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At least 883 records · Page 49Linked to original sources
PubMed1995

Assessment of sucralfate coating by sequential scintigraphic imaging in radiation-induced esophageal lesions.

The value of mucosal protection with sucralfate in cases of gastric ulceration is well documented. Although sucralfate is advocated as treatment of esophageal lesions, we found it to be of limited value in the management of radiation-induced esophagitis; in a pilot study of 10 cases, minor relief of symptoms, with analgetics still required, was noted in 4 patients, and no improvement was seen at endoscopy after 6 weeks of treatment in any patient. To see if this might be the result of inadequate mucosal coating, we administered sucralfate labeled with technetium 99m to 26 patients with endoscopically proven esophagitis secondary to irradiation for esophageal carcinoma. The degree of coating was evaluated according to persistence of the radionuclide in the affected esophageal segment. Scans were performed at regular intervals for 120 minutes after administration of 150 MBq 99mTc-sucralfate. Although scans were positive for radioactivity in 24 of 26 (92%) patients, only 8 (31%) of these represented selective binding of sucralfate to tissue. In the other 16 cases, scans were positive for sucralfate and albumin, indicating nonspecific retention most likely caused by concomitant esophageal stenosis. Residual radioactivity was observed for 30 minutes or more in 11 (42%) patients, but scans were positive for radioactivity after 1 to 2 hours in only 4 (15%). The duration and intensity of tracer accumulation were similar in both acute lesions an chronic radiation damage. These findings suggest that the inability of sucralfate to alleviate irradiation-induced odynophagia may be related to insufficient duration of adherence of this compound to damaged esophageal mucosa.

Aged↗
PubMed2002

Case of radiation-induced esophageal ulcer worsened after endoscopic biopsy.

Esophageal ulcer is one of the most important late complications of the esophagus treated with radiation therapy, especially with intraluminal brachytherapy. We encountered a patient with esophageal cancer treated with external radiation therapy and intraluminal brachytherapy, who developed radiation ulcer and who had severe dysphagia soon after endoscopic biopsy of the ulcer edge. A 55-year-old man was diagnosed as esophageal cancer without symptoms. He received 60 Gy/30 Fr of external radiation therapy and 12 Gy/3 Fr of intraluminal brachytherapy at a point of 5 mm in depth from the mucosa surface. He developed an asymptomatic esophageal ulcer 13 months after treatment, and endoscopic biopsy was obtained from the edge of the ulcer. Thereafter, swallowing difficulties appeared, and endoscopy revealed severe esophageal stenosis and a deep ulcer. A possibility that the biopsy contributed to worsening the ulcer can be considered. Except for cases where relapse is apparent, endoscopic biopsy is considered to be avoided.

Biopsy, Needle↗
PubMed1982

[Esophageal carcinoma: a one-time procedure with stomach transposition as a therapeutic concept (author's transl)].

From December 1979 until October 1981 29 patients with malignant esophageal stenosis were treated in surgical department I of the University of Vienna. The tumor was located in 3 patients in the upper third of the esophagus in 17 cases in the middle, and in 9 in the lower third. The tumor stage permitted curative treatment (exstirpation of the esophagus) in 25 cases; in the remaining 4 patients bypass procedures were performed (retrosternal, antethoracic). In 6 cases the esophagus was excluded by blunt dissection without thoracotomy. For esophageal replacement the stomach was used in all cases in isoperistaltic fashion with cervical anastomosis. Of 13 cervical anastomotic leaks 11 healed spontaneously within 2 weeks. Five patients died, 3 of them because of respiratory failure. Using the stomach for replacement is a safe method with excellent functional results.

Esophageal Neoplasms↗
PubMed1993

Staged repair improves outcome of high-risk premature infants with esophageal atresia and tracheoesophageal fistula.

Twenty-five high-risk premature infants weighing less than 2,000 g at birth (Waterson class C), were treated for esophageal atresia (EA) and tracheoesophageal fistula (TEF). If four patients with associated Trisomy 18 are excluded for whom definitive surgery was denied, 17 of 21 patients (81%) survived. Of significance is that 14 patients with EA and TEF underwent initial gastrostomy tube placement followed by either primary anastomosis or staged repair, depending on clinical status. Four of these infants with distal TEF who were considered low risk underwent a primary anastomosis with 100% survival. However, 3 of these 4 patients developed significant postoperative complications and 2 required subsequent Nissen fundoplication (50%). Ten reached at least 2,000 g in weight with 70% survival. In this group 3 neonates died before the definitive repair could be performed. Of the 7 who survived, only 2 incurred postoperative complications and only 1 patient required Nissen fundoplication (14%). Five other patients were found to have EA without TEF and underwent staged repair with 100% survival. Finally, one additional patient with H-type TEF underwent transcervical ligation and another with a congenital esophageal stenosis died of intracerebral hemorrhage prior to the institution of surgical therapy. Although the number in this series are small, these findings suggest that premature infants with EA and TEF incur a lesser morbidity when treated by a staged repair versus a primary anastomosis.

Comorbidity↗
PubMed1983

Emergency endoscopic sclerotherapy for bleeding esophageal varices: a prospective study in patients not responding to balloon tamponade.

To assess the efficacy of endoscopic paravariceal sclerotherapy (EPS) compared to balloon tamponade, 25 patients with massive hemorrhage from esophageal varices not responding to Sengstaken or Linton tube tamponade were treated by emergency EPS. None of the patients had received vasopressin. Immediate control of hemorrhage was achieved in 92%. Recurrent bleeding occurred in 17.4% of patients during their primary admission. Minor complications resulting from EPS were observed in three patients (12%): esophageal ulcer, esophageal stenosis, and pleural effusion. Ten patients (40%) died in the hospital, seven of them despite arrested hemorrhage. Fifteen patients were discharged and followed at 3-month intervals for a mean of 21.3 months (range, 8.8 to 29.7). During this period one death due to liver failure without recurrent hemorrhage and three rebleeding events in two patients were observed (rebleeding risk per patient month, 9.4 x 10(-3). We conclude that EPS is very effective in controlling acute bleeding from esophageal varices, even in poor risk patients with ineffective balloon tamponade.

Adult↗
PubMed1985

[Therapy of portal hypertension in childhood].

From 1980 to 1984 fortyeight children with portal hypertension were treated, 37 out of these had a prehepatic bloc. In 19 children a sclerotherapy was performed. Seven times a bleeding recurrency occurred and an esophageal stenosis was seen in 2 cases. The distal splenorenal shunt (Warren) was performed 16 times. All children survived, one pneumonia and one slight pancreatitis were observed post-operatively. Four times a shunt obstruction was found at follow-up examinations. Bleeding recurrencies did not appear.

Child↗
PubMed1999

[Implantation metastasis at the exit site after percutaneous endoscopic gastrostomy in esophageal carcinoma].

In patients with esophageal cancer causing obstruction percutaneous endoscopic gastrostomy (PEG) is a well-established procedure with a low complication rate to provide sufficient enteral nutrition. We report on a 68-year-old patient suffering from inoperable squamous cell cancer of the proximal esophagus, who underwent PEG insertion prior to a combined radiochemotherapy. Initially bougienage was performed because of subtotal esophageal stenosis. Four months later a metastasis was found at the PEG exit site with involvement of the gastric wall, most likely caused by spread of tumor cells during insertion of the PEG.

Aged↗
PubMed1988

External beam and intraluminal radiotherapy in the treatment of carcinoma of the esophagus.

During a 10-year period, 46 patients with unresectable or inoperable carcinoma of the esophagus were treated with teletherapy-brachytherapy combination at the University of Southern California School of Medicine. Stage distribution was as follows: stage I, 5 (11%) patients; stage II, 23 (50%) patients; stage III, six (13%) patients; and stage IV, 12 (26%) patients. Thirteen patients were treated for recurrent disease, including 11 patients initially treated with teletherapy and two who had had surgical resection. Radiotherapy was given by teletherapy in 33 and brachytherapy in all 46 patients. An average tumor dose was 50 Gy with teletherapy and 20 Gy per application with brachytherapy. There were 25 patients who had more than one brachytherapy application. The 5-year actuarial survival rate for 28 patients with stage I or II disease was 12%, with a median of 13 months. This compared with no 5-year survivals and a median survival of 10 months for the 18 patients with stage III or IV disease. Failure at the primary site was seen in 16 (35%) patients. Complete response was seen in 20%, partial response in 76%, and no response in 4%. Treatment was well tolerated. Complications included esophageal stenosis in two patients and tracheoesophageal fistula in one. Teletherapy-brachytherapy combination is an effective treatment in the management of unresectable or inoperable carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1986

[Achalasia of the cricopharyngeal muscle in the infant].

Two patients with Cricopharyngeal achalasia have been treated at the Clínica Infantil "La Paz" (Madrid) in the last 20 years. They were one and a half, and four and a half months old at the time of operation. The postoperative period and follow-up has been satisfactory. Clinical symptoms in both of them were cough, cyanosis, regurgitation and aspirative pneumonia. One of them came with the diagnosis of congenital esophageal stenosis, and the other one with the diagnosis of tracheoesophageal fistula. The diagnosis was confirmed by endoscopy and barium-X-ray. Section of the Cricopharyngeus muscle was curative and recovery of the normal function has been complete.

Child, Preschool↗
PubMed1997

[Radiation therapy for advanced gastric cancer].

Thirteen patients with advanced gastric cancer treated by palliative radiotherapy were retrospectively analyzed. The radiation sites were abdominal cavities in 8 cases, superficial masses in 5 and lung metastasis in one. The purposes were to diminish mass size in 5 cases, to relieve pain in 3 and to reduce stenosis in 6. The total doses were more than 40 Gy in 10 patients. In 2 cases, the intracavitary irradiation was performed using 192Ir. In one case, radiation had to be stopped at the dose of 22.5 Gy because of poor general condition. Partial response was obtained in 6 of 12 cases (RP, 50%). The sites of responders were superficial lesions in 4 and hepatic hilar mass in 2, which were given intracavitary as well as external radiation. Pain relief was achieved in all patients suffering from it. One of 3 cases with esophageal stenosis showed marked improvement in swallowing. Two patients showed a decrease in the levels of tumor markers. Five patients had side effects of more than grade 2. Two of them were grade 3, one thrombocytopenia and one diarrhea. The median survival time of all cases was 9 months, and 5 patients could shift to home care. These results suggest that palliative radiotherapy could be one of the most useful locoregional therapies for advanced gastric cancer, in the aspect of improvement of patient's QOL.

Aged↗
PubMed2004

Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features.

BACKGROUND: Eosinophilic esophagitis is an inflammatory condition in which there is dense eosinophilic infiltration of the surface lining of the esophagus. Reports of eosinophilic esophagitis pertain almost exclusively to pediatric populations. However, eosinophilic esophagitis is emerging as a clinical affliction of adults. This report describes the clinical and endoscopic findings of eosinophilic esophagitis in the largest cohort of adult patients reported to date. METHODS: Twenty-nine patients (21 men, 8 women; mean age 35 years) with documented eosinophilic esophagitis (>/=15 eosinophils per high-power field in biopsy specimens) and a significant history of chronic dysphagia for solid food (24 patients) were evaluated clinically and endoscopically during a 3-year period (1999-2002). Fourteen patients (48%) had a history of asthma, environmental allergy, or atopy. In a subset of 15 patients, the diagnostic accuracy of endoscopy was compared with that of barium contrast esophagography. RESULTS: Twenty-seven patients (93%) had abnormal endoscopic findings; 25 (86%) had unique esophageal structural changes, associated with a preserved mucosal surface, that were highly atypical for acid reflux injury. Structural alterations seen in adult patients with eosinophilic esophagitis may occur in combination or as a primary characteristic, e.g., uniform small-caliber esophagus, single or multiple corrugations (rings), proximal esophageal stenosis, or 1 to 2 mm whitish vesicles scattered over the mucosal surface. Barium contrast radiography combined with swallow of a barium-coated marshmallow identified 10 (67%) of the primary features observed endoscopically in 15 patients. However, radiography failed to detect other features noted at endoscopy (e.g., only 3/6 patients with proximal stenosis, 5/9 patients with concentric rings and none of 4 patients with small caliber esophagus). Eight of the 29 patients (20%) had a history of chronic heartburn. Twelve patients had been treated with a proton pump inhibitor and only 3 reported some improvement in the severity of dysphagia. CONCLUSIONS: Relatively young age, a history of chronic dysphagia for solid food, and endoscopic detection of unique structural alterations atypical for GERD in an adult patient should prompt a suspicion of EE and subsequent biopsy confirmation. Acid reflux appears to have a secondary role in eosinophilic esophagitis. In an uncontrolled comparison, endoscopy was superior to barium contrast radiography for the diagnosis of eosinophilic esophagitis. The incidence of eosinophilic esophagitis in adults appears to be increasing.

Adult↗
PubMed2005

Salvage radiation therapy for residual superficial esophageal cancer after endoscopic mucosal resection.

PURPOSE: To analyze the outcomes of radiation therapy for patients with residual superficial esophageal cancer (rSEC) after endoscopic mucosal resection (EMR). METHODS AND MATERIALS: From May 1996 to October 2002, a total of 30 rSEC patients without lymph node metastasis received radiation therapy at Tohoku University Hospital and associated hospitals. The time interval from EMR to start of radiation therapy ranged from 9 to 73 days (median interval, 40 days). Radiation doses ranged from 60 Gy to 70 Gy (mean dose, 66 Gy). Chemotherapy was used in 9 of 30 patients (30%). RESULTS: The 2-year, 3-year, and 5-year overall survival rates and cause-specific survival rates were 91%, 82%, and 51%, respectively, and 95%, 85%, and 73%, respectively. The 2-year, 3-year, and 5-year local control rates for mucosal cancer were 91%, 91%, and 91%, respectively, and those for submucosal cancer were 89%, 89%, and 47%, respectively. These differences in survival rates for patients with two types of cancer were not statistically significant. Local recurrence and lymph node recurrence were more frequent in patients with submucosal cancer than in patients with mucosal cancer (p = 0.38 and p = 0.08, respectively). Esophageal stenosis that required balloon dilatation developed in 3 of the 30 patients, and radiation pneumonitis that required steroid therapy developed in 1 patient. CONCLUSIONS: Radiation therapy is useful for preventing local recurrence after incomplete EMR.

Aged↗
PubMed1995

[Prognostic parameters after surgical therapy of achalasia].

For operative treatment of achalasia transabdominal myotomy combined with a semifundoplication was performed in 37 patients. 35 patients could be followed up during an average period of 41 months. 19 patients (54%) were completely and 12 (34%) almost symptom-free. In one case a peptic esophageal stenosis developed. The results of operation were especially in the group of young patients under 40 years favourable and there was no influence on results of preoperative duration of symptoms or number of dilatations before surgery. Transabdominal myotomy with semifundoplication has shown as a procedure with low complication rates and good long-time results for the symptomatically therapy of achalasia.

Adolescent↗
PubMed1990

[Laser and afterloading therapy: esophageal cancer].

In the palliative treatment of malignant esophageal stenosis endoscopic laser therapy and intracavitary radiation currently represent the best alternative. The results achieved with elimination of dysphagia, duration of the complaint-free interval, survival period, and complications are presented from a group of 167 patients. Referring to the quality of life, an evolving tendency towards the use of laser therapy instead of endoscopic intubation is reported.

Adenocarcinoma↗
PubMed1981

[Laryngeal and laryngotracheal stenoses. Classification and treatment (author's transl)].

Results of treatment of 63 cases of laryngeal and laryngotracheal stenosis are presented and a classification of these lesions discussed. Two main types are distinguished: simple isolated stenoses (arytenoid, cricoid and tracheal) and compound stenoses (arytenocricoid, tracheocricoid, arytenotracheocricoid, arytenotracheal). Only arytenoid stenoses, those with an arytenoid component, or lesions associated with laryngeal paralysis provoke cord immobility. The arytenoid lesion therefore differentiates stenoses with fixed from those with mobile vocal cords. Treatment mainly involves adequate enlargement of the larynx and crico-tracheal resection, or a combination of these two techniques. Results were positive in 45 cases, insufficient in 5, and nil in 2 cases. Four patients were not seen again, one patient died, and 3 are still being treated. Three patients with successful results still retain a temporary tube while awaiting further therapy for another affection (esophageal stenosis). Results are analysed as a function of the site of the stenosis, the presence or absence of a tracheotomy, the technique employed, and whether previous treatment had been employed. Excluded from this report, which concerns 63 patients with laryngeal or laryngotracheal stenoses treated in the Hôpital Laennec, Paris, were cases of pure tracheal stenosis treated by resection and tracheotracheal or cricotracheal anastomosis, and with healthy cricoids, and synechiae or anterior glottic (or anterior commissural) stenoses. They were either congenital, or iatrogenic following endoscopic surgical procedures in the glottic region. Also excluded were cases of stenosis where surgery was not indicated, as well as two patients with laryngeal stenosis, one due to an amyloid tumor and the other to Launois Bensaudes disease.

Adult↗
PubMed2000

Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET.

UNLABELLED: Because both the number and location of metastatic lymph nodes and the N stage influence survival in esophageal cancer, accurate noninvasive evaluation of individual lymph node groups for the presence of metastasis is essential for therapeutic planning. Therefore, we investigated the accuracy of FDG PET for evaluating individual lymph groups in esophageal cancer patients and compared the results with those of CT and endoscopic sonography (ES). METHODS: Sixty-one consecutive patients with histologically proven primary esophageal carcinoma were studied prospectively with FDG PET. Thirteen patients who were treated nonsurgically were excluded from data analysis. The remaining 48 patients underwent esophagectomy and lymph node dissection. All 48 patients underwent CT scanning, including the lower neck, thorax, and upper abdomen, with intravenous administration of contrast medium. ES was performed in 45 of the patients but was incomplete in 12 patients because of esophageal stenosis. The accuracies of FDG PET, CT, and ES were compared with histologic findings. RESULTS: During surgery, a total of 382 lymph node groups were dissected in 48 patients, of which 100 node groups in 32 patients were malignant on histologic examination. For assessing metastasis to individual groups, FDG PET showed 57% sensitivity, 97% specificity, and 86% accuracy, whereas CT showed 18% sensitivity (P < 0.0001), 99% specificity (P = 0.033), and 78% accuracy (P = 0.003). For N staging, FDG PET was correct in 83% (40/48) of the patients, whereas CT and ES were correct in 60% (29/48; P = 0.006) and 58% (26/45; P = 0.003), respectively. CONCLUSION: FDG PET is more accurate than is CT or ES for evaluating metastasis to individual lymph node groups and for N staging in esophageal cancer and thus may be helpful in determining the therapeutic plan.

Aged↗