus. Out of these animals, 11 were immediately subjected to allogeneic oral mucosal cell sheet transplantation at the resection site, whereas four pigs underwent circumferential ESD only. We performed upper endoscopy 1 and 2 weeks after ESD and assessed the degree of esophageal stricture and histologic characteristics. RESULTS Dysphagia scores and weight change ratios recorded 1 and 2 weeks after ESD did not differ between the two groups. The stricture rate 2 weeks after ESD was 100% in the control group and 90.9% in the cell sheet group (p = 1.000). The median mucosal constriction rates of the control and cell sheet groups were 73.5% (range 63.0-80.0%) and 53.8% (37.5-73.3%, p = .018), respectively. With regard to microscopic measurements, the length of re-epithelialization was greater in the cell sheet group than in the control group (2,495 µm vs. 369 µm, p = .008). Median fibrosis thickness and degree of muscle damage were not significantly different between groups. CONCLUSIONS Although allogeneic epithelial cell sheet transplantation showed greater re-epithelialization and less mucosal constriction of post-ESD ulcers, it was not sufficiently effective in preventing post-ESD stricture.
Collapse
Affiliation(s)
- Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Kyong Shim
- Department of Biomedical Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Jai Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Lock JF, Reimer S, Pietryga S, Jakubietz R, Flemming S, Meining A, Germer CT, Seyfried F. Managing esophagocutaneous fistula after secondary gastric pull-up: A case report. World J Gastroenterol 2021; 27:1841-1846. [PMID: 33967561 PMCID: PMC8072190 DOI: 10.3748/wjg.v27.i16.1841] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/05/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric pull-up (GPU) procedures may be complicated by leaks, fistulas, or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperation may be necessary. Here, we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.
CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital. Local and systemic infection originating from the infected fistula was resolved by endoscopy. Hence, elective esophageal reconstruction with free-jejunal interposition was performed with no subsequent adverse events.
CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophago-cutaneous fistula after GPU. Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
Collapse
Affiliation(s)
- Johan F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Stanislaus Reimer
- Department of Gastroenterology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Sebastian Pietryga
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Rafael Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Alexander Meining
- Department of Gastroenterology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany
| |
Collapse
|
29
|
Tustumi F, Seguro FCBDC, Szachnowicz S, Bianchi ET, Morrell ALG, da Silva MO, Duarte AF, de Sousa JHB, Laureano GG, da Rocha JRM, Sallum RAA, Cecconello I. Surgical management of esophageal stenosis due to ingestion of corrosive substances. J Surg Res 2021; 264:249-259. [PMID: 33839340 DOI: 10.1016/j.jss.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Corrosive ingestion is a significant challenge for healthcare systems. Limited data are available regarding the best treatments, and there remains a lack of consensus about the optimal surgical approach and its outcomes. This study aims to review the current literature and show a single institution's experience regarding the surgical treatment of esophageal stenosis due to corrosive substance ingestion. METHODS A retrospective review that accounted for demographics, psychiatric profiles, surgical procedures, and outcomes was performed. A systematic review of the literature was performed using PubMed. RESULTS In total, 27 surgical procedures for esophageal stenosis due to corrosive substance ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. Esophagectomies and esophageal bypasses were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. CONCLUSION Surgical intervention either by esophagectomy or esophageal bypass results in durable relief from dysphagia. However, successful clinical outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
Collapse
Affiliation(s)
- Francisco Tustumi
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Sérgio Szachnowicz
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Edno Tales Bianchi
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Luiz Gioia Morrell
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Matheus Oliveira da Silva
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - André Fonseca Duarte
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gabriela Gomes Laureano
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
30
|
Kobayashi Y, Nishikawa K, Akasaka T, Kato S, Hamakawa T, Yamamoto K, Kobayashi N, Kitakaze M, Maeda S, Uemura M, Miyake M, Hama N, Miyamoto A, Kato T, Miyazaki M, Nakamori S, Mita E, Sekimoto M, Mano M, Hirao M. Retrograde endoscopic submucosal dissection for early thoracic esophageal carcinoma. Clin J Gastroenterol 2021; 14:434-438. [PMID: 33689125 DOI: 10.1007/s12328-021-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 12/01/2022]
Abstract
Although the standard treatment for intramucosal esophageal cancer without lymph node metastasis is endoscopic submucosal dissection (ESD), we sometimes encounter patients who are not able to undergo a transoral endoscopic examination. Here, we report a surgical procedure consisting of transgastric retrograde ESD to treat early esophageal cancer (T1a-EP, N0, M0) because of a stricture after hypopharyngeal cancer surgery. This retrograde ESD procedure can be a safe and effective treatment option for early esophageal cancer. This is the first report of a surgical retrograde ESD method for esophageal cancer.
Collapse
Affiliation(s)
- Yuta Kobayashi
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Kazuhiro Nishikawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Tomofumi Akasaka
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Seiya Kato
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan.,Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Kei Yamamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Noboru Kobayashi
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Masatoshi Kitakaze
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Sakae Maeda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji, Sakai, Osaka, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Naoki Hama
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Digestive Surgery, Ikeda City Hospital, 3-1-18 Jonan, Ikeda, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Shoji Nakamori
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Eiji Mita
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
| |
Collapse
|
31
|
Chen CC, Chen AC, Wu SF. Alkaline substances gastroesophageal injury in young children: emphasis on Asian food preparation habits. J Formos Med Assoc 2021; 120:1907-1913. [PMID: 33422399 DOI: 10.1016/j.jfma.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ingestion of alkaline substances should not be disregarded because a small amount can cause chemical burns in the esophagus, with esophageal stricture being the most common late complication. METHODS We enrolled children with alkaline corrosive damage receiving treatment at China Medical University Children's Hospital's emergency department between 2008 and 2018. Patients were divided into groups A (ingested causative agents other than alkaline oil), and B (ingested alkaline oil). RESULTS Altogether, 40 (27 [67.5%] male and 13 [32.5%] female) patients aged 7 months-7 years were enrolled. The most commonly ingested agent was alkaline oil (13 cases, 32.5%), followed by oven and drainage cleaners (8 cases, 20%), bleach (6 cases, 15%), laundry and dish cleaners (4 cases, 10%), sodium hydroxide (4 cases, 10%), sodium carbonate (2 cases, 5%), sodium phosphate (2 cases, 5%), and sodium citrate (1 case, 2.5%). High proportions of children had esophagitis (40/40, 100%), erosive gastritis (7/40, 17.5%), and gastric ulcer (6/40, 15%). The incidence of esophageal stricture was 38.4% (5/13) and 7.4% (2/27) in groups B and A, respectively. In group B, 4 children developed growth stunting or malnutrition during the first decade after onset, with reduced immunity and feelings of inferiority. CONCLUSION Alkaline ingestion usually results in esophageal injury that is difficult to cure. Corrosive esophageal strictures cause swallowing difficulties and growth stunting in children. Young children who ingested alkaline oil have more complications. Given that alkaline corrosive injuries are often accidental, prevention of corrosive agent ingestion is crucial.
Collapse
Affiliation(s)
- Chin-Chiang Chen
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; Department of Pediatrics, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - An-Chyi Chen
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Fen Wu
- Department of Pediatrics Gastroenterology, Children's Hospital of China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
32
|
Liu D, Pickering T, Kokot N, Crookes P, Sinha UK, Swanson MS. Outcomes of Combined Antegrade-Retrograde Dilations for Radiation-Induced Esophageal Strictures in Head and Neck Cancer Patients. Dysphagia 2021; 36:1040-1047. [PMID: 33386998 DOI: 10.1007/s00455-020-10236-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/17/2020] [Indexed: 01/13/2023]
Abstract
The purpose of this study is to analyze outcomes of combined antegrade-retrograde dilations (CARD). This retrospective study was conducted on 14 patients with a history of head and neck cancer, treated with radiation therapy that was complicated by either complete or near-complete esophageal stenosis. All patients had minimal oral intake and depended on a gastrostomy tube for nutrition. Swallow function before and after CARD was assessed using the Functional Oral Intake Scale, originally developed for stroke patients and applied to head and neck cancer patients. Patients undergoing CARD demonstrated a quantifiable improvement in swallow function (p = 0.007) that persisted at last known follow-up (p = 0.015) but only a minority (23.1%) achieved oral intake sufficient to obviate the need for tube feeds. Complication rates were 24% per procedure or 36% per patient, almost all complications required procedural intervention, and all complications occurred in patients with complete stenosis. Our study suggests further caution when considering CARD, careful patient selection, and close post-operative monitoring.
Collapse
Affiliation(s)
- Derek Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Trevor Pickering
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Niels Kokot
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, 1540 Alcazar St, Suite 204M, Los Angeles, CA, 90033, USA
| | - Peter Crookes
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Uttam K Sinha
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, 1540 Alcazar St, Suite 204M, Los Angeles, CA, 90033, USA
| | - Mark S Swanson
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, 1540 Alcazar St, Suite 204M, Los Angeles, CA, 90033, USA.
| |
Collapse
|
33
|
Kawamura Y, Kawada K, Ito T, Saito K, Fujiwara N, Okada T, Hoshino A, Tokairin Y, Nakajima Y, Kawano T, Tokunaga M, Kinugasa Y. Histological changes in the human esophagus following triamcinolone injection to prevent esophageal stricture after endoscopic submucosal dissection. Esophagus 2021; 18:594-603. [PMID: 33651217 DOI: 10.1007/s10388-021-00818-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Locoregional steroid injection prevents post-endoscopic submucosal dissection (ESD) esophageal stricture, but histological changes that occur following steroid injection in the human esophagus are unclear. This study investigated the histopathological characteristics caused by locoregional triamcinolone acetonide (TA) injection using human esophagectomy specimens. METHODS From January 2014 to December 2019, among 297 patients (373 lesions) who underwent esophageal ESD, 13 patients who underwent additional esophagectomy after ESD were examined. Seven patients (TA group) with wide excisions were injected with TA after ESD and another six patients (Non-TA group) with smaller tumors were not injected with TA. The clinical background of these patients and histopathological features of ESD ulcer scar obtained from esophagectomy specimens were retrospectively investigated. RESULTS The circumferential rate of ESD excision was more than three-quarters in all cases in the TA group, whereas it was less than three-quarters in the Non-TA group. No other statistical difference in the clinical background was found between the two groups. The subepithelial fibrous tissue of the ESD ulcer scar in the TA group was significantly thinner than that in the Non-TA group (P < 0.05). There was no significant difference in the thickness of the regenerated epithelium and muscularis propria layer of the ESD ulcer scar. CONCLUSIONS Histological finding of thinning of the subepithelial fibrous tissue of ESD ulcer scar in the human esophagus after TA injection was obtained. This suggests that TA suppresses the proliferation of the fibrous tissue of the subepithelial layer to help prevent esophageal stricture after widespread ESD in the human esophagus.
Collapse
|
34
|
Cornejo-Villa MDR, Torres-Rojas A, Soto-Blanquel MA, Soto-Mancilla JL. Estado nutricional de niños con estenosis esofágica secundaria a quemadura por cáusticos, alimentados por gastrostomía en el Hospital Civil de Guadalajara. CIR CIR 2020; 88:726-731. [PMID: 33254186 DOI: 10.24875/ciru.20001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The ingestion of caustic substances constitutes a serious problem in the pediatric age that can cause injuries in the esophagus that may require oral feeding. Gastrostomy nutrition is a safe way to guarantee an adequate evolution of the nutritional status, as well patient's growth and development. Objective To evaluate the nutritional status of children with esophageal stenosis, secondary to caustic ingestion, after 6 months of gastrostomy placement as a feeding route. Method A descriptive, longitudinal ambispective study was carried out, with a sample of 20 patients. Nutritional status before and after gastrostomy placement; was obtained through anthropometric measurements and pediatric indexes. Statistical analysis: t-test. Results The anthropometric indexes of W/A and BMI/A reflect a statistically significant improvement in nutritional status over 6 months of gastrostomy treatment, but not for H/A. Conclusion The nutritional status evolves adequately from gastrostomy management in these patients.
Collapse
Affiliation(s)
- Martha Del R Cornejo-Villa
- Departamento Institucional de Nutrición Clínica y Cirugía Pediátrica, Organismo Público Descentralizado (OPD), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - Andrea Torres-Rojas
- Departamento Institucional de Nutrición Clínica y Cirugía Pediátrica, Organismo Público Descentralizado (OPD), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - María A Soto-Blanquel
- Departamento Institucional de Nutrición Clínica y Cirugía Pediátrica, Organismo Público Descentralizado (OPD), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - Juan L Soto-Mancilla
- Departamento Institucional de Nutrición Clínica y Cirugía Pediátrica, Organismo Público Descentralizado (OPD), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| |
Collapse
|
35
|
Zou J, Chai N, Linghu E, Li H, Chai M, Shi Y, Wang Z, Li L. Autologous skin-grafting surgery to prevent esophageal stenosis after complete circular endoscopic submucosal tunnel dissection: a case-matched controlled study. Surg Endosc 2021; 35:5962-70. [PMID: 33029731 DOI: 10.1007/s00464-020-08081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of postoperative stenosis after endoscopic resection of wholly circumferential superficial esophageal squamous cell neoplasms (SESCNs) is extremely high. METHODS Between January 2011 and April 2019, 19 patients who underwent autologous skin-grafting surgery (ASGS) after complete circular endoscopic submucosal tunnel dissection (ccESTD) were enrolled to form the ASGS group. Cases in the ASGS group were individually matched at a 1:1 ratio to cases undergoing fully covered esophageal stent (FCES) placement alone (FCES group) based on pathological diagnosis, curative resection, longitudinal length of ulceration, lack of stent migration, time to stent removal, follow-up period and operators. Baseline characteristics and treatment outcomes were compared between the two groups. RESULTS Baseline characteristics were comparable between the ASGS group and the FCES group. The incidence of patients with esophageal stenosis after removal of the stent in the ASGS group was significantly reduced compared that in the FCES group (36.8% vs 78.9%, p = 0.020). Comparison of preventive methods (ASGS vs FCES alone) between the stenosis group and nonstenosis group revealed that ASGS accounted for a higher proportion than FCES alone in the nonstenosis group (p = 0.020). CONCLUSIONS Compared with FCES placement alone, ASGS appeared to be more effective in preventing esophageal stenosis after ccESTD for SESCNs.
Collapse
|
36
|
Abstract
Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10-14 days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21 days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18-20 mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind.
Collapse
Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery, Faculty of Medicine, Kutahya Health Sciences University, Evliya Celebi Training and Research Hospital, Merkez, 43040, Kutahya, Turkey.
| | - Salih Bayram
- Clinic of Pediatric Surgery, Artvin Government Hospital, Artvin, Turkey
| |
Collapse
|
37
|
Sugaya T, Hikichi T, Nakamura J, Hashimoto M, Takasumi M, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Rikimaru M, Uematsu M, Minemura H, Kobayakawa M, Ohira H. Esophagobronchial fistula complicated by esophageal achalasia treated by per-oral endoscopic myotomy. Clin J Gastroenterol 2020; 13:1051-1056. [PMID: 32909156 DOI: 10.1007/s12328-020-01226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
A 48-year-old man who underwent balloon dilation for esophageal achalasia more than 20 years prior developed severe dysphagia and cough during mealtimes. Endoscopic findings showed a markedly dilated esophagus with residue, narrowing of the esophagogastric junction (EGJ), and a fistula in the middle thoracic esophagus. Esophagography showed narrowing of the EGJ and outflow of contrast from the esophagus to the bronchus. In addition, computed tomography showed marked esophageal dilatation and diffuse granular shading in both lungs. Based on these imaging findings, the patient was diagnosed with deterioration of esophageal achalasia and an esophagobronchial fistula (EBF) secondary to achalasia. The increased intra-esophageal pressure caused by the achalasia was suspected to have inhibited the closure of the EBF. Therefore, we believed that per-oral endoscopic myotomy (POEM) would help treat the achalasia and simultaneously contribute to closing of the EBF. Immediately after POEM, the dysphagia and cough improved. Furthermore, the EBF was closed. 14 months after POEM, the patient did not exhibit deterioration of esophageal achalasia and EBF. To the best of our knowledge, there have been no reports of POEM implemented in cases of esophageal achalasia complicated by EBF. Therefore, this case is worth reporting.
Collapse
Affiliation(s)
- Tatsuro Sugaya
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan.
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
| | - Minami Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Manabu Uematsu
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Medical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| |
Collapse
|
38
|
Suzaki K, Kobayashi K, Matsuoka M, Okura Y, Nozaka T, Yauchi M, Watabe T, Matsumoto T, Furumoto Y, Horiuchi T, Asano T, Fujiki K. A case of cytomegalovirus esophagitis during topical steroid therapy for eosinophilic esophagitis. Clin J Gastroenterol 2020; 13:1046-1050. [PMID: 32875424 DOI: 10.1007/s12328-020-01219-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Systemic immune deficiency is a major cause of cytomegalovirus (CMV) esophagitis. We report a case of CMV esophagitis during topical steroid therapy of eosinophilic esophagitis (EoE) in a non-immunodeficient patient. An 85-year-old man with dysphagia was on a 6-year regimen of oral budesonide (1200 mcg daily) for EoE. He underwent right upper lobectomy and postoperative radiotherapy 25 years ago for lung squamous cell carcinoma. Esophageal cicatricial stenosis due to EoE or previous radiation therapy persisted. Esophagogastroduodenoscopy revealed ulcerating mucosa with a thick white coat originating from the fixed stenotic lesion to the oral side. Histopathological examinations revealed CMV esophagitis. All signs of CMV esophagitis rapidly disappeared after reducing the budesonide dose and initiating anti-viral treatment with ganciclovir and valganciclovir for 12 and 2 days, respectively. The patient continued topical budesonide 400 mcg daily after anti-viral therapy. The clinical course was uneventful and without CMV esophagitis recurrence. This suggests that topical steroid therapy, particularly the local stasis of steroids at stenotic lesions, may induce CMV esophagitis. This is the first report of CMV esophagitis complicating the local steroid therapy of EoE with a stenotic lesion. When EoE patients' clinical symptoms worsen with topical steroid therapy, CMV esophagitis should be considered.
Collapse
Affiliation(s)
- Ken Suzaki
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Mana Matsuoka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yukito Okura
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takahito Nozaka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Masato Yauchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Taro Watabe
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Taichi Matsumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takao Horiuchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Toru Asano
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuhiko Fujiki
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| |
Collapse
|
39
|
Kim HR. Stricture Following Esophageal Reconstruction. Korean J Thorac Cardiovasc Surg 2020; 53:222-225. [PMID: 32793456 PMCID: PMC7409887 DOI: 10.5090/kjtcs.2020.53.4.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
Owing to varying clinical definitions of anastomotic stricture following esophageal reconstruction, its reported incidence rate varies from 10% to 56%. Strictures adversely impact patients’ quality of life. Risk factors, such as the anastomosis method, leakage, ischemia, neoadjuvant chemoradiotherapy, and underlying disease have been mentioned, but conflicting information has been reported. Balloon dilation is regarded as a safe and effective treatment method for patients with benign anastomotic strictures. Reoperations are seldom required. The etiology and management of anastomotic strictures are reviewed in this article.
Collapse
Affiliation(s)
- Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
40
|
Shiratori Y, Nakamura K, Ikeya T, Fukuda K. Treatment of esophageal perforation with mediastinal abscess by nasomediastinal drainage placement. Clin J Gastroenterol 2020; 13:703-7. [PMID: 32514685 DOI: 10.1007/s12328-020-01144-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
Although endoscopic submucosal dissection has been increasingly performed for managing superficial esophageal carcinomas, the risk of post-operative esophageal stenosis remains. Endoscopic balloon dilation for esophageal stenosis is the most common cause of esophageal perforation. Esophageal perforation complicated with mediastinal abscess and sepsis has a high mortality rate. The standard treatment for esophageal perforation is closure. However, the late diagnosis of a case necessitates that treatment of mediastinitis be prioritized over closure of the perforation. We report the case of a 70-year-old man with post-endoscopic submucosal dissection stenosis who underwent endoscopic balloon dilation. Six days after the 16th endoscopic balloon dilation, the patient came to our hospital with a complaint of chest discomfort. Upon assessment, an esophageal perforation and a mediastinal abscess became evident. Because the patient's systemic condition remained stable, instead of performing surgery, we treated the patient conservatively by placing a nasomediastinal drain. After daily rinsing, the mediastinal abscess eventually regressed on the 15th hospital day. The esophageal perforation also closed spontaneously after removing the drainage tube. Nasomediastinal drainage placement appears to be effective in treating an esophageal perforation with a mediastinal abscess.
Collapse
|
41
|
Chen M, Dang Y, Ding C, Yang J, Si X, Zhang G. Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection. Surg Endosc 2020; 34:4065-71. [PMID: 31953729 DOI: 10.1007/s00464-020-07368-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) is used to treat early esophageal cancer and precancerous lesions. Patients undergoing ESD are prone to esophageal stenosis, which impairs therapeutic efficacy and quality of life. This retrospective study aimed to investigate the potential association between patient demographics and esophageal lesion characteristics with the risk of esophageal stenosis following ESD. METHODS For this retrospective study 190 consecutive patients who underwent ESD between January 2013 and January 2015 were recruited. Data on patient demographics, esophageal lesion-related factors, operation details, esophageal stenosis occurrence and measures taken to prevent or treat stricture were collected, and the normality of distribution of each indicator was assessed with a Kolmogorov-Smirnov test. Stenosis risk factors were then identified using univariate and multivariate logistic regression. RESULTS Post-ESD esophageal stenosis occurred in 51 cases. Multivariate logistic regression analysis was performed to identify independent risk factors. A history of EMR/ESD (OR = 4.185, 95% CI: 1.511-11.589), resection circumferential diameter (OR = 1.721, 95% CI: 1.135-2.610), non-en bloc resection (OR = 7.413, 95% CI: 2.398-22.921), submucosal infiltration (OR = 3.449, 95% CI: 1.014-11.734) and circumferential resection range (OR = 57.493, 95% CI: 17.236-191.782) were identified as independent risk factors for post-ESD esophageal stenosis. Spraying porcine fibrin adhesive on the resection bed reduced neither the incidence of postoperative stenosis nor the extent of postoperative dilation. CONCLUSION Post-ESD esophageal stenosis is significantly related to size and circumferential range of lesion resection. EMR/ESD history, non-en bloc resection and submucosal infiltration may be additional risk factors.
Collapse
|
42
|
Ruan RW, Yu JP, Tao YL, Liu YJ, Zhu SW, Wang S. Efficacy of single local triamcinolone injection for prevention of stenosis after endoscopic submucosal dissection for superficial esophageal carcinoma. Shijie Huaren Xiaohua Zazhi 2019; 27:1313-1319. [DOI: 10.11569/wcjd.v27.i21.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables en bloc resection and has now been widely used in the resection of superficial esophageal carcinomas. However, refractory postoperative stenosis develops frequently when the mucosal defect involves more than three-quarters of the circumference, which decreases the patient's quality of life seriously.
AIM To evaluate the efficacy and safety of single local triamcinolone injection for the prevention of stenosis after ESD for superficial esophageal carcinoma.
METHODS The clinical data of 49 patients with superficial esophageal carcinomas treated by ESD at the Endoscopy Center of Zhejiang Cancer Hospital from January 2013 to December 2017 were retrospectively analyzed. Among them, 27 patients were only treated with ESD, which were used as a control group, and the other 22 patients who underwent triamcinolone acetonide injection into the residual submucosal layer of the resected region immediately after ESD for prevention of stenosis were used as a study group. Systematic endoscopic follow-ups were performed in both groups, and if esophageal stenoses were detected, repeated endoscopic balloon dilations (EBD) were performed until dysphagia symptoms were successfully relieved. The rate of esophageal stenosis and the frequency of EBD were compared between the two groups.
RESULTS The rate of esophageal stenosis in the study group was 22.7% (5/22), which was significantly lower than that in the control group [74.1% (20/27), P = 0.001]. The mean number of EBD procedures was 4.4 ± 2.1 (range 2-7) in the study group, which was also significantly lower than that in the control group [8.7 ± 4.2 (range, 1-17), P = 0.037]. No bleeding, perforation, mediastinal abscess, or other serious complications occurred with local triamcinolone injection in our study.
CONCLUSION Single local triamcinolone injection after esophageal ESD can effectively prevent the occurrence of esophageal stenosis and significantly reduce the number of EBD treatments.
Collapse
Affiliation(s)
- Rong-Wei Ruan
- Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Endoscopy Center, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Jiang-Ping Yu
- Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Endoscopy Center, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Ya-Li Tao
- Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Endoscopy Center, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Yong-Jun Liu
- Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Endoscopy Center, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Shu-Wen Zhu
- Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Endoscopy Center, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Shi Wang
- Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Endoscopy Center, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
| |
Collapse
|
43
|
Andreevski V, Deriban G, Isahi U, Mishevski J, Dimitrova M, Caloska V, Joksimovic N, Popova R, Serafimovski V. Four Year Results of Conservative Treatment of Benign Strictures of the Esophagus with Savary Gilliard Technique of Bougienage: Cross-Sectional Study Representing First Experiences in Republic of Macedonia. ACTA ACUST UNITED AC. 2018;39:29-35. [PMID: 30110262 DOI: 10.2478/prilozi-2018-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Background: Benign esophageal strictures are complications resulting from various causes. They can be structurally categorized in two groups: simple and complex. Treatment is similar in most cases that require dilatation and means use of three general types of dilators that are currently in use. However, despite the last guidelines on esophageal dilatation, the therapeutic response, optimal timing of treatment and interval between sessions may vary and there is no strong consensus in the literature regarding this fact.
Aims: To analyzethe first 4 year experience of Digestive Endoscopy Unit at the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia in treating benign esophageal strictures, since the Savary-Gilliard technique of “bougienage” was introduced for the first time in Republic of Macedonia, at our Institution, in December 2013, by assessing etiology, length of stricture, number of dilations required to achieve satisfactory therapeutic response, as well as the relationship between the type, extent of stenosis and therapeutic response.
Methods: One hundred and forty five dilations, during a period from 20th December 2013, until March 2017, have been analyzed in 31 patients
Results: The caustic strictures were the most prevalent, occurring in 15 (48%) of patients, followed by peptic stenosis presenting 26% of patients. The long and corrosive strictures needed more sessions to the absence of dysphagia. Peptic and short stenoses best respondedon treatment and needed fewer dilatation sessions per patient.
Conclusion: Caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long one. Peptic stenosis is the second cause of benign esophageal strictures and responded well to endoscopic therapy. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage using Savary-Gilliard or American type of technique, irrespective of the type and the extent of esophageal stenosis, is safe and purposeful procedure.
Collapse
|
44
|
Gómez-Aldana A, Jaramillo-Santos M, Delgado A, Jaramillo C, Lúquez-Mindiola A. Eosinophilic esophagitis: Current concepts in diagnosis and treatment. World J Gastroenterol 2019; 25:4598-4613. [PMID: 31528089 PMCID: PMC6718043 DOI: 10.3748/wjg.v25.i32.4598] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/13/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. Its symptoms, which include heartburn, regurgitation, and esophageal stenosis (with dysphagia being more frequent in eosinophilic esophagitis in young adults and children), are similar to those of gastroesophageal reflux disease, causing delays in diagnosis and treatment. Although endoscopic findings such as furrows, esophageal mucosa trachealization, and whitish exudates may suggest its presence, this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia (parasitic infections, hypereosinophilic syndrome, inflammatory bowel disease, among others) for which treatment could be initiated. Currently, the 3 “D”s (“Drugs, Diet, and Dilation”) are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. Herein, the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed, in addition to evidence for the various treatments.
Collapse
Affiliation(s)
- Andrés Gómez-Aldana
- Departament of Internal Medicine, Section of Gastroenterology, Santa Fe Foundation of Bogotá (Fundación Santa Fe de Bogotá), Bogotá 220246, Colombia
- University of Los Andes, Bogotá 111711, Colombia
| | - Mario Jaramillo-Santos
- Department of Endoscopy, Caldas University, Manizales 275, Colombia
- Department of Endoscopy, Surgeons’ Union SAS (Joint stock company) (Union de cirujanos SAS), Manizales 170001661, Colombia
| | - Andrés Delgado
- Departament of Internal Medicine, Section of Gastroenterology, Santa Fe Foundation of Bogotá (Fundación Santa Fe de Bogotá), Bogotá 220246, Colombia
| | - Carlos Jaramillo
- Department of Endoscopy, Caldas University, Manizales 275, Colombia
| | | |
Collapse
|
45
|
Bharath Kumar C, Chowdhury SD, Ghatak SK, Sreekar D, Kurien RT, David D, Dutta AK, Simon EG, Joseph AJ. Immediate and long-term outcome of corrosive ingestion. Indian J Gastroenterol 2019; 38:356-61. [PMID: 31643028 DOI: 10.1007/s12664-019-00978-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Corrosive ingestion (CI) has short- and long-term consequences. The aim of this study was to assess the outcome of mucosal injury grade ≥ 2A. METHODS Consecutive patients between January 2008 and January 2015 who presented within 48 h of CI were included. Details of substance ingested, intent, symptoms, injury grade at endoscopy, and treatment were obtained by a review of medical records. Patients aged less than 15 years or injury grade less than 2A were excluded. Patients were followed up using a structured symptom-based questionnaire and barium swallow. RESULTS A total of 112 patients were admitted with CI during the study period. Eighty-two patients were included in the study. There was no relationship between the presence of symptoms or oral mucosal injury and the grades of gastrointestinal mucosal injury. Grades 2B and 3A were the most common grades of mucosal injury. Five patients died at index hospitalization. Patients were followed up for a median period of 31 months (6-72) during which 11 patients were lost to follow up. During follow up, 2 patients with high-grade injury died as a consequence of CI and 4 died of unrelated causes. Sixteen (26.6%) patients remained symptomatic. Forty-three patients underwent barium swallow. Esophageal stricture was identified in 11 patients, gastric stricture in 8, and combined esophageal and gastric in 2. High-grade esophageal mucosal injury was associated with a high risk of stricture formation (p = 0.02). CONCLUSIONS CI is associated with high immediate and long-term morbidity and mortality.
Collapse
|
46
|
Arasu S, Liaquat H, Suri J, Ehrlich AC, Friedenberg FK. Incidence and risk factors of dysphagia after variceal band ligation. Clin Mol Hepatol 2019; 25:374-380. [PMID: 31315388 PMCID: PMC6933116 DOI: 10.3350/cmh.2019.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/12/2019] [Indexed: 01/08/2023] Open
Abstract
Background/Aims There is a lack of data on long-term morbidity, particularly dysphagia, following endoscopic variceal band ligation (EVL). The aim of this study are to assess the incidence of dysphagia and variables associated with this complication after EVL. Methods We identified individuals who completed at least one session of EVL as their sole treatment for varices from August 2012 to December 2017. Included patients achieved “complete eradication” of varices not requiring further therapy. Patients ≥90 days from their last EVL session completed a modified version of the Mayo Clinic Dysphagia Questionnaire. Individuals with dysphagia were invited to undergo a barium esophagram. Patients with pre-EVL dysphagia were excluded. Results Of the patients, 68 possessed inclusion criteria, nine (13.2%) died and 20 (29.4%) were lost to follow up. For the remaining 39 (57.4%) patients, 23 were males, mean age of 61.7±8.6 years. The most common etiology of liver disease was hepatitis C virus (n=18; 46.2%). The median number of banding sessions was 2.0 (interquartile range [IQR], 1.0–4.0) with a median of 9.0 bands placed (IQR, 3.0–14.0). Twelve patients (30.8%) developed new-onset dysphagia post-EVL. In univariate analysis, pre-EVL MELD score and non-emergent initial banding were associated with long-term dysphagia. In a regression model adjusted for age, sex, number of bands, and use of acid suppression after EVL, no factor was independently associated with dysphagia (all p>0.05). No strictures were identified on subsequent esophageal evaluation. Conclusions Approximately 30% of patients developed new-onset, chronic dysphagia post-EVL. Incident dysphagia was associated with a non-emergent initial banding session. The mechanism for dysphagia remains unknown.
Collapse
Affiliation(s)
- Saraswathi Arasu
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Hammad Liaquat
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jaspreet Suri
- Internal Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adam C Ehrlich
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Frank K Friedenberg
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
47
|
Oztan MO, Arslan FD, Oztan S, Diniz G, Koyluoglu G. Effects of topical application of platelet-rich plasma on esophageal stricture and oxidative stress after caustic burn in rats: Is autologous treatment possible? J Pediatr Surg 2019; 54:1397-1404. [PMID: 30086993 DOI: 10.1016/j.jpedsurg.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 04/23/2018] [Revised: 07/04/2018] [Accepted: 07/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Caustic esophageal burn is still an important health problem in pediatric surgery. Although there are a number of experimental and clinical studies to increase the recovery of the esophagus and reduce the stenosis rate, there is no consensus on the treatment protocol. Platelet-rich plasma (PRP) is an autologous blood product, which has positive effects on wound healing, reepithelization and scar prevention. The aim of our study was to investigate the effects of PRP on stricture formation and oxidative status after caustic esophageal injury in rats. METHODS Twenty-one rats were divided into three groups [Sham operation (n = 8), corrosive esophageal burn with 30% NaOH (n = 6), topical PRP application after corrosive burn (n = 7)]. On the postoperative 21st day, oxidative markers were measured in the serum, and collagen accumulation and stenosis index were measured histopathologically to assess the efficacy of PRP treatment. RESULTS Postoperative weight was higher than preoperative weight in Sham and PRP groups, but lower in the Burn group (p < 0.05). No difference was observed between Sham and PRP groups at total antioxidant status and paraoxonase values, but a significant decrease was found in the Burn group. Group PRP had higher total oxidant status and arylesterase levels than Group Burn (p < 0.05). There was no difference in total thiol values between PRP and Sham group. Histopathological scoring for muscularis mucosa damage revealed a significant reduction in Group PRP, compared to Group Burn (p < 0.05). Esophageal wall thickness and SI were reduced, and luminal diameter was increased in Group PRP compared to Group Burn (p < 0.05). CONCLUSION For the first time in the literature, these results indicate that topical PRP treatment after the experimental corrosive burn has a positive effect on oxidative stress, mucosal healing and decreased stricture development. PRP may be an alternative at the clinical treatment because it can be used during diagnostic esophagoscopy. TYPE OF STUDY Treatment study Level I (randomized controlled trial).
Collapse
Affiliation(s)
- Mustafa Onur Oztan
- Izmir Katip Çelebi University, Department of Pediatric Surgery, Cigli, Izmir, Turkey.
| | - Fatma Demet Arslan
- University of Health Sciences, Department of Medical Biochemistry, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey
| | - Sule Oztan
- MEST Aesthetic and Plastic Surgery Center, Konak, Izmir, Turkey
| | - Gulden Diniz
- University of Health Sciences, Department of Pathology, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey
| | - Gokhan Koyluoglu
- Izmir Katip Çelebi University, Department of Pediatric Surgery, Cigli, Izmir, Turkey
| |
Collapse
|
48
|
Wu Y, Wu C. Congenital Esophageal Atresia Associated with a Tracheobronchial Remnant. Korean J Thorac Cardiovasc Surg 2019; 52:170-173. [PMID: 31236378 PMCID: PMC6559189 DOI: 10.5090/kjtcs.2019.52.3.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022]
Abstract
A rare case of esophageal atresia/tracheo-esophageal fistula (EA-TEF) with an associated tracheobronchial remnant (TBR) is reported and discussed herein. A 13-month-old patient was seen with a complaint of vomiting of solid food 1 year after EA-TEF repair. An esophagogram showed a tapered narrowing in the lower segment of the esophagus. A re-operation was carried out and a pathologic examination of the resected stenotic segment revealed the presence of a TBR.
Collapse
Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
49
|
Wang C, Lu J, Wang Y, Zhu GY, Chen L, Li JC, Li TK, Chen L, Guo JH. A New Fully Covered Irradiation Stent Versus a Partially Covered Irradiation Stent for Unresectable Malignant Dysphagia: A Single-Center Experience. Cardiovasc Intervent Radiol 2019; 42:1142-1152. [PMID: 31144010 DOI: 10.1007/s00270-019-02252-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 01/23/2019] [Accepted: 05/23/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess the efficacy and safety of a newly developed fully covered irradiation stent (FCIS) compared with a partially covered irradiation stent (PCIS) in patients with unresectable malignant dysphagia. MATERIALS AND METHODS Data of 195 patients [158 (81.0%) males, median age of 75 years (range 49-89 years)] who underwent FCIS or PCIS placement for unresectable malignant dysphagia from January 2012 to November 2017 were retrospectively analyzed. The median follow-up time was 181 days (range 4-547 days). Outcomes were measured in terms of recurrent dysphagia (primary), technical success, clinical success, overall survival, and adverse events. Recurrent dysphagia was analyzed by Fine-Gray regression model. RESULTS The technical success rate was 97.8% (87/89) in the FCIS group and 99.1% (105/106) in the PCIS group (P = 0.59). The clinical success rate was 100.0% in both groups. There was no statistically significant difference in the recurrent dysphagia rate between the FCIS and PCIS groups (21.8% vs. 28.6%; P = 0.12). Compared with PCISs, FCISs were associated with a decrease in tissue/tumor growth rate (11.5% vs. 21.9%; P = 0.01), while stent migration rates were statistically comparable (11.5% vs. 5.7%; P = 0.23). The median overall survivals were comparable between the FCIS and PCIS groups (164 days vs. 162 days; P = 0.70). A dysphagia score of 4 and metastasis were risk factors for survival. No significant differences were observed in the rates of adverse events, including chest pain, fistula formation, hemorrhage, and aspiration pneumonia (P > 0.05). CONCLUSION For patients with unresectable malignant dysphagia, this newly developed FCIS can provide efficacy and safety comparable to those of a PCIS. Compared with PCIS, this FCIS is more successful in preventing tissue/tumor growth, with a comparable stent migration rate.
Collapse
Affiliation(s)
- Chao Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yong Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jun-Chao Li
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Tian-Kuan Li
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Lei Chen
- Department of Intervention and Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215001, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
| |
Collapse
|
50
|
Fujisawa D, Asato H, Tanaka K, Itokazu T, Kojya S. Reconstruction of esophageal stenosis that had persisted for 40 years using a free jejunal patch graft with virtual endoscopy assistance: A case report. Arch Plast Surg 2019; 47:178-181. [PMID: 31018631 PMCID: PMC7093279 DOI: 10.5999/aps.2019.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.
Collapse
Affiliation(s)
- Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Katsunori Tanaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Tetsuo Itokazu
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Shizuo Kojya
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| |
Collapse
|