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At least 595 records · Page 33Linked to original sources
PubMed1995

Gianturco-Z stents in the palliative treatment of malignant esophageal obstruction and esophagotracheal fistulas.

BACKGROUND AND STUDY AIMS: The palliative endoscopic treatment of malignant obstruction of the upper gastrointestinal tract, including esophagorespiratory fistulas, is often difficult. The efficacy of polyethylene-coated [corrected] Gianturco-Z stents in these sometimes complicated tumor stenoses was investigated. PATIENTS AND METHODS: Twenty patients with malignant obstruction of the esophagus and the cardia, including six patients with esophagotracheal fistulas, were treated with Gianturco-Z stents. Five patients had previously been provided with another type of self-expanding metal endoprosthesis (two with Wallstents and three with Ultra-flex memory metal stents), and needed retreatment because of tumor ingrowth or overgrowth, esophagotracheal fistulas, or insufficient stent expansion. All data acquired prior to and during stent implantation, as well as during the follow-up period, were recorded prospectively. RESULTS: No technical problems occurred during the implantation of the stents. Nineteen of 20 Gianturco-Z stents (95%) spontaneously showed sufficient expansion at the endoscopic control, which was conducted within the following 48 hours. All patients, with the exception of one, reported immediate improvement of their dysphagia. The sealing of the six fistulas was also achieved. Severe early complications, such as bleeding or perforation, did not occur, but one stent migration was encountered. Two types of minor problems were observed: short-term retrosternal and epigastric pain (11 patients) and formation of a pouch at the upper rim of the stent (one patient). In the follow-up, tumor overgrowth of the stent ends was found in one patient, who was retreated with electrocoagulation. Tumor infiltration of the wire mesh has not been observed so far. In one patient, dislocation of a stent into the stomach occurred (probably as a result of endoscopic measures being performed to control tumor bleeding). CONCLUSIONS: We conclude that the treatment of malignant esophageal obstructions, including esophagorespiratory fistulas, with Gianturco-Z stents is effective, and that implantation is safe, especially in the case of tumor stenoses in the proximal esophagus. The expansile force of the stent is sufficient even for very firm strictures; and the polyethylene [corrected] covering of the stent seems to prevent tumor ingrowth.

Adenocarcinoma↗
PubMed1993

Influence of tumor stenosis on the accuracy of endosonography in preoperative T staging of esophageal cancer.

The T stage is an important criterion for determining prognosis in esophageal carcinoma. Endosonography, although established as a highly accurate method in preoperative determination of the T stage, may be less reliable in non-traversable tumor stenoses. In a comparative prospective study, 41 patients with carcinoma of the esophagus were investigated to determine the role of tumor stenosis on the accuracy of endosonography in preoperative T staging. The results were correlated with the histology of the resected specimen. The overall accuracy in T staging with endosonography was 76%, compared with 49% in computed tomography. T staging results of endosonography were good in easily and non-traversable stenoses (92%, 87% respectively), but lower accuracy was obtained in stenoses which could be traversed only with difficulty (46%). Computed tomography was inferior to endosonography in all three groups of patients. The high accuracy of endosonography in non-traversable stenoses might be due to the fact that all tumors were in an advanced stage (T3 or T4). When passage of the echoendoscope proves difficult, the low focal distance between the ultrasonic transducer and tumor may hamper clear visualisation of the wall layers and tumor penetration depth. These limitations of endosonography should stimulate further efforts in improving ultrasonic resolution in these cases.

Adenocarcinoma↗
PubMed2006

Survival and complications after insertion of self-expandable metal stents for malignant oesophageal stenosis.

OBJECTIVE: To report on survival and complications after insertion of self-expandable stents in patients with malignant oesophageal stenosis. MATERIAL AND METHODS: Data were gathered retrospectively from the medical records of 92 consecutive patients in the period 1994-2003. The study comprised 68 men and 24 women (median age 72 years, range 46-93 years) with stenosis from cancer of the oesophagus (n=61), the gastric cardia (n=26) and the lung (n=5), located mainly above (n=4) or below (n=62) the carina, or at the gastro-oesophageal junction (n=26). One uncovered stent and six different covered stents were used. RESULTS: Median and mean survival times after stenting (n=92) were 83 (range 4-1102) and 125 days, respectively. Thirty-day mortality was 19% (n=17), and 7% (n=6) survived more than one year. Survival was neither significantly influenced by division of the patients into diagnostic subgroups nor by comparison of the three most frequently used stents. One, two, three and four stents were received by 76, 11, 4 and 1 patient(s), respectively. There was no stent-related mortality, and complications were bleeding 1 (1%), stent migration 7 (8%), recurrent stenosis 8 (9%) from both tumour overgrowth (n=8) and tumour ingrowth (n=2) when using uncovered stents. Thirteen (14%) patients were re-stented because of recurrent stenosis (n=8) including fistula formation to the left main bronchus (n=2) and stent migration (n=5). CONCLUSIONS: Use of self-expandable stents in patients with inoperable malignant oesophageal stenosis carried few complications and resulted in relatively long survival in comparison with similar studies.

Aged↗
PubMed2006

Reconstruction of long cervical esophageal defects with the radial forearm flap.

The radial forearm flap has been used for reconstruction of the cervical esophagus most often as a patch or for circumferential repair of short defects (less than 5 cm). In the following three cases, the radial forearm flap was used to reconstruct circumferential cervical esophageal defects ranging from 5 to 12 mm in length. These procedures were successfully carried out in three patients in whom the intraoperative defect was unexpectedly large or the intra-abdominal viscera harvest would have been difficult. These patients had reliable esophageal function 8 to 24 months after surgery. We conclude that the radial forearm flap can be used for reconstruction of large circumferential defects of the cervical esophagus.

Adult↗
PubMed1997

Safety of esophagoscopy in the irradiated esophagus.

Carcinoma of the esophagus is a disease with a poor prognosis. Surgery is considered the treatment of choice. Patients who are surgically unresectable may receive radiotherapy, plus or minus chemotherapy. While this offers reasonable palliation, a significant number of patients develop benign or malignant strictures. Frequent esophagoscopy with dilation is required if they are to swallow. Patients with strictures or malignancy of the esophagus are more prone to complications if they undergo an esophagoscopy. We examined the morbidity of esophagoscopy in a group of patients who had received radiotherapy for carcinoma of the esophagus. Over a 10-year period, 21 patients receiving irradiation for carcinoma of the esophagus were examined. All patients underwent esophagoscopy for staging and diagnosis. The tumor locations were upper (6), middle (6), and lower (9) esophagus. The T-stages were 1 (7), 2 (6), 3 (6), and 4 (2). Five patients had dilation of a malignant stricture at the time of diagnosis. Fever developed and resolved within 24 hours in 2 patients. Following completion of irradiation, a total of 83 esophagoscopies were performed (range 1 to 11 per patient). Six patients with no tumor or stricture underwent 8 esophagoscopies (3 rigid, 5 flexible). There was 1 episode of minimal bleeding and 1 fever that resolved within 24 hours. Ten patients with malignant strictures underwent 62 esophagoscopies (5 rigid, 57 flexible). There were 17 (27%) episodes of fever (all resolved within 24 hours) and 14 (22%) episodes of bleeding. Five patients with benign strictures underwent 13 esophagoscopies (2 rigid, 11 flexible). One patient had a perforation that resolved with conservative treatment, and 1 patient developed an epidural abscess 2 months following dilation. This patient is the only one that required surgical intervention and had prolonged hospitalization. Esophagoscopy of the irradiated esophagus can be performed relatively safely and excellent palliation obtained. Morbidity consisting of minimal bleeding, and fever lasting less than 24 hours, is frequent but self-limited.

Adult↗
PubMed1987

Bypass with transdiaphragmatic Roux loop in nonresectable malignant stricture of the lower oesophagus.

Bypass with a Roux-en-Y loop is proposed for palliation of nonresectable malignant obstruction in the distal oesophagus and cardia without peritoneal dissemination. Over a 15-year period, 51 transdiaphragmatic Roux-en-Y procedures with side-to-end oesophagojejunal anastomosis were performed. The 11.8% mortality was unrelated to anastomotic leakage. Gastrostomy should be avoided because of its nutritional and psychologic disadvantages. Other methods for surgical bypass are discussed and comparison is made with intubation. Wider indications for the Roux loop bypass are mentioned.

Cardia↗