ABSTRACT
Since its introduction as an alternative intestinal lengthening technique, the serial transverse enteroplasty (STEP) procedure has been used increasingly as the surgical treatment of choice for children with short bowel syndrome (SBS). On the other hand, there are few report of its efficacy in adults with SBS, particularly those who have previously undergone a gastrectomy. This case report describes a 34-year-old woman with a short bowel after an esophagectomy and total gastrectomy due to lye ingestion followed by an extensive intestinal resection due to small bowel strangulation. The STEP procedure was performed successfully and the small intestine was lengthened from 55 to 75 cm. The patient tolerated the procedure well and was weaned off total parenteral nutrition. The frequency and characteristics of diarrhea improved, and her weight remained acceptable via management with intermittent parenteral nutritional support for 6 months postoperatively. This case suggests that the STEP procedure should be considered for gastrectomized patients with SBS.
Subject(s)
Adult , Child , Female , Humans , Diarrhea , Eating , Esophagectomy , Gastrectomy , Hand , Intestine, Small , Lye , Nutritional Support , Parenteral Nutrition, Total , Short Bowel SyndromeABSTRACT
Describir las características clínicas y endoscópicas de las lesiones producidas por cáusticos en el tracto digestivo superior en pacientes del Hospital Nacional Daniel Alcides Carrión. Materiales y métodos: Se realizó un estudio descriptivo, se incluyó a pacientes con diagnóstico de ingesta de cáusticos admitidos en el servicio de Gastroenterología del HNDAC para la realización de una endoscopia digestiva alta durante el periodo de enero del 2009 a diciembre del 2012. Se documentó el tipo de sustancia cáustica ingerida, causa de ingesta, cantidad ingerida, modo de ingesta, síntomas o signos presentes, hallazgos endoscópicos según la clasificación de Zargar, presencia de complicaciones y tratamiento realizado. Se realizó el análisis descriptivo comparándolos según la sustancia cáustica ingerida: ácido o álcali. Resultados: Se obtuvieron 91 pacientes, la edad promedio fue de 30,6 +/- 16,3 años. Las sustancias caústicas ingeridas fueron: lejía (hipoclorito de sodio) en 71 (78%) pacientes, ácido muriático (ácido clorhídrico) en 18 (20%) pacientes, soda cáustica en 2 (2%) pacientes. La cantidad promedio ingerida fue de 136ml (entre 30-500 ml). Los síntomas y signos más frecuentes fueron: vómitos, dolor abdominal, náuseas y odinofagia. El 46% de los pacientes presentaron lesiones. El 100% de los pacientes que ingirieron ácido y el 33% de los que ingirieron álcali presentaron lesiones. Cinco (5%) pacientes presentaron lesiones orofaríngeas, 24 (26%) en esófago, 36 (40%) en estómago y 12 (13%) en duodeno. Se encontró 10 (11%) pacientes con lesiones de grado I, 16 (18%) pacientes con lesiones de grado II y 15 (16%) de pacientes con lesiones de grado III; 12 pacientes que consumieron ácido presentaron lesiones de grado III. Estenosis esofágica se encontró en 2 (2%) pacientes, estenosis gástrica en 7 (8%) pacientes y estenosis esofágica y gástrica en 3 (3%) pacientes. Dos pacientes requirieron dilataciones neumáticas y 10 tratamiento quirúrgico...
To describe the clinical and endoscopic features of caustics injuries in the upper gastrointestinal tract in patients of the National Hospital Daniel Alcides Carrión. Materials and methods: A descriptive study was conducted; the study populations were patients diagnosed with caustic ingestion who were admitted into the Gastroenterology service of the HNDAC to perform an upper endoscopy during the period of January 2009 to December 2012. We documented the type of caustic substance ingested, cause of intake, amount ingested, intake mode, signs or symptoms present, endoscopic findings as classified by Zargar, presence of complications and treatment performed. Analysis was performed comparing them based on the ingested caustic type: acid or alkali. Results: We obtained 91 patients; the average age was 30.6 +/- 16.3 years. Caustic substances ingested were: bleach (sodium hypochlorite) in 71 (78%) patients, muriatic acid (hydrochloric acid) in 18 (20%) patients, caustic soda in 2 (2%) patients. The average intake was 136ml (30-500 ml). The most frequent signs and symptoms were vomiting, abdominal pain, nausea and sore throat. The 46% of patients had injuries. 100% of patients who ingested acid and 33% who ingested alkali had lesions. Five (5%) patients had oropharyngeal lesions, 24 (26%) in the esophagus, 36 (40%) in the stomach and 12 (13%) in the duodenum. Grade I lesions were found in 10 (11%) patients, 16 (18%) patients with grade II lesions and 15 (16%) of patients with grade III, 12 patients who toke acid had lesions of grade III. Esophageal stricture was found in 2 (2%) patients, gastric stenosis in 7 (8%) patients and esophageal and gastric stenosis in 3 (3%) patients. Two patients required pneumatic dilation and 10 surgical treatments...
Subject(s)
Humans , Caustics , Endoscopy, Gastrointestinal , Wounds and Injuries , Lye/adverse effects , Gastrointestinal Tract/injuries , Epidemiology, Descriptive , PeruABSTRACT
Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.
Subject(s)
Aged , Female , Humans , Carcinoma, Squamous Cell/diagnosis , Diagnosis, Differential , Esophageal Neoplasms/diagnosis , Esophageal Stenosis/chemically induced , Esophagoscopy , Hyperplasia/diagnosis , Iodides/chemistry , Lye/toxicityABSTRACT
Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.
Subject(s)
Aged , Female , Humans , Carcinoma, Squamous Cell/diagnosis , Diagnosis, Differential , Esophageal Neoplasms/diagnosis , Esophageal Stenosis/chemically induced , Esophagoscopy , Hyperplasia/diagnosis , Iodides/chemistry , Lye/toxicityABSTRACT
OBJECTIVE: We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture. MATERIALS AND METHODS: The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). RESULTS: A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD. CONCLUSION: Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Acetic Acid/poisoning , /methods , Burns, Chemical/diagnostic imaging , Caustics/poisoning , Deglutition Disorders/etiology , Esophageal Stenosis/chemically induced , Esophagus/diagnostic imaging , Lye/poisoning , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: Though caustic injury of the upper digestive tract can lead to severe sequelae, there are few clinical studies on this subject. This study was undertaken to evaluate the clinical characteristics, the endoscopic findings and the risk factors of the upper digestive lesions in patient with caustic ingestion injury. METHODS: We retrospectively reviewed the medical records of 137 patients who ingested caustic materials and who visited to our emergency room from January, 2000 to June, 2009. RESULTS: The most common ingested agent was sodium hypochlorite (44.5%), followed by acetic acid (19.7%), hydrochloric acid (11.7%) and lye (8.0%). Ingestion for suicidal attempt (62.0%) was more frequent than accidental ingestion (30.7%). Grade IIa injury was the most frequent finding on endoscopy of the esophagus and Grade I injury was the most frequent finding on endoscopy of the stomach. For the late sequelae, there were 9 cases (6.6%) of esophageal stricture and 2 cases (1.5%) of gastric outlet obstruction. The initial signs and symptoms did not correlate with the development of stricture, but leukocytosis, and grade III injury were related to the risk of developing stricture. CONCLUSION: Caustic injury of the upper gastrointestinal tract is frequently observed on early endoscopy and it can cause significant late sequelae such as stricture. Therefore, it is necessary to evaluate these patients with regular follow up endoscopic examinations for the management of late sequelae.
Subject(s)
Humans , Acetic Acid , Constriction, Pathologic , Eating , Emergencies , Endoscopy , Esophageal Stenosis , Esophagus , Follow-Up Studies , Gastric Outlet Obstruction , Gastrointestinal Tract , Hydrochloric Acid , Leukocytosis , Lye , Medical Records , Retrospective Studies , Risk Factors , Sodium Hypochlorite , Stomach , Upper Gastrointestinal TractABSTRACT
Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature.
Subject(s)
Child , Humans , Middle Aged , Alkalies , Dilatation , Eating , Esophageal Stenosis , Esophagus , Inflammation , Lye , Mitomycin , Mucous Membrane , StentsABSTRACT
Se estudiaron 187 pacientes, entre 2-72 meses, 104/187 (55.61 por ciento) varones y 83/187 (44.38 por ciento) hembras. 173/187 (92.51 por ciento) se incluyeron en el grupo A (evaluación temprana) y 14/187 (7.48 por ciento) en el B (evaluación tardía). En ambos, el cáustico ingerido principalmente fue el hidróxido de sodio (lejía) (52 por ciento y 21.43 por ciento, respectivamente). El hidróxido de sodio (soda cáustica), easy off), el amoníaco, el ácido sulfúrico y la nieve carbónica (hielo seco) son los agentes productos de lesiones más severas en orofaringe y esófago. El grupo A prersentó vómitos (48.55), sialorrea (20.23 por ciento) y disfagia (10.40 por ciento), y el B disfagia (92.85 por ciento), vómitos (57.14 por ciento) y odinofagia (35.71 por ciento). A todos se les realizó endoscopia digestiva superior, dilataciones precoces en esofagitis grado II-III y dilataciones terapaúticas en los pacientes de evaluación tardía. El grupo A se resolvió con éxito. Ningún paciente ameritó intervención quirúrgica. Concluimos, que la endoscopia digestiva superior y las dilataciones precoces constituyen un método adecuado para manejar pacientes con lesiones esofágicas por cáustica antes de las 48 horas de evolución
Subject(s)
Humans , Male , Child, Preschool , Female , Infant , Child , Acids/analysis , Caustics , Endoscopy, Digestive System , Esophageal Stenosis/etiology , Gastric Dilatation , Infant Nutrition Disorders , Lye/administration & dosage , Sodium , Gastroenterology , Pediatrics , VenezuelaABSTRACT
La ingesta de cáusticos representa un grave problema a menudo de consecuencias devastadoras, sobre el esófago y estómago. OBJETIVOS.- 1) Determinar el principal agente cáustico ingerido y las lesiones de la mucosa esófago-gástrica. 2) Conocer las características clínico-epidemiológicas de estos pacientes en nuestro hospital. RESULTADOS.- Se evaluó 45 pacientes hospitalizados en el Hospital nacional Hipólito Unanue entre 1996 y el año 2001, 29 pacientes fieron mujeres (64.4 por ciento) y 16 varones (35.6 por ciento) con un promedio de edad de 28 años y un rango entre 15 a 60 años. Las sustancias cáusticas ingeridas fueron: lejía 30 pacientes (66.7 por ciento), acido muriático 13 pacientes (28.9 por ciento), acido nítrico y soda cáustica con un paciente cada uno (2.2 por ciento). En las mujeres: 24 pacientes ingirieron lejía (82.7 por ciento), 4 pacientes ácido muriático (13.7 por ciento), y un paciente soda cáustica (3.4 por ciento), en los varones: 9 pacientes ácido muriático (56.3 por ciento), 6 pacientes lejía (37.5 por ciento), 01 pacientes ácido nítrico (6.25 por ciento). 29 pacientes ingirieron los cáustico en forma pura (64.4 por ciento) y 16 pacientes en forma diluida con otras sustancias: agua, bebidas alcohólicas, gaseosa, quacker, (35.5 por ciento). El tiempo entre la ingesta y la atención fue de 104 minutos, rango entre 15 y 360 munitos. El promedio de solución total fue 73 ml., con un rango entre 10 ml. y 170 ml. En 24 pacientes (53.4 por ciento) el motivo de ingesta fue conflictos con su pareja, conflicto familiar en 13 pacientes (28.9 por ciento), accidentes en 4 pacientes (8.9 por ciento), problemas psiquiátricos en 3 pacientes (6.7 por ciento) y el factor económico en 1 paciente (2.2 por ciento). Los signos y síntomas de ingreso fueron : dolor abdominal en 31 pacientes (68.9 por ciento), nauseas en 22 pacientes (48.9 por ciento), vómitos en 21 pacientes (46.7 por ciento), dolor en cavidad bucal (31.1 por ciento), odinofagia en 13 pacientes (15.6 por ciento), transtorno del sensorio en 7 pacientes (15.6 por ciento), disfonía en 3 pacientes (6.7 por ciento) y cefalea en 1 paciente (2.2 por ciento). El compromiso oral fue: normal en 11 pacientes (24.4 por ciento), congestión 23 pacientes (51.1 por ciento) y erosiones 11 pacientes (24.1 por ciento)...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Esophagitis , Acids , Lye , Retrospective StudiesABSTRACT
Aortoesophageal fistula induced by endoesophageal stent is rare;however,it is usually a fatal disorder,with few survivors reported.We report a case of a 32-year old female with aortoesophaeal fistula after insertion of the esophageal stent in esophageal lye stricture who was successfully diagnosed with endoscopy and treated in a two-stage operation.In the first stage,we performed esophagectomy,primary repair of the fistula site in the descending thoracic aorta,and feeding gastrostomy.After the patient recovered well postoperatively,a retrosternal interposition of the right colon and cervical esophago-colo-grastostomy were performed,to re-establish the gastrointestinal tract.
Subject(s)
Adult , Female , Humans , Colon , Constriction, Pathologic , Endoscopy , Fistula , Gastrointestinal Tract , Lye , Stents , SurvivorsABSTRACT
BACKGROUND/AIMS: The incidence of corrosive injury has been decreased, compared with past years. However, the ingestion of corrosive agent for suicidal attempt is on an increasing trend. Though corrosive injury on gastrointestinal tract is very common, there are few clinical studies on this field. METHODS: Retrospective study was performed on 48 patients who ingested corrosive agent from 1992 to 1998. The kinds of corrosive agent, cause of ingestion, symptoms, gastroscopic findings, treatment and complications were analyzed. RESULTS: The most common agent of ingestion was acetic acid (47.9%), followed by hydrocholoric acid (18.8%), cresol (10.4%), lye (10.4%), sulfuric acid (4.2%). Ingestion for suicidal attempt (60.4%) was more frequent than accidental ingestion (39.6%). The frequent symptoms were sore throat (31.3%), dysphagia (27.1%), epigastric pain (22.9%), vomiting (18.8%), chest pain (18.8%), GI bleeding (12.5%), dyspnea (12.5%) and hematuria (8.3%). The esophagus was the most common site of corrosive injury and Grade IIa injury was the most frequent finding on gastroscopy. In most cases, prophylactic antibiotics with or without steroid was administered for conservative treatment. For long-term sequelae, there were 7 cases (14.6%) of esophageal stricture, and 2 cases (4.2%) of gastric outlet obstruction. CONCLUSIONS: Corrosive injury on gastrointestinal tract is frequently observed on early gastroscopy and can cause significant late sequelae, such as stricture. Therefore, it is necessary to evaluate regular follow up gastroscopy for the management of late sequelae.
Subject(s)
Humans , Acetic Acid , Anti-Bacterial Agents , Chest Pain , Constriction, Pathologic , Deglutition Disorders , Dyspnea , Eating , Esophageal Stenosis , Esophagus , Follow-Up Studies , Gastric Outlet Obstruction , Gastrointestinal Tract , Gastroscopy , Hematuria , Hemorrhage , Incidence , Lye , Pharyngitis , Retrospective Studies , Sulfur , Upper Gastrointestinal Tract , VomitingABSTRACT
The principal manifestation of poisoning induced by the alkaline substance is a corrosive effects in tissues. The alkalies combine with protein and fat of the tissue, causing deep penetrating injury and liquefactive necrosis of the organs. Liquid lye is the most frequently ingested form of corrosive agents and causes most of the deaths associated with corrosive agent ingestion. We have experienced 5 fatal cases which were accidentally administered liquid lye as soap-saline enema in the hospital during 30 days. the 3 cases of them were autopsied at this institute. At autopsy, the digestive tract including rectum, colon and small intestine revealed hemorrhagic necrosis with multiple area of perforation. Because these were the first proved cases that the liquid lye was used as enema solution, we report here.
Subject(s)
Alkalies , Autopsy , Colon , Corrosion , Eating , Enema , Gastrointestinal Tract , Intestine, Small , Lye , Necrosis , Poisoning , RectumSubject(s)
Humans , Male , Female , Lye/adverse effects , Esophageal Stenosis , Esophagitis/etiologyABSTRACT
Ten cases with esophageal foreign body were treated surgically from July 1980 to October 1995 at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. The mean age was 45.3 years, with a range from 25 to 71. Out of ten cases, 6 were female and four were male. Common symptoms were dysphagia, fever, foreign body sensation and neck pain. Three cases of foreign bodies were of fish bones, two of bubble package of drugs, one case of a beer bottle cap, one of a piece glass, one of a bathtub plug, one of chicken and one of a bean. The diagnosis was established by esophagography using a water soluble contrast material and esophagoscopy. Among of ten cases, two had esophageal stricture due to the ingestion of lye at a young age. One case had experienced psychological problems. All foreign bodies were removed by surgical procedures. Five cases were treated by cervical esophagostomy, one case by right thoracotomy, one case by retrograde bougienation through gastrostomy and two cases by cervical incision and drainage for cervical abscess. Three cases developed post operative esophageal leaks which healed spontaneously and transient hoarseness developed in one case. One case developed traumatic pneumothorax and subcutaneous emphysema which was treated by closed thoracostomy. There were no operative deaths.
Subject(s)
Female , Humans , Male , Abscess , Beer , Chickens , Deglutition Disorders , Diagnosis , Drainage , Eating , Esophageal Stenosis , Esophagoscopy , Esophagostomy , Esophagus , Fever , Foreign Bodies , Gastrostomy , Glass , Hoarseness , Lye , Neck Pain , Pneumothorax , Sensation , Subcutaneous Emphysema , Thoracostomy , ThoracotomyABSTRACT
We experienced a case of unusual complication following esophageal reconstruction. In 1969, accidentally the patient swallowed lye and was developed benign esophageal stricture one year later. In 1972, esophageal reconstruction with right colon was done but pus was drained out of the abdominal wound. After then wound disruption and healing were repeated. In 1996, stenosis of colonic graft was found and resection of stenotic area and end to end anastomosis was done. We concluded that it was developed inflammatory change of graft by intraoperative infection.
Subject(s)
Humans , Abscess , Colon , Constriction, Pathologic , Esophageal Stenosis , Lye , Postoperative Complications , Suppuration , Transplants , Wounds and InjuriesABSTRACT
Swallowing caustic materials may produce full-thickness burn and loss of esophageal function. Caustics, both acid and alkalis, can corrode and destroy living tissue. Full-thickness burn of esophiageal epithelium causes severe stricture which frequently requires surgical repair. Recently, non-operative dilatation of luminal stenosis has been utilized. Esophageal endoscopic endoprosthesis has been used widely in malignant esophageal stricture but not in benign stricture. In recurrent benign esophageal stricture following repetitive balloon dilatation, we experienced a case of an 18-year-old woman with severe stricture which was successfully managed by esophageal endoprosthesia So we report this case with the review of the literature.
Subject(s)
Adolescent , Female , Humans , Alkalies , Burns , Caustics , Constriction, Pathologic , Deglutition , Dilatation , Epithelium , Esophageal Stenosis , Lye , PhenobarbitalABSTRACT
Swallowing caustic materials may produce full-thickness burn and loss of esophageal function. Caustics, both acid and alkalis, can corrode and destroy living tissue. Full-thickness burn of esophiageal epithelium causes severe stricture which frequently requires surgical repair. Recently, non-operative dilatation of luminal stenosis has been utilized. Esophageal endoscopic endoprosthesis has been used widely in malignant esophageal stricture but not in benign stricture. In recurrent benign esophageal stricture following repetitive balloon dilatation, we experienced a case of an 18-year-old woman with severe stricture which was successfully managed by esophageal endoprosthesia So we report this case with the review of the literature.
Subject(s)
Adolescent , Female , Humans , Alkalies , Burns , Caustics , Constriction, Pathologic , Deglutition , Dilatation , Epithelium , Esophageal Stenosis , Lye , PhenobarbitalABSTRACT
PURPOSE: To assess the effects and complications of balloon dilatation in the treatment of postoperative stricture at the gastrointestinal tract. MATERIALS AND METHODS: From February 1991 to July 1993, balloon dilatation was performed under fluoroscopic guidance on 5 patients (age:l month to 64 yrs, male:female=2:3) who previously had undergone abdominal surgery because of stomach cancer (n=2), congenital tracheoesophageal fistula (n=l), lye stricture (n=l), and colon cancer (n=l). Causes of the stricture were all benign (n=4) except for one (recurrence of malignant tumor). We dilatated the stricture site with balloon catheter (8--25 mm in diameter) 3 to 4 times per session which was repeated 1 to 5 times in each patient. Follow-up periods ranged 8 to 15 months after the treatment. RESULTS: Two out of four benign strictures were relieved at one session, and the remaining two needed repeated sessions of balloon dilatation. Symptoms did not improve in the patient with malignant stricture in~pite of balloon dilatation, and feeding jejunostomy was reginred. Partial tear of anastomosis site occurred in one patient, however, it did not require any treatment. CONCLUSION: Balloon dilatation is relatively safe and effective in the treatment of postoperative stricture at the gastrointestinal tract.
Subject(s)
Humans , Catheters , Colonic Neoplasms , Constriction, Pathologic , Dilatation , Follow-Up Studies , Gastrointestinal Tract , Jejunostomy , Lye , Stomach Neoplasms , Tracheoesophageal FistulaABSTRACT
The patient was a 51 year-old woman suffering fraen dysphagia due to upper esoyhageal lye stricutue whieh had developed as a result of a suicide attempt 21 years ago. Shortly after that, she underwent feeding gastrostomy and has lived in the gastrostomy state for 2l years. After admission, she underwent a barium esophagoram which revealed a near total obstruction at the cricoid cartilage level. Bougie dilatation with American Dilation System was tried on day 3. But the spring tip marked guide wire which was to be used with the American Dilation System could not be passed through the stricuture. Therefore, we performed a bougie dilatation using angiographic guide wire M(H-AG-35in-150 cm) with success. On day 14, she underwent a barium esophagogram which revealed her improved condition, and she was discharged on day 16.