Biomechanical Study of New Biodegradable Esophageal Stent / 中国医疗器械杂志

The radial force of the degradable esophageal stent before and after degradation is one of the important indicators for effective treatment of esophageal stricture. Based on a combination of in vitro experiments and finite element analysis, this paper studies and verifies the biomechanical properties of a new type of degradable esophageal stent under different esophageal stricture conditions. Under radial extrusion conditions, the maximum stress at the port of the stent is 65.25 MPa, and the maximum strain is 1.98%; The peak values of stress and strain under local extrusion and plane extrusion conditions both appear in the extrusion area and the compression expansion area at both ends, which are respectively 48.68 MPa, 46.40 MPa, 0.49%, 1.13%. The maximum radial force of the undegraded stent was 11.22 N, and 97% and 51% of the maximum radial force were maintained after 3 months and 6 months of degradation, respectively. The research results verify the safety and effectiveness of the radial force of the new degradable esophageal stent, and provide a theoretical basis for the clinical treatment of esophageal stricture.

Stent biodegradable como tratamiento de la estenosis esofágica benigna refractaria / Biodegradable stent as treatment of refractory benign esophageal stricture (RBES)

Paciente mujer de 26 años de edad, natural y procedente de La Paz-Bolivia. Acudió con un tiempo de enfermedad de 15 meses caracterizado por disfagia progresiva. Un mes antes del comienzo de la sintomatología ingirió lejía con intenciones autolíticas. En el estudio de endoscopia digestiva alta diagnóstica se evidenció a los 25 centímetros de la arcada dentaria una estenosis, de unos 3 mm de diámetro, central y con el epitelio esofágico adyacente de aspecto conservado. En la radiografía de esófago contrastada se evidenció a nivel de tercio medio de esófago una estenosis tubular corta, de bordes lisos, de aproximadamente 2 cm de longitud. Se inició tratamiento mediante dilataciones mecánicas axiales con bujías Savary Guilliard con un intervalo entre sesiones de 2 a 3 semanas y con 8 sesiones en total. En la última sesión la bujía de mayor calibre usada fue 12,8 mm. Es entonces que tomando en consideración los criterios diagnósticos de Kochman, se hizo el diagnóstico de estenosis esofágica cáustica refractaria. Durante el periodo de realización de las dilataciones con bujías la paciente quedo embarazada, lo que dificultaba la realización de los procedimientos por el rutinario uso de control fluoroscópico. Con 14 semanas de gestación se implantó un Stent esofágico biodegradable no cubierto SX-ELLA de 10 cm de longitud. Presentamos el caso por ser un manejo alternativo y novedoso para este tipo de patología.

A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.

Experiencia del uso de endoprótesis metálica autoexpandibles en esófago / Expandable metallic stents in esophageal: experience in the National Center for Minimal Access Surgery

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)

Estenosis esofágica congénita: A propósito de un caso / [Congenital esophageal stenosis: a case report].

Congenital esophageal stenosis, a rare disease of unknown cause which reports have increased in the last few years, requires a high index of suspicion for its diagnosis and treatment. It can be classified in three types based on the etiology of the stenosis: tracheobronchial rest, fibromuscular hypertrophy and membranous diaphragm. Symptoms may vary depending on location and severity of the stenosis. Treatment options are based on clinical suspicion of the histologic type and they can be balloon dilation or surgical resection of the stenotic segment. The definitive diagnosis is the histological study.

Reconstituição do trato digestivo após falha de esofagogastro ou esofagocolo anastomose / Digestive tract reconstitution after failed esophago-gastro or esophago-coloanastomosis

RACIONAL: Disfagia grave ou mesmo afagia pode ocorrer após esofagectomia secundária à necrose do órgão ascendido com estenose severa ou separação completa dos cotos. Ruptura catastrófica esofágica ou gástrica impulsiona a decisão de "desconectar" o esôfago, a fim de evitar graves complicações sépticas. As operações utilizadas para restabelecer a descontinuidade do esôfago não são padronizadas e reoperações para restabelecimento do trânsito digestivo superior são um verdadeiro desafio. MÉTODOS: Este é estudo retrospectivo da experiência dos autores durante 17 anos incluindo 18 pacientes, 14 previamente submetidos à esofagectomia e quatro esofagogastrectomia. Eles foram operados com o fim de restabelecer o trato digestivo superior. RESULTADOS: Refazer esofagogastro anastomose foi possível em 12 pacientes, 10 por meio da abordagem cervical e combinando esternotomia em quatro, a fim de realizar a nova anastomose. Em cinco pacientes esofagocolo anastomose foi novamente realizada. Interposição de enxerto livre de jejuno foi realizada em um paciente. As complicações ocorreram em 10 pacientes (55,5%): deiscência anastomótica em três, estenose em quatro, condrite esternal em dois e abscesso cervical em um. Não se observou mortalidade. CONCLUSÃO: Existem diferentes opções cirúrgicas para o tratamento desta situação clínica difícil e arriscada; deve ser tratada com procedimentos adaptados de acordo com o segmento anatômico disponível para ser usado, escolhendo o procedimento mais conservador.

BACKGROUND: Severe dysphagia or even aphagia can occur after esophagectomy secondary to necrosis of the ascended organ with severe stricture or complete separation of the stumps. Catastrophic esophageal or gastric disruption drives the decision to "disconnect" the esophagus in order to prevent severe septic complications. The operations employed to re-establish esophageal discontinuity are not standardized and reoperations for re-establishment of the upper digestive transit are a real challenge. METHODS: This is retrospective study collecting the authors experience during 17 years including 18 patients, 14 of them previously submitted to esophagectomy and four to esophagogastrectomy. They were operated on in order to re-establish the upper digestive tract. RESULTS: Redo esophago-gastro-anastomosis was possible in 12 patients, 10 through cervical approach and combined with sternotomy in four in order to perform the new anastomosis. In five patients a new esophago-colo anastomosis was performed. Free jejunal graft interposition was performed in one patient. Complications occurred in ten patients (55.5 %): anastomotic leaks in three, strictures in four, sternal condritis in two and cervical abscess in one. No mortality was observed. CONCLUSION: There are different surgical options for the treatment of this difficult and risky clinical situation which must be treated with tailored procedures according to the anatomic segment available to be used, choosing the most conservative procedure.

Imagen del mes / Image of the month

Reportamos un caso de un paciente joven que ingresó para estudio y manejo de una hipocalcemia grave. Durante su evolución el paciente presentó dolor abdominal (cólico vesicular) relacionado con la presencia de un ejemplar de Ascaris lumbricoides en la vesícula biliar, que respondió a terapia médica conservadora.

We report a case of a young patient who was admitted for study and management of severe hypocalcemia. During evolution of the condition the patient presents abdominal pain (biliary colic) related to the presence of Ascaris lumbricoides in the gallbladder, responding to conservative medical therapy.

Esophageal surgery in newborns, infants and children.

The most common surgery on the esophagus by pediatric surgeons the world over is performed in the newborn period in babies with congenital esophageal atresia with tracheo-esophageal fistula. Post-operative complications like recurrent fistula, anastomotic stricture and some patients with gastroesophageal reflux would also require surgical intervention. Apart from esophageal dilatation, gastrostomy and feeding jejunostomy, children with strictures secondary to caustic ingestion, reflux or previous esophageal anastomosis may require esophageal substitution. This operation may also be required in babies with pure esophageal atresia as well as those with a long gap esophageal atresia with fistula. The entire stomach, stomach tubes, colon or jejunum are often used but techniques preserving as much of the original esophagus as possible are preferable and more physiological. Surgery is also required in children with congenital esophageal stenosis and duplication cyst.

Tratamiento quirúrgico de las estenosis esofágicas por cáusticos: experiencia en el Hospital Universitario de Maracaibo / Surgical treatment of the caustic esophageal stenosis: experience in Hospital Universitario of Maracaibo

Evaluar los procedimientos diagnósticos y el tratamiento quirúrgico en pacientes con estenosis esofágica en el Hospital Universitario de Maracaibo. Se evaluaron en 22 pacientes con estenosis cáustica, el agente etiológico, signos y síntomas presentes, procedimientos diagnósticos, tratamiento quirúrgico, complicaciones quirúrgicas y evolución postoperatoria. Las manifestaciones clínicas más frecuentes fueron disfagia (95.45 por ciento), pérdida de peso (18.18 por ciento), odinofagia (18.18 por ciento) y dolor torácico (4.54 por ciento). La endoscopia reportó estenosis esofágica en todo el trayecto en seis pacientes (27.27 por ciento) y congestión y ulceración esofágica en seis pacientes (27.27 por ciento). Las intervenciones quirúrgicas más frecuentemente realizadas fueron: esofagectomía transhiatal + ascenso gástrico en ocho pacientes (36.36 por ciento) y ascenso colónico izquierdo en siete pacientes (31.81 por ciento). Las complicaciones postoperatorias más frecuentes fueron las relacionadas con las anastomosis tales como las fístulas cervicales y las estenosis de la anastomosis. La estenosis esofágica por cáustico es una patología esofágica de difícil tratamiento debido a la morbilidad y mortalidad relacionada con los procedimientos quirúrgicos utilizados.

Free jejunal intrathoracic graft after esophageal replacement failure

We present the case of a 24 year old man who suffered from severe chronic esophagitis and an esophageal stricture. He was managed by gastric pull-up but complicated by leakage of the anastomosis. Subsequent sophageasurgical treatment with free jejunal graft was performed and the rationale for the technique selected is discussed.

Estenose esofágica secundária a escleroterapia endoscópica de varizes: o que fazer? / Esophageal stenosis after endoscopic sclerotherapy of varizes: what to do?

A escleroterapia endoscópica das varizes esofágicas é um método muito utilizado no tratamento de hepatopatas crônicos que apresentam hemorragia digestiva. Embora seja procedimento eficiente, várias complicações tais como disfagia, dor torácica, febre e estenoses esofágicas são descritas. Objetivo - descrever e analisar casuística de doentes portadores de estenoses esofágicas secundárias à escleroterapia endoscópica de varizes / The endoscopic sclerotherapy of esophageal varices is a method frequently used in the treatement of patientes with chronic liver disease when they have upper digestive bleeding. Although it as procedure efficient, several complications such as disphagia, thoracic pain, fever and esophageal stenosis are described. Aim - To describe and analyse a group of patients with esopageal stenosis secondary to endoscopic sclerotherapy of varices...

Congenital Esophageal Stenosis: To dilate or To resect

Congenital esophageal stenosis [CES] is a rare condition in children. The definitive preoperative diagnosis often is difficult to make, and a standard therapeutic protocol remains controversial. This study was carried out to determine the proper management strategy in children suffering from CES. The medical records of 17 patients with CES treated during a period of10 years [from 1995 to 2005] were retrospectively reviewed. Each patient was evaluated as regard to the clinical presentation, pathology, management, and outcome. The ages of patients at time of diagnosis ranged from 3 months to 9 years. The sites of stenosis were located more frequently at the lower third of the esophagus [n=10] than the upper third [n-3] and middle third [n=4], The diagnosis was made by esophagogram, esophagoscopy and was confirmed by histopathologic examination. Fifteen patients were diagnosed primarily, while 2 patients were diagnosed after unsuccessful surgical treatment for an initial misdiagnosed achalasia of the cardia. Six patients had confirmed tracheobronchial remnants [TBR], five had fibromuscular stenosis [FMS] and 2 had membranous web stenosis [MS]. The histopathology was unknown in 4 patients due to inadequate biopsies taken during esophagoscopy. All patients were treated initially by repeated esophageal dilatations [2-8 times] over two to thirty month period. The dilatation alone was successful in 11 patients, but was complicated by esophageal perforation in one case. Six patients required surgery; five of them were treated by resection and anastomosis, and one required esophageal replacement The pathology of this later group was TBR in 5 patients and FMS in one. 1. this study emphasizes the diagnostic difficulties in some children with CES; 2. Esophageal dilatation may be tried initially 3. Resection should be reserved for cases not responding to repeated dilatation particularly those with proven TBR

three-year audit of rigid oesophagoscopy at lady reading hospital Peshawar

The number of oesophagoscopies performed annually provides an indication of the extent of oesophageal disorders in any particular setting. The present study aimed to provide such data for rigid oesophagoscopy at the only referral centre for this procedure in Peshawar. An audit of all available records of patients undergoing rigid oesophagoscopies from January 2002 to December 2004, at the Lady Reading Hospital Peshawar was performed. A total of 200 cases of rigid oesophagoscopies were performed during this three-year period of study. The ages of patients ranged from 1 to 90 years, with a two fold male preponderance. The main indication was dysphagia with major causes being oesophageal carcinoma [115, 57.5%], reflux oesophagitis [56, 28%], strictures of various aetiologies [19, 9.5%] and foreign bodies [10, 5%]. Successful dilatation was possible in 70% of cases; the morbidity rate was 4.5% due to perforation observed in 9 cases. The mortality rate was 1.5% due to septicemia in 3 cases. A high rate of rigid oesophagoscopies was observed indicating an increased frequency of oesophageal disorders in this setting. The morbidity and mortality rates observed are within acceptable ranges for this procedure

Estenosis esofágica congénita asociada a atresia esofágica. Presentación de un Caso / Congenital esophageal stenosis associated to esophageal atresia. Presentation of one case

La estenosis congénita del esófago es una enfermedad muy rara, esta condición habitualmente se ha confundido históricamente con la estenosis esofágica secundaria a un proceso inflamatorio, particularmente secundario a un reflujo gastroesofágico. Esta entidad se ha reportado con una incidencia de un caso por cada 25 000 a uno por cada 50 000 nacidos, hasta 1995 solo se habían reportado 500 casos en la literatura mundial. Los síntomas de la enfermedad se presentan generalmente en los lactantes alrededor de los seis meses de edad, los pacientes presentan disfagia progresiva y vómitos cuando se introducen alimentos sólidos y semisólidos. Existen casos que presentan desde el momento del nacimiento síntomas severos como regurgitaciones y distress respiratorio. El diagnóstico se confirma mediante esofagograma y endoscopía esofágica. En este trabajo se presenta un caso tratado en nuestro hospital con esta enfermedad y se exponen elementos clínicos, diagnósticos y terapéuticos del mismo...

Tratamientos endoscópicos del cáncer avanzado de esófago y otras estenosis esófagocardiales. Revisión de 54 casos personales / Endoscopic treatment of avanced esophageal cancer and other esophagocardial stenosis. Revision of 54 personal cases

El cáncer avanzado de esófago (CAE) se diagnostica en etapas en que la cirugía, si es posible, es paliativa de la disfagia, con morbimortalidad elevada. En casos inoperables o irresecables, tratamientos alternativos como radioterápicos o endoscópicos pueden paliar la disfagia. Endoscópicamente se puede colocar una sonda nasogástrica (SNG) transtumoral para nutrición preoperatorio o para braquiterapia (iridium intratumoral). Puede dilatarse el tumor o colocarse una prótesis plástica o autoexpandible, o inyectar alcohol absoluto intratumoral. Se evalúan resultados y morbimortalidad de una casuistica personal a través del estudio retrospectivo de 54 pacientes (p) en quienes se realizaron 120 procedimientos de los referidos. La serie incluye 41 hombres y 13 mujeres (3-1), estando el 79,5 por ciento de los p. comprendidos entre 61 y 90 años. Se utilizan endoscopios de fibra óptica o videoendoscopio, dilatadores coaxiales, balones hidroneumáticos, guías metálicas, prótesis plásticas artesanales y autoexpandibles. 34.1 por ciento de los procedimientos se realizaron bajo radioscopia. Integran el grupo 1 y 2 de SNG: 11 p. (8 para nutrición y 3 para braquiterapia). El grupo 3: dilataciones de estenosis rádica con o sin recidiva neoplásica, o infiltración neoplásica del esófago, 6 p. El grupo 4: 14 p. para dilatación de neoplasma de esófago. Grupo 5: de prótesis, 12 p. Grupo 6: 11 p. con estenosis anasfomóticas. Los p. de los grupos 1-2-3, todos se solucionaron. En el grupo 3 hubo una perforación. En el grupo 4, de 14 p. se dilataron 13. En el grupo 5 no se pudo colocar la prótesis en 2 p., colocándose 12 prótesis (7 plásticas y 5 autoexpandibles) en 10 p. Hubo una muerte por hemorragia digestiva masiva, por una segunda prótesis autoexpandible al mismo p. En el grupo 6 todos fueron tratados. La mortalidad de las series fue de 2 p. (3,7 por ciento).

Lesões esofagianas causadas por ingestão de substâncias cáusticas ou corrosivas / Esophageal lesions caused by ingestion of caustic or corrosive agents

A ingestão de cáusticos ou corrosivos constitui importante situação de emergência. Objetivo - analisar os aspectos clínicos de indivíduos que referiam tentativa de suicídio, utilizando para tal a ingestão de cáusticos ou corrosivos. Pacientes e métodos - estudou-se 34 pacientes. A substância ingerida pela maioria (32) foi soda cáustica (NaOH) e os demais referiram ácido clorídrico (HCI). Apenas três pacientes foram encaminhados na fase aguda do acidente, os demais já apresentavam as sequelas, comprovadas por endoscopia, a qual revelou estenose esofágica em 30 / The ingestion of caustic or corrosive agents is an important emergency situation. Aim - To analyze the clinical aspects of patients who attempted suicide by ingesting caustic or corrosive substances. Patients and method - this study included 34 patients. Most of them (32) ingested caustic soda (NaOH) and the others hydrochloric acid (HCI). Only three patients were referred during the acute phase of the accident; the others already presented sequelae, corroborated by endoscopic studies, revealing that 30 of them had esophagic stenosis...

Ivor Lowis esophagectomy: experience at Jinnah hospital, Lahore

Although different approaches have been used for surgical resection of esophageal cancer, the Ivor Lewis approach is the standard technique at most centers for resection of the diseased middle and lower third esophagus. This procedure has historically been associated with significant morbidity and mortality. However, modern literature suggests that Ivor Lewis esophagectomy can be performed with an acceptable complication rate and mortality. Patients and methods: We conducted a case series of thirteen consecutive patients who underwent an Ivor Lewis esophagectomy at Jinnah Hospital Lahore from January, 2001 to December, 2002. The objective was to examine the morbidity, mortality and short-term outcome of this surgical procedure. The mean age of the patients was 45.9 years +/- 18.3 years [median: 44.5 years; range: 22 to 78 years]. 7 patients were men and 6 patients were women. 6 patients [46.2%] were operated for benign corrosive esophageal strictures whereas seven patients [63.8%] had esophageal cancer. The median age of the patients with benign strictures was 28 years [range: 20 - 35 years]. The median age of the cancer patients was 58 years [range: 54-70 years]. Of these patients, one had Stage I cancer [9.29%], two had Stage II a [28.57%], two had Stage II b [28.57%], and two had Stage III disease [28.57%]. Five patients [71.42%] had adenocarcinoma and two [28.57%] had squamous cell carcinoma. Seven patients [53.8%] had one or more co-morbid conditions, including diabetes, hypertension, cardiovascular disease and chronic obstructive pulmonary disease. Four patients [30.77%] had history of smoking. The mean operative time was 270 minutes +/- 31 minutes. The mean operative blood loss was 1500 ml +/- 102 ml. The median ICU stay was one day [range: I to 7 days]. The median hospital stay was 19 days [range: 15 to 38 days]. Eight patients [61.54%] developed post-operative complications. Most of these complications were medical [60%] rather than surgical [40%]. Respiratory complications were the commonest [30.77%]. Of the surgical complications, the most common was the development of an anastomotic leak [23.08%]. All of these were managed conservatively and none proved fatal. There were two mortalities on post operative days 7 and 8, due to ARDS and multi-organ failure respectively. The operative mortality was 15.39%.Ivor Lewis esophagectomy represents a major physiological and surgical insult. However, careful patient selection, perioperative monitoring and early aggressive treatment of complications can significantly reduce morbidity and mortality

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)

Congenital esophageal stenosis

Congenital esophageal stenosis CES is an uncommon anomaly that rarely goes undiagnosed until adulthood. We report 2 cases of CES. The first was a one-month-old baby boy who was referred for work up of swallowing disorder and recurrent pneumonias. The diagnosis was confirmed by a continuous fluoroscopic esophagogram, and endoscopic exploration. Simple dilatation resolved his symptoms completely. The second was an 18-month-old boy, who was referred with a feeding gastrostomy due to complete esophageal obstruction. Resection and end-to-end anastomosis was performed with uneventful postoperative course

Prótese enteral no tratamento da estenose gástrica maligna por adenocarcinoma recorrente / Enteralprosthesis inthe treatment of malignant gastric stenosis due to recurrent adenocarcinoma

Este trabalho relata caso de paciente com obstrução gástrica maligna de esôfago recidivado no tubo gástrico 18 meses após a cirurgia (esôfago-gastrectomia parcial), que foi submetido à colocação de prótese metálica auto-expansível com sucesso e boa resposta clínica