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At least 19 recordsLinked to original sources
PubMed1981

Manometric evaluation of esophageal disease.

Esophageal manometry has been helpful in delineating several aspects of the pathophysiology of esophageal disease. Its immediate contribution to patient care, however, is not clear. We reviewed our experience with 59 consecutive patients who had been referred to our laboratory specifically for this study. Manometry provided new information resulting in better patient management in only eight patients (14%). Manometric abnormalities are uncommon when radiographs and endoscopy are normal; thus, manometry should rarely be used alone to evaluate subjective complaints. It is useful preoperatively in patients with reflux esophagitis if a motility disorder is suspected and in patients with cricopharyngeal abnormality. After hiatal hernia repair performed with an adequate preoperative radiologic and endoscopic evaluation for reflux esophagitis, esophageal manometry contributes little additional information to the evaluation of postoperative dysphagia.

Esophageal Achalasia↗
PubMed1977

Rheumatoid esophageal disease.

Esophageal diameters were measured in the roentgenogram in 43 patients with rheumatoid arthritis and in 43 healthy subjects matched by sex and age. The incidence of esophageal dilatation in rheumatoid patients was significantly higher than that of healthy subjects (P LESS THAN 0.01). Higher incidence of esophageal dilatation was seen in groups with pulmonary fibrosis and with subcutaneous nodules (P less than 0.01, P less than 0.05 respectively). An orderly relationship between the incidence of esophageal dilatation and the grades of RA test, stage of joint x-ray, or duration of disease were shown. These results suggest the existence of "rheumatoid esophageal disease".

Adult↗
PubMed2005

Indications and technique of colon and jejunal interpositions for esophageal disease.

Esophageal replacement is a significant undertaking for both surgeon and patient. Because eating and drinking are some of life's great pleasures, the outcome of this undertaking has a direct impact on a patient's quality of life. The primary esophageal replacement organs are the stomach and colon, and each has advantages and disadvantages. As such, the choice of the graft should be tailored to the patient and the disease process in order to maximize the likelihood that the disease will be effectively treated, and that the patient's ability to enjoy a meal with family and friends will be restored.

Colon↗
PubMed2002

Stents for Esophageal Disease.

Esophageal malignancies presenting with dysphagia from luminal obstruction generally are not resectable for cure, and palliative therapy is the primary focus. Self-expandable metal stents (SEMS) have replaced plastic stents as a primary mode of palliation for malignant esophageal obstruction because of the relative ease of insertion, lower initial morbidity, and larger stent diameter. Self-expandable metal stents are ideal for patients with midesophageal tumors. A majority of patients experience relief of dysphagia with SEMS and dietary modification, but the initial cost is high and early morbidity may be significant. The placement of SEMS across the gastroesophageal junction may result in free reflux that may improve with a stent containing a one-way gastric flap valve. The placement of SEMS in the cervical esophagus, although more difficult, less effective, and less well tolerated, also may be successful. Coated SEMS are a treatment of choice for individuals with tracheoesophageal fistula. Delayed complications occur in up to 40% of patients and include stent migration, bleeding, perforation, fistula formation, and occlusion. Most complications can be managed endoscopically and additional stents may be placed for tumor overgrowth. The comparison of three currently available SEMS for esophageal malignancy show no statistically significant differences with regard to ease of placement, effectiveness, complications, and mortality. The use of SEMS for patients with benign disease is still considered experimental.

Journal Article↗
PubMed1998

Esophageal replacement for end-stage benign esophageal disease.

BACKGROUND: Benign esophageal diseases constitute a common group of disorders that are generally managed with medical therapy or surgery designed to improve foregut function. A small subset of patients, however, has advanced disease that requires esophageal replacement to achieve symptomatic relief. PATIENTS AND METHODS: One hundred four patients with benign esophageal disease who underwent esophageal reconstruction over a 21-year period (1975 to 1996) were reviewed retrospectively. Dysphagia was the major symptom driving surgery in 80% of the patients. Colon was used to reconstruct the esophagus in 85 patients; stomach, in 10 patients; and jejunum, in 9 patients. Forty-two patients who had lived with their reconstruction for 1 year or more answered a postoperative questionnaire concerning their long-term functional outcome. RESULTS: In the 104 patients, the primary underlying abnormality leading to esophageal replacement was end-stage gastroesophageal reflux (37 patients), an advanced motility disorder (37 patients), traumatic, iatrogenic or spontaneous perforation (15 patients), corrosive injury (8 patients), congenital abnormality (6 patients), or extensive leiomyoma (1 patient). Ninety-eight percent of patients reported that the operation had cured or improved the symptom driving surgery. Ninety-three percent were satisfied with the outcome of the operation. The overall hospital mortality rate was 2%, and the median hospital stay was 17 days. Graft necrosis occurred in 3% of patients, and anastomotic leak occurred in 6% of patients (or 2% of the total number of anastomoses). CONCLUSIONS: Esophageal replacement for benign disease can be accomplished with a low mortality rate and a marked improvement in alimentation. Reconstruction restores the pleasure of eating and is viewed by the patient to be highly successful.

Adolescent↗
PubMed1986

Evaluation of esophageal diseases.

The diagnosis of esophageal disease can be made by history alone in 80 percent of patients. Primary symptoms include dysphagia, odynophagia, heartburn and central chest pain. Although these symptoms may overlap, one esophageal symptom often predominates. This observation and an understanding of the available diagnostic tests enable the clinician to develop an algorithmic approach to the diagnosis of esophageal diseases.

Barium Sulfate↗
PubMed1982

Esophageal potential difference measurements in esophageal disease.

To determine if esophageal transmural electrical potential difference measurements are of use for evaluating esophageal disease, we recorded potential difference in 129 patients with one or more of the following: heartburn, dysphagia, and chest pain. All potential difference studies were performed at the time of esophageal manometry using a Ringer-perfused catheter technique which yields accurate and reproducible results in healthy subjects. In 103 of the 129 patients, esophageal potential difference measurements could be correlated with findings at manometry, endoscopy, and biopsy. The remaining 26 patients had primary esophageal motor disease and were not biopsied. The results of this investigation showed: (a) that 94% of patients with gross endoscopic lesions have an abnormal esophageal potential difference, (b) that an abnormal esophageal potential difference (found in only 1 of 24 patients with normal mucosa) is highly specific for the presence of esophageal mucosal disease, (c) that the type of potential difference abnormality may suggest the nature of the mucosal abnormality, for example high potential difference with Barrett's esophagus and low potential difference with esophagitis or invasive carcinoma, and (d) that while an abnormal esophageal potential difference is highly sensitive for detecting gross esophagitis (38 of 40 patients), it is less sensitive for diagnosing microscopic esophagitis (8 of 16 patients). Based on these findings we conclude that the measurement of esophageal potential difference at the time of manometry can provide additional valuable information about the state of the esophageal mucosa.

Action Potentials↗
PubMed1987

Colon interposition for benign esophageal disease.

We reviewed 53 consecutive patients with benign disease who underwent esophageal resection followed by colon interposition to assess operative morbidity and long-term results. Indications were gastroesophageal reflux in 32 patients, advanced motility disorders in eight, esophageal perforation in six, and strictures not related to reflux in seven. There were two operative deaths (3.8%). Fourteen other patients (26.4%) had 18 major complications including three graft infarcts, two graft perforations, and four anastomotic leaks, one of which required surgical treatment. Follow-up was complete in 83% of patients and averaged 5 years. Eight patients required dilations; and 15 underwent late reoperations for stricture, persistent symptoms, or anastomotic leak. Of the 20 patients who did not have pyloroplasty done at the initial resection, five (25%) required a subsequent gastric emptying procedure. Results were rated by patients (subjectively) and physicians (objectively, based on symptoms and the need for further therapy) as 1 = excellent, 2 = good, 3 = fair, and 4 = poor. The patients' ratings averaged 1.89, with 27 patients (75%) claiming good or excellent results despite symptoms of postprandial fullness in 78% and dysphagia in 42%. Objective ratings averaged 2.05, with 28 of 39 patients (72%) rating the results as excellent or good. Despite a 30% major complication rate and a 37% late reoperative rate, colon interposition for benign esophageal disease can be accomplished with low mortality and high patient acceptance and remains our preferred technique for reconstruction of benign esophageal disease.

Adolescent↗
PubMed1994

Esophageal disease in human immunodeficiency virus infection.

Up to 40% of patients with the acquired immunodeficiency syndrome may develop symptoms of esophageal disease. Candida esophagitis is responsible for the majority of the cases of esophageal disease; cytomegalovirus, herpes simplex, idiopathic esophageal ulcers, and Kaposi's sarcoma account for most of the remaining cases. Although endoscopy with esophageal biopsy and brushing is the gold standard for the diagnosis of esophageal disease in the acquired immunodeficiency syndrome, we generally recommend initial empiric therapy with an antifungal agent in patients with esophageal symptoms. Since effective treatment is available for most cases of esophageal disease in the acquired immunodeficiency syndrome, we recommend endoscopic evaluation in patients who do not respond to empiric therapy within 1 to 2 weeks.

Esophageal Diseases↗
PubMed1997

[Thoracoscopic surgery for benign esophageal diseases].

The thoracoscopic surgery for two benign esophageal diseases, esophageal leiomyoma and esophageal diverticulum, were successfully performed. Case 1 was a 37-year-old female with esophageal leiomyoma that was located at 30 cm from the incisor of the left anterior esophagus. The tumor was enucleated under the thoracoscopy, combined mini-thoracotomy for 3 cm in length. It was useful enough to rotate the left side to the right with two slings traction for better visualization of lesion site. After resection, the proper muscle layer of the esophagus was closed. Case 2 was a 70-year-old male, who complained of dysphagia because of esophageal diverticulum. It was 8 cm in size and located at 28 cm from the incisor of the right wall of the esophagus. It was also resected under the thoracoscopy, combined mini-thoracotomy for 3 cm in length. Intraluminal esophagoscope was useful to dissect safely and confirm the intralumen of the diverticulum. Its neck was divided parallel to the longitudinal axis of the esophagus by two endo-staplers. And then, the muscle layer was closed. It was suggested that esophageal leiomyoma and esophageal diverticulum were suitable for thoracoscopic surgery.

Adult↗
PubMed2002

[Endoscopic surgery for malignant esophageal disease].

Endoscopic surgery for benign esophageal disease has been well established and is widely performed. On the other hand, endoscopic surgery for malignant esophageal disease has not yet been well established. However, we have developed and have been performing thoracoscopic esophagectomy with lymphadenectomy for esophageal cancer. We introduce here the results of our endoscopic surgery for esophageal cancer. In the early period of this surgery, more operative complications occurred, such as recurrent nerve palsy, chirothorax, bleeding, etc. However, these complications have gradually decreased. The survival rates of patients in each pathological stage who underwent this surgery are comparable to those of patients who underwent conventional surgery. In conclusion, thoracoscopic esophagectomy has become safe and will be acknowledged as the standard procedure for the treatment of esophageal cancer.

Esophageal Neoplasms↗
PubMed1994

[Thoracoscopic surgery for benign esophageal disease].

Two patients with benign esophageal disease were successfully treated by thoracoscopic surgery. First case was a 66 year old male with esophageal diverticulum, who had complained of progressive dysphasia. The esophagogram showed a giant epiphrenic diverticulum which was 8 cm in diameter. Entire procedure was performed thoracoscopically under general anesthesia, while left side univentilation was applied. A flexible videoelectronic thoracoscope was introduced into thoracic cavity at the 5th intercostal space, and 4 additional trocars were inserted. The pleura over the diverticulum was divided, and the diverticulum was fully dissected and exposed. A multifire endoscopic stapler, an Endo GIA, was applied to resect the diverticulum. For security, uninterrupted suture of muscular layer of the esophagus over the stapled line was performed. Second case was a 60 year old male with esophagobronchial fistura, who had complained of choking during liquid intake for 20 years. The bronchogram showed a communication between a esophageal diverticulum and a right B6 bronchus. The operation was performed thoracoscopically. A thoracoscope was introduced as mentioned above, and the esophagus and the peripheral lung around the fistura was dissected and fully exposed. The diverticulum was divided at its base using an Endo GIA, and the fistura was resected with lung parenchyma using also an Endo GIA. The postoperative courses of the both patients were uneventful. The patients started diet on the 4th and the second postoperative day respectively, and the symptoms had disappeared after surgery.

Aged↗