RESUMO
Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Assuntos
Feminino , Humanos , Masculino , Anastomose Cirúrgica , Ductos Biliares , Ferimentos e Lesões , Constrição Patológica , Terapêutica , Fístula do Sistema Digestório , Terapêutica , Refluxo Duodenogástrico , Diagnóstico por Imagem , Endoscopia Gastrointestinal , Métodos , Nutrição Enteral , Métodos , Gastrectomia , Obstrução da Saída Gástrica , Cirurgia Geral , Gastrite , Diagnóstico , Hemorragia Gastrointestinal , Terapêutica , Hemostase Endoscópica , Métodos , Hemostáticos , Usos Terapêuticos , Recidiva Local de Neoplasia , Cirurgia Geral , Complicações Pós-Operatórias , Diagnóstico , Terapêutica , Lesões Pré-Cancerosas , Cirurgia Geral , Piloro , Cirurgia Geral , Stents , Neoplasias Gástricas , Cirurgia Geral , Resultado do Tratamento , Traumatismos do Nervo Vago , Cirurgia GeralRESUMO
Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.
Assuntos
Humanos , Traumatismos dos Nervos Cranianos , Transtornos de Deglutição , Dilatação , Esfíncter Esofágico Superior , Músculos , Manifestações Neurológicas , Traumatismos do Nervo Vago , Nervo VagoRESUMO
Achalasia is rare disorder with an estimated prevalence of 0.5~1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma.
Assuntos
Humanos , Masculino , Deglutição , Eletromiografia , Acalasia Esofágica , Rouquidão , Prevalência , Tórax , Nervo Vago , Traumatismos do Nervo VagoRESUMO
We reported a 56-year-old man who presented with vagus nerve injury after deep laceration in the neck. During being treated the neck insult, he was performed pyloplasty and vagotomy and used total parenteral nutrition due to peptic ulcer perforation and panperitonitis. He suffered from swallowing difficulty and underwent percutaneous endoscopic gastrostomy placement. As formerly, recurrent gastroesophageal reflux symptoms and gastric feeding intolerance were developed. We fixed a transgastrostomal jejunal tube in jejunum through the gastric stoma. The gastroeophageal reflux and feeding intolerance did not recur. After 30 days later, jejunal tube was removed, nutritional support was replaced by gastric tube. We were able to provide a temporary nutritional bridge with percutaneous endoscopic gastrojejunostomy placement for patients who suffered from dysphagia.