Benign Strictures of the Esophagus and Gastric Outlet: Interventional Management

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.

Phytobezoar as a late complication of vertical banded gastroplasty

In the last two decades, bariatric surgery has become a popular mean for treating morbid obesity. Although the newer procedures are claimed to have less complications than the older ones, the world is still at a learning curve. Numerous complications of this surgery are known and require recognition to be appropriately treated. Phytobezoar is one of the rare late complications following Bariatric surgery and various factors can contribute to its development including hypochlorhydria, diminished antral motility, and incomplete mastication. The case being presented is a rare case of gastric outlet obstruction due to phytobezoar almost two years following vertical banded gastroplasty. The patient was successfully treated with Sodium Docusate, which is a faecal softener and weak stimulant laxative. To our knowledge, this is the first case report presenting such a complication following vertical banded gastroplasty. Phytobezoar should be considered in the differential diagnosis of epigastric symptoms in patients with a history of gastric surgery. Sodium docusate was an effective medical therapy in this patient

Balloon Sheaths for Gastrointestinal Guidance and Access: A Preliminary Phantom Study

OBJECTIVE: We wanted to evaluate the feasibility and usefulness of a newly designed balloon sheath for gastrointestinal guidance and access by conducting a phantom study. MATERIALS AND METHODS: The newly designed balloon sheath consisted of an introducer sheath and a supporting balloon. A coil catheter was advanced over a guide wire into two gastroduodenal phantoms (one was with stricture and one was without stricture) ; group I was without a balloon sheath, group ll was with a deflated balloon sheath, and groups III and IV were with an inflated balloon and with the balloon in the fundus and body, respectively. Each test was performed for 2 minutes and it was repeated 10 times in each group by two researchers, and the positions reached by the catheter tip were recorded. RESULTS: Both researchers had better performances with both phantoms in order of group IV, III, II and I. In group IV, both researchers advanced the catheter tip through the fourth duodenal segment in both the phantoms. In group I, however, the catheter tip never reached the third duodenal segment in both the phantoms by both the researchers. The numeric values for the four study groups were significantly different for both the phantoms (p < 0.001). A significant difference was also found between group III and IV for both phantoms (p < 0.001). CONCLUSION: The balloon sheath seems to be feasible for clinical use, and it has good clinical potential for gastrointestinal guidance and access, particularly when the inflated balloon is placed in the gastric body.