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At least 19 recordsLinked to original sources
PubMed1993

Staged Zenker's diverticulectomy with cervical esophagostomy and secondary esophagostomy closure for treatment of massive diverticulum in severely debilitated patients.

Cricopharyngeal myotomy and diverticulectomy have become the standard therapy for the vast majority of patients with pharyngoesophageal diverticula. Potential complications from this approach, however, may be devastating in debilitated, elderly patients with massive Zenker's diverticula. Because of potentially fatal complications, we advocate a staged approach to treat debilitated patients with massive Zenker's diverticula. In the first stage, myotomy, diverticulectomy, and cervical esophagostomy are performed, and a gastric feeding tube is positioned through the esophagostomy. After recovery from pulmonary complications and nutritional improvement, the feeding tube is removed and the esophagostomy is closed. From 1987 to 1992, we treated five severely debilitated patients, four men and one woman with massive Zenker's diverticula, with this novel approach. Age of the patients averaged 80 years, range 58 to 93. All patients had symptoms of pulmonary aspiration requiring multiple hospitalizations for life-threatening pneumonia. Three patients had severe malnutrition associated with major weight loss and cachexia. All patients underwent first stage repair without morbidity or mortality. After an average of 7 weeks, patients had significant nutritional improvement and the esophagostomy was closed. Local wound care adequately treated one wound infection after esophagostomy closure. Although myotomy and diverticulectomy are safe procedures, a staged approach, diverticulectomy and cervical esophagostomy, followed by esophagostomy closure, is advocated for the elderly, severely debilitated patient with massive Zenker's diverticulum.

Aged↗
PubMedDate not supplied

Clinical evaluation of tube esophagostomy in small animals.

An alternative technique for placement of tube esophagostomy in small animals is described. Tube esophagostomy was placed in 13 dogs and nine cats. The mean duration of tube placement was 23 days (range, one to 48 days). No significant complications related to the tube were noted. In each case, tube esophagostomy was tolerated and time to healing of the esophagostomy site following tube removal was less than two weeks. Tube esophagostomy is suitable for use in a nutritionally compromised small animal with a functional esophagus and gastrointestinal tract.

Animals↗
PubMedDate not supplied

Cervical esophagostomy in dogs: endoscopic, radiographic, and histopathologic evaluation of esophagitis induced by feeding tubes.

Prolonged tube feeding is frequently necessary in patients with head and neck cancer, facial trauma, or central nervous system disease. The advantages of cervical esophagostomy over nasogastric and gastrostomy tube feeding are established. One frequently overlooked complication of tube feeding is distal esophagitis and subsequent stricture formation. This complication has been widely reported in the medical literature although the pathophysiologic mechanism has in part been speculative. We have completed a prospective, randomized, controlled animal study in an attempt to delineate the mechanism of feeding tube esophagitis and to devise a method of avoiding it. Twelve dogs underwent cervical esophagostomy and were studied by endoscopy, contrast fluoroscopy, gross and microscopic pathology. The esophageal effects of placement of polyethylene and silicone rubber esophagostomy tubes in the customary position, through the cardioesophageal junction into the stomach, were compared with placement of the distal end of the tube only as far as the midesophagus. Midesophageal placement of silicone rubber tubes greatly reduced esophageal injury inherent is esophagostomy tube feeding. A new esophagostomy feeding tube is presented with advantages over previously used tubes.

Animals↗
PubMed1991

Use of esophagostomy in the management of corrosive esophageal strictures.

Thirty six cases of corrosive esophageal strictures seen over a period of ten years are presented. The primary treatment modalities followed include antegrade dilatation per oral (11 cases), retrograde followed by antegrade dilatation with endless string per oral (12), retrograde followed by antegrade dilatation with endless string through esophagostomy (12), and surgery (1). Per oral dilatation with endless string was not well tolerated by 15 patients due to friction of the string against the posterior 1/3rd of the tongue, and hence compliance was poor. Dilatation through esophagostomy was easy, and patient compliance was good. Furthermore, patients could be trained to do self bougienage easily through the esophagostomy. Esophagostomy closed within 4-6 weeks after successful distal dilatation was achieved.

Adolescent↗
PubMed1998

Two decades of cervical esophagostomy: indications and outcomes.

Diverting cervical esophagostomy is a surgical procedure generally reserved for extremely ill patients as a life-saving maneuver. However, it is also a procedure that is infrequently performed, such that most centers have limited experience with the operation. To investigate the indications and outcomes of cervical esophagostomy, we reviewed the use of this operation at UCLA Medical Center over the last 20 years as employed for esophageal leaks. Eighteen patients underwent this procedure for the following indications: leak with malignant tracheoesophageal fistula (11%), anastomotic leak (44%), endoscopic injury (18%), gunshot wound (5.5%), operative injury (11%), corrosive ingestion (11%), and spontaneous rupture (5.5%). Overall mortality directly attributable to sepsis was 33 per cent. Of the surviving patients, 67 per cent later underwent reconstruction. Seventy-two per cent of patients had end esophagostomies, and the remainder had loop diversions. The primary indication for operation in these patients was persistent sepsis after initial surgical management of esophageal spillage into the mediastinum or neck. This series suggests that cervical esophagostomy, when applied to the appropriate patient population, can decrease mortality and allow subsequent alimentary reconstruction.

Adult↗
PubMed1985

Tube esophagostomy. A new technique in the management of long-term swallowing disorders.

Surgeons whose patients require long-term management of nutritional intake must usually choose from among nasogastric tube feedings, hyperalimentation by intravenous route, and/or gastrostomy. Cervical esophagostomy has been a useful but not widely employed alternative. The advantages of cervical esophagostomy over other modalities include the avoidance of laparotomy, absence of a nasogastric tube, and lack of the complications of a long-term indwelling intravenous catheter. The disadvantages of standard esophagostomy include the need to wear a tube to keep the fistula open, leakage, and skin irritation. Dobie et al presented a skin flap esophagostomy technique in 1978. We report a variation of this concept that has resulted in no salivary leakage and that allows the patient to dispense a tube between feedings. It provides a directional stoma in which the internal orifice is considerably inferior to the external one, resulting in continence and thus preventing substantial leakage.

Deglutition Disorders↗
PubMedDate not supplied

A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes.

Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.

Animal Husbandry↗
PubMed1989

[Experimental models in studying gastric secretion in dogs: innervated pouch, denervated pouch, cervical esophagostomy. Execution, monitoring, use].

Different surgical models are used in the dog for studying gastric secretion: gastric fistula, denervated Heidenhain pouch, innervated Amdrup pouch and cervical esophagostomy. The surgical procedures are described as well as the care and the monitoring allowing long-term survival of the animals. The association of gastric fistula - Heidenhain pouch has been assessed 30 times and 8 times with cervical esophagostomy. The death-rate was been 7% and the morbidity 24%. Three dogs were provided with an Amdrup pouch. Calibration of the animals allowed the acid and pepsin secreting dose-response to be platted and translation according to lineweaver-Burk or Dowd and Riggs is used to calculate the efficient dose (ED 50) and the maximal response (maxR). Pharmacological or physiological effects might be analyzed in regard to the modification of these parameters in response to a pharmacological agonist or antagonist substance. Some physiological studies could be made using sham-feeding on dogs fitted with a cervical esophagostomy.

Animals↗
PubMed1979

Skin flap esophagostomy. A new procedure.

Stoma formation in cervical esophagostomy can be accomplished without tension with the use of cervical skin rotation flaps to form a skin-lined tube. This procedure was performed on six patients; salivary leakage was less, and tube insertion was easier than in patients who had standard esophagostomy procedures. We discuss the indications and contraindications for esophagostomy.

Adult↗
PubMed2003

A nonsurgical technique to create an esophagostomy for difficult cases of percutaneous endoscopic gastrostomy.

BACKGROUND: We developed a minimally invasive technique of esophagostomy called percutaneous transesophageal gastrotubing (PTEG) using a rupture-free balloon (RFB) for enteral nutrition and drainage as well as percutaneous endoscopic gastrostomy (PEG). PTEG using RFB allows surgeons to create a nonsurgical esophagostomy even in difficult cases of PEG (i.e., total gastrectomized patients and massive ascites). METHODS: To create the PTEG, a RFB is inserted into the esophagus through the nose and inflated. The RFB is punctured with a needle at the left neck under ultrasonographic vision. A guidewire is inserted through the needle, followed by dilatation of the punctured site using a dilator with sheath. Finally, the tube is inserted into the gastrointestinal tract and the sheath is peeled off. RESULTS: From January 1998 to June 2002, we treated 115 patients using PTEG with a RFB and there were no major complications. Therapeutic results are as good as those for PEG and it took approximately 15 min to perform. CONCLUSIONS: PTEG with RFB is as safe as PEG and is simple and less invasive. It can be used in some cases for which PEG is contraindicated.

Catheterization↗
PubMed1997

Bilateral thoracotomy and inferior sternotomy for bypass grafting after esophagostomy.

In the presence of a cervical esophagostomy, a median sternotomy may jeopardize the stoma, risk mediastinal or sternal infection, and potentially compromise future esophageal operations. Coronary artery bypass grafting was performed using a modified bilateral thoracotomy before esophageal reconstruction in a patient with cervical esophagostomy. The surgical technique is described with a review of the relevant literature.

Aged↗
PubMed2000

Lateral esophagostomy: an alternative in the initial management of long gap esophageal atresia without fistula.

The authors report an alternative method of cervical esophagostomy that was used in a child with type A esophageal atresia. This method involved performing a lateral esophagostomy in the proximal pouch, preserving its distal end, allowing the child to swallow normally, without choking, while stimulating the spontaneous growth of the proximal esophagus. As a result, the infant could be discharged home on G-tube feedings while waiting for spontaneous growth of the proximal pouch to occur. There were no episodes of aspiration during this period, and definitive reconstruction through end-to-end esophageal anastomosis was accomplished successfully at the age of 18 months. The authors consider that this alternative might increase the possibility of a definitive correction through delayed primary anastomosis of the infant's own esophagus in children with this type of malformation.

Anastomosis, Surgical↗
PubMed1996

Repositioning the stoma of the cervical esophagostomy.

The stoma created with a diverting cervical esophagostomy is often an unsightly inconvenience for the patient because of the high incidence of leakage from the collecting appliance. Secure attachment of a collection device at the base of the neck is difficult. The stoma of the cervical esophagostomy may be moved away from the base of the neck using a tubed skin flap modeled after that originally described by Wookey. Such a procedure has the advantages of removing the appliance from an area of high visibility and providing a flatter base that decreases leakage and soiling. We advocate this simple procedure in patients who desire to rid themselves of a cervical appliance, but who are poor operative candidates for a more extensive procedure replacing the entire esophagus.

Esophagostomy↗
PubMed2005

Cervical esophagostomy using indwelling catheter for analysis of gastric physiology in dogs.

PURPOSE: To describe the technique of cervical esophagostomy with indwelling catheter for the collection of secretions and study of gastric emptying. METHODS: Esophagostomy was performed in 14 dogs, and a tube was introduced into the animals' stomachs and maintained previous for eight weeks. The technique consisted of opening the left lateral surface of the neck for insertion of the tube, with the aid of a Mixter forceps, and the subsequent subcutaneous tunneling and exteriorization of the catheter on the dorsum of the animals. RESULTS: Successful use of the tube and its total permeability were observed in 13 animals (92.8%). In one animal, the tube was obstructed by hair, and it was replaced. Formation of a small abscess occurred in 3 animals (21.4%), followed by spontaneous drainage. No accidents occurred, and the bleeding was minimal. No deaths were registered. CONCLUSION: The described technique can be used in similar researches, as well as for animal feeding in investigations of the upper digestive tract, after esophageal resection and in major neck surgeries.

Animals↗
PubMedDate not supplied

Esophagostomy tubes as a method of nutritional management in cats: a retrospective study.

The use of esophagostomy tubes in 60 feline patients was evaluated retrospectively. Indications for tube placement, complications associated with placement and management, duration of treatment, and change in patient body weight were evaluated. Hepatic disease was the most common indication for tube placement. A minor complication associated with the surgical technique for tube placement was observed in three cases. Inflammation or infection of the tube site, swelling of the head, or vomition of the tube were observed complications during management in 19 cases. Vomiting occurred and was a complicating factor in nine cases. The average duration of tube placement was 23 days, and most patients maintained or gained weight while being fed through their esophagostomy tubes.

Animals↗
PubMed1989

Diverting cervical esophagostomy and construction and primary reconstitution of esophageal continuity.

A simple technique has been described herein that will allow the surgeon to construct a temporary, totally diverting, cervical esophagostomy, and then allow the surgeon to take down the esophagostomy with primary cervical esophageal reconstitution. Crucial to the success of this method is the careful preparation of the esophagus for a tension-free reconstruction at the time of the initial diversion procedure.

Anastomosis, Surgical↗
PubMed1997

[Percutaneous placement of an esophagostomy tube in cats: first experience with a new technique].

A new technique for percutaneous placement of tube esophagostomy for enteral feeding in cats is described. The technique is characterized by its symplicity and rapid placement of the feeding tube. Its use is demonstrated in 8 cats in which nutritional support with enteral feeding was indicated. Placement of the tube was performed without complications. The feeding tube was tolerated well. Complications after placement were restricted to occasional vomiting after feeding (n = 2) and minor inflammation of the esophagostomy incission. Tubes could be removed after 7 to 16 (median 14) days. Two cats died as a result of the primary disease. This technique is a useful aid in the application of enteral feeding because of its simplicity and minimal complications.

Animals↗
PubMed1990

Distal-end esophagostomy of the excluded esophagus in the palliation of upper and mid-esophageal carcinoma.

The gastric bypass of the excluded esophagus in the palliative treatment of carcinoma of the esophagus carries a considerable mortality. One of the most significant events that contributes to this mortality is the disruption of the distal closure of the excluded esophagus. In order to avoid this, a distal-end esophagostomy accompanying the gastric bypass procedure was created in six patients with advanced carcinoma of the upper and middle third of the esophagus. This distal esophagostomy is carried out by extrapleural dissection and is developed to the back, at the level of the eighth rib, just lateral and adjacent to the spinal muscles. Operative survival of all these sick patients proves this to be a safe operation that avoids the fatal complication described.

Aged↗