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PubMed1990

Experimental study and clinical application of a single-row suturing esophagogastrostomy.

A single-row suturing anastomosis (SRA) for an esophagogastrostomy was experimentally investigated in dogs. SRA not only shortened operating time, but also led to better pathological results when compared with double-row suturing anastomosis. Wide-brim suturing and equal distance between the sutures, providing increased and well-distributed blood circulation, are the key points for success of SRA. Its simplicity and safety are advantages of SRA as has been shown in 90 cases in clinical application.

Anastomosis, Surgical↗
PubMed1978

Aortoesophageal fistula.

With the advent of cardiovascular and bypass procedures, aortoesophageal fistula has progressed from the stage of a pathologic curiosity to a treatable lesion. Although the causes of aortoesophageal fistula are varied, a remarkably consistent clinical picture emerges from study of this condition. Chiari's triad of midthoracic pain, sentinel hemorrhage, and a symptom-free interval followed by fatal exsanguination remains the most important clinical finding today. Although contrast esophagography, esophagoscopy, and aortography are important diagnositc aids, immediate left thoracotomy may be the only means of making the diagnosis and saving the patient when hemorrhage is profuse. In most cases (80 per cent of the present series) there is a symptom-free period varying from hours to days from the original sentinel hemorrhage to the final exsanguination. This permits the informed surgeon trained in cardiovascular technics an opportunity to salvage some of these patients. The various methods of aortic and esophageal repair are discussed.

Aorta↗
PubMed1995

A single session of intraluminal brachytherapy in palliation of oesophageal cancer.

Between September 1987 and September 1993, 88 patients with oesophageal cancer were treated by a single session of intraluminal brachytherapy of 15 Gy prescribed at 1 cm distance from the central axis, using MDR137Cs (n = 51) during the first part of the study and HDR192Ir (n = 37) during the second part of the study. All patients were regarded as inoperable. Improvement of dysphagia, assessed 4-6 weeks after treatment, was noted in 50 of 75 (67%) evaluable patients, whereas swallowing ability was completely restored in 47% of them. Relapse of dysphagia occurred in 28 (37%) patients during follow-up. Additional palliative treatment consisted of endoprosthesis in 14 (19%), a second course of brachytherapy in 13 (17%), one or more dilatations only in 11 (15%) and laser treatment in four (5%) patients. One non-fatal haemorrhage and five fistulae occurred, all in the presence of tumour. Two severe ulcerations without evidence of tumour were noted, both managed by combined curative treatment. The median survival of the group investigated was 5.5 months. An exophytic, non-circular growth pattern was associated with a better response. In a multivariate analysis the presence of distant metastases (p = 0.0028), weight loss (p = 0.0051) and an exophytic growth pattern (p = 0.0199) were associated with a worse survival. The present data indicate that a single session of ILB is appropriate in the palliation of dysphagia in patients with inoperable oesophagal cancer showing bad prognostic signs. Up to now there has been no clear evidence for benefit of addition of ERT.

Adenocarcinoma↗
PubMed2006

Endoscopic retrograde dilation of completely occlusive esophageal strictures.

BACKGROUND: Completely occlusive esophageal strictures may develop after head and neck radiotherapy or esophagectomy with gastric or colonic interposition. Major surgical intervention may be required to restore alimentary tract patency when endoscopic lumen reconstitution is not feasible by routine antegrade endoscopy. Retrograde endoscopic lumen identification and dilation is a useful method to reestablish alimentary tract patency, thereby avoiding surgical intervention. METHODS: Patients requiring endoscopic dilation for completely occlusive esophageal strictures were identified by the gastroenterology, thoracic, and head and neck services. Retrograde access was obtained by balloon dilation of either a jejunostomy or gastrostomy tract, and an endoscope was passed to the area of stricture. Antegrade and retrograde endoscopy were performed simultaneously. A guidewire was passed either retrograde or antegrade under direct endoscopic visualization, followed by antegrade Savary dilation under fluoroscopic guidance. RESULTS: From 2003 to 2006, 9 patients were identified with completely occlusive esophageal strictures requiring retrograde lumen identification and dilation. Stricture developed in 6 patients after radiotherapy for head and neck cancer and in 3 after esophagectomy with either gastric or colonic interposition for esophageal cancer. Endoscopic dilation was successful in all patients, without perforation. CONCLUSIONS: Retrograde endoscopic lumen identification and dilation is an option to reestablish lumen patency of completely occlusive esophageal strictures after esophagectomy with gastric or colonic interposition or after head and neck chemoradiotherapy.

Aged↗
PubMed2006

Successful recovery of esophageal patency in 2 patients with complete obstruction by using combined antegrade retrograde dilation procedure, needle knife, and EUS needle.

BACKGROUND: Esophageal occlusion is typically caused by cancer or postradiation changes; it is difficult to treat, with poor surgical outcomes. The combined antegrade retrograde dilation (CARD) method has been used to endoscopically restore the esophageal lumen after complete occlusion by cancer or postradiation changes, with good preliminary results. Reproducing this technique and improving its speed and convenience would be advances in treating this difficult clinical problem. OBJECTIVE: A demonstration of 2 alternative endoscopic techniques for treating complete esophageal obstructions. DESIGN: The CARD method was performed in 2 patients with unresectable cancer and complete esophageal occlusion. In the first patient, a needle knife was used to cut through the obstruction, instead of removing it piecemeal with biopsy forceps before over-the-wire dilation. In the second patient, an EUS needle was used to cross a particularly long obstruction, which allowed subsequent dilation and recanalization. SETTING: A tertiary referral center. PATIENTS: Two patients with complete esophageal obstruction secondary to head and neck cancer, with associated radiation therapy. RESULTS: In both cases, this method resulted in successful recanalization of the occluded lumen in a relatively short amount of time, without complications. LIMITATIONS: The small number of patients in this series. CONCLUSIONS: The CARD needle-knife method may be a safe, effective, and efficient approach to complete esophageal occlusion. In addition, the CARD-EUS needle method may be an preferable technique to cross long obstructions quickly; however, more experience will be required.

Aged↗
PubMed1995

Palliation of malignant oesophageal perforation and proximal oesophageal malignant dysphagia with covered metal stents.

Twelve patients underwent placement of nine polyethylene-covered self-expanding metal stents (Cook), and three polyurethane-covered Wallstents (Schneider). All obstructing lesions were crossed fluoroscopically and stents placed under fluoroscopic control. Eleven of the 12 patients had recently undergone failed endoscopic stent insertion, which had resulted in oesophageal perforation. Technical success was achieved in 100% of patients, with no immediate complications. The stents were well tolerated and allowed the patients to eat within 12 h of their insertion. Covered stents are technically safe to insert, are best inserted fluoroscopically, and are particularly cost-effective in proximal oesophageal lesions and perforations, where Atkinson tubes are often not tolerated.

Adult↗
PubMed2000

Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management.

BACKGROUND: Endoscopic ultrasonography (EUS) with fine-needle aspiration identifies patients with esophageal cancer who are unlikely to be cured by surgery. In approximately 30% of patients the staging procedure cannot be completed without dilation of an obstructing tumor. METHODS: All EUS examinations for esophageal cancer requiring dilation from July 1995 to December 1998 were included. Yield was defined as newly diagnosed metastatic (celiac lymph nodes) or locally invasive disease that could not have been detected without dilation. RESULTS: EUS was performed in 132 patients. Forty-two (32%) required 44 dilations. No complications occurred. Of the 42 patients with obstruction, 18 (43%) had celiac adenopathy of which 7 had malignant cells confirmed histologically, 3 had benign adenopathy, and 8 did not undergo fine-needle aspiration due to T4 stage disease (5) or intervening vessels (3). Two patients were upstaged after successful dilation from T2 N1 Mx to T4 N1 Mx and from T3 Nx Mx to T3 N1 M1. Overall, dilation allowed detection of advanced disease in 8 of 42 (19%) patients. Dilation to 11 to 12.8 mm was insufficient (36% success rate) to complete EUS compared with dilation to 14 to 16 mm (87%, p < 0.01). CONCLUSION: Dilation of obstructing esophageal tumors allows identification of a large number of patients with advanced stage malignancy. Dilation to 14 to 16 mm is sufficient for complete staging in almost all patients.

Aged↗
PubMed1997

Relation between endoscopic ultrasound findings and outcome of patients with tumors of the esophagus or esophagogastric junction.

BACKGROUND: Endoscopic ultrasound (EUS) is considered to be the best staging technique for cancer of the esophagus or the esophagogastric junction. This study evaluates the relation between preoperative EUS staging results of these tumors and survival. It also examines how EUS staging predicts resectability. METHODS: Survival data of 86 patients who underwent EUS for staging of tumors of the esophagus or esophagogastric junction were analyzed. Most patients (78 of 86) were treated surgically (73 resections, 5 bypasses). Eight patients did not undergo surgery. RESULTS: Survival of patients was significantly related to EUS T staging (log rank test: p = 0.05), EUS N staging (p = 0.02), detection of celiac lymph node metastasis (p = 0.0027), and the presence of stenosis (p = 0.02). Also, the endosonographic AJCC classification was significantly related to survival (p = 0.0012). Total accuracy for T staging amounted to 59%. Accuracy for recognition of transmural growth was 82%. There was a good association between endosonographic findings (EUS stage II, absence of lymph nodes) and the possibility of complete resection. Incomplete resection was less well predicted. CONCLUSION: Survival of patients with tumors of the esophagus or esophagogastric junction is strongly related to EUS TNM staging results. Tumor resectability is related to endosonographic findings. However, more advanced EUS findings do not necessarily predict unresectability.

Endosonography↗
PubMed2000

Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation.

Endoscopic tube implantations were carried out in 40 patients with malignant stenosis of the esophagus and gastric cardia using self-expanding metallic stents. The indications for endoscopic intubation were the advanced stage of the tumor in 27 cases and risk factors that made resection inadvisable in 13 cases. In three patients, it proved impossible to implant a stent endoscopically because we were not able to pass the guide wire through the stenosis, whereas correct stent placement was achieved in 37 cases. Functional results were good in 33 patients, but four patients did not show any improvement of symptoms. Complications occurred in nine patients (24.3%): two bleedings, three neoplastic obstructions, one food obstruction, and three distal dislodgements of the prosthesis were observed, but could be readily corrected. No deaths occurred. The median survival time was 151 days (range 25-545 days). This study suggests that endoscopic placement of metallic self-expanding stents is safe and is to be preferred to plastic stents for easier implantation and lower morbidity.

Aged↗
PubMed2005

Prospective evaluation of patient tolerability, satisfaction with patient information, and complications in endoscopic ultrasonography.

BACKGROUND AND STUDY AIMS: Prospective data are lacking on the safety of endoscopic ultrasonography (EUS) and on patient satisfaction with the procedure. We prospectively recorded complications related to EUS in order to establish morbidity and mortality. In addition the levels of patient satisfaction were evaluated, with regard to the tolerability of the procedure (pain, discomfort, and anxiety levels) and the provision of information. PATIENTS AND METHODS: 3324 consecutive patients who underwent EUS were studied with regard to complications. During the study period 300 patients were interviewed and followed up in detail as part of the evaluation of patient satisfaction. RESULTS: Ten patients (0.3 %) suffered from a complication related to the EUS procedure, and two patients died (0.06 %). There were no significant differences between the complication rates for EUS-guided fine-needle aspiration (EUS-FNA) and for EUS, but both fatal cases related to EUS-FNA/EUS-guided intervention. Nine of the ten patients with complications (90 %) had a diagnosis of malignancy, and esophageal perforation accounted for half of all complications. Although the majority of patients with nonlethal complications were managed well on conservative regimens, only one case, of self-limiting acute pancreatitis, could be classified as a mild complication. With regard to patient tolerability, only minor incidents occurred during the EUS procedure (tracheal suction 5 %, vomiting 0.3 %, aspiration 0.3 %) and no intervention was necessary. During the procedure, 80 % of the patients had no or only slight pain and more than 95 % experienced only slight or no anxiety, whereas more than half of the patients experienced moderate to severe discomfort. More than 90 % of the patients were satisfied or very satisfied with the information provided to them before and after the EUS, and the same number of patients were ready without hesitation to undergo an additional EUS examination if necessary. CONCLUSIONS: EUS, EUS-FNA and EUS-guided intervention are safe techniques, but severe and lethal complications do occur. The EUS procedures can be performed with a high level of patient satisfaction and with low levels of pain, discomfort and anxiety.

Abdominal Abscess↗
PubMed2000

[Bougie endosonography in the preoperative diagnosis of stenosing esophageal carcinomas].

BACKGROUND AND OBJECTIVE: Nowadays ultrasonic endoscopy is accepted as the most accurate method in the preoperative TNM staging of oesophageal tumour. At the time a diagnosis of oesophageal is made, 25-62% of patients have marked oesophageal stricture due to an advanced stage of the tumour. As a result, it is often impossible to pass a conventional endoscope and the examination is incomplete or a dilator has to be introduced at high risk of perforation or other complications. An ultrasonic oesophagoprobe (Olympus MH 908) with a diameter of 7.9 mm, its tip acting as a dilator has been developed so that even in high-grade oesophageal stricture a complete and low-risk investigation can be undertaken. The value of this instrument has been compared prospectively with that of a standard ultrasonic endoscope in patients with oesophageal stricture due to carcinoma and in relation to the postoperative histology. PATIENTS AND METHODS: Between May 1996 and February 1997, 62 patients (55 men, 7 women; average age 55.8 [41-82] years) with suspected or histologically confirmed oesophageal carcinoma were examined with the standard ultrasonic endoscope and the new oesophagoprobe. The two independent results were related to the postoperative histology. RESULTS: It was possible to compare the endoscopic results with the postoperative histology in 47 patients. In 55.8% it was not possible to pass the stricture with the standard ultrasonic endoscope (SE) so that an accuracy of only 41% was obtained in the T stage and 56.4% in the N stage. But with the oesophagoprobe (OP) an accuracy of 74.5% in the T stage and of 63% in the N stage were achieved. The difference in the findings between the two instruments was highly significant (p < 0.001) in those patients in whom the SE could not be passed through the stricture. For the T stage the accuracy was 14.3% vs. 76.2% (SE vs. OP); in the N stage it was 38.1% and 57.2%, respectively. When both instruments could be passed the results were comparable. CONCLUSIONS: Examination with the ultrasonic oesophagoprobe is a reliable and accurate method free of complications for the preoperative assessment of oesophageal carcinoma with stricture.

Adult↗
PubMed2002

Palliation of non-resectable carcinoma of the cardia and oesophagus by argon beam coagulation.

INTRODUCTION: The aim of this study was to describe the argon beam coagulation (ABC) technique in the palliative treatment of patients with nonresectable carcinoma of the cardia and oesophagus and this treatments needs, complications and tolerance. METHODOLOGY: A retrospective evaluation of 31 patients referred for palliation by ABC over a period of nearly four years (1.1.98-31.8.01). RESULTS: Twenty-two men and nine women, median age 72 years (range 49-91 years), underwent a total of 163 treatments and a median of five treatments per patient (range 1-18). Recanalisation enabling passage of the scope was achieved in 89% of treatments, and most of these patients had dysphagia grade = 2. The median range between reinterventions was 25 days (range 1-175 days). Perforation was seen in three patients and in 1.8% of treatments; procedure related mortality was 1.2%. The median hospital stay for every treatment was two days (range 1-27 days) and the median inpatient stay as a proportion of survival time was 8%. The median survival was 190 days (range 7-612 days) with the 1-year survival 19%. DISCUSSION: ABC is a well-tolerated, safe and effective treatment in patients with non-resectable cancer of the oesophagus or cardia and offers an acceptable complication rate and number of reinterventions compared with laser and stent placement. The technique is easy and cheap, and requires no further restrictions than conventional monopolar electro coagulation does. Prospective randomised trials comparing the efficacy of the different palliative treatments for patients with oesophagogastric cancer are needed.

Aged↗
PubMed2004

[Surgical treatment of cancer and scar strictures of the esophagus and cardial part of the stomach].

Experience in surgical treatment of 78 patients with cancer of the esophagus and 43 patients with scar strictures of the esophagus was analyzed. Surgical methods using produced in Russia and foreign staplers and laser technologies are described. Various surgeries performed in these diseases are presented: Lewis, Garlok, Torek, Akiyama, Mardwell-Vendel surgeries, gastrectomies, shunting esophagocoloplasties. These techniques were compared, their advantages, disadvantages and complications are described in detail.

Adult↗