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PubMed2001

[Bouginage in chemical burns of the esophagus in children].

851 children suspected to have chemical burn of the esophagus were treated from 1996 to 2000. Use of esophageal bouginage along the guiding string has changed medical policy for esophageal burns. We completely rejected early bouginage. Late bouginage was necessary for 22% patients with II-III degree of chemical burns (3.8% of all hospitalized children). Results of the new policy depended on chemical agent. The best results were achieved after acetic acid burns. It is difficult to treat alkali burns leading to prolonged esophageal stenosis, and manganese crystal burns leading to pharynx injuries.

Burns, Chemical↗
PubMed1998

[Preoperative staging of esophageal carcinoma: comparison of endoesophageal ultrasonography, computerized tomography and conventional clinical staging].

OBJECTIVE: To evaluate the value of different methods in preoperative staging of esophageal carcinoma. METHOD: Thirty-six patients undergoing resection of esophageal carcinoma were examined with endoesophageal ultrasonography (EU) before operation. Eight of 36 patients could not be evaluated because of severe esophageal stenosis. Computerized tomography (CT) was performed in 21 patients. Comparison was made between stagings based on EU, CT as well as the conventional clinical staging system, respectively with surgical-pathological staging after resection. RESULT: The accuracy of conventional clinical staging for esophageal cancer was only 36%. The accuracy of CT in T, N and pTNM staging was 38.1%, 57.1% and 47.6% respectively. For EU, the figures were 77.8%, 72.2% and 72.2%, and were improved to be 85.7%, 78.6% and 83.1% when untraversable patients were excluded. CONCLUSION: While conventional clinical staging system lacks accuracy in evaluating esophageal carcinoma, CT makes only moderate improvement. Based on direct morphological examination of lesions, EU is highly accurate in preoperative staging of esophageal carcinoma, especially in evaluating the extent of luminal wall invasion and regional lymph node involvement. Therefore, EU is of critical value in the therapeutic selection for esophageal carcinoma.

Endosonography↗
PubMed1985

Upper airway lesions in children after accidental ingestion of caustic substances.

Of 33 children admitted within 24 hours after accidental ingestion of a caustic substance, 14 (42.5%) had evidence of upper airway lesions on direct laryngoscopy. Three patients, 10 to 12 months old, needed endotracheal intubation for acute respiratory obstruction; four patients younger than 2 years had severe dyspnea without obstruction; seven patients had mild or no respiratory symptoms. All were discharged without respiratory sequelae, although esophageal stenosis developed in six patients. Nine of 13 patients younger than 2 years, compared to five of 20 patients older than 2 years, had upper airway lesions (P less than 0.01). The frequency of respiratory tract lesions was higher in patients with severe esophagitis. Eleven of 17 patients with severe esophagitis, compared to three of 16 with mild inflammation, had respiratory tract lesions (P less than 0.025). No specific caustic substance predisposed to upper airway lesions.

Ampicillin↗
PubMed2001

Achalasia in childhood: surgical treatment and outcome.

Achalasia is a rare disorder of the esophagus in children. From 1971 to 1999, 20 children with achalasia of the esophagus have been treated at our institution including two patients who were referred to us after esophagomyotomy. There were 13 boys and 7 girls (average age, 8.2 years; range 2 to 15 years). Presenting symptoms were vomiting (n = 18), dysphagia (n = 11), loss of weight (n = 5), recurrent respiratory infections (n = 3), cough (n = 2) and noisy respiration (n = 1). Barium swallow established diagnosis in all patients. Esophagoscopy was used as a supportive investigation in some patients (n = 10). Nineteen patients underwent Heller-Zaiger operation (modified Heller esophagomyotomy) either by transabdominal (n = 16) or transthoracic approach (n = 3) with (n = 6) or without concomitant antireflux procedure. The postoperative period was uneventful in all patients. Follow-up ranged from 2 months to 16 years. Decreased or absent peristalsis persisted in initial control esophagograms in all patients. Gastroesophageal reflux was encountered in only one patient. Complete relief of symptoms was noted in 14 patients. Mild to moderate dysphagia was encountered in 5 patients and all of them were evaluated by endoscopy and upper gastrointestinal series. Dysphagia resolved spontaneously in one child and following two dilations in another child. One child has moderate dysphagia after a short follow-up period. Esophageal stenosis was seen in the remaining two and subsequently treated by esophagocardioplasty (Heyrowsky and Wendel operations). Achalasia should be considered in the differential diagnosis in any children with persistent dysphagia, recurrent respiratory tract infections and vomiting, including children treated for clinically suspected gastroesophageal reflux. The obvious mode of treatment is surgical myotomy in children. Modified Heller esophagomyotomy is the procedure of choice, which can be performed either by an abdominal or a thoracic approach. The need to carry out a concomitant antireflux procedure remains controversial. The most frequent postoperative problem is persistent dysphagia. It may be self-limited in some cases and disappear during follow-up. Resistant stenosis following esophagocardiomyotomy can be treated by esophagocardioplasty procedures such as Heyrowsky and Wendel operations.

Adolescent↗
PubMed1996

Management of esophageal varices in children by endoscopic variceal ligation.

Endoscopic variceal sclerotherapy (EVS) has been considered the mainstay of therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation (EVL) is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done in children. This report describes experience with EVL in 22 children with esophageal variceal hemorrhage. Eighty-seven EVL procedures were performed during a 9-year period in 22 children. The causes of portal hypertension were biliary atresia (10), portal vein thrombosis (8), chronic active hepatitis (1), cirrhosis secondary to cystic fibrosis (2), and primary sclerosing cholangitis (1). The age range at the onset of variceal bleeding was 8 months to 19 years. Twelve patients had EVS before EVL treatment was begun. Distal esophageal varices (one to four per session) were mechanically ligated using an elastic band ligature device attached to a flexible endoscope. The aim of therapy was obliteration of distal esophageal varices by EVL, every 2 to 4 weeks, until eradication. Subsequent EVL was dictated by the status of the varices. Outcome was assessed with respect to survival, rebleeding, status of varices, and complications. The patients underwent a mean of four sessions of EVL (range, one to eight). Four patients subsequently underwent liver transplantation. Of the 18 patients remaining (average follow-up period, 5.3 years), 12 had their varices eradicated (average of four EVL sessions), four are still in treatment, one has not been evaluated in the past 4 years, and one died of liver failure. Complications included bleeding between sessions (6 patients), cervical esophageal perforation (1 patient), and transient fever (2 patients). No child has experienced symptoms of esophageal stenosis or gastroesophageal reflux. Two patients died of liver disease, unrelated to bleeding from portal hypertension. EVL is effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology. The complication rate is low, and EVL is an acceptable and perhaps preferable alternative to EVS in children with esophageal varices.

Adolescent↗
PubMed1995

Endoscopic detection and treatment of early esophageal cancer: a critical analysis.

Early-stage esophageal cancer is almost asymptomatic. The endoscopic findings are minimal, and there is no esophageal stenosis. However, a risk of malignant propagation into vessels and lymph nodes is present in small tumors. Endoscopic destruction or resection should be performed only at the predissemination stage. We present here a critical analysis of whether endoscopic detection and treatment is feasible and efficacious, based on the pathology of esophageal tumors.

Carcinoma, Squamous Cell↗
PubMed2005

Down's syndrome and esophageal achalasia: a rare but important clinical entity.

We report a case of esophageal achalasia (EA) in Downa9s syndrome. A six-year-old girl with DS was referred from another hospital for further management of dysphagia and growth retardation (weight 16.3 kg, height 105.4 cm: both below -1.5 SD). Dysphagia commenced when she was one year old and gastroesophageal reflux (GER) was diagnosed when she was four. Routine investigations suggested EA or esophageal stenosis secondary to GER. While dissecting the esophago-gastric junction in preparation for a Heller-Dor esophagocardiomyotomy (HD-ECM), the crus of the diaphragm was noted to be narrowed, severely fibrosed and attached to the lower esophagus which was covered by dense scar tissue suggestive of an old esophageal perforation secondary to GER esophagitis. A Nissen fundoplication was performed, but dysphagia persisted postoperatively, and a narrowing 2 cm above the fundoplication wrap with proximal dilatation was found on repeated barium studies. At re-laparotomy, the fundoplication was unwrapped and HD-ECM performed. Eight months postoperatively, she is well with no recurrence. EA must be considered in any DS patient presenting with dysphagia.

Cardia↗
PubMed1979

Surgical treatment of tracheal stenosis.

During the last 3 1/2 years 8 patients underwent segmental resection of the trachea and one patient underwent resection of the carina at the Department of Surgery, University Hospital, Köln. Follow-up investigation in 6 month intervals showed good results in 6 patients. The complicated course of 1 of our patients with tumor infiltration of the trachea is discussed. In this case a large esophagotracheal fistula was covered with a vascularized esophageal segment. Suggestions for surgical indications in segmental resection of benign esophageal stenosis are outlined.

Adolescent↗
PubMed1977

Corrosive gastritis.

Cases of corrosive gastritis are relatively few in the literature. Fifteen patients with combined corrosive esophagogastritis are reported on herein. In the acute stage (with severe degree of esophagogastritis) feeding jejunostomy was recommended, whereas in the chronic stage (with gastric obstruction) posterior gastrojejunostomy was performed for all patients. Patients were classified into three grades depending on the extent of associated esophagitis. We conclude that corrosive gastritis is a possible associated complication of corrosive intake (particularly for suicide) and requires a latent period of time to be clinically evident.

Accidents, Home↗
PubMed2000

Metachronous triple cancers of the sigmoid colon, stomach, and esophagus: report of a case.

We report herein an unusual case of metachronous triple cancers of the sigmoid colon, stomach, and esophagus. A 60-year-old man was initially admitted to our hospital for investigation of occult fecal blood. This was found to be caused by sigmoid colon cancer which was resected in July 1985 (T3, N0, M0; Stage II). A follow-up endoscopy performed in 1990 showed early gastric cancer, and a gastrectomy was performed in August 1990 (Tis, N0, M0; Stage 0). Another endoscopic examination performed as follow-up in 1993 revealed early cancer of the remnant stomach, and all the remnant stomach was surgically resected in March 1993 (Tis, N0, M0; Stage 0). He presented again in December 1996, complaining of discomfort in the chest which was found to be caused by cancer of the middle thoracic esophagus. Although surgery was considered necessary, the patient refused to undergo any further operations. Instead, radiation was administered from January 1997. An endoscopy after the completion of radiotherapy confirmed that the cancer had almost disappeared; however, it started to grow again from the beginning of 1998. He was hospitalized due to esophageal stenosis in April 1998, and died of carcinomatous cachexia in September of the same year.

Adenocarcinoma↗
PubMed1990

Endoscopic treatment for submucosal tumors of the esophagus: studies in 25 patients.

Twenty-five patients with submucosal tumor of the esophagus were treated endoscopically. All patients underwent submucosography. The tumors were classified as intra-luminal or intra-mural types according to growth pattern. Twenty tumors were resected using electrocautery in single sessions. Another 5 lesions (more than 20 mm in diameter) were subjected to absolute ethanol injections in multiple sessions to necrotize the tissue, after the overlying mucosa was stripped off by electrocautery. These procedures were not accompanied with serious complications such as perforation or massive bleeding. Oozing bleeding occurred in 3 patients, which was easily stopped by topical injection of absolute ethanol with an endoscope. Esophageal stenosis did not occur. Local reccurence of a submucosal tumor was found in a patient after 14 months, and was retreated successfully. Although the wall of the esophagus is thinner than that of the stomach, endoscopic treatment for a submucosal tumor of the esophagus can be performed safely. Submucosography and endoscopic ultrasonography reveals the extent of the tumor in relation to the esophageal wall thickness. These examinations are helpful in preventing complications. Endoscopic treatment for submucosal tumors using electrocautery and topical injection of absolute ethanol were effective and safe.

Adult↗
PubMed1989

[Study of complications after endoscopic sclerotherapy for esophageal varices--particularly 2 cases that changed portal circulation after sclerotherapy].

In 116 patients with esophageal varix due to liver cirrhosis who received the endoscopic sclerotherapy, the following complications were observed after the sclerotherapy: 38 ulcer formation; 19 chest pain; 16 hypotension; 15 fever; 12 pleural effusion; 6 esophageal stenosis and so on. Furthermore, two cases with marked changes of portal circulation were experienced after the sclerotherapy. The first case had severe bleeding out of duodenal varix four months after the sclerotherapy and died because of massive bleeding. The second case had hepatic encephalopathy six months after the sclerotherapy. In both cases, angiography revealed the development of collateral veins after the sclerotherapy. Because the abrupt intercept of the esophageal varix by the successful sclerotherapy causes the increase of the other collateral blood flow, the changes of portal circulation must be watched carefully afterward.

Adult↗
PubMed2002

Two cases of steakhouse syndrome associated with nutcracker esophagus.

The most common type of esophageal food-related foreign body is the meat bolus, which is frequently associated with underlying esophageal stenosis. Herein, we report two cases of meat bolus impaction associated with nutcracker esophagus. In the first case, the 63-year-old male patient had chest discomfort and swallowing difficulty after ingestion of butcher's meat. In the second case, the 55-year-old male patient had complained of swallowing difficulty after ingestion of chicken. In both cases, no pathologic findings were observed endoscopically after removal of the esophageal meat bolus. We performed esophageal manometry, which showed very high amplitudes of esophageal pressure in the mid- and distal esophagus. These findings were consistent with nutcracker esophagus. These cases show that esophageal motility disorder may be the cause of esophageal foreign body impaction, and esophageal manometry should be performed for evaluation of the cause of foreign body, especially in an endoscopically normal patient.

Deglutition Disorders↗
PubMed2001

[Chemoradiotherapy and salvage surgery in a patient with advanced esophageal cancer].

We report a case of advanced esophageal cancer, which was treated by chemoradiotherapy combined with surgical treatment. Moreover, 14 advanced esophageal cancer patients treated by chemoradiotherapy are discussed. The chemoradiotherapy showed beneficial control of the tumor; however, it sometimes leads to esophageal stenosis and ulcer. We conclude that additional salvage surgery is needed for such complications.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Synchronous esophageal and stomach neoplasm: importance of diagnosis and treatment].

The association of esophageal and gastric cancer has been described because of the better technology in methods for diagnosis. In surgery for esophageal cancer, a gastric tube is often prepared to provide a new route for oral ingestion. Although patients with simultaneous esophageal cancer and gastric cancer have been reported, it is often difficult to diagnose the coexistence of gastric cancer preoperatively due to the presence of esophageal stenosis. In this paper we report on one case of the rare combination of squamous cell cancer of the esophagus and simultaneous adenocarcinoma of the stomach.

Adenocarcinoma, Mucinous↗