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Data of 7 patients with complex benign esophageal strictures (CBESs) who underwent endoscopic longitudinal incision combined with local injection of bleomycin were retrospectively reviewed at Air Force Medical Center from August 2018 to November 2019.The length of preoperative esophageal stenosis was 4-14 cm and the minimum diameter of esophageal stenosis was 0.2-0.4 cm in 7 cases. The procedure was successful for all 7 patients.No adverse events occurred during 5-14 months of follow-up period.Restenosis and dysphagia occurred in 5 cases.The interval between the first endoscopic treatment and the recurrence of esophageal stenosis was 30-120 days.Among the 5 cases of recurrence, 4 cases remained unobstructed after 2 treatments and 1 case remained unobstructed after 4 treatments. The dysphagia scores of 7 patients were graded from 0 to 1 by the end of follow-up. Endoscopic longitudinal incision combined with bleomycin therapy in treatment of CBESs is safe and effective.
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Children′s esophageal stenosis is mainly benign stenosis. Esophageal foreign bodies and corrosion are common causes of esophageal stenosis in children requiring emergency management. Endoscop￣ic treatment of esophageal stricture includes endoscopic balloon dilatation,endoscopic radial incision,medical treatement,endoscopic stenting and so on. According to the cause of the stenosis,the nature of the lesion and the morphological structure of the lesion,formulating appropriate endoscopic treatment strategy are important for therapeutic effect and reducing the incidence of complications.
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Introducción: las endoprótesis autoexpandibles constituyen una de las alternativas terapéuticas en la actualidad para tratar de manera paliativa las estenosis malignas y benignas del tracto gastrointestinal y biliopancreatico con el fin de mejorar la calidad de vida de los pacientes. Objetivos: mostrar los resultados alcanzados por nuestro grupo en la colocación de endoprótesis metálicas autoexpandibles en pacientes con estenosis malignas o benignas del tracto digestivo superior remitidos de diferentes partes del país. Métodos: se evalúa una serie de casos de manera prospectiva la experiencia cubana de inserción de 101 endoprótesis autoexpandibles (Niti-S Stent) en 86 pacientes atendidos en el Centro Nacional de Cirugía de Mínimo Acceso, con diagnóstico de estenosis malignas y benignas del tractus digestivo superior. Resultados: la mayor proporción de prótesis insertada se realizó en las estenosis malignas (86 por ciento) y en el grupo de 60 y más años de edad (81,3 por ciento). Las complicaciones más frecuentes fueron el dolor retroesternal (100 por ciento) inmediato y la migración de la endoprótesis en las benignas y el sobre crecimiento tumoral en las malignas. Hubo un paciente con perforación que falleció posteriormente. Conclusiones: se muestra la utilidad de las prótesis autoexpandibles en la paliación de las estenosis malignas y benignas digestivas altas(AU)
Introduction: expandable metallic stents are one of the treatment alternatives currently palliatively treating benign and malignant stenosis of the gastrointestinal tract and biliopancreatic order to improve the quality of life of patients. Objectives: to show the results achieved by our group in the placement of self-expanding metal stents in patients with malignant or benign strictures of the upper digestive tracts referred from different parts of the country. Methods: a number of cases were prospectively evaluated the Cuban experience of 101 self-expanding stent insertion (Niti-S Stent) in 86 patients treated at the National Center for Minimal Access Surgery, diagnosed with malignant and benign strictures of the upper digestive tractus. Results: the highest proportion of inserted prosthesis was performed in malignant stenosis (86 percent) and in the group of 60 and more years old (81, 3 percent). The most frequent complications were chest pain (100 percent) immediately and migration of the stent in benign and on tumor growth in malignant. A hole that had subsequently died. Conclusions: utility Stents for palliation of malignant and benign strictures high digestive shown(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Esophageal Stenosis/surgery , Minimally Invasive Surgical Procedures/methods , Prosthesis Implantation/methods , Self Expandable Metallic Stents/statistics & numerical data , Prospective StudiesABSTRACT
Objective To explore the efficacy and safety of improved covered metallic stents for proximal malignant esophageal strictures.Methods A total of 56 patients with proximal malignant esophageal strictures were treated with improved covered metallic stents whose diameter was 14 mm or 16 mm at Shanxi Province Tumor Hospital from Feburary 2013 to August 2014.Swallowing condition, physical and life quality were compared before and after surgery and analyzed.At the same time, side effects and complications were recorded during and after surgery.Results All 56 patients were treated successfully with improved covered metallic stents, no complications related with stents occurred after surgery.Swallowing conditions were improved after surgery, there were 45 patients with obvious improvement, 10 patients with better improvement and 1 patient's stent taken out due to stent intolerance.Remission rate of swallowing conditions was 98.2％ (55/56).Two weeks after surgery, Stooler of swallowing conditions obviously improved (t =7.05, P ＜ 0.05), physical conditions (ZPS) also improved (t =22.49, P ＜ 0.05), but there was no significant difference in life quality (Kamofsky scores) (t =1.07, P ＞ 0.05).During 90 days of follow-up there was no hemorrhage or perforation.Conclusion The application of improved covered metallic stents for proximal malignant esophageal strictures is safe and effective.
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Objective To evaluate the efficacy and safety of covered metallic stents in the management of proximal esophageal strictures.Methods Retrievable covered self-expanding metallic stents were inserted individually in 43 patients with malignant strictures of the proximal esophagus.Main outcome measures included improvement of dysphagia,sealing of fistula and complications were evaluated.Results A total of 45 stents were placed in 43 patients,with a success rate of 95.6％ (43/45) at the first stent placement attempt.The dysphagia score improved significantly from 3.3 ± 0.6 to 1.8 ± 0.9 (P ＜ 0.001),with 18 having an excellent response and 25 having a good response.Improvement rate of dysphagia was 95.6％ (43/45).Fistula sealing was achieved in 7 of 9 patients (77.8％).Early complications included severe pain (n =5),mediastinal emphysema (n =1),moderate fever (n =9) and collapse of the proximal end of the stent (n =1),while late complications included migration (n =3) and tissue overgrowth (n =6).Conclusion Retrievable covered metallic stent placement is effective and safe for the palliation of obstructive dysphagia and sealing of fistulas in malignant proximal esophageal strictures.
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Benign strictures of the esophagus and gastric outlet are difficult to manage conservatively and they usually require intervention to relieve dysphagia or to treat the stricture-related complications. In this article, authors review the non-surgical options that are used to treat benign strictures of the esophagus and gastric outlet, including balloon dilation, temporary stent placement, intralesional steroid injection and incisional therapy.
Subject(s)
Humans , Catheterization , Electrocoagulation , Endoscopy, Gastrointestinal , Esophageal Stenosis/therapy , Gastric Outlet Obstruction/therapy , Injections, Intralesional , Radiography, Interventional , Stents , Steroids/administration & dosageABSTRACT
Objective To investigate the efficacy of two different methods of catheter balloon dilatation therapy in treating cricopharyngeal achalasia and benign strictures,and to correlate balloon capacity with improve-ments in swallowing function. Methods Twenty-three cricopharyngeal achalasia patients and 7 with benign stric-tures of the cricopharyngeal muscles were diagnosed using videonuoroscopic swallowing study(VFSS).All cases re-ceived active dilatation or passive balloon dilatation therapy,combined with manipulation,indirect training,direct training and feeding instruction.Efficacy and the correlation were evaluated using VFSS and a swallowing function scale. Results Passive and active dilatation had the same efficacy.The correlation coefficient between balloon ca-pacity and swallowing function was 0.92 1.Re-evaluation using VFSS showed that opening of the cricopharyngeal muscles had improved significantly.Conclusions Balloon catheter dilation is an effective treatment for cricopha-ryngeal achalasia and benign strictures.The improvement in swallowing function is highly correlated with balloon ca-pacity in balloon dilatation therapy.Comprehensive treatment for dysphagia would provide better outcomes.