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Results for “ESOPHAGEAL STENOSIS”

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PubMed1985

[Reconstruction of the esophagus and hypopharynx by free jejunum interposition].

Beside conventional procedures the hypopharyngeal and esophageal reconstruction using a free jejunum-transfer represents an additional method for primary reconstruction of the hypopharynx and esophagus. Out of 48 free jejunum-transfers 16 were used for bridging an hypopharyngeal or esophageal defect, 32 as a patch for reconstruction of the oral cavity. In 7 patients a hypopharynx carcinoma was resected, in 6 cases the cervical esophagus was infiltrated by carcinoma. 3 patients suffered from an esophageal stenosis caused by corrosion after acid ingestion. 11 free grafts healed without any complications. In 2 cases the jejunum was removed because of necrosis. In 3 cases fistulation from the lower anastomosis was observed. Free, microvascular jejunum-transfer using physiological graft material not only seems to be advantageous for tolerance to radiation but is also a one step surgical procedure.

Adolescent↗

PubMed1995

[Application of oesophagogastric double anastomosis in the treatment of esophageal caustic stricture].

Between 1982 and 1992, nine cases of oesophageal caustic stricture underwent oesophagogastric double anastomosis with success. There was no need to dissect and resect the strictured esophagus, and traumatizing organs adjacent to oesophgus was avoided. This method also eliminated the possibility of occurrence mediastinal abscess due to postoperative rebindling or infection by the esophageal segment. Indications for this operation are as follows: the esophageal stenosis located below the aorta arch; the stomach mobilized and pulled up to the upper level above the aorta arch dispite the presence of scattered caustic shrinkage; to assess the location and extent of corrosive injury and determine the level of reestablishment of the digestive tract through routine preoperative fiberoptic oesophagoscopy. This simplified procedure shortens the operating time, but yields excellent result.

Adolescent↗

PubMed1991

[Partial esophagectomy and cervical esophagogastrostomy via the esophageal bed].

Partial esophagectomy through left thoracotomy and cervical esophagogastrostomy via the esophageal bed was done in 250 patients with esophageal cancer of the upper and middle-third segment and with cicatrical esophageal stenosis. Two patients (0.8%) had cervical anastomotic leakage and 3 (1.2%) had cardiopulmonary complications. There was no operative death. This procedure is effective in keeping the position of intrathoracic organs normal, reducing the tension at the site of esophagogastrostomy, preventing the heart and lungs from being compressed by the distension of thoracic stomach, and reducing the incidence of postoperative anastomotic leakage and cardiopulmonary complications.

Adolescent↗

PubMed1987

Late-onset regurgitation associated with persistent right aortic arch in two dogs.

Congenital persistent right aortic arch was diagnosed as the cause of weight loss and regurgitation in 2 dogs, aged 2.5 and 8 years, respectively. The first dog had 2 brief episodes of regurgitation that resolved spontaneously before the most recent onset of signs and diagnosis. The second dog had no clinical signs attributed to persistent right aortic arch until 2 months before the diagnosis was made. Dogs born with persistent right aortic arch typically have clinical signs of esophageal stenosis around the time of weaning. Evidence from the 2 dogs in this report indicate that clinical signs associated with vascular ring anomalies may not become evident until later in life. Veterinarians should consider the diagnosis of persistent right aortic arch in any age dog that is admitted because of regurgitation, weight loss, and dilatation of the cranial portion of the esophagus.

Animals↗

PubMedDate not supplied

A simple endoscopic intubation technique in esophageal obstruction.

Endoscopic intubation was effected in 42 cases of malignant esophageal stenosis during the period 1979-1981. The stenosis was dilated with the aid of thermoplastic probes passed through a rigid esophagoscope of sufficient length, whereupon a tube was introduced under endoscopic control and left in situ in the malignant stricture. This "rigid" technique is suitable for process confined to the esophagus. Introduction of the tube requires adequate endoscopic skill and is not devoid of risk. Perforation, the gravest risk, occurred in two cases. Proximal tube migration was observed in five patients.

Esophageal Neoplasms↗

PubMed1989

A new objective measurement of esophageal lumen patency.

This study was performed to develop a system to measure dysphagia in an objective fashion, test its correlation with subjective estimates of dysphagia, and encourage the use of a standardized measure of esophageal stenosis. Thirty-five patients with mechanical dysphagia underwent subjective estimates of dysphagia using a dysphagia scale graded from 0 to 5, as well as a diet scale. Lumen diameter was measured endoscopically, using the open or closed biopsy forceps as a measuring guide. Patients were then given barium capsules or tablets of increasing diameter under fluoroscopy, in the upright position. Pills were given sequentially until a pill failed to traverse the esophagus in less than 20 s. The diameter of the pill failing to traverse the esophagus within 20 s correlated strongly with the endoscopically measured diameter by Spearmans rank correlation (Rs = 0.85). The weakest correlation was between endoscopically measured diameter and the dysphagia scale (Rs = 0.48). The diameter of the pill failing to traverse the esophagus within 20 s is an excellent estimate of esophageal lumen diameter. Pill size correlates much better with esophageal lumen diameter than dysphagia or diet scales. This new dysphagia assessment system should simplify standardization of the grading of dysphagia.

Barium Sulfate↗

PubMed2001

Accidental caustic ingestion in children: is endoscopy always mandatory?

BACKGROUND: Patients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested-substance types as markers of severe esophagogastric lesions and to define indications for endoscopy. METHODS: Ingested-product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion. RESULTS: Forty-eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1). CONCLUSIONS: In conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.

Accidents, Home↗

PubMed2002

Amifostine in simultaneous radiochemotherapy of advanced head and neck cancer.

The authors discuss the results of 3 studies of their group reflecting the possible role of amifostine in simultaneous radiochemotherapy (RCT) of advanced head and neck cancer. In a controlled phase II trial (1995 through 1996), 39 patients were included in this pilot investigation. A control group (n = 14) received simultaneous RCT of the head and neck region with an irradiation dose of 60 Gy and 2 cycles of carboplatin (700 mg/m(2) cumulative dose). Twenty-five patients received the same basic therapy and an additional 500-mg dose of amifostine before each chemotherapy. Amifostine was administered less than 45 minutes before the end of radiotherapy. The authors observed a dramatic reduction of typical radiotherapy-associated toxicities (mucositis, xerostomia, loss of taste, dysphagia). The hematologic side effects (leukocytopenia, anemia, thrombocytopenia) also were decreased significantly. The overall survival rate and locoregional control of both groups were comparable after 12 months. In a controlled intensification trial (1997 through 1999), the authors included 76 consecutive patients (69 men, 7 women) with pharyngeal cancer (oropharynx, n = 33; hypopharynx, n = 43). The tumors were characterized as unresectable and locally advanced without distant metastasis. All patients received a conventional radiotherapy (2-Gy single dose, daily fractionation) up to doses of 60 Gy and an additional 10 Gy as a boost in the tumor-infiltrated region. A dose of carboplatin, 70 mg/m(2), was given to a group of 45 patients on days 1 through 5 and 29 through 33 of radiotherapy (RCT arm). The resulting cumulative dose was 700 mg/m(2). A group of 31 patients (RCTintens arm) received the same dose of carboplatin on days 1 through 5, 22 through 26, and 43 through 47 or 1 through 5, 15 through 19, 29 through 33, and 43 through 47 of radiotherapy (cumulative dose 1.05 to 1.40 mg/m(2)). All patients received 500 mg of amifostine before each carboplatin administration. If the tumor volume was less than 20 cm(3), we observed an increased 1-year overall survival rate (91% v 71%) and time to progression (17 months v 10 months). If the tumor volume was greater than 20 cm(3), we observed comparable treatment results in both groups (1-year survival rate, 60% v 61%; time to progression, 13 months v 12 months). In a long-term follow-up investigation (1999 through 2000), 531 patients (89 women, 442 men) were analyzed according to their toxicities during regular follow-up investigations at our outpatient facility. All patients were treated by surgery or radio(chemo)therapy because of an advanced head and neck cancer. A total of 218 of 531 patients received the antineoplastic therapy without cytoprotection. An additional 313 patients received their RCT combined with amifostine administration before administration of the radiosensitizer. A significant influence of cytoprotection was registered in the following toxicities: xerostomia, fibrosis, loss of taste, and dysphagia. No impact was seen on the development of interstitial lymph edema and esophageal stenosis. Amifostine could be integrated in simultaneous radiochemotherapy of advanced head and neck cancer patients. The authors favor the administration of amifostine before chemotherapeutics alone. Selective cytoprotection could decrease the main acute toxicities (mucositis, xerostomia, dysphagia) as well as late side effects (xerostomia, loss of taste, fibrosis) of this form of combined treatment. The enhanced therapeutic index may be changed into a prognostic benefit for selected patients with unresectable tumors, if the volume is smaller than 20 cm(3).

Adolescent↗

PubMed1994

[Paroxysmal unilateral hyperhidrosis].

We report the case of a 35-year-old woman with paroxysmal unilateral hyperhidrosis which developed after thoractotomy for Barret's esophagus (benign esophageal stenosis). Hyperhidrosis was on the right side of the face and in the metameric areas corresponding to the right spinal roots C2, C3 and C4. Paroxysms of sweating lasting from 15 to 30 min occurred several times daily, either spontaneously or related with acid food ingestion. The symptoms have been present for the last 10 years. Paroxysmal unilateral hyperhidrosis is a rare disorder of the autonomic nervous system. It has been reported in association with peripheral nerve, spinal cord and cerebral lesions, and in some cases the etiology is unknown.

Administration, Topical↗

PubMed1983

[Reflux disease of the esophagus].

An attempt is made to correlate clinical respectively endoscopic and histomorphological findings in patients with gastroesophageal reflux disease. The histological stage Ia cannot be identified endoscopically. However, certain correlations can be found between endoscopic stage I (the "red spot") on the one hand and the histological stage Ib (hyperemic capillaries) on the other, just as well as between subsequent endoscopical and histological stages. The histomorphological stage IV corresponds to the clinical stage IV and represents the ultimate complication of the reflux disease, esophageal stenosis caused by ulceration plus endobrachyesophagus. In this stage no restitutio ad integrum is possible anymore. The initial changes of the gastroesophageal reflux disease occur within the epithelium and the papillae and can be recognized microscopically in biopsies taken during endoscopy. Changes in the submucosal layer are of no importance during the early reversible stages. The lining of the endobrachyoesophagus with cylindrical epithelium ("Barrett mucosa") is probably the consequence of reflux. This type of lining presents an irregular picture from the morphological as well as from the clinical point of view and is to be considered as a pre-stage of adenocarcinoma of the esophagus.

Barrett Esophagus↗

PubMed2004

Tracheoesophageal fistula secondary to chemotherapy for malignant B-cell lymphoma of the thyroid: successful surgical treatment with jejunal interposition and mesenteric patch.

We report a case of tracheoesophageal fistula (TEF) secondary to chemotherapy for primary thyroid lymphoma. A 65-year-old man with a short history of a rapidly enlarging neck mass was diagnosed as having thyroid lymphoma of diffuse, large B-cell type. The TEF occurred during the first course of chemotherapy including cyclophosphamide, doxorubicin, vincristine and prednisolone. After placing a feeding gastrostomy without oral intake, eight cycles of chemotherapy were completed and complete remission was achieved. Although the cervical mass disappeared, TEF and esophageal stenosis persisted. Total thyroidectomy and resection of the stenotic cervical esophagus were carried out followed by interposition of the revascularized jejunum and its mesenteric patch to cover the TEF. This seems to be the first report of a TEF caused by chemotherapy for primary thyroid B-cell lymphoma. A variety of treatments for TEF including simple closure, tracheal resection, colonic bypass and muscle flap have been reported with low success rates. Our procedure using a jejunal mesenteric patch seems to be unique and may be a new treatment strategy for TEF.

Aged↗

PubMed1994

Laparoscopic assisted gastrostomy tube placement.

Gastrostomy commonly is performed for patients who have esophageal stenosis or difficulty in swallowing. The fact that most patients who require a gastrostomy are malnourished or debilitated urges surgeons to seek a safe and simple procedure. Percutaneous endoscopic gastrostomy (PEG) was introduced into clinical use and recommended as the procedure of choice in the 1980s. However, for patients with obstruction of the oroesophageal canal, PEG was not possible, and only traditional open gastrostomy could be considered. We describe a technique for placement of a gastrostomy tube under laparoscopic guidance. The technique is simple and easily mastered, requires equipment routinely used in laparoscopic surgery, and can be used by surgeons without gastroendoscopic experience. When performed properly, the method is simple, economical, and reliable.

Enteral Nutrition↗

PubMed2000

The submental island flap in head and neck reconstruction.

BACKGROUND: The submental island flap (SIF) is a new alternative in the reconstruction of various head and neck defects. We present our preliminary experience in the use of this flap and describe the surgical technique. METHODS: Nine patients underwent reconstruction with the SIF between January 1998 and July 1999. The SIF has been used for the reconstruction of the cervical esophageal stenosis in 2 patients, floor of mouth and tongue defects in 6 patients, and a hemilaryngectomy defect in 1 patient. RESULTS: With the exception of one partial flap loss caused by arterial insufficiency, no flap failures were observed. All the donor site defects but one were closed primarily. One patient who underwent reconstruction of a hemilaryngectomy defect underwent revision surgery because of intractable hair growth on the transferred skin paddle. Marginal mandibular nerve function was intact in all the cases. CONCLUSIONS: When combined with the reported experience of other surgeons, our preliminary experience showed that the SIF was an excellent alternative in the reconstruction of head and neck defects because of its reliability, versatility, and relative ease of application.

Adolescent↗

PubMed1986

[Evaluation of 16 severe pharyngo-esophageal caustic stenoses. Value of the anterior approach in an ileo-colic transplant].

Results of treatment of 16 cases of severe pharyngo-esophageal stenosis of caustic origin are reviewed. Emergency treatment is described, the place of otorhinolaryngology in investigation of lesions of upper respiratory and digestive tract discussed, and a description given of a technique of esophagopharyngoplasty by right ileocolic transplant with a suprahyoidal or supraglottic anterior cervical approach with epiglottectomy. Strict selection of patients is essential, taking into account their psychiatric profile. The functional result of this operation, with its long and difficult postoperative course, was inconstant (11 of the 16 cases could be fed liquids and solids by mouth exclusively, ensuring maintenance of body weight, although endoscopic dilatation might be necessary in one or two cases), and appears to depend on the outcome of corrosive lesions and psychologic behavior of patients.

Adolescent↗

PubMed1981

[New approach to the management of caustic esophageal stricture in children (author's transl)].

The management of long segment esophageal stenosis following chemical burns in children remains a difficult problem although various kinds of treatment have been proposed. The surgical treatment, consisting in replacing the injured segment, is mutilating and always performed at some risks. On the other hand dilatations must be carried on over several years in order to produce results and are not compatible with normal life. Furthermore, they are often followed by complications. The authors have been led to develop a method which would both allow the conservation of the esophagus and avoid long term dilations. This procedure mainly consists in a lengthwise myotomy of the residual structure after 12 or 18 months retrograde dilatations so as to peel off the wall fibrosis. The technique is presented and discussed about 2 successfully treated cases with a 9 to 12 months follow up.

Burns, Chemical↗

PubMed2004

[Withdrawal syndrome in a critically ill child after sedation with midazolam and fentanyl].

A 7-year-old girl suffered from withdrawal syndrome with systemic convulsion after sedation with midazolam and fentanyl. She had a history of severe accidental alkaline esophagitis, and under went polysurgeries. This time, she was scheduled to receive reconstruction of the esophagus with small intestine in order to resolve esophageal stenosis. Operation and anesthesia lasted for 14 hours, and 17 hours, respectively. In the postoperative period, she was under heavy sedation with midazolam and fentanyl in order to keep neck position immobile. Her sedation persisted for 14 postoperative days, and the total doses of midazolam and fentanyl were more than 100 mg x kg(-1), and 6.4 mg x kg(-1), respectively. Thereafter, her sedation was tapered and discontinued within about 24 hours. After 12 hours, she suddenly developed systemic convulsion with loss of consciousness. There was no evidence of obvious organic central nervous system abnormality. We suspected withdrawal syndrome, and gradual decrease of midazolam and fentanyl prevented her from going into withdrawal syndrome. We have to pay attention to withdrawal syndrome when heavy and long sedation with midazolam and fentanyl was employed and the drugs were then tapered and discontinued.

Child↗

PubMed2004

Self-expandable metallic stents for palliation of malignant esophageal obstruction: special reference to quality of life and survival of patients.

SUMMARY. Self-expandable metallic stents (EMS) provide a common option for malignant esophageal stenosis because of the low complication rate and high dysphagia improvement rate. However, there are few studies on the functional duration of EMS and the extent of improvement of the quality of life. We retrospectively analyzed 18 patients who received EMSs in our division from 1996 to 2002. The median duration of possible food intake and the median survival period were 94.5 and 108 days. The median duration of domiciliary treatment was 56 days. Six of the 18 patients were not discharged from hospital after EMS insertion. The Karnofsky index was found to be a significant determinant of the feasibility of domiciliary treatment. One-third of the patients are incapable of obtaining the benefits of the palliative therapy. EMS deployment should be prudently selected for patients exhibiting low performance status.

Adult↗

PubMedDate not supplied

Can clinicians accurately assess esophageal dilation without fluoroscopy?

This study questioned whether clinicians could determine the success of esophageal dilation accurately without the aid of fluoroscopy. Twenty patients were enrolled with the diagnosis of distal esophageal stenosis, including benign peptic stricture (17), Schatski's ring (2), and squamous cell carcinoma of the esophagus (1). Dilation attempts using only Maloney dilators were monitored fluoroscopically by the principle investigator, the physician and patient being unaware of the findings. Physicians then predicted whether or not their dilations were successful, and they examined various features to determine their usefulness in predicting successful dilation. They were able to predict successful dilation accurately in 97% of the cases studied; however, their predictions of unsuccessful dilation were correct only 60% of the time. Features helpful in predicting passage included easy passage of the dilator (98%) and the patient feeling the dilator in the stomach (95%). Excessive resistance suggesting unsuccessful passage was an unreliable feature and was often due to the dilator curling in the stomach. When Maloney dilators are used to dilate simple distal strictures, if the physician predicts successful passage, he is reliably accurate without the use of fluoroscopy; however, if unsuccessful passage is suspected, fluoroscopy must be used for confirmation.

Aged↗