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At least 523 records · Page 29Linked to original sources
PubMed1993

Treatment-related esophageal stricture in pediatric patients with cancer.

BACKGROUND: Intensive antineoplastic regimens have enhanced long-term survival in pediatric patients with cancer, but can result in long-term complications. Esophageal stricture formation is one such complication. METHODS: We reviewed the experience with benign esophageal stricture in pediatric patients with cancer over the past 15 years in a major cancer center. Clinical course, along with endoscopic, radiologic, and manometric esophageal studies, was reviewed. RESULTS: Esophageal strictures formed in five pediatric patients who were treated with radiation and/or chemotherapy. Stricture formation was associated with abnormal esophageal motility in four out of the five patients. Repeated esophageal dilation was performed from 3-50 times and resulted in stricture resolution in only 2 of the 5 patients. CONCLUSIONS: Esophageal stricture formation in this population is rare, but is associated with long-term morbidity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Resection of carcinoma in the cervical esophagus following prior removal of a thoracic esophageal carcinoma--a case report.

We report herein, a rare case of a patient who, having undergone resection of a thoracic esophageal cancer, underwent removal of a cervical esophageal cancer, for which a free jejunal graft with microvascular anastomoses was utilized. The tumor in the cervical esophagus had originated from a second primary squamous cell cancer, which had occurred synchronously but had unfortunately escaped detection before the first operation. Due to the high incidence of other multicentric neoplasma or metastatic skip lesions accompanying esophageal carcinoma, careful evaluation during preoperative examinations in order to avoid overlooking another lesion, especially in the cervical portion of the esophagus is imperative.

Carcinoma, Squamous Cell↗
PubMed1999

Molecular evolution of the metaplasia-dysplasia-adenocarcinoma sequence in the esophagus.

The incidence of adenocarcinoma of the esophagus has been increasing in developing countries over the last three decades and probably reflects a genuine increase in the incidence of its recognized precursor lesion, Barrett's metaplasia. Despite advances in multimodality therapy, the prognosis for invasive esophageal adenocarcinoma is poor. An improved understanding of the molecular biology of this disease may allow improved diagnosis, therapy, and prognosis. We focus on recent developments in the molecular and cell biology of Barrett's metaplasia, a heterogeneous lesion affecting the transitional zone of the gastro-esophageal junction whose associated molecular alterations may vary both in nature and temporally. Early premalignant clones produce biological and genetic heterogeneity as seen by multiple p53 mutations, p16 mutations, aneuploidy, and abnormal methylation resulting in stepwise changes in differentiation, proliferation, and apoptosis, allowing disease progression under selective pressure. Abnormalities in expression of growth factors of the epidermal growth factor family and cell adhesion molecules, especially cadherin/catenin complexes, may occur early in invasion. Exploitation of these molecular events may lead to a more appropriate diagnosis and understanding of these lesions in the future.

Adenocarcinoma↗
PubMed2003

[Esophageal and intestinal stents].

Implantation of expandable metal stents has evolved during the last decade as an established method for the palliation of tumourous obstruction within the gastrointestinal tract. Rigid plastic stents have initially been used for the treatment of dysphagia due to esophageal carcinoma. The development of different types of self expandable metal stents with differing physical characteristics has facilitated their use for the palliative treatment of not only esophageal but gastroduodenal and colonic obstruction as well. The hallmark of these devices is the thin diameter of the compressed stents which allows introducing them into the obstructed segment without the need of aggressive dilatation. Once in place their compression is released and they self expand to a final diameter of approximately 20 mm. Perforation thus occurs rarely and these stents may successfully be placed in over 90% of patients with complete relief of obstruction in over 80%. The most frequent complications are stent dislocation and stent obstruction due to food impaction or tumour overgrowth.

Cardia↗
PubMed1999

Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study.

BACKGROUND AND STUDY AIMS: Endosonographic staging of esophageal carcinoma may be limited by non-traversable tumor stenoses. Dilation of malignant esophageal strictures carries a significant risk of esophageal perforation. We therefore evaluated the use of ultrasonic miniprobes in the staging of stenotic esophageal carcinoma compared with conventional endoscopic ultrasound. PATIENTS AND METHODS: In a blinded, prospective study, which included histopathological evaluation, 53 consecutive patients (43 male, 10 female, mean age 61 years) with stenosing esophageal carcinomas were examined preoperatively. Endosonography was done using the optical GF-UM3 echo endoscope. If tumor strictures were not traversable with this instrument, a blind esophagoprobe, the MH-908 was used for endosonography. Miniprobe sonography (MPS) was done during esophagoscopy in all patients. The various imaging modalities were assessed in terms of complete tumor traversability and correct tumor staging. Every patient underwent surgical tumor resection. RESULTS: MPS of the esophagus and proximal parts of the stomach was possible in all 53 patients without prior dilation of tumor stenoses. Endosonography with the GF-UM3 instrument was precluded in 23 patients (43.4%) while in 20 of the latter patients the MH 908 esophagoprobe could be passed through tumor stenoses. The overall accuracy rates for depth of tumor infiltration (T) staging were: 62% (31/50) for endosonography (GF-UM3 plus esophagoprobe) and 86.8% (46/53) for MPS. The accuracy rates for T staging in tumors traversable both with the GF-UM3 echo endoscope and with miniprobes were 56.7% (17/30) for GF-UM3 and 80% (24/30) for MPS. The accuracy rates for T staging in tumors traversable only with the MH-908 esophagoprobe and with miniprobes were 70% (14/20) for the MH-908 and 95% (19/20) for MPS. With regard to the presence or absence of peri-esophageal metastatic lymph nodes (N staging), the accuracy rates were 83% (25/30) for MPS and 70% (21/30) for the GF-UM3, and 80% (16/20) for MPS and 70% (14/20) for the MH-908. CONCLUSION: Compared with conventional endosonography using 7.5-MHz large diameter instruments, MPS enables: a) safe passage through high-grade malignant esophageal strictures, achieving b) higher accuracy rates for T staging, and c) similar rates for N staging. The use of MPS can also represent an improvement in the comfort and safety of patients. Moreover, miniprobe sonography is highly cost-effective compared with conventional endosonography. Thus, MPS appears to be a valuable addition to the armamentarium for staging esophageal carcinoma.

Adult↗
PubMed1984

Free jejunal graft for reconstruction of oral, oropharyngeal, and pharyngoesophageal defects.

A free jejunal graft was used either as a patch or as a conduit in 40 cases of reconstruction of the oral cavity, hypopharynx, and upper esophagus. Compared with previous intraoral reconstructive techniques using skin or myocutaneous flaps, one-stage free jejunal grafts result in low morbidity, rapid postoperative recovery, and no additional head and neck scars. Because of secure vascularization, the retention of temporary mandible implants is made safer. In addition to tongue reconstruction, facial contouring can also be achieved by the use of mesenteric fatty tissue. The well-vascularized physiologic lining created by utilizing the jejunal graft is highly resistant to mechanical stress and postoperative radiation therapy.

Adolescent↗
PubMed1980

Esophageal carcinoma: a survey of populations at risk.

Carcinoma of the esophagus is found more commonly in association with head and neck tumors, lye stricture, achalasia, and Barrett esophagus than in the general population. Our experience with these associated entities in a population of 680 patients with carcinoma of the esophagus is reviewed. Carcinoma of the esophagus has traditionally had a very poor prognosis which continues to the present. Routine periodic use of double contrast esophagography is advocated to screen populations containing these associated high-risk entities. This may ultimately increase survival through diagnosis of earlier stages of carcinoma of the esophagus.

Adult↗
PubMed2002

Self-administered symptom questionnaires in patients with dyspepsia and their yield in discriminating between endoscopic diagnoses.

BACKGROUND/AIMS: Symptoms are generally considered to be poor predictors of organic findings in patients with dyspepsia. We aimed at evaluating whether specific gastrointestinal symptoms, identified by self-administered questionnaires, correlate with specific endoscopic diagnoses and discriminate organic from functional dyspepsia. METHODS: Adult patients with pain or discomfort centred in the upper abdominal region were consecutively enrolled. Patients with heartburn, acid regurgitation, or defaecation and bowel habit problems as their predominant symptoms were excluded. Three self-administered questionnaires were applied before an oesophagogastroduodenoscopy was performed. RESULTS: Among the 799 patients, 50.6% had a normal endoscopy. Endoscopic diagnoses comprised: non-erosive oesophagitis (7.5%), erosive oesophagitis (11.1%), Barrett's oesophagus (1.1%), gastritis/duodenitis (8.4%), gastric ulcer (4.5%), duodenal ulcer (8.3%), and cancer (1.3%). Non-dominant heartburn and acid regurgitation were significantly more common in patients with organic dyspepsia, whereas hunger pains and rumbling occurred more often in those with functional dyspepsia. Multivariate analyses demonstrated that younger age, female gender, high scores for hunger pain, rumbling, hard stools, low scores for heartburn, and acid regurgitation predicted functional dyspepsia. CONCLUSIONS: Self-administered questionnaires revealed differences in the symptom patterns between patients with functional and organic dyspepsia. Furthermore, the health-related well-being in patients with functional and organic dyspepsia centred was impaired to the same extent.

Adolescent↗
PubMed2002

Stenting of the gastrointestinal tract.

Self-expandable metal stents are being increasingly used to palliate malignant stenoses of the gastrointestinal tract. These prostheses have made it possible to reestablish luminal continuity in patients with malignant obstruction of esophagus, gastric outlet, small bowel, or colon who are at high risk of surgical intervention. Despite technologic refinements in the stents and their delivery systems, and an increasing number of studies related to self-expandable metal stents, data regarding their long-term efficacy, side effect profile, and true cost efficacy in comparison with other treatment modalities remain incomplete. This article reviews the available technology, placement techniques, indications, and outcomes relating to the use of self-expandable metal stents in esophagus, stomach, small bowel, and colon.

Colonic Diseases↗
PubMed1984

Reconstruction of the laryngopharynx and cervical esophagus.

The historical evolution of reconstruction of the cervical esophagus and laryngopharynx over the past 100 years is documented. The impact of these technical achievements is contrasted to the failure to improve the 5-year survival rate of 24%. While the clinician awaits new protocols of treatment to improve survival statistics, the thrust of the surgical oncologist is to develop a reliable method of reconstruction which meets specific minimal criteria. The following objectives should be achieved: Reconstruction should not limit the effectiveness of the ablative technique. Short hospitalization and one stage techniques are superior. Technique mortality and morbidity must be low. A 10-year institutional study using the Montgomery 2-stage technique is presented. In contrast, comparative literature data analysis of all methods of laryngopharyngocervical reconstruction indicates that single stage techniques offer a greater advantage. This study suggests that visceroplasty (stomach), free jejunal transfer, and single stage reconstruction, using the pectoralis myocutaneous flap, approach the previously established criteria more effectively than others. A new technique (1-stage), using partial tubulation of the pectoralis major myocutaneous flap, is recommended for regional reconstruction of the cervical esophagus and pharynx. In order to decrease the pressure and torsion on the vascular pedicle of the pectoralis major myocutaneous flap and increase its predicted length, partial resection of the ipsilateral clavicle is proposed.

Aged↗
PubMed1990

Update on esophageal radiology.

This article reviews the current status of double-contrast radiography in diagnosing pharyngeal tumors and opportunistic esophagitis and the radiologic evaluation of esophageal motility disorders in patients with chest pain. Double-contrast pharyngography is a valuable technique for detecting pharyngeal tumors. These lesions may be manifested by an intraluminal mass, mucosal irregularity, or asymmetric distensibility. Furthermore, barium studies may demonstrate lesions involving the valleculae, tongue base, lower hypopharynx, and pharyngoesophageal segment that are difficult to visualize at endoscopy. Double-contrast radiography is also a valuable technique for detecting opportunistic esophagitis and for differentiating the underlying causes. Mucosal plaques should suggest Candida esophagitis, whereas discrete ulcers should suggest herpes esophagitis, and one or more large, relatively flat ulcers should suggest cytomegalovirus esophagitis. Finally, in evaluating patients with chest pain, in only a small percentage are esophageal motility disorders found to be a possible cause of their pain. Instead, the majority are found to have cardiac disease, structural esophageal lesions, or gastroesophageal reflux, so that barium studies are more useful in documenting normal motility or structural abnormalities in these patients.

Esophageal Motility Disorders↗
PubMed1999

[The natural history and complications of esophageal cancer].

Squamous cell carcinoma of the oesophagus has a poor prognosis, owing in part to the compromised status of the patients. Early oesophageal cancer is rarely diagnosed, even if its endoscopic aspects are well known. From the mucosa, the disease progresses step by step, and also via the submucosa. Furthermore, multiple locations are not uncommon. Bulky tumours progressively obstruct the oesophageal lumen while infiltrative tumours invade the oesophageal layers, and then the perioesophageal fat and the mediastinal organs. Involvement of mediastinal, cervical and abdominal lymph nodes occurs early. Distant metastases occur later. Complications are mainly due to the locoregional spread of the disease, leading to death.

Adipose Tissue↗
PubMed1992

[Palliative treatment with an endoluminal prosthesis for obstruction of the esophagus and the cardia].

Between December 1984 and September 1991, a total of 68 palliative esophageal intubations were performed in 57 patients. The mean age was 64 years, there were 40 males and 17 females. The more frequent causes of esophageal obstruction were malignant tumors of the esophagus (49%), lung (23%) and cardia (19%). Total dysphagia (24.5%), dysphagia to liquids (47%) and esophagotracheal aspiration (14%) were present in these patients. In 65% of patients insertion of the prosthesis was the first attempt at palliation, in the remaining patients it followed the failure of another type of palliation. The decision to palliate esophageal obstruction was established preoperatively in 86% of patients, in the remaining 14% it was decided at the time of surgery. The intubation by pulsion (Atkinson) [1] was successful in 57% of patients and by traction (Celestin) [2] in 86% of patients. The associated morbidity was 36% for the Atkinson prosthesis and 13% for the Celestin prosthesis, although the latter required a laparotomy. The in hospital mortality was 12.5%. The mean survival was 85 days. A normal or semi-solid diet was tolerated by over 60% of patients following intubation. Palliation of esophageal obstruction by intubation improves the quality of life but is associated with a high morbidity.

Cardia↗
PubMed1987

Multiple squamous papillomas of the esophagus associated with Goltz syndrome.

A 30-yr-old white female with a history of focal dermal hypoplasia (Goltz syndrome), chronic gastroesophageal reflux, and dysphagia was found to have, by barium esophagram and esophagogastroduodenoscopy, multiple 2- to 3-mm papillary projections in the distal esophagus and an esophageal stricture. Biopsy of these lesions revealed squamous papillomas and a benign stricture. Although chronic irritation from gastroesophageal reflux has been suggested as a possible etiology of acquired esophageal papillomas, the previous association of congenital papillomas of the oral mucosa in Goltz syndrome suggests that the multiple papillomas in this patient are congenital in origin.

Adult↗
PubMed1986

[Radiation ulcer after radiotherapy of esophageal carcinoma].

17 patients with esophageal ulceration (benign or non-cancerous ulcer) after irradiation for esophageal carcinoma are reported. Nearly half of these 17 patients had been misdiagnosed as cancer recurrence (malignant ulcer) and deprived of further effective treatment. In this series, the cause of misdiagnosis is analysed. The clinical symptoms of benign ulcer and its manifestations on the X-ray films are described. The etiology and differentiation between the benign and malignant ulcer are discussed.

Adult↗
PubMed1979

[Surgical treatment of cancer in the middle 3d of the esophagus].

19 cases with carcinoma of the middle third of the oesophagus were treated by resection in one session by laparotomy and right thoracotomy: in two cases with instrumental perforation substitution of the oesophagus by stomach via the retrosternal route--in 15 cases resection and high intrathoracal oesophagogastrostomy--in 2 cases resection and colon interposition because of previous gastric resection. 2 patients died postoperatively. 2 patients survived more than 5 years. There is an indication for resection in all functionally and technically operable cases.

Adult↗