Esophageal dilation in pediatric patients using balloon along the side of the endoscope.

Balloon dilation is an effective modality of treatment for esophageal strictures. As standard through-the-scope balloons do not pass through the biopsy channel of pediatric endoscopes, we have developed a technique by which these balloons can be used in pediatric patients by passing them alongside the endoscope. We report our experience of dilation in four patients using this technique.

Rectal lymphogranuloma venereum in association with rectal adenocarcinoma.

Rectal involvement in lymphogranuloma venereum (LGV) is more common in women. Inguinal bubo is often absent and the patient seeks medical attention only at a late stage when rectal stricture has developed. LGV rectal stricture resembles and is known to predispose to rectal cancer. Hence it is necessary to rule out rectal malignancy in patients with LGV stricture. We report a case of rectal LGV associated with rectal adenocarcinoma.

Role of endoscopic ambulatory laser therapy in palliation of malignant colorectal diseases.

BACKGROUND: Endoscopic laser therapy is widely used in the palliation of advanced malignant colorectal diseases. The role of this therapy in improving the quality of life of these patients needs adequate assessment. METHODS: Nine patients with advanced colorectal cancers and three patients with secondary colorectal involvement by pelvic cancers underwent endoscopic Nd:YAG laser therapy for palliation using non-contact laser guides for tumor bleeding alone (n = 12) or associated with obstruction (n = 7). The therapy was performed on an outpatient basis in 9 of the 12 patients. One patient was lost to follow up. RESULTS: Symptom control was achieved in all the 11 bleeding tumors and in 5 of the 7 obstructive tumors. There were no major complications. Three patients had no improvement in the quality of life in spite of control of symptoms. CONCLUSION: Ambulatory endoscopic laser therapy is a minimally invasive, safe and effective method of palliation for selected patients with non-resectable malignant colorectal tumors.

Percutaneous endoscopic gastrostomy for long term enteral nutrition.

BACKGROUND. Percutaneous endoscopic gastrostomy for long term enteral nutrition is often indicated in patients with head, neck and oesophageal cancer but despite its growing popularity elsewhere, it is not widely used in India. METHODS. Between March 1990 and July 1991, we performed percutaneous endoscopic gastrostomy in 54 patients. The primary sites of tumour were the hypopharynx (11), oral cavity (7), tongue (7), cricopharynx (7), oesophagus (16) and other sites (6). The indications were difficulty in swallowing following treatment (22), preoperative nutritional support (7) and terminal care (21). In 49 patients, it was performed by the 'pull' technique in the endoscopy room under local anaesthesia and mild sedation. Indigenously prepared tubes and blenderised foods were used. Fifteen patients underwent dilatation of the tumour prior to the gastrostomy. RESULTS. The procedure was successful in 50 (93%) patients. Three failures were caused by obstructing tumours and one by a previous gastric resection. Feeding was started 18 to 24 hours after the procedure in 48 patients. No major complications occurred but minor complications were seen in 11 (22%) patients. Fourteen patients had their gastrostomy tube removed after 2 to 6 months of use while 15 patients undergoing therapy or with persistent dysphagia were on gastrostomy feeds for 1 to 6 months. Of the 21 terminally ill patients, 8 died, 6 were lost to follow up and 7 were on feeds for 1 to 6 months. CONCLUSIONS. Percutaneous endoscopic gastrostomy is a simple, safe and effective method for long term enteral feeding. Indigenous tubes and home made blenderised foods are adequate substitutes for the more expensive commercial kits and enteral formulations.