PubMed · 4037283
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D J Ferguson. 1985. Tissue expanders complicating intubation.. https://doi.org/10.1111/j.1365-2044.1985.tb11028.x
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Recurrence of esophageal peptic stricture necessitating repeated dilation treatments remains a problem for many patients despite optimal acid suppressive therapy. The factors associated with frequent relapses are poorly understood. We studied retrospectively a population of 58 patients with benign peptic strictures and dysphagia treated by esophageal dilation and followed for 66.5 +/- 6.7 months. Data was collected for age, sex, heartburn, weight loss, esophagitis, Barrett's esophagus, number of dilation treatments during the first year of follow-up, frequency and number of subsequent dilation treatments, type of dilator used, and history of other concurrent treatments. Patients who lacked heartburn (P = 0.007) or who reported a history of weight loss (P = 0.006) at the time of their initial presentation required more frequent dilations during the first year of follow-up. The mean number of dilations in year 1 was 6.2 +/- 0.9 for patients lacking heartburn versus 3.2 +/- 0.5 for patients with heartburn (P = 0.004), and 9.0 +/- 1.8 for patients who reported weight loss versus 4.1 +/- 0.5 (P = 0.006) for those who did not. The patients requiring frequent treatment during their first year also required frequent subsequent dilations because of stricture recurrence (P < 0.0001). We did not demonstrate any relationship between the other factors studied and treatment frequency. These observations suggest that patients who require frequent retreatment for recurrent peptic stricture are more likely to provide a history of weight loss and less likely to complain of heartburn at initial presentation. The pattern of frequent repeat dilation for recurrent peptic strictures is established during the first year of follow-up.
PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is considered standard therapy for most renal calculi as well as more than 80% of all upper urinary tract stones. The development of flexible and small diameter rigid ureteroscopes, and the increased availability of laser lithotriptors have made endoscopic treatment of ureteral calculi more successful and safe. This report represents our contemporary series of 80 single mid and proximal ureteral calculi treated endoscopically. MATERIALS AND METHODS: A total of 78 patients underwent 80 primary endoscopic procedures with 3 auxiliary ESWL and 2 endoscopic re-treatments for 41 mid and 39 proximal ureteral calculi. Lithotripsy was performed for 55 of the 80 stones. RESULTS: Of the 80 stones 75 (94%) successfully cleared 1 month after 1 endoscopic procedure. The success rate was 38 of 39 (97%) for proximal calculi and 37 of 41 (90%) for mid ureteral stones. With a single re-treatment overall success increased to 96%. If adjuvant ESWL was added, 100% success was attained. Currently all procedures are performed on an outpatient basis. Morbidity is low and there have been no major complications, such as stricture, renal loss or death. CONCLUSIONS: Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of mid and proximal ureteral calculi. Thus, ureteroscopic treatment should be considered a treatment of choice for upper ureteral calculi.
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