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ABSTRACT BACKGROUND: Esophageal stenosis (ES) in children is a fixed intrinsic narrowing of the esophagus due to numerous aetiologies. OBJECTIVE: This study aimed to determine the clinical and nutritional impacts of endoscopic balloon dilation (EBD) in Iranian children with an esophageal stricture. METHODS: This retrospective study, pediatric patients (aged <18 years) who underwent EBD for esophageal stricture from April 2015 until March 2020 in Abuzar Children's Hospital (Ahvaz, Iran) were enrolled in the study. Outcome parameters were the frequency of dilations, nutritional status, complications, and clinical success rates. EBD was used in children with radiologic evidence of esophageal stenosis. The nutritional status was evaluated by weight-for-age (z-score). Clinical success was considered as no necessity of EBD for a minimum of one year and/or increasing interval among dilation and the frequency of EBD was less than four times per year. RESULTS: A total of 53 cases (mean age, 4.72±3.38 years) were enrolled. There were 25 (47.2%) females and 28 (52.8%) males. During follow-up, a total of 331 EBD sessions were performed, with an average of 6.24 sessions per patient. There was one case of perforation and one case of mediastinitis, while there was no other complication or mortality. The clinical success rate of EBD therapy was 62.3% (33/53). The mean standard deviation z-score weight-for-age of patients before and after endoscopic dilation was 2.78 (2.41) and 1.18 (1.87), respectively. The t-test showed a significant difference between the weights-for-age (z-score) before and after endoscopic dilation. The majority of the patients had raised weight-for-age (z-score) after EBD treatment. CONCLUSION: EBD attained a good clinical success rate and nutritional improvement in children with an esophageal stricture.
RESUMO CONTEXTO: Estenose esofágica (EE) em crianças é um estreitamento intrínseco fixo do esôfago devido a inúmeras etiologias. OBJETIVO: Este estudo teve como objetivo determinar os impactos clínicos e nutricionais da dilatação do balão endoscópico (DBE) em crianças iranianas com restrição esofágica. MÉTODOS: Foram inscritos neste estudo retrospectivo, pacientes pediátricos (com idade <18 anos) submetidos a DBE para restrição esofágica de abril de 2015 a março de 2020 no Hospital Infantil de Abuzar (Ahvaz, Irã). Os parâmetros de desfecho foram a frequência de dilatações, o estado nutricional, complicações e taxas de sucesso clínico. A DBE foi usada em crianças com evidência radiológica de estenose esofágica. O estado nutricional foi avaliado pelo peso-por-idade (escore z). O sucesso clínico foi considerado como não necessidade de DBE por um período mínimo de um ano e/ou aumento de intervalo entre dilatações e frequência inferior a quatro vezes por ano. RESULTADOS: Foram incluídos 53 casos (média de idade, 4,72±3,38 anos). Eram 25 mulheres (47,2%) e 28 homens (52,8%). Durante o acompanhamento, foram realizadas 331 sessões de DBE, com média de 6,24 sessões por paciente. Houve um caso de perfuração e um caso de mediastinite, enquanto não houve outra complicação ou mortalidade. A taxa de sucesso clínico da terapia de DBE foi de 62,3% (33/53). A média (escore z) peso-para-idade dos pacientes antes e depois da dilatação endoscópica foi de 2,78 (2,41) e 1,18 (1,87), respectivamente. O teste t mostrou uma diferença significativa entre os pesos por idade (escore z) antes e depois da dilatação endoscópica. A maioria dos pacientes havia aumentado o peso por idade (escore z) após o tratamento com DBE. CONCLUSÃO: A DBE atingiu boa taxa de sucesso clínico e melhora nutricional em crianças com restrição esofágica.
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ABSTRACT BACKGROUND: Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures. OBJECTIVE: To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures. METHODS: We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients. RESULTS: Three randomized clinical trials were included for final analysis with a total of 190 patients. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone, with statistical significance between the two groups (RD: 0.42 - [CI: 0.29-0.56]; P-value <0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34). CONCLUSION: Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilation sessions needed to alleviate dysphagia without rising morbidity.
RESUMO CONTEXTO: A ingestão de soda cáustica e o desenvolvimento de estenoses esofágicas são reconhecidos como importantes problemas de saúde pública na infância. Diferentes métodos terapêuticos têm sido propostos no manejo dessas estenoses. OBJETIVO: Avaliar a eficácia e o risco da aplicação endoscópica tópica de mitomicina C no tratamento de estenoses esofágicas cáusticas. MÉTODOS: Buscamos as bases de dados MEDLINE, EMBASE, Central Cochrane e LILACS. Os desfechos avaliados foram taxa de resolução da disfagia, número de dilatações realizadas nos casos resolvidos e número de dilatações realizadas em todos os pacientes. RESULTADOS: Três ensaios clínicos randomizados foram incluídos para análise final com um total de 190 pacientes. O grupo de aplicação de mitomicina C tópica apresentou aumento significativo na taxa de resolução da disfagia, correspondendo a uma resolução da disfagia 42% maior em comparação à dilatação endoscópica isolada, com significância estatística entre os dois grupos (RD: 0,42 - [IC: 0,29-0,56]; P-valor <0,00001). O número médio de dilatações realizadas em casos resolvidos foi significativamente menor no grupo de aplicação tópica de mitomicina C, em comparação com as dilatações endoscópicas isoladas, com significância estatística entre os dois grupos (MD: 2,84 [IC: 1,98-3,69]; P-valor <0,00001). Ao comparar o número de dilatações em todos os pacientes, não houve diferença estatística entre os dois grupos (MD: 1,46 [IC: -1,53-4,44]; valor de P=0,34). CONCLUSÃO: A aplicação de mitomicina C tópica com dilatações endoscópicas em estenoses esofágicas cáusticas foi mais eficaz na resolução da disfagia do que a terapia endoscópica isolada na população pediátrica. Além disso, a aplicação tópica de mitomicina C também reduziu o número de sessões de dilatação necessárias para aliviar a disfagia sem aumentar a morbidade.
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Humans , Child , Caustics/toxicity , Esophageal Stenosis/chemically induced , Esophageal Stenosis/drug therapy , Randomized Controlled Trials as Topic , Administration, Topical , Esophagoscopy , Treatment Outcome , Mitomycin/therapeutic useABSTRACT
Background: Foreign body ingestion and food bolus impaction is a common clinical scenario and can present as an endoscopic emergency. Though majority of them pass spontaneously 10-20% require endoscopic intervention. Flexible endoscopy is recommended as therapeutic measure with minimal complications. The aim of our study is to present 5 years’ experience in dealing with foreign bodies in the upper gastrointestinal tract.Methods: Cases of foreign body ingestion admitted to department of general surgery from March 2015 to March 2020 were evaluated. The patients were reviewed with details on age, sex, type of FB, its location in gastrointestinal tract, treatment and outcome.Results: A total of 55 cases were studied. Age range was 1-85 years. Males were predominant 61.81%. Coins were found most commonly 63.6%. Esophagus was the commonest site of FB lodgement 70.9%. Upper esophagus being the most common 36.36%. Upper gastrointestinal flexible endoscopy was useful in retrieving FB in all the 55 cases. There were no complications throughout the study period.Conclusions: Flexible endoscopy should be used as definitive treatment and endoscopic treatment is safe and effective.
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Background: The objective of the study was to effect of steroids in the long term outcome of esophageal benign stricture after endoscopic balloon dilation in terms of recurrence.Methods: With purposive sampling, 50 cases were taken in these studies who were admitted with strictures at any location along the esophagus and of any size at New Civil Hospital, Surat. The indoor patients for a three year period were retrieved using a prepared case sheet proforma on the basis of the patient’s demographic profile and clinical findings. Patients had undergone endoscopic balloon dilation for esophageal benign stricture. In 25 patients endoscopic dilation was followed by submucosal injection of long-acting steroid triamcinolone and the remaining 25 patients were taken as a control.Results: All patients have normal dietary intake including solid food at the time of discharge. All patients under study were regularly followed quarterly. Overall stricture recurrence can be reduced by intralesional triamcinolone injection providing stricture length <6 cm. Stricture >6 cm required a repeated procedure or other treatment modalities, In study group duration between endoscopic dilatation sessions fell significantly over a post dilatation period of 3 to 12 months.Conclusions: In addition to endoscopic dilatation, intralesional trimicinolone injection is safe, effective and significantly decrease stricture rate and decrease endoscopic dilatation sessions.
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BACKGROUND: The esophagus is the most common part of gastrointestinal (GI) tract at the risk of stricture. Benign disorders are the leading causes of narrowing. Caustic ingestion is the most common cause of esophageal stricture in children, especially in developing countries. Clinical responses to the topical application of Mitomycin C in various medical procedures have been reported. PURPOSE: The study aimed to evaluate the methodology, efficacy, and side effects of Mitomycin C in the treatment of esophageal strictures. METHODS: This study included 30 children with resistant esophageal strictures. Upper GI endoscopy was performed up to the area of stricture, esophageal dilatation was done, endoscopy was repeated, and Mitomycin C was applied topically under direct endoscopic vision. The effect of the procedure was followed over a period of 3–5 years. RESULTS: The response to Mitomycin C was excellent (clinically and endoscopically) in 28 patients (93.3%) and good (endoscopically only) in 2 patients (6.7%). No side effects of topical Mitomycin C in children with esophageal strictures were reported in this study. CONCLUSION: Esophageal dilatation followed by local Mitomycin C application may be a useful strategy for treating resistant esophageal strictures.
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Child , Humans , Constriction, Pathologic , Developing Countries , Dilatation , Eating , Endoscopy , Esophageal Stenosis , Esophagus , MitomycinABSTRACT
Currently, benign esophageal stricture is a common clinical esophageal disease in children, and its common treatment is balloon dilatation. According to the complexity of the lesion, the child often suffers from multiple esophageal dilation. Besides, esophageal stent provides a new choice for the treatment of esophageal stricture in children because of the long-lasting support. However, the complications limit its clinical application, such as chest pain, restenosis, and stent displacement. This article reviewed the current research and clinical application of esophageal stents for children.
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A estenose esofágica benigna é uma afecção rara em pequenos animais, comumente secundária a esofagites ulcerativas. O refluxo gastroesofágico, frequente durante procedimentos anestésicos, é a principal causa de esofagite grave, com consequente formação de cicatriz esofágica. O presente trabalho tem por objetivo descrever dois casos de estenose esofágica ocorrentes após ovário-histerectomia, com destaque para os procedimentos diagnósticos realizados. Em ambos os casos, a combinação dos sinais clínicos sugestivos e os achados de esofagograma e esofagoscopia foram determinantes. No primeiro caso, devido ao tempo avançado de desenvolvimento dos sinais clínicos, o paciente veio a óbito antes mesmo que a intervenção direta da região de estenose fosse realizada. Já no segundo, o procedimento de gastrostomia para melhor manejo alimentar, associado à dilatação esofágica via esofagoscopia e à terapia com medicamentos antiácidos, resultou em melhora clínica.(AU)
Benign esophageal stricture is a rare affection in small animals, usually secondary to ulcerative esophagitis. Gastroesophageal reflux, frequent during anesthetic procedures, is the main cause of severe esophagitis with consequent formation of esophageal cicatrix. The objective of this work is to describe two cases of esophageal stricture occurring after ovariohysterectomy, highlighting the diagnostic procedures performed. In both cases, the combination of the suggestive clinical signs and findings from an esophagram and an esophagoscopy were determinants. In the first case, due to the advanced stage of the clinical signs, the patient died before direct interventions on the stenosis region were performed. But in the second case, the gastrostomy procedures for better feed management associated with esophageal dilatation by esophagoscopy and therapy with antacids resulted in clinical improvement.(AU)
Subject(s)
Animals , Female , Dogs , Esophageal Stenosis/veterinary , Esophagitis/complications , Gastroesophageal Reflux/veterinary , Hysterectomy/veterinary , Ovariectomy/veterinaryABSTRACT
Objective To establish a benign esophageal stricture model and observe the effect of 32P radioactive isotopes on benign esophageal stricture scarring with intracavitary irradiation so as to provide experimental evidence for inhibiting scar hyperplasia and preventing esophageal restenosis after endoscopic dilation for benign esophageal stricture.Methods Benign esophageal stricture models were established in 18 healthy adult rabbits by annular incision and anastomosis.Then the rabbits were randomly divided into control group,hormone group and irradiation group,with six rabbits in each group.On day 2 after surgery,we measured inner diameter of the anastomotic stoma;then the control group received saline intervention,the hormone group was given dexamethasone,and the irradiation group was given 32P radioactive isotopes.The rabbits were observed for two weeks for their general condition and weight.After the intervention,we measured inner diameter of the anastomotic stoma.Liver functions (ALT and AST) were tested again before modeling and after intervention.Then the rabbits were put to death and had tissue in the esophageal stricture area removed for pathological examination and esophageal HE staining.We determined hydroxyproline (HYP) content of esophageal tissue around the anastomotic stoma.Restlts Benign esophageal stricture model was established successfully.After 2 weeks,the rabbits' appetite was obviously diminished in control group and relatively poor in hormone group;obviously improved in irradiation group.The rabbits' weight increased in radiation group compared with the other two groups (P＜0.05).The esophageal inner diameter in irradiation group widened obviously compared with the other two groups (P ＜ 0.05).In irradiation group,the number of fibroblasts decreased obviously,collagen fiber and granulation tissue were not obvious;HYP content was lower than that in the other two groups,and was close to that in a normal esophagus (P＞0.05).ALT and AST did not differ before and after intervention in all groups (P＞0.05).Conclusion ① We can establish benign esophageal stricture model successfully through the surgery.② 32Pradioactive isotopes radiation therapy can be used to prevent early scar formation in esophageal benign stricture,and is superior to dexamethasone therapy.
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Objective To assess the safety, effectiveness and predictive factors of endoscopic balloon dilatation for the treatment of esophageal stricture and esophageal achalasia in children. Methods 28 patients with esophageal stricture and esophageal achalasia treated by endoscopic balloon dilatation from January 2012 to November 2014 were included. All the patients were divided into two groups, 22 in group A (esophageal stricture) and 6 in group B (esophageal achalasia). All procedures were performed under tracheal intubation and intravenous anesthesia using the 3rd grade controlled radial expansion (CRE) balloon with gastroscope. Outcomes, including success, complications and recurrence data were recorded, and predictors for outcomes were analyzed. Results A total of EBD 57 sessions (1 to 5 per patient, 2.00 ± 1.15) were performed on 28 patients in this study. 22 patients were diagnosed with esophageal stricture (78.57%) and 6 with esophageal achalasia (21.43%). The median age was 25 months (range 0 ~ 150), and female/ male ratio was 12/16. EBD was successful in all the 28 cases. The total success rate was 100.00%. Complications occurred in 6 patients during the dilatation, and no complication in 22 patients. Completely remission of symptoms was seen in 82.14% cases (n = 23), relief in 14.28% (n = 4), non-response in 3.57% (n = 1), and recurrence in 3.57% (n = 1). The stricture diameter before EBD was (6.28 ± 1.77) mm (range 3.0 ~ 10.0 mm), and it was (10.85 ± 2.51) (range 6 ~ 15 mm) after the last EBD. The difference was significant (P 0.05). The effectiveness of EBD was significantly associated with the diameter and number of strictures (P 0.05). Conclusions The results of this study indicated that EBD under general anesthesia was an effective primary treatment in children with esophageal stricture and esophageal achalasia. The diameter and number of stricture were the most important predictive factors for successful clinical outcomes, while the interval between surgery and the first EBD was the most risk factor for EBD sessions in the patients with anastomotic esophageal strictures.
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[Summary] Benign esophageal strictures can arise from various causes and mainly induce dysphagia .Commonly , the majority of benign esophageal strictures can achieve long-term relief through about three dilation sessions .However, some refractory benign esophageal strictures require other treatments , such as endoscopic stent placement and intralesional drug injection , but these treatments just attain short-time satisfactory results with a disappointingly low rate of long-term improvement.Recently, biodegradable stents and drug-eluting stents are developing and have obtained the positive effects .In this paper , we performed a review about the treatment of benign esophageal strictures .
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Objective To investigate therapeutic effect of endoscope?guided bougie dilatation on children with benign esophageal stricture. Methods Data of 71 patients with benign esophageal stricture were retrospective analyzed.Patients were divided into group A (reflux stricture),B (congenital esophageal atresia stricture) and C ( caustic injuries stricture) ,based on different causes. The expansion effectiveness and factors of the three groups were analyzed. Results A total of 885 expansions were performed on 71 patients with the total efficacy rate 94?37%( 67/71) . No statistic differences were shown in expansion effectiveness among the 3 groups; group C ( 14?9 times/case, P < 0?05 ) showed more expansion frequencies than group A (9?1 times/case,P<0?05)and group B(10?7 times/case, P<0?05),more complications than group A(1?22%VS 0,P<0?05) and group B(1?22% VS 0?31%,P<0?05). Conclusion Endoscope?guided bougie dilatation is safe and effective for childrens′ benign esophageal stricture. Caustic injuries, refractory benign esophageal stricture,need more expansions and may be accompanied with more complications.
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Las estenosis esofágicas benignas son una causa común de consulta en los servicios de endoscopia y gastroenterología. Usualmente, dada su naturaleza no neoplásica, estas se han manejado con dilataciones endoscópicas a repetición, incómodas y costosas para el paciente, dada su constante repetición; además de tener siempre el riesgo de perforación esofágica en cada sesión. El uso de prótesis esofágicas para manejo de las estenosis esofágicas benignas viene en progresivo aumento con resultados prometedores para varias de las etiologías de este tipo de obstrucciones. Presentamos el caso de una estenosis esofágica benigna secundaria a infección por Histoplasma capsulatum, manejada con una prótesis metálica totalmente cubierta con resolución completa de la obstrucción.
Benign esophageal strictures are a common cause of medical consultation and gastroenterological endoscopy. Usually, given their non-neoplastic nature, they have been managed with recurrent endoscopic dilation which is uncomfortable for the patient and which generates high costs due repetition. In addition, there is always the risk of esophageal perforation at every session. The use of esophageal stents for management of benign esophageal strictures is becoming increasingly more common and is promising for various etiologies. We present a case of a benign esophageal stricture secondary to infection with histoplasma capsulatum which was managed entirely with a completely covered metal stent. This led to complete resolution of the obstruction.
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Humans , Male , Adult , Esophageal Stenosis , Histoplasma , Prostheses and ImplantsABSTRACT
Stent implantation plays a more and more important role in the treatment of benign esophageal stenosis. Metal stents are most commonly used in the clinical practice, which can be classified into permanent stents and temporary retrieval stents. Permanent implantation of metal stents is easy to cause complications such as inflammatory hyperplasia, in-stent restenosis, perforation, bleeding, etc. Temporary retrieval stents should be removed with one week after it is implanted in order to avoid esophageal scar tissue repair and in-stent tissue hyperplasia, which can cause difficulty in its removing and produce higher recurrence rate of esophageal restenosis. Clinically, drug-eluting stents have already been used in cardiovascular system procedures, but at present the gastrointestinal drug-eluting stents are still in development and animal experiment stage. Biodegradable magnesium alloy stents have been widely employed in cardiovascular system procedures. With the rapid development of biological engineering materials, drug-eluting magnesium alloy stent has become a hot spot and the frontier in research field. This paper aims to make a comprehensive review about the current research status and prospect of the drug-eluting magnesium alloy stents, focusing on the stent technology, stent molding, coating modification, and the treatment of drug-eluting.
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BACKGROUND AND OBJECTIVES: To report our experience of colon interposition without thoracic inlet widening for the management of esophageal stricture. SUBJECTS AND METHOD: Between 2005 and 2012, five patients underwent esophageal replacement using colon graft. Clinical data, such as surgical techniques including thoracic inlet widening, surgical outcomes, and patient's age and gender were retrospectively analyzed. The follow-up period ranged from 10 months to 5 years. RESULTS: All five patients had corrosive esophageal stricture and underwent colon interposition without thoracic inlet widening; four underwent pharyngocologastrostomy and one total laryngopharyngectomy and pharyngocologastrostomy. No major complications, such as aspiration, dysphagia, reflux, or swallowing disorder developed during the postoperative long term follow-up. CONCLUSION: A colon graft without enlargement of the thoracic inlet is an excellent esophageal substitute for patients with an esophageal corrosive stricture. Further surgical experience and more long-term follow-up data are required to produce more precise and statistically meaningful results.
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Humans , Bays , Colon , Constriction, Pathologic , Deglutition Disorders , Esophageal Stenosis , Follow-Up Studies , Retrospective Studies , TransplantsABSTRACT
In the present report, we describe a case of long-term follow-up esophageal stricture occurring in a patient with nasogastric tube use. A 63-year-old man who had experienced dislocation of the 6th and 7th cervical vertebrae as the result of an external injury received treatment at another hospital and was admitted to the rehabilitation department of our hospital. After he exhibited normal swallowing in a videofluoroscopic swallowing test, the nasogastric tube was removed and oral feeding with a dysphagia diet was initiated. However, during oral feeding, the patient complained of swallowing difficulties in his lower throat. An esophagogastroduodenoscopy was performed to examine the lesions below the pharynx and a 2-mm stricture was observed. A balloon dilatation was performed for a total of 9 times to extend the stricture. After the procedure, the patient was able to easily swallow a normal diet through the esophagus and the vomiting symptoms disappeared. An esophagography showed that the diameter of the esophageal stricture was 11 mm.
Subject(s)
Female , Humans , Middle Aged , Cervical Vertebrae , Constriction, Pathologic , Deglutition , Deglutition Disorders , Diet , Dilatation , Joint Dislocations , Endoscopy, Digestive System , Esophageal Stenosis , Esophagus , Follow-Up Studies , Pharynx , Rehabilitation , VomitingABSTRACT
Esophageal candidiasis is a common opportunistic infection that develops in human immunodeficiency virus (HIV)-infected patients. It is usually effectively treated with fluconazole, and the occurrence of an esophageal stricture in association with esophageal candidiasis has rarely been reported in HIV-infected patients. In the case presented here, a 49-year-old man was diagnosed with severe esophageal candidiasis with HIV infection. At the time of the HIV diagnosis, he had immunodeficient status with a CD4+ T lymphocyte count of 150 cells/mm3. He received antifungal treatment with fluconazole and combined antiretroviral therapy. Although the esophageal candidiasis improved with rapid recovery of the CD4+ T lymphocyte count, a recurrent esophageal stricture developed. To treat the recurrent esophageal stricture, the patient received repeated balloon dilatation and stent insertion. We report this rare case of severe esophageal stricture complication of esophageal candidiasis in an HIV-infected patient.
Subject(s)
Humans , Middle Aged , Candidiasis , Dilatation , Esophageal Stenosis , Fluconazole , HIV , HIV Infections , Lymphocyte Count , Opportunistic Infections , StentsABSTRACT
Esophageal candidiasis is a common opportunistic infection that develops in human immunodeficiency virus (HIV)-infected patients. It is usually effectively treated with fluconazole, and the occurrence of an esophageal stricture in association with esophageal candidiasis has rarely been reported in HIV-infected patients. In the case presented here, a 49-year-old man was diagnosed with severe esophageal candidiasis with HIV infection. At the time of the HIV diagnosis, he had immunodeficient status with a CD4+ T lymphocyte count of 150 cells/mm3. He received antifungal treatment with fluconazole and combined antiretroviral therapy. Although the esophageal candidiasis improved with rapid recovery of the CD4+ T lymphocyte count, a recurrent esophageal stricture developed. To treat the recurrent esophageal stricture, the patient received repeated balloon dilatation and stent insertion. We report this rare case of severe esophageal stricture complication of esophageal candidiasis in an HIV-infected patient.
Subject(s)
Humans , Middle Aged , Candidiasis , Dilatation , Esophageal Stenosis , Fluconazole , HIV , HIV Infections , Lymphocyte Count , Opportunistic Infections , StentsABSTRACT
ObjectiveTo explore the safety and efficacy of endoscopic dilatation combined with submucosal injection of triamcinolone acetonide in treatment of benign esophageal stricture.MethodsThe patients of benign esophageal stricture proved by biopsy were randomly divided into three groups.Group A were treated by expansion only,group B were injected with triamcinolone acetonide submucosal combined with expansion,and we treated group C by another injection a week later on the basis of treatment in group B.A 12 months' follow-up was conducted,the dysphagia score,the cure rate.time to sustained symptom relief,re-expansion time interval and adverse reactions were recorded.ResultsSome patients experienced chest pain and regurgitation after the procedure and all improved by corresponding managements.No complications including massive bleeding,infection,perforation or local tissue atrophy were observed.The dysphagia scores in 3 groups after the procedure were all improved ( P ＜ 0.05 ),and no significant difference was noticed between 3 groups (P ＞ 0.05 ).At the end of the follow-up,the duration of dysphagia remission and the interval between 2 consecutive dilatation in Group A were 14.4 ± 3.2 weeks and 18.2 ± 3.7 weeks,respectively,which were significant shorter than those in Group B ( 19.3 ±3.9 weeks and 24.6 ±4.2 weeks,respectively) and those in Group C (20.2 ±4.2 weeks and 26.1 ±4.5 weeks,respectively),while there was no difference between Groups B and C.The cure rate in Group C (43.5％,10/23) was significantly higher than that of Group A (29.2％,7/24) or Group B (27.3％,6/22),while there was no difference between Groups A and B.ConclusionEndoscopic dilatation combined with submucosal injection of triamcinolone acetonide is safe and may improve the symptoms of dysphagia and delay the re-stenosis for patients with benign esophageal stricture,meanwhile,multi-frequency treatment may improve the cure rate.
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Objective To observe the effects of esophageal stricture treated with esophageal stenting.Methods 23 esophagus stenosis patients were expanded to 1 lmm,and the stent was implanted-.Results 23 patients were set into successfully,7 cases could enter the common food,11 caces could enter the soft food,5 cases could enter the semiliquid food.18 cases had the ache,6 cases had the stomach esophagus regurgitation symptom.During 1?12 month follow-up,10 cases survived,13 cases died,the cause of death was mainly later period cancer failure and metastasis.Conclusion Esophagus stenosis treatment operation was simple,safe,and the wound small,the short-term curative effect would be good.
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Self-expandable metallic stents (SEMS) are widely used for the palliative treatment of malignant strictures of the gastrointestinal tract. Recently, several studies tested whether a SEMS is an effective and safe option for benign esophageal stricture. Serious complications such as hemorrhage, compression of the bronchus, bronchoesophageal fistula, and esophageal rupture were infrequently encountered as complications of esophageal stent placement. Aortoesophageal fistula is extremely rare as a complication of esophageal SEMS insertion; only seven cases have been reported worldwide. We now report a case of an 80-year old female with aortoesophageal fistula after placement of a SEMS for an esophageal stricture.