Risk factors of restenosis after dilation of anastomotic stenosis in patients with esophageal cancer surgery / 中华全科医师杂志

Objective:To investigate the risk factors of restenosis after dilation of anastomotic stenosis in patients with esophageal cancer surgery.Methods:Clinical data of 997 patients who underwent endoscopic dilation due to anastomotic stenosis after esophageal cancer radical surgery in the Affiliated Huai′an First Hospital of Nanjing Medical University from June 2015 to July 2021, were retrospectively analyzed. There were 486 cases receiving single dilation (single dilation group) and 511 cases receiving more than two dilations (multiple dilation group). The risk factors of restenosis were explored using univariate and multivariate logistic regression analysis.Results:There were 682 males and 315 females with a median age of 65 years, the median distance between the stenosis and incisor was 20 (20, 22) cm, the median stenosis diameter was 4 (3, 5) mm, and the median stenosis diameter after dilation was 11 (11, 13) mm. Univariate analysis showed that there were significant differences in the distance of the stenosis and incisor ( Z=-2.303, P<0.05), stenosis diameter ( Z=-4.637, P<0.05) and stenosis diameter after dilation ( Z=-5.773, P<0.05) between single and multiple dilation groups. Stratified multivariate logistic regression showed that for male patients, risk of multiple dilations dropped by approximately 3% for every 1-mm increase in the distance between the stenosis and incisor ( OR=0.97, 95% CI:0.93-1.00, P=0.047); the risk of multiple dilations decreased by about 15%, for every 1-mm increase in stenosis diameter ( OR=0.85, 95% CI:0.76-0.94, P=0.004); the risk of multiple dilations decreased by about 13% for every 1-mm increase in stenosis diameter after dilation ( OR=0.87, 95% CI:0.78-0.96, P=0.007). For females patients under 60 years old, the risk of multiple dilations decreased by about 31%, for every 1-mm increase in stenosis diameter after dilation ( OR=0.69, 95% CI:0.47-0.98, P=0.049); for female patients≥60 years old, the risk decreased by about 5%, for every 1-year increase in age ( OR=0.95, 95% CI:0.91-1.00, P=0.037), risk of multiple dilations dropped by 17%( OR=0.83, 95% CI:0.70-0.99, P=0.039) for every 1 mm increase in stenosis diameter after dilation. Stratified smooth curve fitting indicated that the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm were risk factors for multiple dilations. Conclusions:The study indicates that patients with the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm may need multiple dilations; and the first dilation should expand the stenosis diameter to 12 mm or above as far as possible to reduce the risk of restenosis in patients receiving esophageal cancer radical surgery.

Aberrant right subclavian artery in a dog - case report / [Ectopia de artéria subclávia direita em cão - relato de caso]

The brachiocephalic trunk and the left subclavian artery originate from the aortic arch, and both supply blood to the head, neck, and thoracic limbs. Anatomical variations, such as an aberrant right subclavian artery, are congenital conditions rarely observed in dogs, Thus, the objective of the present report was to describe a case of aberrant right subclavian artery in a 9-year-old Dalmatian. However, this anomaly was a finding in which the patient was asymptomatic during its 9 years of life and only at this age did he exhibit signs including sialorrhea, vomiting, hyporexia, and noisy deglutition. Blood count, biochemical profile, and thoracic radiography led to a diagnosis of megaesophagus and aspiration pneumonia. Despite the recommended treatment, the patient did not respond well; as such, the owner elected to euthanize the animal. On necropsy, the right subclavian artery originated directly from the aortic arch, followed a route from left to right dorsally to the esophagus, and then formed an impression of the vascular path over the muscular wall of the esophagus. The esophagus, in turn, exhibited a flaccid wall and dilation in the caudal portion to the vascular path made by the ectopic position of the right subclavian artery.(AU)

O tronco braquiocefálico e a artéria subclávia esquerda emergem do arco aórtico e são responsáveis por fazerem o suprimento sanguíneo para cabeça, pescoço e membros torácicos. Variações anatômicas, como a ectopia da artéria subclávia direita, são alterações congênitas raramente encontradas em cães, cujas alterações do sistema digestivo acontecem em pacientes recém-desmamados e não em adultos. Assim, o objetivo deste relato é descrever um caso de ectopia da artéria subclávia direita em uma cadela, Dálmata, de nove anos de idade. No entanto, essa anomalia foi um achado do qual o paciente foi assintomático durante os nove anos de vida e somente com essa idade apresentou sinais como sialorreia, vômito, hiporexia e deglutição ruidosa. O hemograma e os perfis bioquímicos, associados à radiografia torácica, levaram a um diagnóstico de megaesôfago e pneumonia aspirativa. Mesmo seguindo o tratamento recomendado, houve piora clínica do quadro e o animal foi submetido à eutanásia. À macroscopia, a artéria subclávia direita originava-se direto do arco aórtico, fazia um percurso da esquerda para a direita dorsalmente ao esôfago e, então, formava uma impressão do trajeto vascular sobre a parede muscular do esôfago. O esôfago, por sua vez, apresentava parede flácida e dilatação na porção caudal ao trajeto vascular feito pela posição ectópica da artéria subclávia direita.(AU)

Experiencia en la evaluación diagnóstica y terapéutica de la disfagia orofaríngea y esofágica en niños / Experience in diagnostic and therapeutic evaluation of oropharyngeal and esophageal dysphagia in children

Introducción: La disfagia puede ser a nivel orofaríngeo o esofágico debido a trastornos estructurales o funcionales. Su abordaje diagnóstico y tratamiento evita la desnutrición y el riesgo de aspiración. Objetivo: reportar la experiencia en la evaluación diagnóstica y tratamiento en niños con disfagia orofaríngea y esofágica. Pacientes y método: estudio descriptivo y transversal, de 49 niños con disfagia, durante dos años. Protocolo de estudio: historia clínica, patologías asociadas, estudio radiológico, endoscopia, nasolaringoscopia-videodeglutoscopia, terapia deglutoria, videofluoroscopia, manometría y ph-metría esofágica y tratamiento indicado. Resultados: 20(40,82%) hembras y 29(59,18%) varones. Edad promedio 2,56 años (rango: 1m-16 años). El 46,93% presentó trastornos neurológicos como patología asociada. El 65,31% con disfagia a sólidos y 34,69% a líquidos, otros síntomas: vómitos, regurgitaciones y reflujo faringo-nasal. Posterior a la evaluación y estudios se encontró: disfagia orofaríngea 25/49(51,02%), de origen funcional en 22/25(88%) y mecánica 3(12%); disfagia esofágica 13/49(26,53%), mecánica en 1/13(7,69%) y funcional en 12/13(92,30%) de los cuales 6 con dismotilidad inespecífica y 4 asociada a esofagitis; disfagia mixta 11(22,44%). Evaluación nutricional fue requerida en 65,30%, se indicó nutrición por sonda de alimentación en 21 niños, por gastrostomía endoscópica en 4 y cambio en la consistencia de los alimentos en 7. Dilatación esofágica por estenosis congénita en un caso y por acalasia esofágica en 2. Terapia deglutoria en 71,42%. Conclusiones: la evaluación integral del niño con disfagia orofaríngea y esofágica es fundamental para identificar la causa e indicar el tratamiento específico con apoyo nutricional, procedimientos endoscópicos y terapia deglutoria.

Introduction: Dysphagia can be oropharyngeal or esophageal level due to structural or functional disorders. Its diagnosis and treatment approach prevents malnutrition and the risk of aspiration. Objective: To report our experience in the diagnostic evaluation and treatment for children with oropharyngeal and esophageal dysphagia. Patients and methods: Descriptive, cross-sectional, 49 children with dysphagia, for two years. Study protocol: clinical history, associated diseases, radiographs, endoscopy, Nasolaryngoscopy-videodeglutoscopia therapy, swallowing, videofl uoroscopy, manometry and esophageal pHmetry and appropriate treatment. Results: 20 (40.82%) females and 29 (59.18%) males. Average age 2.56 years (range: 1m-16 years). The 46.93% had neurological disorders and associated diseases. The 65.31% with dysphagia to solids and 34.69% for liquids, other symptoms: vomiting, regurgitation and nasal pharyngeal reflux. After the evaluation and studies found: Oropharyngeal Dysphagia 25/49 (51.02%) of functional origin in 22/25 (88%) and mechanical 3 (12%) Esophageal Dysphagia 13/49 (26.53% ) mechanical 1/13 (7.69%) and functional in 12/13 (92.30%) of which 6 and 4 with dysmotility associated nonspecifi c oesophagitis Mixed Dysphagia 11 (22.44%). Nutritional assessment was required to 65.30%, is indicated feeding tube 21 feeding children endoscopic gastrostomy 4 and change in the consistency of food at 7. Dilatation Congenital esophageal stenosis in one case and two esophageal achalasia. Swallowing therapy in 71.42%. Conclusions: The evaluation of the child with oropharyngeal and esophageal dysphagia is essential to identify the cause and indicate the specifi c treatment with nutritional support and therapeutic endoscopic procedures swallowing.

Estenose péptica do esôfago em crianças: incidência e achados clínicos / Esophageal peptic stricture in children: incidence and clinical findings

Introdução: estenose péptica de esôfago resulta da inflamação crônica da mucosa, causada pela doença do refluxo gastroesofágico. O objetivo deste estudo é apresentar a experiência com estenose péptica de esôfago, em um serviço de endoscopia digestiva pediátrica, analisando os achados clínicos e, principalmente, a diminuição da incidência dessa entidade nos dias atuais. Métodos: estudo retrospectivo de janeiro de 1996 a setembro de 2002. As dilatações foram realizadas com velas de Savary-Gilliard. O número de estenoses por ano, relativo ao número de endoscopias, foi avaliado através dos testes do qui-quadrado e da tendência linear. Resultados: no período de 6,5 anos, 1.636 crianças e adolescentes foram submetidos a endoscopia digestiva alta. Desses, 26 eram portadores de estenose péptica. As idades desses pacientes variaram de 10 meses a 16 anos, com uma média de 6,5 anos, sendo que 69% eram meninos.Treze pacientes eram portadores de condições predisponentes ou associadas a refluxo mais grave. Nenhum era portador de esôfago de Barrett. Foram realizadas 69 sessões de dilatação (2,65/paciente). Um paciente apresentou pneumomediastino, após a dilatação. Todos os outros apresentaram boa resposta às dilatações. O número de estenoses pépticas diminuiu com o passar dos anos, embora o número total de endoscopias tivesse aumentado. Conclusões: as dilatações com velas de Savary foram eficazes em diminuir a disfagia dos pacientes portadores de estenose péptica. Houve uma diminuição da incidência de estenose péptica, apesar do aumento do número de endoscopias nesse serviço pediátrico (AU)

Introduction: esophageal peptic stricture results of chronic mucosal inflammation caused by gastroesophageal reflux disease. The aim of this study is to present the experience with esophageal peptic strictures in a pediatric gastrointestinal endoscopy unit showing clinical aspects and mainly the decreasing incidence of this entity nowadays. Methods:retrospective study from January 1996 to September 2002. The esophageal dilations were performed with Savary-Gilliard bougies. The number of the strictures per year, relatively to endoscopies number, was evaluated by qui-square test and linear tendency. Results: in the period of 6.5 years 1,636 children and adolescents were submitted to upper digestive endoscopy. Twenty-six individuals had a peptic esophageal stricture. The ages varied between 10 months and 16 years with a mean age of 6.5 years and 69% were male patients. Thirteen patients had an associated or predisposing condition to more severe gastroesophageal reflux. There was no Barrett esophagus. We have done 69 esophageal dilations sessions (2.65/patient). One patient presented with pneumomediastine post-dilation. All the others presented a good outcome. The total number of strictures decreased with time although total number of endoscopic procedures increased. Conclusions: dilations with Savary-Gilliard bougies were efficacious to decrease the disphagia of the esophageal peptic strictures in children. There was a decreasing incidence of peptic strictures although the increasing incidence of endoscopic examinations performed in this pediatric endoscopy unit (AU)