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PubMed1993

High-grade malignant stricture is predictive of esophageal tumor stage. Risks of endosonographic evaluation.

BACKGROUND: Endosonography is very accurate for the preoperative staging of esophageal carcinoma. Approximately 20-38% of patients with esophageal carcinoma present with high-grade malignant strictures that preclude passage of the dedicated echoendoscope. In patients with such strictures, endosonographic staging of esophageal tumors may be performed after aggressive esophageal dilatation. However, aggressive dilatation and passage of the echoendoscope in patients with high-grade malignant strictures is not without risk. A detailed assessment of the tumor stage in patients presenting with high-grade malignant stenoses has not been previously reported to the authors' knowledge. METHODS: Seventy-nine patients with esophageal carcinoma were staged preoperatively using endosonography. The results of preoperative staging were compared with the pathologic stage of the esophagectomy specimen when available or the surgical stage (detection of adjacent organ involvement [Stage T4] or metastatic disease [Stage M1] at the time of surgery). RESULTS: Twenty-one patients (26.6%) presented with high-grade malignant strictures precluding endosonographic examination without prior esophageal dilatation. Nineteen of the 21 patients (91%) with high-grade malignant stricture had Stage III or IV disease by histopathologic examination of the surgical specimen. Five of these 21 patients (24%) sustained an esophageal perforation as a result of either wire-guided dilatation, or as a direct consequence of the endosonographic staging procedure. The discovery of metastatic lymph nodes proximal to the stricture resulted in successful staging (assessment of depth of tumor penetration and lymph node involvement) in only 2 of these 21 patients before esophageal dilatation (incomplete staging). Staging of the proximal aspect of the tumor was obtained in the remaining 19 patients before dilatation; however, the accuracy for such incomplete staging was only 33%. CONCLUSIONS: The majority of patients with esophageal carcinoma presenting with high-grade malignant strictures precluding endoscope passage without prior dilatation have a relatively advanced stage of disease (Stage III or IV) compared with those patients presenting with less severe stenoses. There is a significant risk for esophageal perforation (24%) when patients with high-grade malignant esophageal strictures undergo preoperative staging using endosonography. Patients with high-grade malignant strictures, therefore, present a relative contraindication to endosonography using the dedicated echoendoscope.

Carcinoma↗
PubMed2006

[Spontaneous pneumomediastinum].

Spontaneous pneumomediastinum is a presence of free air in the mediastinum without previous injury and without previously known lung disease. Spontaneous pneumomediastinum is infrequent and little known by physicians. Authors present a case report of three young men with spontaneous pneumomediastinum. There was no evident causation in two cases. In one case there was previous excessive sport activity. Main presenting symptoms were chest and neck pain, odynophagia, dysphonia, vomiting, and neck subcutaneous emphysema. Esophageal perforation was ruled out. All patients recovered spontaneously. Spontaneous pneumomediastinum is the benign disease. Its main importace is in differential diagnosis concerning especially esophageal perforation.

Adult↗
PubMed1996

Iatrogenic esophageal pseudodiverticulum: a case report.

Iatrogenic injury of the esophagus is not an uncommon complication of diagnostic endoscopy and dilation. Herein is described what is felt to be the first reported case of a traumatic pseudodiverticulum after dilation of an esophageal stricture. The management of what was preoperatively felt to be an esophageal perforation is discussed.

Aged↗
PubMed1992

Pneumococcal empyema following endoscopic sclerotherapy in a child with cavernous transformation of the portal vein.

Esophageal sclerotherapy is widely used in the treatment of bleeding esophageal varices. Complications vary from chest pain to esophageal perforation. Our patient, suffering from cavernous transformation of the portal vein, developed massive empyema following sclerotherapy. Although small asymptomatic pleural effusions have been reported, massive empyema requiring surgical drainage, without evidence of esophageal perforation, has, to our knowledge, not been described.

Anti-Bacterial Agents↗
PubMedDate not supplied

Pneumomediastinum as a complication of upper gastrointestinal endoscopy.

Secondary or complex pneumomediastinum following esophagoscopy is due to an esophageal perforation. Primary or simple pneumomediastinum may be caused by maneuvers such as coughing, gagging, swallowing, choking, and valsalva. These maneuvers are common during upper gastrointestinal endoscopy. Esophageal perforation is a potentially life threatening event, while simple pneumomediastinum is usually a benign self-limited disorder. Although the presentation may be similar, different morbidities compel prompt evaluation for distinction between these two entities and appropriate management. We present a case of pneumomediastinum that developed immediately following upper gastrointestinal endoscopy. Implications of diagnosis, management, and prognosis are discussed.

Aged↗
PubMed2004

[Case of esophageal foreign body complicated by mediastinitis and broncho-esophageal fistula].

Authors describe the case of esophageal perforation in 85-year woman ended with good outcome. The patient was admitted to our ward with suspicion of foreign body in esophagus and the clinical manifestation of early stage mediastinitis. We resigned esophageal perforation debridement because of the old age and patient's poor general condition. Conservative treatment was administrated during a long period including high-doses of antibiotics and nutritional support. In the third week of patient's admission mediastinitis was cured but esophageal radiograms showed the bronchoesophageal fistula on the left side. There were no signs of self-existent closure of fistula. The patient was sent to the Thoracic Surgery Ward of John Paul Hospital in Cracow where the performance of thoracotomy was used as surgical treatment. Closure of fistula made that our patient was able to return to normal life.

Aged↗
PubMed2001

[Comparison of iodinated and barium-containing contrast media of different viscosity in the detection of pharyngeal perforation].

PURPOSE: In contrast to esophageal perforations, the more radiopaque barium-suspensions are not as important as iodinated aqueous contrast agents for the detection of pharyngeal perforations. This study was performed to find out whether the highly different viscosities (of iodinated and barium-containing contrast agents with comparable radiopacities) are a reason for this. METHODS: Viscosity, subjective difference in contrast, and CT-density of an iodinated aqueous (Telebrix) and a 50 wt/vol% barium-containing contrast agent (Micropaque) were determined. Moreover, to exclude postoperative perforation, 104 patients were prospectively examined by pharyngography using both contrast media. Pharyngographies of patients with perforation were later compared by two independent readers. All patients with perforation were followed up clinically to exclude complications due to barium administration. RESULTS: In-vitro comparison showed comparable radiopacity but the 50 wt/vol% barium-suspension was much more viscous than the iodinated contrast agent. During pharyngography, totally, 14 perforations were clearly delineated with the iodinated aqueous contrast agent. However, two of them were not detected with the barium-suspension. All the other perforations presented equally. CONCLUSIONS: Given a sufficient radiopacity, a low viscosity appears to be essential for a contrast agent to detect especially pharyngeal perforations. Thus, we recommend the sole use of an iodinated contrast agent (at suspicion of aspiration as isoosmolar variant) for this purpose.

Adult↗
PubMed1995

[Surgical treatment of esophageal carcinoma complicated with perforation--a report of nine cases].

Malignant perforation in patients with esophageal carcinoma, a catastrophic life-threatening complication, is usually treated conservatively with very poor prognosis. From December 1992 through November 1994, surgical resections was carried out in 9 patients with perforated esophageal carcinoma of these 9 cases, two received esophagogastrectomy alone and 7 received esophagogastrectomy with synchronous pulmonary resections of various types. One patient died of anostomotic leakage on the 33rd postoperative day. Eight patients recovered uneventfully. Postoperative irradiation therapy was given to two patients: one in the third month due to mediastinal lymph node metastasis and the other is still being irradiated in the first month after operation. On follow-up, six patients had been surviving for 20, 18, 11, 9.5, 8.5 and 8 months after operation, respectively. In this paper options of treatment, pre-operative diagnostic procedures, intra-operative judgement and post-operative management for the perforated esophageal carcinoma are emphasized. The authors stress that the indication of extended operation for the esophageal carcinoma complicated with perforation should be further explored.

Adult↗
PubMed1989

Shear stress in the performance of esophageal dilation: comparison of balloon dilation and bougienage.

While both the balloon catheter and the bougie are effective for esophageal dilation, each has its proponents. From a biomechanical point of view, the two methods should differ significantly, since bougienage depends on advancing a tapered dilator to generate radial force and balloon catheter dilation depends solely on balloon inflation to generate its radial dilating force. In a series of equivalent esophageal stenoses made by suture plication in swine esophageal segments, the authors measured shear force and radial force generated by dilation with a Maloney bougie, a Savary-Gilliard bougie, and an esophageal balloon. The mean radial forces generated were 6.42, 4.46, and 4.04 N, respectively, which did not differ significantly. However, the mean shear forces measured were 16.92, 6.92, and 1.44 N, respectively. The shear force with the Maloney bougie differed significantly from that with the Savary-Gilliard and the balloon and was on the same order of magnitude as the tensile strength of the esophagus (25-27 N). The shear force with the balloon was significantly lower than that with either bougie. In theory, the reduced shear force associated with balloon dilation might reduce the risk of esophageal perforation, but safety will have to be determined in clinical trials.

Animals↗
PubMed1985

[A new cricothyreotomy set for emergencies].

Cardio respiratory emergencies in which intubation is by any reason not possible are rare. The traditional procedure of emergency tracheotomy can be complicated by tracheal esophageal perforation. There is now available a new emergency cricothyreotomy set "Nu-Trake" which is easy to handle even by the less experienced anaesthesiologist. As shown in our study the risk of tracheo esophageal perforation is very small with the new emergency coniotomy set. We believe the device should be part of the standard equipment of every emergency ambulance, after some improvements by the manufacturer.

Emergencies↗
PubMed1996

One-stage retrograde approach to Nd:YAG laser palliation of esophageal carcinoma.

BACKGROUND AND STUDY AIMS: The aim of the present study was to determine the safety, efficacy, and feasibility of a one-stage retrograde approach to Nd:YAG laser palliation of esophageal carcinoma carried out under general anesthesia. PATIENTS AND METHODS: Endoscopic Nd:YAG laser therapy was used on 150 occasions in 62 consecutive patients with advanced malignant obstruction of the esophagus. All procedures were carried out under general anesthesia. The lesion was first dilated using a Savary-Gilliard dilator or balloon technique, and the endoscope was then passed beyond the lesion. Laser energy was applied to the lesion in a circumferential manner as the scope was withdrawn along the length of the lesion, until an adequate lumen was established. RESULTS: Ninety-three percent of the patients had symptomatic improvement, defined as reduction in the subjective dysphagia grade, and only 14% of the patients required repeat procedures within 30 days. Fifty percent of the patients experienced effective palliation with only one procedure over the entire course of their illness. In patients with recurrent dysphagia, the mean time between procedures was 100 days. Seventy-six percent of the patients were discharged on the day following the procedure. Complications included the development of pneumomediastinum or subcutaneous emphysema in five cases, and esophageal perforation in two cases. All cases of pneumomediastinum or subcutaneous emphysema or perforation were managed by conservative therapy. Hemorrhage requiring transfusion occurred in two cases. There were three apparently procedure-related deaths occurring within 30 days of the initial procedure. CONCLUSIONS: Effective palliation of obstructing esophageal carcinoma can be achieved in one session using a one-stage retrograde approach with the Nd:YAG laser under general anesthesia. When compared to other palliative modalities, this method produces a longer dysphagia-free interval, and patients with a terminal illness are therefore able to spend more time out of hospital.

Adult↗
PubMed1996

[Analysis of surgery of gastroesophageal reflux by laparotomy and laparoscopy approach].

UNLABELLED: The development of the laparoscopic surgery has allowed its use in the treatment of gastroesophageal reflux. PATIENTS AND METHODS: We have reviewed the results and follow-up of 30 patients treated with open procedure (group A) and 30 patients with laparoscopic surgery (group B). The most frequent indication for surgery was failure of medical therapy and the Nissen fundoplication was the method most commonly used. RESULTS: The average surgical time was shorter in group A (66 minutes) than in group B (140 minutes). Intraoperative complications were: in group A, 2 patients with splenic injury; in group B, 3 patients required conversion to the open procedure (pneumothorax, gastric perforation, technical problems) and 1 patient with pneumothorax which didn't require conversion. Postoperative morbidity and mortality occurred in 20% (26% group A, 13% group B); the most common complications were: respiratory (4 patients), gas bloat syndrome (2 patients) and esophageal perforation (1 patient). At follow-up we observed complete heartburn relief in 95%, 4 patients in group A had mild dysphagia, 3 patients with recurrent hiatal hernia (2 in group A and 1 in group B) and 2 patients required reintervention in group A (intestinal occlusion caused by adherence and laparotomic hernia). Mortality occurred in a patient with esophageal perforation in group B. CONCLUSIONS: Treatment for gastroesophageal reflux is feasible with similar effectiveness with open and laparoscopic procedures. The results are advantageous with the laparoscopic procedure relative to postoperative morbidity and follow-up.

Adult↗
PubMed1975

Delayed C.N.S. complications.

Patients with esophageal stricture being treated with dilatation, who developed esophageal perforation or local peritonitis and subsequent central nervous system infection, are reviewed. It is suggested that the vertebral venous system may be the route by which the metastatic infection is carried. Physicians caring for patients with esophageal stricture, who are receiving dilatation, should be aware of the possible intracranial complications and should be alert to the first sign of central nervous system abnormality.

Brain Abscess↗
PubMed1984

Peroral pulsion intubation of malignant esophageal strictures using a fiberoptic technique.

Palliative peroral pulsion intubation of malignant esophageal strictures in 44 patients with incapacitating dysphagia is reviewed. Intubation, using a fiberoptic endoscope, the Nottingham introducer, and a modified Celestin tube was performed, usually under intravenous sedation. Intubation was successful in 93 per cent and provided satisfactory relief of dysphagia. Six deaths (14%) were the result of intubation, three from esophageal perforation, two from aspiration pneumonia, and one from hemorrhage. The overall hospital mortality was 23 per cent. Six patients required reintubation for proximal or distal migration of the prosthesis. Although mean survival was short (3.2 months), esophageal intubation by this technique is relatively safe, minimizes hospitalization, and offers reasonable palliation in most patients.

Adult↗
PubMed1997

Particular aspects and limits of palliation of secondary malignant esophageal strictures.

The value of palliative intubation in the secondary malignant stricture of the thoracic esophagus is discussed. One hundred and eleven patients with secondary involvement of the esophagus due to primary inoperable (in 64) or recurrent bronchial tumor (after lobectomy or pneumonectomy in 34) and mediastinal tumor (in 9) or metastases after mastectomy of breast cancer (in 4) underwent a limited invasive surgical intubation with a personally designed, composite tube in the past 15 years. The distal part of the tube is detachable, which allows insertion of the tube only into the esophagus. The overall hospital mortality was 9.9%. Esophageal perforation and intraabdominal septic complication were never recorded. Nonfatal complication rate was low (5.4%). All survivors have resumed on oral soft diet. By this technique, all attempts of tube insertion were successful, although in 33% of the cases various esophageal axis deviations or tortuosity were present. Reintubation for tube dislodgement was necessary in 7.2% of the patients. Stenotic tracheobronchial invasion, vena cava superior syndrome, bronchial stump fistula as well as cardiac arrhythmias are the main contraindications of the palliative intubation in such cases. In the remaining group of patients with secondary invasion of the esophagus by intrathoracic malignancies, intubation may be considered a unique type of management with acceptable risk.

Arrhythmias, Cardiac↗