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At least 613 records · Page 34Linked to original sources
PubMed1992

[Studies on changes in low esophageal sphincter function after esophageal transection or esophago-esophagostomy in children].

An aim of the present study is to clarify the changes of esophageal function after surgical treatments of the esophageal varices or the congenital esophageal stenosis in children. Esophageal manometric studies were performed in sixteen children undergoing the esophageal transection with paraesophageal devascularization or the esophago-esophagostomy with partial esophagectomy before, within 1 month and over 7 months after the operation. The pressure of lower esophageal sphincter (LES), the length of LES, the LES relaxation test and the gastroesophageal reflux (GER) inducing test were measured. 1) Esophageal transection; The pressure dropped within 1 month and returned to the preoperative level over 11 months after the operation. Temporal deterioration of LES function was observed during the early postoperative days. However, return to the preoperative state was gained over 1 year. 2) Esophago-esophagostomy; The pressure and the length of LES were not changed after the operation. The LES function was disturbed preoperatively and moreover long postoperatively, in the case when congenital stenosis closely existed to the esophago-gastric junction. Degree of the postoperative disturbance of the LES function may be influenced by the distance to the part of the transection or the partial esophagectomy from the E-C junction.

Anastomosis, Surgical↗
PubMedDate not supplied

[INGESTION OF CORROSIVE SUBSTANCES]

Every patient that ingests any caustic substance still constitutes a medical and surgical. The severity and extension of the chemical damage will basically depend on the concentration and quantity of the caustic substance ingested. Likewise, when a highly concentrated alkali or acid substance is ingested, the esophagus and stomach will be damaged, and this lesion could also spread to the duodenum, and in some cases to the jejunum. Furthermore, it may compromise adjacent organs with a high morbimortality. The severity degree of the lesion can be determined with no risk by a flexible endoscopy, and correlates well with the intensity of tissue damage, enabling us to decide the manner in which this lesion is to be handled, with a prognosis value. A superficial grade (1 or 2a),will require no treatment and it will evolve without sequela. However, upon the determination of deep, ulcerated circumferential lesions, or with necrotic fundus by endoscopy (Grade 2b, and 3), patients shall be hospitalized and shall receive enteral or parenteral nutrition, as well as antibiotic protection. Careful attention should be given due to the risk of perforation or hemorrhage, and ocasionally, urgent surgical treatment will be necessary.The use of corticosteroids has proved to be innefective in preventing stenosis and is potentially dangerous. The most frequent late sequela is the developing of esophageal stenosis (developing in 50-70% of the 2b, and in all of the 3 who survive), and antral stenosis. The esophageal stenosis are tributaries of dilatations with bougies. An option to avoid stenosis, specially in children, is the placement of short plastic tubes, temporarily. In cases where there is no good response to the dilatations. or when the stenosis are long and multiple, surgery with interposition of colon or jejunum will be necessary. Usually, the development of gastric stenosis requires surgery. Motor alterations and gastroesophageal reflux as sequela may also be present, and belatedly, a greater risk to develoop squamous cancer.

Journal Article↗
PubMed1993

[Palliative endoscopic treatment of esophageal neoplastic stenosis].

The authors examined a series of 231 patients suffering from unoperable neoplastic dysphagia of the esophagus and treated using prevalently palliative endoscopic methods (photocoagulation and/or intubation) during the period 1980-1991. They draw the following conclusions: a) endoscopic methods are better than surgical techniques; b) there are a greater number of indications for endoscopic intubation than for photocoagulation (approximately 2 to 1); c) some situation which are indicated for photocoagulation are not contraindicated for intubation; d) the sole contraindication for intubation is stenosis in which the proximal limit is less than 2 cm from the upper esophageal sphincter; e) contraindications for photocoagulation are long stenoses and/or those of the infiltrating type, and/or involving the upper third of the esophagus; f) sometimes the two methods may be complementary in the sense that intubation may be preceded by a few photocoagulation sessions in order to necrotize the vegetating portion of an infiltrating tumour; g) it is best to choose intubation wherever possible since this technique is less expensive and the quality of remaining life better, even if the percentage of severe and generally fatal complications (perforation) is still too high; h) the possible introduction of expandable metal prostheses might increase indications for intubation and reduce the number of severe complication.

Esophageal Neoplasms↗
PubMed1996

[Digestive involvement in dystrophic bullous epidermolysis. Presentation of 2 cases and review of the literature].

Congenital epidermolysis bullosa is an inherited disorder characterized by an anomaly of joint structures between epidermis and dermis. This anomaly involves different malpighian epithelium and particularly in the digestive chorioepithelial junction. Digestive and oropharyngeal manifestations include bullae, erosions and ulcerations that heal by fibrosis, leading to retraction and stenosis. We report two cases of esophageal stenosis, the first one in a young patient with a congenital epidermolysis bullosa of Hallopeau-Siemens and the second one, in a young woman with a Pasini variant. In the first case, the esophageal stenosis was treated by careful dilation. In the second case, the endoscopy induced hemorragic bullae and septicemia, which were treated with antibiotics and total parenteral nutrition.

Adolescent↗
PubMed1994

Successful surgical management and long-term follow-up of epidermolysis bullosa.

BACKGROUND: Esophageal stenosis and hand deformity are serious complications of recessive dystrophic epidermolysis bullosa that influence the prognosis of patients. To control such complications we have used surgical treatments with favorable results. Additional objectives were to summarize the results of long-term follow-up. METHODS: Six patients with esophageal stenosis and nine patients (13 hands) with hand deformity (contracted fingers, mitten-like deformity) were treated surgically after anemia and malnutrition were corrected by intravenous iron infusion, high-energy diet, and blood transfusion. As intubation was contraindicated, topical anesthesia was used (eg., lidocaine spray to the nasopharyngeal mucosa for esophageal dilatation and brachial block, ketamine drip, and nitrous oxide inhalation for reconstruction of contracted fingers). We established a new method for esophageal dilatation using a microvasive rigiflex balloon catheter. This catheter was advanced to the stenotic area under radiography and then expanded by injecting contrast medium into the balloon. For reconstruction of hand deformities, the epidermal glove was initially peeled off, and then the combined digits separated carefully by hand. If the release of the contracture was not sufficient, a skin incision was made avoiding injury to nerves and blood vessels. Any skin defects that appeared after the release of the contracture were covered with skin grafts taken from the abdominal wall. K-wire fixation was used to maintain the extended position of the fingers. Three weeks after the operation, the K-wires were removed and rehabilitation was commenced. RESULTS: The esophageal stenosis was successfully dilated with the balloon catheter; in all six cases the dysphagia was relieved immediately. There was no recurrence in any of the patients on long-term follow-up. After reconstruction of the hand, daily activity improved in 12 of the 13 hands. The remaining hand was difficult to reconstruct due to severe mutilation and bone deformity. During follow-up, 6 of the 12 hands maintained successful reconstruction, whereas the remaining 6 hands showed slight to moderate recontraction of the fingers. CONCLUSION: Esophageal dilatation with a balloon catheter is safer and has fewer side effects compared to other surgical procedures. This method can provide favorable results and can be carried out repeatedly in a short time. Daily and social activities of patients can be improved upon reconstruction of hand deformities.

Adolescent↗
PubMed1990

Pyloric stenosis with esophageal involvement in Behçet's syndrome.

A 43-yr-old man with a diagnosis of Behçet's syndrome since 1977 developed esophageal aphthous ulcerations, duodenal ulcer, and pyloric stenosis. The pyloric stenosis was due to edematous hypertrophy of the pyloric ring. The evidence strongly suggested that these findings were complications of Behçet's syndrome.

Adult↗
PubMed1996

[Palliative treatment of esophageal neoplastic stenosis using bipolar electrocoagulation probe].

OBJECTIVE, PATIENTS AND METHODS: The objective of this study was to evaluate the results of palliative bipolar electrocoagulation probe (BICAP) treatment in 26 patients with non surgical, obstructive esophageal cancer. The mean tumor length was 7.2 cm. The strictures were located as follows: 3 in the cervical esophagus, 8 in the thoracic esophagus, 13 in the distal third of the esophagus and 2 involved both the cervical and thoracic esophagus. Most lesions were circumferential (73% versus 27% non circumferential) and exophytic (78% versus 22% sub mucosal). Coagulation was carried out under direct endoscopic control in the forward direction. The success of treatment was evaluated on the basis of the degree of reopening achieved (easy passage of an endoscope 12 mm in diameter) and good functional results (improvement of dysphagia, scored from 0 to 4 using a standard grading scale, for more than 15 days). RESULTS: Twenty-six patients underwent a total of 45 BICAP treatments (31 initial sessions, 14 repeated sessions). Reopening was achieved in 92% of cases and good functional results were obtained in 85% (mean dysphagia score: 3.2 before treatment versus 1.1 after treatment). The improvement of dysphagia resulted in a significant improvement of general performance status and stabilization or weight improvement in 21 patients. The mean number of sessions necessary for good initial results was 1.2 +/- 0.4. After the initial treatment by BICAP, radiotherapy or radiochemotherapy were respectively associated in 4 and 10 patients. The median duration of improvement was significantly longer in patients who underwent radiochemotherapy as compared with patients treated by BICAP alone (22 weeks versus 4 weeks). During the follow-up, 9 patients required several BICAP treatments and at the end of their disease, 12 patients underwent other palliative procedures. Major complications occurred in 4 cases (2 esotracheal fistulas, 1 hemorrhage, and 1 aspiration pneumonia) and mortality related to the procedure was 8%. CONCLUSIONS: Palliative BICAP treatment of obstructing esophageal and cardial cancer provide quick relief of dysphagia but repeated treatment sessions are necessary to maintain initial improvement. The procedure requires a short hospitalization stay and can be easily accomplished in all cases regardless of the tumor features.

Aged↗
PubMed1999

[Intraesophageal stent in the prevention of stenosis caused by caustic ingestion].

Esophageal stenosis is a frequent consequence of lye ingestion, and their treatment is of longstanding and complex matter. The search of new solutions for this problem is challenging and always attractive if its associated with less aggressiveness to the patient. The use of intraesophageal stents is not new in the treatment of stenosis, but it was anecdotal, until histocompatible material came out in the market. The stent is designed in the OR, having the same length as the stenosis, previously observed by endoscopy, its made out of a silicone tube 30 or 36 French, mounted over an ng tube 16, all this is fixed in the ends of the silicone tube, that way won't slip over the ng tube. It is placed with a laryngoscope assistant, the proximal end of the ng tube comes out the nasal nares. Once the location of the tube is checked, the stent is left in place for six weeks. Our experience, with seven patients, has shown excellent tolerance to the stent; at the third post procedure day the patients were eating soft diet by mouth, we believe that the esophageal spasm had resolved by this day. Once the stent was withdraw, five cases were free of esophageal lesions, in the other two small areas of bleeding were visualized. In the follow-up the five cases that were free of lesions, had a normal esophageal diameter, in the other two, one had a moderate restenosis and the other case was severe.

Age Factors↗
PubMed1997

[Palliative intubation of esophageal prosthesis in two patients with lung cancer].

Case one: A 61-year-old man was admitted to the hospital because of coughing. Adenocarcinoma of the lung was diagnosed. The patient was treated with bronchial artery infusion of cisplatin and mitomycin C, followed by irradiation; and there was a partial response. Eighteen months later he was admitted to the hospital because of dysphagia. An esophageal prosthesis was inserted because of esophageal stenosis surrounded by local recurrent tumor. After intubation, the patient was able to eat and was discharged. Although the patient died 5 months later, the tube was patent and functional until that time. Case two: A 63-year-old man was admitted to the hospital because of coughing. Adenocarcinoma of the lung was diagnosed. The patient was treated with 3 cycles of chemotherapy consisting of cisplatin, vindesine, and mifomycin C, which were followed by irradiation; and there was a partial response. Six months later he was admitted to the hospital because of dysphagia. An esophageal prosthesis was inserted because of esophageal stenosis surrounded by mediastinal lymph nodes. Although the patient was able to eat, bilateral pleuritis and mediastinitis developed and he died ten days after intubation. At autopsy the esophagus was found to have been perforated. Palliative intubation of an esophageal prosthesis can be effective in patients with esophageal stenosis due to lung cancer, but care must be taken to prevent fatal complications.

Adenocarcinoma↗
PubMedDate not supplied

[Esophagus-enteric anastomosis ulceration caused by alendronate].

BACKGROUND: Alendronate sodium is an aminobisphosphonate indicated for the treatment of osteoporosis in post-menopausal women and has been associated with esophagitis in many reports. Esophageal stenosis, gastrointestinal symptoms as dyspepsia, nausea, vomiting and abdominal pain could be present. OBJECTIVE: Report a case of a patient who underwent total gastrectomy with Y-en-Roux anastomosis for a gastric carcinoid tumor and developed an esophagus-enteric anastomosis ulceration after the use of alendronate. PATIENT AND METHOD: A 63-year-old woman started medical therapy with alendronate in a dose of 10 mg daily. After a period of one month of medical treatment with this drug she began to complain of dysphagic symptoms and abdominal pain. She was submitted to endoscopic examination that showed an esophageal ulceration, an enteric ulceration of the anastomosis and an esophageal stenosis. RESULTS: Medical treatment with alendronate was discontinued and the symptom of abdominal pain disappeared. The intensity of dysphagia has decreased. The ulcerated lesion remitted although esophageal stenosis did not. The patient was subsequently treated with esophagus-enteric anastomosis dilation. She improved in her general state and nowadays she is free of symptoms. CONCLUSION: Alendronate sodium could cause lesions of the inferior esophageal portion or in distal segments of the gastrointestinal tube, in patients with a fast gastrointestinal transit. Special attention must be given to gastrectomized patients that use this drug because of the possibility to develop mucosal lesions in the enteric anastomosed part and its fearful complications as stenosis.

Alendronate↗
PubMed2005

Diagnosis of the depth of invasion of esophageal carcinoma using digital radiography.

OBJECTIVE: The purpose of our investigation was to determine the usefulness of digital radiography (DR) for diagnosing the depth of invasion of esophageal carcinoma. METHODS: We evaluated 59 patients with esophageal carcinomas who underwent DR. During continuous DR in tangential views, the most distended image of the esophagus was chosen. Percent esophageal stenosis (PES) was based on the diameter across the lesion of maximal narrowing and the average of the normal oral and anal side diameters. The maximal thickness of the tumor was measured on sequentially prepared specimens. We evaluated whether the percent of esophageal stenosis correlated with the maximal thickness of the tumor on histologic findings. Receiver-operating characteristic (ROC) curves were constructed to establish the cut-off level for PES in diagnosing the depth of tumor invasion. Accuracies for the depth of the invasion were calculated based on PES using DR. For the accuracy rate, DR was compared with endoscopy and endoscopic ultrasonography (EUS). RESULTS: There was a close correlation between PES and pathological thickness of the tumor. PES values (mean+/-S.D.) were 2.45+/-0.75% in Tis and T1a tumors, 13.3+/-10.9% in T1b tumors, 35.2+/-11.1% in T2 tumors, 55.2+/-18.1% in T3 tumors, and 86.1+/-7.5% in T4 tumors. Using the ROC analysis, 12.5, 37.5, and 44.4% were the highest cut-off values of PES for differentiating < or =T1a, < or =T1b, and < or =T2 tumors. Regarding T staging, 45 (76%) of 59 lesions were staged correctly with EUS, whereas 47 (80%) were staged correctly with DR. CONCLUSION: DR is useful for diagnosing the depth of the invasion because esophageal stenosis calculated using DR is an objective index of tumor infiltration. The accuracy rate of the depth of invasion with DR was as good as that of EUS.

Aged↗
PubMed1997

[Dilatation of esophageal strictures with balloon catheter. Safety and effectiveness of balloon dilatation].

Radioscopically-guided balloon dilation of esophageal stenosis is an effective and easily performed palliative procedure. Our experience with balloon dilation of esophageal stenosis in 12 patients was reviewed. Every patient underwent 2-5 sessions. Dysphagia disappeared completely in 2 patients. Ten patients had significant improvement. No case of esophageal perforation occurred during balloon dilation.

Adolescent↗
PubMedDate not supplied

Radiologic diagnosis of benign esophageal strictures: a pattern approach.

Benign esophageal strictures are a leading cause of dysphagia. Therefore, radiologists have an important role in detecting esophageal strictures and determining their cause. The most common cause of strictures in the distal esophagus is gastroesophageal reflux disease. Reflux-induced ("peptic") strictures may be associated with sacculations, fixed transverse folds, or esophageal intramural pseudodiverticula. In addition, scleroderma, nasogastric intubation, Zollinger-Ellison syndrome, and alkaline reflux esophagitis may be associated with stricture formation in the distal esophagus. Upper and midesophageal strictures may be caused by Barrett esophagus, mediastinal irradiation, ingestion of drugs or caustic substances, congenital esophageal stenosis, skin diseases, or esophageal intramural pseudodiverticulosis. Other unusual causes of esophageal stricture formation include Crohn disease, Candida esophagitis, graft-versus-host disease, eosinophilic esophagitis, Behçet disease, endoscopic sclerotherapy for esophageal varices, and glutaraldehyde contamination at endoscopy. Esophageal strictures are best evaluated with biphasic esophagography that includes both single- and double-contrast spot images. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings.

Barium Sulfate↗
PubMedDate not supplied

[Transhiatal esophagectomy].

Between 1991-2001, 40 patients underwent esophagectomy without thoracotomy for: caustic esophageal stenosis (26 cases), cervical esophageal cancer (1), lower esophageal cancer (7), and acute post-caustic oesophagitis (2). Thirty-four patients underwent transhiatal esophagectomy, 3 patients had an esophagectomy by "stripping" and in 3 other patients a combination of stripping and transhiatal esophagectomy. Postoperative complications included: injuries of the laryngeal recurrent nerve (2), pulmonary complications (13), anastomotic leakage (5). Two patients died in the postoperative period one from a myocardial infarction and the other from an acute myocardial dilatation. Trans-hiatal esophagectomy can be considered as a viable alternative to transthoracic esophagectomy in the management of the benign and malignant diseases of the esophagus. Transhiatal esophagectomy is a safe method of resection because of its reported lower morbidity and mortality and similar survival rates compared to transthoracic esophagectomy.

Adult↗