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At least 559 records · Page 31Linked to original sources
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↗
PubMedDate not supplied

[Esophageal stenosis and esophagotracheal fistula with concomitant gastric ulcer in "caustic soda" ingestion].

The article deals with a special case through it's gravity and lesional complexity. A forty years old ill person with esophagus stenosis and postcaustic esophagotracheal fistula, having both a gastric ulcer on the date of surgery is operated in three stages: 1. Vagotomy, pyloroplasty and gastrotomy. 2. Esophagectomy with Kirschner-Nakayama gastric grafting. Posterior tracheorraphy with esophageal muscular patch. 3. Anastomotic cervical stenosis--plastic replacement (grafting) with a fat-less skin.

Adult↗
PubMed1987

Treatment of cervical esophageal stenosis with a long-term indwelling prosthesis.

Intubation of the cervical esophagus with a long-term indwelling prosthesis is described to palliate malignant strictures, and manage benign strictures in high-risk patients. The inner cannula of a Moore design tracheostomy tube was used as the prosthesis. Over a 10-year period, seven cases were managed in this fashion. The tube remained in place in five of seven patients for periods of 1.5 to 11 months, while a pureed or well-masticated soft diet was tolerated. There were no major complications in this small series. Retrograde displacement was the most common minor complication; displacement did not occur in the last two cases after addition of a silicone sponge ring to the distal end of the prosthesis. Pain and discomfort was experienced in two cases, requiring temporary removal in one patient.

Adult↗
PubMed1999

[The palliative treatment of malignant esophageal stenosis and fistulae with self-expanding metal prostheses].

OBJECTIVE: To evaluate the efficiency of self-expanding metal stents (SES) for the palliative treatment of malignant oesophageal strictures and fistulas. MATERIAL AND METHODS: Fifty non-operable patients with malignant oesophageal strictures and/or fistulas were treated with SES placement. All patients had dysphagia, the mean degree for the studied group being 3.36. Ten patients presented associated tumoral fistula. Uncoated SES were placed for simple stenosis cases and coated SES for cancers with associated fistulas. RESULTS: A improvement in dysphagia was obtained in 47 patients (94%). The mean degree of dysphagia after the procedure was 1.12. In nine patients (90%) the fistula closed with resolution of the associated clinical picture. Complication were observed in six patients (12%), the perioperative mortality rate being 2%. During follow-up, twelve patients (25%) had malfunction of the stent, which was successfully treated in eight patients. CONCLUSION: SES are efficient for the palliative treatment of malignant oesophageal strictures and/or fistulas, but not commonly re-interventions are necessary to maintain a long-term functionality.

Adenocarcinoma↗
PubMed1989

[Endoprosthesis in the palliative treatment of malignant esophageal stenosis].

31 patients with inoperable malignancies of the esophagus were treated for severe dysphagia or fistula by endoscopic placement of an endoprosthesis. The mortality rate was 4%. 56% of the patients with dysphagia and 55% with fistulation experienced relief of symptoms. Complications occurred in about one third of all patients. Median patient survival after diagnosis was 9 months. Median survival after placement of the endoprosthesis was 25 days (25 and 75% quartiles 10 and 50 days, minimum and maximum 1 and 371 days respectively). Prior to placement of an endoprosthesis 66% of the patients had already been treated by chemotherapy, radiotherapy, repeated bougienage or laser photocoagulation. Almost all patients died as a result of their primary illness with the tube still in place. In patients with neoplastic fistulation palliative intubation is the therapy of choice. In addition to intubation, alternative methods are available today for treatment of severe dysphagia. However, further investigation is needed to determine the patients who will benefit most from the placement of a prosthesis.

Aged↗
PubMedDate not supplied

[Nutritional treatment in the therapeutic strategy in benign esophageal stenosis].

Oesophageal strictures prevent a normal alimentation, and in chronic and more prolonged cases are the cause of severe denutrition. Many organs then undergo changes reflected on ultrastructural morphology, that in most severe and lasting cases can demonstrate irreversible. The functional aspect of such changes correspond to a hindered performance of the damaged organs with possible sudden cardiovascular accidents, which are particularly meaningful in the surgical steps of reconstruction, that is heavy for the patient not only in the perioperative period but also during the recovery when higher are the caloric energetic requirements. For the positive outcome of the surgical therapy of these strictures it is therefore necessary to preventively restore an acceptable nutritional status of the patient by the use of one or more of the nowadays available techniques of artificial nutrition. A particular topic of the need of a efficacious nutritional treatment can be pointed in the cases of oesophageal caustic burns, where the caloric requirements is high since the beginning to meet the catabolic effects of the traumatic condition, while malnutrition represents one of the negative factors in prolonging connettival and fibroblastic proliferation, cause of most severe strictures and recurrences. After a general survey of the whole problem, the characteristics of the various artificial nutrition techniques are discussed, with the identification of an optimal scheme of global and nutritional treatment in oesophageal caustic burns.

Burns, Chemical↗
PubMed1989

[Esophagoplasty in caustic esophageal stenosis in children].

Over a period of 30 years, 53 children suffering from caustic stenosis of the oesophagus were treated by oesophagoplasty. The left colon was most often used (49), though on occasions a Gavriliu gastric tube (3) or the right ileo-colon was used (1). Technical failure occurred in 7 cases with left esophagocoloplasty and this was treated with either a gastric tube (4) or right esophagocoloplasty (3). Oesophagectomy to prevent cancer was carried out on 20 occasions after the oesophagoplasty, on 23 occasions at the same time at the oesophagoplasty, and has yet to be carried out in 6 children. Early mortality was zero; 4 uncomplicated cervical fistulae occurred; 12 anastomotic stenoses were cured by dilatation and 5 required further surgery. Death occurred in 3 children as a late event: one at 2 months, due to difficulty with deglutition, one at 2 years, due to meningococcal septicemia, and one at 3 years due to obstruction from adhesions. Peptic reflux was seen in 3/9 Gavriliu plasties and in 6/45 coloplasties. Functional sequelae were absent in 29 cases and 12 cases suffered occasional episodes of obstruction. The best procedure appeared to be posterior mediastinal esophagocoloplasty combined with resection of the damaged oesophagus.

Burns, Chemical↗
PubMed1996

[Self-expanding nitinol stents for treatment of tracheobronchial and esophageal stenosis caused by lung cancer].

A 57-year-old man was admitted because of dysphagia. Two year earlier, endoscopic ND-YAG laser treatment had been performed for squamous cell carcinoma of the tracheal carina. The esophagus was compressed and narrowed by invasion of lung cancer. After ballooning, under endoscopic and fluoroscopic control, a self-expanding nitinol stent (SENS, Ultraflex, Microvasive) was implanted in the esophagus. Immediately after esophageal prosthesis implantation, severe dyspnea and stridor developed because of tumor strictures in the left main bronchus. Under fluoroscopic and guide-wire control, SENS (Accuflex, Microvasive) was implanted in the tracheobronchial tree. Dyspnea, dysphagia and stridor were markedly improved after placement of two nitinol stents. Highly flexible, knitted, self-expanding nitinol stent is made of a nickel titanium alloy. Although the implantation of SENS in tracheobronchial stenosis has not previously been reported, it should be useful for prevention of airway obstruction.

Alloys↗
PubMed1994

[Advantages and disadvantages of esophagogastroplasty in reconstruction of malignant and benign esophageal stenosis].

Advantageous morphology, sufficient blood supply and good tissue quality predispose use of stomach for ideal substitute in subtotal and total esophagoplasty. Additional advantages are one act surgery and possibility of single anastomosis formation. In an eighteen years' time, since 1976., two hundred nine (209) patients were operated with use of esophagogastroplasty for malignancies and benign diseases of esophagus and hyphopharinx. The esophagogastric anastomosis is most common reconstructive procedure for esophageal and hyphopharingeal malignancies. Anastomosis on pharyngeal level was made in 13 pts., on cervical esophagus level in 168 pts. and on thoracic esophagus level in the rest of 28 pts. Overall postoperative morbidity was 25,36%. Most common complication was anastomotic dehiscence (18,66%), transplant necrosis occurred in 2% of pts., whereas stenosis of the anastomosis was observed in 4,78% of pts. Overall intrahospital mortality was 14,38%, while specific mortality (anastomotic dehiscence and/or transplant necrosis) was 10,04% (21 pts.), whereas nonspecific mortality (predominantly lung insufficiency) was 4,78% (10 pts.). Anastomotic dehiscence is major disadvantage of this method.

Anastomosis, Surgical↗
PubMed1998

[Results of the surgical treatment of severe caustic pharyngo-esophageal stenosis. The value of complete reconstruction of the pharynx by transposition of the ileum and colon].

STUDY AIM: The aim of this study was to report the results of pharyngoesophageal reconstruction in extensive corrosive strictures and to describe an original conception concerning extensive chemical burns of the pharynx with involvement of the epiglottis, oro-hypopharyngeal junction and cricopharyngeal pinchcock. PATIENTS AND METHODS: A personal series of 253 esophageal reconstructions using the colon and ileum is reported. In 124 patients, the cervical anastomosis of the graft was performed at the level of the pharynx, and these cases with extensive pharyngeal lesions were the basis of this study. The anastomosis was performed with the hypopharynx in 27 patients, with the oropharynx in nine and a total reconstruction of the pharynx or "pharyngoplasty" was carried out in 69 patients. The pharyngoplasty was classified according to the approach, in anterior, posterior, lateral, superior (transmandibular) and inferior. In high strictures with epiglottic injury, epiglottectomy was necessary in order to prevent recurrence. A visceral pharyngoplasty was performed in 61 patients, using the colon in 42 and the ileum in 19, a skin reconstruction in six patients and a myocutaneous flap in two. RESULTS: The global postoperative mortality rate was 4.7%. Stenosis of the cervical anastomosis occurred in 4.9% of the whole series. With a follow-up from 6 months to 10 years, 70% of the patients resumed a normal oral diet, 21% had mild symptoms and 7% had poor results (patients with tracheostomy and gastrostomy). CONCLUSION: Extensive chemical burns of the pharynx are very severe and their treatment very difficult. For the author, total visceral pharyngeal reconstruction is considered to be the procedure of choice, using ileopharyngoplasty with realization of an ileal pouch. Good results were obtained in 70% of the patients with extensive corrosive strictures.

Anastomosis, Surgical↗
PubMed2001

High-dose omeprazole in esophagitis with stenosis after surgical treatment of esophageal atresia.

The authors describe 4 children with recurrent stenosis and persistent esophagitis after secondary repair of a long gap esophageal atresia. They underwent an esophageal reconstruction by elongation of the lesser gastric curvature according to Schärli at the age of 11 to 14 months. All had esophagitis grade III to IV (Savary-Miller classification), esophageal stenosis, and failure to thrive. Effective treatment of the esophagitis and prevention of stenosis consisted in high doses of omeprazole (1.9 to 2.5 mg/kg/d). After this treatment, the need for esophageal dilatation disappeared, and nutritional status normalized.

Digestive System Surgical Procedures↗
PubMed2002

Esophageal striated muscle contractions in patients with gastroesophageal reflux symptoms.

Although there are studies showing that the amplitude of contraction in the distal esophageal body may be lower in gastroesophageal reflux (GER) disease than in asymptomatic subjects, there are no data about proximal striated muscle contraction in this disease. We studied the esophageal contraction 2 or 3 cm below the upper esophageal sphincter in response to swallowing a 5-ml bolus of water in 122 consecutive patients submitted to esophageal manometry who complained of heartburn and acid regurgitation. Sixty-nine had esophagitis seen at endoscopy. Thirty-three also complained of dysphagia. No patients had esophageal stenosis, esophageal motility abnormalities in distal esophagus, chest pain, or extraesophageal manifestations of GER. We also studied 20 patients with systemic sclerosis (SSc), a disease with no involvement of striated muscle. When we measured the amplitude, duration, and area under the curve (AUC) of the proximal esophageal contraction, we did not find any differences (P > 0.05) between patients with esophagitis (N = 69) or without esophagitis (N = 53), with dysphagia (N = 33) or without dysphagia (N = 89), with mild (N = 55) or severe (N = 14) esophagitis, or younger than 40 years (N = 45) or older than 60 years (N = 19). There was also no difference between patients with GER symptoms and patients with SSc (P > 0.05). We conclude that patients with GER symptoms with or without esophagitis and with or without dysphagia have similar esophageal striated muscle contractions.

Adolescent↗