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PubMedDate not supplied

[Pneumatic dilatation in patients with esophageal achalasia].

From October 1984 to March 1992, 21 patients of Hospital Nacional Guillermo Almenara Irigoyen-IPSS, Lima, Perú, with esophageal achalasia were treated with pneumatic dilatation using a 3.5 cm diameter Rider-Moeller balloon. The mean age was 40.5 years (range: 24-54). Six were men and 15 women. The mean time with dysphagia previous to treatment was 5.3 years. A total of 29 sessions were performed, 1.38 sessions per patient. The follow-up of the first 10 patients was carried for a mean time of 48.3 months (range:6-91). A satisfactory response to treatment was obtained in 8 patients (80%). Two patients (20%) relapsed after 2 and 3 treatment sessions needing surgery. One patient suffered a esophageal perforation recovering after surgical treatment. We conclude that pneumatic dilatation with Rider-Moeller balloon is a safe and not difficult medical procedure for esophagus achalasia.

Adult↗
PubMed1987

Esophageal ulceration due to oral medications.

From 1975 through 1984 at the Department of Otolaryngology, Turku University Central Hospital, a total of 88 patients with esophageal ulceration due to oral medications were diagnosed endoscopically. The frequency of ulcerations increased until 1980 (14 cases) and was then followed by a decline. There were 24 patients (27.3%) under 20 years of age and 67 patients (76.1%) under 40 years of age, the mean age being 30 years 5 months. Emepronium bromide was the cause of esophageal injury in 24 patients (28.9%), doxycycline in 22 patients (26.5%) and analgetics in 11 patients (13.3%). There were three serious complications in the present series: an esophageal perforation due to doxycycline, an acute mediastinitis and a pericarditis due to emepronium bromide. In this material there was only 1 patient needing dilatation because of stricture formation.

Adolescent↗
PubMed2002

Is the use of a bougie necessary for laparoscopic Nissen fundoplication?

HYPOTHESIS: Esophageal intubation with a bougie during laparoscopic Nissen fundoplication (LNF) is commonly used to prevent an excessively tight wrap. However, a bougie may cause intraoperative gastric and esophageal perforations. We hypothesized that LNF is safe and effective when performed without a bougie. DESIGN: Retrospective review of 102 consecutive patients who underwent LNF without a bougie. SETTING: Tertiary care university hospital. PATIENTS: All patients presented with symptoms of reflux disease. Mean (+/- SD) percentage of time with pH of less than 4 was 12.6% +/- 9.4%. Mean DeMeester score was 47.8. Mean (+/- SD) resting lower esophageal sphincter pressure was 15.0 +/- 9.4 mm Hg. Mean (+/- SD) distal esophageal amplitude was 69.4 +/- 39.2 mm Hg. INTERVENTION: During LNF, we obtained 2 to 3 cm of intra-abdominal esophagus, divided all short gastric vessels, reapproximated the crura, and performed a loose 360 degrees fundoplication without a bougie. MAIN OUTCOME MEASURES: Postoperative rates of dysphagia, gas bloat, and recurrent reflux. RESULTS: In the early postoperative period, 50 patients (49.0%) complained of mild, 11 (10.8%) of moderate, and 7 (6.9%) of severe dysphagia. Average (+/- SD) duration of early dysphagia was 4.6 +/- 2.1 weeks. Dysphagia resolved in 61 (89.7%) of 68 patients within 6 weeks. Late resolution of dysphagia was noted in 4 (5.8%) patients. Three patients were successfully treated with esophageal dilatations. Persistent dysphagia was found in 1 patient. Thirty patients (29.4%) had transient gas bloat. Mild persistent reflux, requiring daily medication, was noted in 5 (4.9%) patients. CONCLUSIONS: Performance of LNF without a bougie offers a safe and effective therapy for gastroesophageal reflux disease. While avoiding the potential risks for gastric and esophageal injury, it may provide low rates of long-term postoperative dysphagia and reflux recurrence.

Deglutition Disorders↗
PubMed1986

Management of long-gap esophagus: experience with end-to-end anastomosis under maximal tension.

From 1969 to 1982, 15 cases of long-gap esophageal atresia were treated. Twelve patients could be managed by direct end-to-end anastomosis - ten primary and two delayed. Anastomotic leakage was noted in all patients, causing anastomotic obstruction in nine, which had to be treated with repeated esophageal dilatations. In one patient the esophageal dilatation resulted in esophageal perforation, with a fatal outcome. The remaining 11 patients are all doing well. Three patients were subjected to colonic transposition, two primary and one delayed according to Waterston. One of these subjected to primary colonic transposition died postoperatively from cerebral hemorrhage. The other one is now doing well after resection of the transposed colonic segment which fibrotized but could be resected, after which the esophageal ends could be anastomosed. The patient subjected to delayed colon transposition is also free of major swallowing problems following immediate postoperative anastomotic stricture which could be managed by repeated dilatations.

Colon↗
PubMed1991

[Spontaneous giant intramural hematoma of the esophagus. Apropos of a case].

Spontaneous esophageal hematoma is rare, occurring in a context of high esophageal pressure with abnormalities of hemostasis in some cases. We report a case involving the whole length of the esophagus with no evidence of any etiologic factor. The value of CT Scan is reviewed comparatively with esophageal barium examination and endoscopy. CT Scan confirms the diagnosis and the absence of true esophageal perforation. The general course monitored by CT scanning is uneventful, even in the case of extensive mucosal lesions. This justifies the nonaggressive attitude advocated by the majority of authors.

Esophageal Diseases↗
PubMed1998

EsophaCoil: long-term results in 81 patients.

BACKGROUND: Cancer of the esophagus and gastric cardia cause progressive dysphagia. Half of patients are not amenable to surgical resection; of those who are, about 20% will suffer either from local recurrence or anastomotic strictures. Self-expandable metallic stents of diverse characteristics have been used in these clinical conditions. However, expandable metallic stents have several drawbacks: low radial force, migration, epithelial trauma, and tumor ingrowth. We herein report our long-term experience with EsophaCoil, a self-expandable esophageal metallic coil, in 81 patients. METHODS: From January 1993 to July 1996, 84 stents were placed in 81 consecutive patients (53 men and 28 women, mean age 69.8 years (range 40 to 90 years). 41 patients had esophageal squamous cell carcinoma, 32 adenocarcinoma of the esophagus and cardia, 5 mediastinal metastasis, 1 sarcoma, and 2 had benign esophageal strictures. Five patients had bronchoesophageal fistulas. Mean dysphagia score before treatment was 3.5, mean stricture length 6 cm. Most patients were hospitalized for at least 24 hours after stent implantation. Patients were followed and early and late complications were recorded. RESULTS: Stents were successfully placed in all patients. Dysphagia improved in 96% of patients (score dropped from 3.5 to 1.2). Mean patient survival after stent insertion was 4 months (range 0.5 to 20 months). Bronchoesophageal fistulas were closed in all 5 cases. Early complications occurred in 11 patients. These were severe in 3 (esophageal perforation) and mild in 8 patients (precordial pain lasting 24 to 48 hours). Late complications occurred in 18 patients and included migration to the stomach (5 patients), stent breakage (5 among the first 20 cases), food impaction (5), tumor overgrowth (2), and bleeding (1). CONCLUSIONS: In a long-term follow-up, EsophaCoil was effective in the palliative treatment of dysphagia caused by malignant esophageal strictures, including cases of fistulas, having low malfunction and migration rates. No tumor ingrowth was seen.

Adenocarcinoma↗
PubMed2003

Management of esophagogastric corrosive injuries in children.

There has been an increase in the number of patients admitted to our hospital with caustic esophageal injuries during the last five years. The aim of this study was to analyze the complications and results of the treatment of corrosive esophagogastric injury. Between 1990 and 2000, 120 caustic ingestion accidents were admitted to our unit. The mean age was 4 years, with a 2 : 1 male to female ratio. The average time between the caustic ingestion and admission to hospital was 14.9 days. The ingested substances were alkali in 80.9 % and acid in 19.1 % of the cases. Stenosis of the esophagus developed in 31 (25.8 %) and gastric outlet obstruction (GOO) in 6 (5 %) patients. Management of the esophageal stricture consisted of dilatation in 28 patients. Three children underwent colonic interposition without a dilatation attempt. Six children were lost to follow-up; 4 patients were successfully treated; 13 patients were still in the dilatation program at the time of writing with 6 improving and 2 patients waiting for interposition surgery; 4 patients underwent colonic interposition and 1 patient underwent resection of the stenotic part of the esophagus. Among the patients in the dilation program, we observed 4 esophageal perforations. Three of them were treated medically and further dilatations were carried out, while one was managed by colonic interposition. The treatment modalities for GOO cases consisted of pyloroplasty in 3, Billroth I in 2 and balloon dilation of the pylorus in 1 child. Although balloon dilatation of the esophagus carries the risk of perforation, it should be the first line of treatment in suitable cases. GOO cases may require surgical therapy following a detailed endoscopic evaluation.

Acids↗
PubMedDate not supplied

Balloon dilation and stent placement for esophageal lesions: indications, methods, and results.

Esophageal balloon dilation and expandable stent placement are safe, minimally invasive, effective treatments for esophageal strictures and fistulas. These procedures have brought the management of dysphagia due to esophageal strictures into the field of interventional radiology. Esophageal dilation is usually indicated for benign stenoses and is technically successful in more than 90% of cases. Most patients with esophageal carcinoma are not candidates for resection; thus, the main focus of treatment is palliation of malignant dysphagia and esophagorespiratory fistulas. Esophageal stent placement, which is approved only for malignant strictures, is one of the main therapeutic options in affected patients and relieves dysphagia in approximately 90% of cases. Dedicated commercially available devices continue to evolve, each with its own advantages and limitations. Stent placement is subject to technical pitfalls, and adverse events occur following esophageal procedures in a minority of cases. Although chest pain is common and self-limited, reflux esophagitis, stent migration, tracheal compression, and esophageal perforation and obstruction require specific interventions. In many cases, these complications can be recognized and treated by the interventional radiologist with minimally invasive techniques.

Catheterization↗
PubMed2000

Palliation of advanced esophageal carcinoma by photodynamic therapy and irradiation.

BACKGROUND: We wanted to determine the role of photodynamic therapy in a multimodal approach for the treatment of patients with advanced cancer of the esophagus. METHODS: We reviewed the cases of 119 patients with nonresectable esophageal carcinoma who underwent endoluminal palliation. Twenty-one patients required initial dilation and tumor obliteration with a neodymium: yttrium-aluminum-garnet laser prior to therapy. Forty-four patients received photodynamic therapy followed by brachyradiotherapy, and 75 patients were treated with brachyradiotherapy. In both groups, some patients also received external-beam irradiation. RESULTS: Photodynamic therapy produced a significant difference in relieving stenosis caused by tumor stenosis (mean, 6.6 mm; p = 0.0000). The dysphagia score improved by one to three levels in all patients, with a significant difference in favor of PDT (p = 0.0003). The mean number of overall treatment sessions was four (range, one to seven). The rate of major complications was 9.2%. Four esophageal perforations occurred, three after intervention and one spontaneously 5 months later. Four esophagorespiratory tract fistulas developed several months after combined PDT and irradiation. The mean overall survival was 7.7 months, and analysis of variance revealed a significant difference in favor of PDT and external-beam irradiation (p = 0.0129 and p = 0.0001, respectively). CONCLUSIONS: Photodynamic therapy has been shown to be an effective palliative treatment of advanced esophageal cancer. However, proper patient selection is necessary to prevent serious complications.

Adenocarcinoma↗
PubMed1991

[Spontaneous giant intramural hematoma of the esophagus. Apropos of a case].

Spontaneous esophageal hematoma is rare, occurring in a context of high esophageal pressure with abnormalities of hemostasis in some cases. We report a case involving the whole length of the esophagus with no evidence of any etiologic factor. The value of CT Scan is reviewed comparatively with esophageal barium examination and endoscopy. CT Scan confirms the diagnosis and the absence of true esophageal perforation. The general course monitored by CT scanning is uneventful, even in the case of extensive mucosal lesions. This justifies the nonaggressive attitude advocated by the majority of authors.

Diagnosis, Differential↗
PubMed1999

Endosonographic staging of 100 consecutive patients with esophageal carcinoma: introduction of the 8-mm esophagoprobe.

Endoscopic ultrasound of esophageal carcinoma is conventionally performed using the 13-mm fiberoptic/ultrasound echoendoscope. However, the large diameter results in an inability to negotiate the primary tumor in 25% of patients. The aim of this study was first to determine whether use of the 8-mm esophagoprobe would overcome this problem and second to evaluate the accuracy of the smaller diameter instrument. One hundred consecutive patients with esophageal cancer underwent initial gastroscopy. Based upon the degree of luminal stenosis, patients were staged with either the conventional echoendoscope (luminal diameter > or = 15 mm) or the esophagoprobe (luminal diameter < 15 mm). The primary tumor was successfully negotiated in all subjects (echoendoscope 30, esophagoprobe 70) so that T- and N-staging was accomplished in every patient. Esophageal dilatation was performed in 12 patients (12%). The procedure was well tolerated and there were no complications, in particular no patient suffered esophageal perforation. The accuracy of the esophagoprobe for T-staging was 90% (19 out of 20) and that for N-staging was 75% (15 out of 20). This was similar to the accuracy of staging with the conventional echoendoscope, 90% (9 out of 10) for T-stage and 90% (9 out of 10) for N-stage. The esophagoprobe can safely and accurately stage patients with esophageal carcinoma, including those with high-grade stenoses.

Adult↗
PubMed2006

Thoracoscopic resection of foregut duplication cysts.

BACKGROUND: Foregut duplications are rare entities that include both esophageal and bronchogenic cysts. The diagnosis of foregut duplication cyst is made most often from an incidental finding on chest radiograph, or due to respiratory compromise due to mass effect or infection. Treatment consists of complete resection. Recurrences are associated with incomplete resection. Six cases of foregut duplication cysts are presented that were resected thoracoscopically. MATERIALS AND METHODS: From May 1998 to April 2003, six patients underwent thoracoscopy for resection of foregut duplication cyst. One patient required conversion to open thoracotomy due to esophageal perforation. The distribution of cysts was 4 on the left and 2 on the right; all procedures were performed with three or four ports. Single lung ventilation was used in three patients. The masses were removed via a port site after intrathoracic decompression. Chest tubes were placed in all patients, and most were removed within 12 hours. RESULTS: Five of six cases underwent successful thoracoscopic resection. Pathology demonstrated esophageal duplication cyst in three patients and bronchogenic cyst in the other three patients. Average hospital stay was 5.5 days. Complications included aspiration pneumonia and chest tube dislodgment. There were no deaths, and no recurrences. CONCLUSION: Thoracoscopic resection is a safe and effective method of treating foregut duplications. Outcomes have been good with little short-term morbidity and no mortality. Morbidity and cosmesis are improved by avoiding thoracotomy. Thoracoscopic resection should be considered the first-line therapy for these benign masses.

Adolescent↗
PubMed2006

Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns.

OBJECTIVE: We sought to present our experience in preventing esophageal stricture formation using modified intraluminal stenting in patients with caustic burns. METHODS: Between April 1976 and June 2005, 33 of 162 patients with corrosive esophageal burns were included in this study. Endoscopy was performed to define the degree of injury in all the patients but one. Among the 33 patients, 31 underwent modified esophageal intraluminal stenting through laparotomy 2-3 weeks after ingestion of corrosive agent and the remaining 2 patients underwent immediately after experiencing esophageal perforation. RESULTS: There was no death in this series. A 1-year-old child had aspiratory pneumonia because of poor compliance. The stent was removed without requiring anesthesia after it had been in situ for 4-6 months in the 33 patients. All the patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow. However, five patients had esophageal stenosis from 2 to 3 months during follow-up. One of them responded to esophageal bougienage, the remaining four patients required esophageal reconstruction and had a normal diet postoperatively. Twenty-four-hour pH monitoring in five patients showed that there was no gastroesophageal reflux. CONCLUSION: The modified esophageal intraluminal stent is able to prevent the formation of caustic esophageal stricture.

Adolescent↗
PubMed1989

[Long-term course of esophageal stenosis treated with pneumatic dilatation. A comparative study versus other methods].

Dilatation of benign esophageal strictures by means of a balloon catheter is a well established procedure in children. In this report a comparison of bouginage and balloon dilatation is made in eight patients treated by both procedures. The lesions treated included two strictures secondary to surgical anastomosis, one restrictive Nissen fundoplicature and five esophageal stenosis following caustic ingestion. These eight patients had a total of 44 bouginage procedures with a mean relapse free period of 80 days. There were two esophageal perforations. The clinical course was unsatisfactory in five cases. Only one patient had good results. In contrast, to date, the 15 balloon dilatations have resulted in a mean relapse free time of 174 days. There were no complications that required treatment. The clinical follow up shows four asymptomatics patients and the other four presenting difficulties to swallow with spontaneous resolution. We have the best results in younger patients with esophageal stenosis secondary to esophageal atresia repair. Balloon dilatation of esophageal stenosis in children is effective and safe, and should be considered before other methods of treatment are used.

Catheterization↗
PubMedDate not supplied

Multicenter prospective evaluation of laparoscopic antireflux surgery. Preliminary report.

BACKGROUND: A prospective study of 116 patients undergoing laparoscopic antireflux surgery was undertaken in four centers in the United Kingdom and the United States. METHODS: Patients with a hiatal hernia (n = 80) underwent total Rosetti-Hell fundoplication, whereas those without a hiatal defect (n = 36) were treated by a partial fundoplication (Toupet). The follow-up period ranged from 3 to 24 months; median was 13 months. RESULTS: The median duration of the operations was 2.5 h. Intraoperative complications were encountered in 16 patients (14.0%) and conversion to laparotomy was necessary for esophageal perforation in one. The postoperative recovery of gastrointestinal function was rapid and the median hospital stay from the time of the operation to discharge was 2 days, range 1-10. A good symptomatic result (> 70% reduction of preoperative symptom score) was observed in 106 patients (91%). There were no postoperative deaths but 15 patients (13.0%) developed complications in the immediate postoperative period. At 3 months, complete endoscopic healing of the esophagitis was observed in 65/92 patients (71%) and improvement by at least one grade was seen in 19 patients (21%). Twenty-four-hour pH monitoring, which was abnormal preoperatively in 93% of patients, was normal after surgery in 95%. There were 10 symptomatic failures (persistent reflux symptoms) and 14 patients (12%) developed adverse symptoms related to the procedure (gas-bloat 8, dysphagia 9, gastroparesis 1, explosive diarrhoea 1). Readmission to hospital within 3 months was necessary in 9 patients. CONCLUSIONS: Laparoscopic antireflux surgery can be performed with a low morbidity. In the short term, 83% of patients were rendered symptom free. These results are similar to those reported after the equivalent open operations.

Adult↗
PubMed2003

Assessment of spontaneous pneumomediastinum: experience with 12 patients.

BACKGROUND: The aim of this study is to report a series of spontaneous pneumomediastinum in a population of young, tall, and thin patients with a history of thoracic hyper pressure, and to analyze the assessment required in such patients. METHODS: A retrospective study of an unicentric series and a review of the literature from 1980 to 2002 were performed. RESULTS: Between December 1996 and January 2002, 12 patients (mean age, 25 years old; mean height, 172 cm; and mean weight, 63 kg) were admitted with spontaneous pneumomediastinum. In all patients, high intrathoracic pressure by cough or acute effort was the precipitating factor. Most frequent complaints were acute chest pain, asthenia, and subcutaneous emphysema. The following assessment was performed: chest roentgenogram in 12 of 12 patients (12/12); computer tomography (CT) scan in 8/12; bronchoscopy in 7/12; esophagoscopy in 6/12; esophagography in 2/12. Outcome was always uneventful without any recurrence. Hospital stay ranged from 0 to 6 days. The Medline research revealed that articles consist mainly of case reports. Two articles only report a multicentric series of 25 and 36 cases, respectively. No organ perforation was found either in our series or in our review of the literature. CONCLUSIONS: Spontaneous pneumomediastinum follows alveolar rupture in the pulmonary interstitium. The dissection of gas towards the hilum and mediastinum is produced by an episode of acute high intrathoracic pressure. It affects mostly young people, and this is the case in our series. Endoscopic thoracic assessment may be risky and is not always necessary. Chest CT or esophageal contrast study should be performed in case of diagnostic doubt of esophageal perforation.

Acute Disease↗
PubMed1975

Achalasia of the esophagus. A reappraisal of esophagomyotomy vs forceful pneumatic dilation.

56 patients with achalasia of the esophagus were reviewed in a retrospective study to compare the results of a forceful pneumatic dilation with those of a Heller esophagomyotomy. 22 of 33 patients treated with forceful dilation (67%), showed relief of dysphagia and reduction in the average esophageal diameter by barium swallow during the follow-up period (mean = 6.5 years). In 2 patients (6%), forceful dilation was complicated by esophageal perforation, promptly diagnosed, and successfully treated at surgery in both patients. 21 out of 23 patients who underwent esophagomyotomy (91%) showed permanent relief of symptoms and improvement by endoscopic and radiographic criteria. There were no significant postoperative complications during the follow-up period ranging between 1.5 and 10.0 years. The results of this study indicate that esophagomyotomy constitutes a more effective therapeutic modality than forceful dilation (P less than 0.05). Although esophageal dilation has a place in the treatment of early achalasia, esophagomyotomy appears to be a safer and a more successful form of treatment, of particular value in advanced esophageal disease and in those instances where pneumatic dilation fails to result in immediate clinical improvement.

Adult↗