Cause Of Esophageal Stricture Research Articles

Recurrent Esophageal Stricture in a Child Post Steven-Johnson Syndrome: A Case Report

Background: Esophageal stricture is an abnormal narrowing of the esophageal lumen, resulting in dysphagia. Despite its rarity, this condition could be caused by various etiologies, including Steven-Johnson Syndrome (SJS). In some cases, stricture could recur, which complicates the management. This case report presented a rare case of refractory esophageal stricture in children with Steven-Johnson Syndrome. Case: A 5-years-old boy with a prior history of SJS presented with dysphagia for one month. The patient experienced choking, blood vomiting, stomatitis, swelling on the lips, and difficulty in swallowing solid food. Barium meal and EGD test confirmed the diagnosis of esophageal strictures. The patient then underwent dilation using bougie dilator. However, he continued to experience dysphagia, resulting in a total of 15 serial dilation sessions. Discussion: Esophageal dysphagia is observed in patients who experience difficulty swallowing solid food. SJS can contribute to the development of esophageal dysphagia by causing inflammation of the esophageal mucosa, resulting in lesions and strictures. In patients with esophageal strictures, two types of dilation methods are available: bougie dilator with wire guidance (Savary-Gilliard) and balloon dilator, with the current consensus for dilation procedures supporting the rule of three. For patients with refractory strictures, other modalities such as mitomycin-C injection and stent placement are also available. Esophageal replacement surgery is considered as the last resort for refractory stricture patients who have not responded to previous treatments. Conclusion: Steven-Johnson Syndrome is a rare cause of esophageal strictures. The management of refractory esophageal stricture requires a comprehensive subspecialty care and long-term monitoring.

Role of mechanoregulation in mast cell-mediated immune inflammation of the smooth muscle in the pathophysiology of esophageal motility disorders.

Major esophageal disorders involve obstructive transport of bolus to the stomach, causing symptoms of dysphagia and impaired clearing of the refluxed gastric contents. These may occur due to mechanical constriction of the esophageal lumen or loss of relaxation associated with deglutitive inhibition, as in achalasia-like disorders. Recently, immune inflammation has been identified as an important cause of esophageal strictures and the loss of inhibitory neurotransmission. These disorders are also associated with smooth muscle hypertrophy and hypercontractility, whose cause is unknown. This review investigated immune inflammation in the causation of smooth muscle changes in obstructive esophageal bolus transport. Findings suggest that smooth muscle hypertrophy occurs above the obstruction and is due to mechanical stress on the smooth muscles. The mechanostressed smooth muscles release cytokines and other molecules that may recruit and microlocalize mast cells to smooth muscle bundles, so that their products may have a close bidirectional effect on each other. Acting in a paracrine fashion, the inflammatory cytokines induce genetic and epigenetic changes in the smooth muscles, leading to smooth muscle hypercontractility, hypertrophy, and impaired relaxation. These changes may worsen difficulty in the esophageal transport. Immune processes differ in the first phase of obstructive bolus transport, and the second phase of muscle hypertrophy and hypercontractility. Moreover, changes in the type of mechanical stress may change immune response and effect on smooth muscles. Understanding immune signaling in causes of obstructive bolus transport, type of mechanical stress, and associated smooth muscle changes may help pathophysiology-based prevention and targeted treatment of esophageal motility disorders.NEW & NOTEWORTHY Esophageal disorders such as esophageal stricture or achalasia, and diffuse esophageal spasm are associated with smooth muscle hypertrophy and hypercontractility, above the obstruction, yet the cause of such changes is unknown. This review suggests that smooth muscle obstructive disorders may cause mechanical stress on smooth muscle, which then secretes chemicals that recruit, microlocalize, and activate mast cells to initiate immune inflammation, producing functional and structural changes in smooth muscles. Understanding the immune signaling in these changes may help pathophysiology-based prevention and targeted treatment of esophageal motility disorders.

A rare cause of esophageal stricture: undifferentiated carcinoma of the lower esophagus

Undifferentiated carcinoma of the esophagus (UEC) is an uncommon esophageal malignancy. Patient with UEC has a notably poor prognosis because of extensive metastasis despite at the early stage. A standard treatment regimen for UEC has not yet been established. We reported a case of undifferentiated carcinoma in a 46 years old male with a common chief complaint of progressive dysphagia accompanied by chest discomfort after meal and significant weight loss. Base on the history of illness, physical examination, imaging, and histopathology we concluded that the patient was diagnosed with UEC at the gastroesophageal junction. The patient the received chemoradiotherapy of CDDP + 5-FU along with radiation, but declined the temporary gastrostomy as nutritional intervention. Esophageal undifferentiated carcinomas are rare neoplasms and often associated with locoregional recurrence and/or distant metastasis. Multidisciplinary involvement for the treatment of this disease is necessary to obtain a better outcome.

S2313 Esophageal Stricture Recalcitrant to Repeated Dilation in Complex Rheumatological and Bullous Disease

Introduction: Many rheumatological diseases have been well characterized to affect the esophagus. Esophageal involvement in autoimmune bullous disease is rare and almost always occurs with severe cutaneous symptoms. We report a case of severe esophageal strictures recalcitrant to repeated dilatation in a patient with complex rheumatological disease and isolated esophageal bullous disease. Case Description/Methods: A 50-year-old female presented with complete inability to tolerate oral intake for several weeks. Past history included Sjogren's syndrome and esophageal strictures with many previous dilatations. Physical exam findings were relevant for poor skin turgor, dry mucous membranes, and skin hyperpigmentation on her hands and forearms. Laboratory studies showed hypokalemia, hypoalbuminemia, and anemia. The patient was admitted. Her esophagram and esophagogastroduodenoscopy (EGD) showed a proximal esophageal stricture which was dilated using a push style dilator to 14mm. The stricture recurred, requiring repeated dilatation and placement of a percutaneous gastrojejunostomy. Once oral intake was tolerated, she was discharged with outpatient follow-up. Outpatient rheumatological workup showed antibodies to ANA, RNP, SSA, CCP, and Smith indicating mixed connective tissue disease with features of systemic lupus erythematosus, rheumatoid arthritis, and scleroderma. She required multiple dilatations over several months and was started on mycophenolate mofetil with some clinical improvement. The dysphagia recurred 2 months later and EGD showed and esophageal stricture measuring 7mm requiring a neonatal upper gastroscope to facilitate balloon dilatation. Biopsies examined for immunofluorescence showed continuous linear deposition along the basement membrane zone for IgG and C3, consistent with atypical esophageal bullous systemic lupus erythematosus or atypical esophageal bullous pemphigoid. The patient declined systemic steroids. Her mycophenolate mofetil dose was increased and she received weekly dilatations to prevent Koebnerization and allow time for medical therapy effect. After 3 months of treatment, she had symptom improvement (Figure). Discussion: In patients with systemic immune mediated disorders including rheumatological disease, bullous diseases can be considered as a cause of esophageal stricture. Bullous disease with esophageal involvement can be difficult to treat, especially in this patient who declined corticosteroids. A combination approach using both immune suppression and dilatation was effective.Figure 1.: a. Pre- dilatation during repeated dilation treatments. Diameter 8mm. b. Post- dilatation. Diameter 11mm. c. Immunofluorescence showing IgG deposition along the basement membrane.

Efficacy and Safety of Endoscopic Esophageal Dilatation in Pediatric Patients with Esophageal Strictures.

Materials and Methods In this retrospective cross-sectional single center study, records of patients with esophageal strictures presented to the pediatric department, Salmaniya Medical Complex, Bahrain, in the period between 1995 and 2019 were reviewed. Demographic data, indications of endoscopic dilatations, the procedure success rate, and possible complications were assessed. Results Forty-six children were found to have esophageal strictures. Twenty-five (54.3%) patients were males. Most patients presented during infancy (86.5%, 32/37 patients). Twenty-six (56.5%) patients required 88 dilatation sessions, while the remaining 20 (43.5%) patients did not require dilatations. The median number of dilatation sessions per patient was three (interquartile range = 2–5). Savary-Gilliard bougienages were the main dilators used (80.8%, 21/26 patients). Anastomotic stricture (post esophageal atresia/tracheoesophageal fistula repair) was the main cause of esophageal strictures and was found in 35 (76.1%) patients. Patients with nonanastomotic strictures had more frequent dilatations compared to those with anastomotic strictures (P = 0.007). The procedure success rate was 98.8%. Yet, it was operator dependent (P = 0.047). Complete response to dilatation was found in 18 (69.2%) patients, satisfactory in seven (26.9%), and an inadequate response in one (3.9%). Those with satisfactory responses still require ongoing dilatations based on their symptoms and radiological and endoscopic findings. No perforation or mortality was reported. Patients with dilatations had more recurrent hospitalization (P < 0.0001), more dysphagia (P = 0.001), but shorter hospital stay (P = 0.046) compared to those without dilatations. Surgical intervention was required in one patient with caustic strictures. The median follow-up period was six years (interquartile range = 2.25–9.0). Conclusions Endoscopic esophageal dilatation in children with esophageal strictures is effective and safe. Yet, it was operator dependent. Nonanastomotic strictures require more dilatations compared to anastomotic strictures. Findings of this study are comparable to those reported worldwide.

ETIOLOGY AND OUTCOME OF ESOPHAGEAL STRICTURE AMONG CHILDREN: LOCAL DATA FROM TERTIARY CARE CHILDREN HOSPITAL OF MULTAN, PAKISTAN

OBJECTIVES: To find out the etiology and outcome in terms of clinical improvement among children having esophageal stricture (ES). METHODS: This prospective study was conducted from July 2019 to March 2020 at Children’s Hospital, Multan, Pakistan on diagnosed patients of ES, ageing &lt;15 years. Demographic details, different etiologies, location of the ES and treatment outcome were recorded. After initial management, endoscopy and dilatation was done at 6 weeks. Patients were followed-up for at least 12 weeks. RESULTS: Out of 32 children with ES, 19 (59.4%) were males. Mean age of children was 36.58±19.6 months. Twenty-four (75%) patients had proximal and 8 (25%) had distal stricture. Chemical burn (n=23; 71.9%) and esophageal atresia (n=4: 12.5%) were commonest causes of ES. Dilatation and surgery were performed in 21 (65.6%) cases followed by dilatation only in 10 (31.3%) cases and surgery alone in one (3.1%) case. In patients with chemical burns, majority (n=16/23; 69.6%) required both dilatation and surgery. Overall outcome of treatment options was good in 62.5% (n=20/32) patients. Outcome was good in 61.9% (n=13/21) of patients requiring both dilatation and surgery and 70% (n=7/10) in patients having dilatation alone (p=0.385). Outcome was good in 69.6% (n=16/23) of patients with chemical burns and 70% (n=7/10) in patients with dilatation only (p=0.385). Mortality rate was 3.1% (n=1). CONCLUSION: Chemical burn and esophageal atresia were the commonest causes of ES. Outcome of all procedures was good in 62.5% cases and had no significant relationship with causes and site of ES or types of treatment.

Isolated Esophageal Crohn’s Disease with Diffuse Stricture

Background: Esophageal strictures are considered to be one of the most challenging matters for gastroenterologist, general and thoracic surgeons in diagnosis and management. They can be grouped into three general categories: intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease (CD) is a very rare cause of esophageal stricture. The prevalence of esophageal CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when complications have occurred as Strictures, fissures, esophagobronchial fistulas, and mediastinal abscesses. Case Report: Thirty-nine years old Kurdish patient, referred to our department for evaluation. Although many consultations during the last two years, the Pt was still undiagnosed. She had progressive dysphagia, and weight loss of about 25 kg. She had no other digestive or extra digestive complaint, nor caustic ingestion history and nor drug history. Chest CT scan and UGI Contrast study revealed diffuse smooth and regular esophageal stenosis. Attempts to do upper endoscopy and biopsy failed due to severe stenosis. Prolonged medical history and radiologic signs exclude malignancy, so esophagectomy with stomach pull-through was done by the aid of VATS and laparoscopy with excellent results. Pathological finding of the resected esophagus suggested the diagnosis of Crohn’s disease CD. Conclusions: CD is a rare cause of esophageal stricture and still to be a challenging early diagnosis due to the low specificity of clinical manifestations (aphthous ulcers), histologic findings (absence of granulomas), and endoscopic findings. So many patients have been diagnosed with complications (esophageal strictures, fistulas) which needed surgical treatment, adding greater morbidity and mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the morbidity and mortality and improving the quality of life for those patients.

The Outcome of Pediatric Esophageal Strictures Managed with Endoscopic Balloon Dilation in Saudi Arabia.

Background: Esophageal strictures can affect nutrition of infants and children impairing their weight gain. To our knowledge, this is the first article evaluating and comparing between the two methods of dilation in terms of outcome and one of few, if any, to assess both weight and height to evaluate the nutritional outcomes following dilation. To determine the safety, efficacy, and long-term effects of endoscopic dilation in managing pediatric esophageal strictures by assessing the clinical and nutritional outcomes. Methods: A retrospective study of 137 patients with esophageal strictures who underwent either endoscopic balloon dilatation or Savary dilatation, or both. Outcome parameters measured include the number of dilatations, nutritional status, and if symptoms had been relieved. Results: The most frequent cause of esophageal strictures was post-tracheoesophageal fistula repair (n = 51, 37.2%), and the majority were lower third strictures (n = 47, 34.3%). However, 8 cases (5.8%) had failed the dilation procedure. Savary dilatation had the highest number of complications. Overall, success rate was 79.6%. Higher success rate was for cases dilated by endoscopic balloon dilation (EBD) (n = 47, 90.4%). There was a statistically significant correlation between the success rate and the method of dilatation (P = .042). Statistically significant increment of weight was recorded for lower strictures (P = .001). Conclusion: EBD was associated with the highest success rate. Endoscopic dilatations are safe and efficient in managing pediatric esophageal strictures with improvement in both clinical and nutritional outcomes.

The Most Common Causes of Benign Esophageal Stricture in Children and the Success Rate of Endoscopic Balloon Dilatation, a Single-Center Experience

Background: Benign esophageal strictures are not rare. Over the past two decades, endoscopic balloon dilatation (EBD) has been used to treat them. Objectives: The purpose of this study was to identify the most common causes of benign esophageal stricture in children determine the success rate of endoscopic balloon dilatation. Methods: Children younger than 16 years with benign esophageal strictures referred to the endoscopy department during one year (2016 - 2017) were enrolled. After obtaining written consent from parents, endoscopy balloon dilatation was performed with two types of balloon catheters. Response to treatment was evaluated based on clinical symptoms and was classified according to the Vantrappen table score. Results: In this study, thirty-one (31) children participated including 19 (61%) boys and 12 (39%) girls. The mean age was 5.1 ± 3.9 years. The most common causes of esophageal stricture were: achalasia (45%), esophageal atresia (19%), stenosis due to the caustic ingestion (19%), another congenital stenosis (16%). Overall, 27 children (87.1%) had a good response to treatment. In children with stenosis due to caustic ingestion, the inappropriate response was higher than the rest (33%). However, only in 4 (12.9%) patients, balloon dilatation failed. No complications were observed. Conclusions: Achalasia, esophageal atresia, and caustic ingestion are the most common cause of benign esophageal stricture in the children. EBD is an effective and safe treatment in these children, even in cases of previous surgery and recurrence. If this procedure is performed by an expert using appropriate balloon catheters, no complications will be created.

What is the Best Choice for Esophageal Replacement in Children?

Esophageal replacement surgery is performed in children with either congenital long gap esophageal atresia or acquired esophageal damages such as caustic injury of the esophagus. although the left colon because of less variation in blood supply and suitable diameter in comparison with right colon is the better choice. A secured pedicled colon is mandatory for reducing the sever complications, such as leak and necrosis. Ileocolic conduit is an alternative method of colon interposition which has anti reflux effect and therefore with less complications related to gastroesophageal reflux. When we have a short segment esophageal stricture due to corrosive esophagitis or other causes of esophageal strictures which is refractory to repeated dilatations, it is advisable to perform colon patch esophagoplasty. Gastric transposition can produce a good way for gastrointestinal continuity with a perfect weight gain and oral feeding, therefor it can be a safe choice for esophageal replacement in children. Partial gastric pull-up is an alternative operation for esophageal replacement in children and infants with long gap esophageal atresia. Gastric conduit replacement is another alternative technique for esophageal replacement, in which a gastric tube is created in the abdomen and it is pulled to via thoracic cavity to the neck and is committed by cervical anastomosis. Antral patch esophagoplasty is used for benign and limited esophageal stricture due to gastroesophageal reflux. Usefulness of pedicled jejunum was under optimal results because of technical problems and high rate of necrosis and mortality for decades. Sternocleidomastoid myocutaneous esophagoplasty is a scarce method which is reported by some surgeons for limited cervical esophageal stricture repair. Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty is used for reconstruction of a pharyngoesophageal defect, and Patch esophagoplasty by using of degradable bioscaffolds of extracellular matrix have shown good results in preclinical and clinical outcomes to prevent stenosis after endoscopic mucosectomy. We will explain the advantages and disadvantages of these different surgical methods in this review article.

Sa2002 THE CLINICAL EFFICACY OF ENDOSCOPIC POSTDILATION INTRALESIONAL INJECTION OF MITOMYCIN-C IN ADULT PATIENTS WITH REFRACTORY BENIGN ESOPHAGEAL STRICTURE

Refractory benign esophageal stricture (RBES) still remains as a clinical challenge, even though repeated endoscopic therapies with bougie or balloon dilation has clinically been tried. Intralesional Mitomycin-C (MMC) injection has recently been introduced to resolve it mostly in children. The aim of this study was to evaluate the clinical efficacy of endoscopic postdilation intralesional injection of MMC in adult patients with RBES. The patients who had RBES even after five or more sessions of bougination were prospectively enrolled. A submucosal needle injection of 4mL of a MMC preparation (0.5mg/mL) was endoscopically done with a 0.5mL of eight each injection mainly into the tearing esophageal wall, after esophageal bougie dilation had done up to 14mm in diameter. Additional therapy of bougination alone or combined with MMC injection was done, if dysphagia symptoms recurred with dysphagia score 3 or more. It was considered as treatment failure if there was no clinical improvement even after 3 additional MMC injections with the interval of 8 weeks. Initial and overall clinical success rates were evaluated with drug- and procedure-related complication rates during the follow-up period of at least 12 months after last MMC injection. Thirteen of 16 patients enrolled in this study were evaluated except 3 patients who had been dropped out. The causes of esophageal stricture were post-operative stricture in 6, corrosive in 5, post-ESD in 1, and peptic in 1 patient. The lengths of stricture were less than 1cm in 5 and longer than 5cm in 2 patients. In 7 patients, GOOSS scores were significantly improved after single MMC injection and consistently kept without further treatments during follow-up period (median, 369 days) with 53.8 % (7/13) of initial clinical success rate. Of the remaining 6 patients, additional MMC injections were performed once more in 3, 2 more in 1, and 3 more times in 2 patients during follow-up, resulting in significant improvement of dysphagia in 4 patients out of them with 84.6% (11/13) of overall clinical success rate. Two patients who failed in achieving overall clinical success after 3 more MMC injections had longer stricture than 5cm in length. The major drug- and procedure-related complications did not occur in any patients during follow-up. Endoscopic postdilation intralesional injection of MMC was safe and effective in adult patients with RBES, especially whom shorter length (<5cm) of esophageal stricture exist.

Brain Abscess and Esophageal Dilatation: Where is the Link? - Case Report

Abstract Introduction Caustic substance ingestion is a common cause of esophageal stricture in children. The primary treatment is esophageal dilatation. Although it is known that endoscopic esophageal dilatation is a procedure associated with a high rate of bacteremia, current guidelines do not recommend routine throat swab cultures or antibiotic prophylaxis for the general children population. Case Report We describe a case of a 7-year-old boy presenting with refractory headaches who was diagnosed with cranial abscess after multiple esophageal dilatations due to stenosis caused by caustic soda ingestion. The patient was subjected to neurosurgical intervention and intravenous antibiotic treatment for 6 weeks. Streptococcus viridans culture was positive in purulent abscess content. Conclusion We highlight this condition that, although rare, needs immediate diagnosis and proper treatment. We also recommend routine testing of throat swabs and antibiotics prophylaxis to children undergoing esophageal dilatation.

Endoscopic postdilatation application of Mitomycin C in children with resistant esophageal strictures.

BackgroundThe esophagus is the most common part of gastrointestinal (GI) tract at the risk of stricture. Benign disorders are the leading causes of narrowing. Caustic ingestion is the most common cause of esophageal stricture in children, especially in developing countries. Clinical responses to the topical application of Mitomycin C in various medical procedures have been reported.PurposeThe study aimed to evaluate the methodology, efficacy, and side effects of Mitomycin C in the treatment of esophageal strictures.MethodsThis study included 30 children with resistant esophageal strictures. Upper GI endoscopy was performed up to the area of stricture, esophageal dilatation was done, endoscopy was repeated, and Mitomycin C was applied topically under direct endoscopic vision. The effect of the procedure was followed over a period of 3–5 years.ResultsThe response to Mitomycin C was excellent (clinically and endoscopically) in 28 patients (93.3%) and good (endoscopically only) in 2 patients (6.7%). No side effects of topical Mitomycin C in children with esophageal strictures were reported in this study.ConclusionEsophageal dilatation followed by local Mitomycin C application may be a useful strategy for treating resistant esophageal strictures.

Actinomyces-Induced Esophageal Stricture in an Immunocompetent Host

Actinomyces is an anaerobic organism that resides in the GI tract and is a rare cause of esophageal stricture, usually in immunocompromised patients. We present an immunocompetent patient with chronic dysphagia whom we found to have an esophageal stricture growing Actinomyces. A 44 year-old Haitian woman with no past medical history was admitted for 6 months of dysphagia to both solids and liquids that later progressed to odynophagia. She also complained of fatigue, weakness, and 15 lb weight loss. She denied having nausea, vomiting, abdominal pain, or substernal burning. Our initial EGD showed an esophageal stricture 15 cm from the incisors that was too narrow for the scope to pass (Fig. 1). Biopsies at the site showed ulceration with granulation tissue and clusters of Actinomyces. Brush cytology was negative for malignancy. Dilation was deferred due to extensive edema and friability. A follow-up barium esophagram confirmed the stricture was 2cm long (Fig. 2). She was started on IV penicillin G. Our repeat EGD six weeks later showed resolution of the swelling (Fig. 3) and subsequent video fluoroscopy showed 50% luminal narrowing over a 5-6 cm segment. We then scheduled the patient for balloon dilatation, which was successful, and six more months of antibiotics, which are ongoing.1726_A Figure 1. Initial EGD Finding1726_B Figure 2. Esophagram Findings1726_C Figure 3. Post-Treatment EGD FindingsActinomyces typically resides in the GI and genitourinary tracts, but can become pathogenic upon breaching the mucosal barrier. Commonly affected groups include men, diabetics, and the immunosuppressed. It will generally present with odynophagia, dysphagia, and weight loss. Initial work-up includes neck CT and barium studies, but definitive diagnosis is via tissue biopsy. Fewer than 30 cases of esophageal Actinomyces have been reported and only 9 involved immunocompetent hosts. Factors such as trauma, surgery, malignancy, chemotherapy, and radiation therapy may increase risk of pathogenesis. Esophageal dysmotility from hiatal hernias is another potential mechanism for infection in immunocompetent hosts since acid reflux can damage the mucosa and lead to invasion. Strictures causing dysphagia can be treated with mechanical dilatation, and any infection must be treated with beta-lactam antibiotics. There have been no reported incidents of recurrent symptoms in immunocompetent hosts following treatment.

Efficacy and safety of endoscopic dilatation in the management of esophageal strictures in children.

Objectives:To determine the outcomes of endoscopic dilatation of esophageal strictures in children.Methods:Children younger than 18 years of age diagnosed with esophageal strictures over a period of 7 years (June 2010 to June 2017) were reviewed and analyzed retrospectively. The study took place at King Khalid University Hospital, Riyadh, Saudi Arabia. The patients’ clinical characteristics, endoscopic findings, and details of the strictures, treatment, and outcomes were documented.Results:Forty-three children with esophageal strictures were identified (median age, 8.1 years; range, 2-17 years; 23 [53.5%] boys). The median age at presentation was 2 years (range, 1-16 years), and the median follow-up period was 3 years (range, one month-17 years). Tracheoesophageal fistula (n=14, 32.6%), gastroesophageal reflux disease (n=10, 23.3%) and eosinophilic esophagitis (n=8, 18.6%) were the leading causes of esophageal strictures. Forty-three patients underwent 180 dilatation sessions; the median number of dilatation sessions per patient was 3 (range, 1-48), and the median interval between sessions was 8 weeks (range, 1-24 weeks). Among 180 dilatation sessions, 3 events (1.7%) of esophageal perforation were observed. The outcomes varied depending on the primary cause of the stricture; complete response was achieved the best in eosinophilic esophagitis-related strictures (87.5%), followed by anastomotic strictures post tracheoesophageal fistula repair (71.4%) and gastroesophageal reflux disease-related strictures (70%).Conclusion:Endoscopic dilatation is a safe and effective intervention in the management of esophageal strictures in children, with minimal complications when conducted by experts.

Efficacy and safety of endoscopic balloon dilatation of esophageal strictures without fluoroscopy: a pilot study

IntroductionEsophageal strictures can be caused by malignancy, congenital stenosis, motility disorders or benign strictures. Endoscopic balloon dilatation is a simple procedure with low complication rates to treat gastrointestinal strictures. This study aims to analyze indications and results of balloon dilatation without fluoroscopy.Material and methodsThe patients who underwent pneumatic balloon dilatation (PBD) for esophageal stricture were included in the study. The demographic characteristics of the patients, indications for PBD, number of operations and complications were recorded.ResultsTwelve patients were included in this pilot study. The most common cause of esophageal strictures was malignancy. In this group, PBD was performed before stenting in the patients who were planned to receive neoadjuvant therapy, had locally advanced esophageal cancer or inoperable esophageal cancer, and complained of difficulty swallowing. Three patients underwent PBD due to achalasia. One of these patients underwent PBD 3 times due to recurrence of symptoms during the follow-up period. The success rate of PBD in this study was 91.6%. The success rate for the patients who underwent PBD for the first time was 83.3%. None of the patients who underwent endoscopic balloon dilatation had major complications (such as massive bleeding and perforation) or procedural mortality.ConclusionsEndoscopic balloon dilatation without fluoroscopy performed by experienced endoscopists is an effective and safe method for the treatment of esophageal strictures. Successful results are obtained with low complication rates in experienced centers.

Acute pancreatitis: An unusual cause of esophageal stricture

Acute pancreatitis: An unusual cause of esophageal stricture

Diseases of the Stomach

There are multiple diseases of the stomach and esophagus that will lead a patient to seek emergent care, including peptic ulcer disease (PUD), esophagitis, dysphagia, esophageal foreign bodies, and gastroesophageal reflux disease (GERD). Hemorrhage and perforation are major emergencies in peptic ulcer disease and esophageal disease requiring early recognition with immediate resuscitative efforts to stabilize. This review covers the risk factors, pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for patients with diseases of the stomach and esophagus. Figures show illustrations of esophageal anatomy, an algorithm for the evaluation of dysphagia, the pathogenesis of peptic ulcers, and radiographs demonstrating an esophageal button battery and pneumoperitoneum caused by a perforated ulcer. Tables list some common causes of esophageal stricture and pill-induced esophagitis, differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate Helicobacter pylori infection. Key Words: Peptic ulcer disease, esophagitis, dysphagia, esophageal foreign body, GERD, H. Pylori, button battery

Diseases of the Stomach

There are multiple diseases of the stomach and esophagus that will lead a patient to seek emergent care, including peptic ulcer disease (PUD), esophagitis, dysphagia, esophageal foreign bodies, and gastroesophageal reflux disease (GERD). Hemorrhage and perforation are major emergencies in peptic ulcer disease and esophageal disease requiring early recognition with immediate resuscitative efforts to stabilize. This review covers the risk factors, pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for patients with diseases of the stomach and esophagus. Figures show illustrations of esophageal anatomy, an algorithm for the evaluation of dysphagia, the pathogenesis of peptic ulcers, and radiographs demonstrating an esophageal button battery and pneumoperitoneum caused by a perforated ulcer. Tables list some common causes of esophageal stricture and pill-induced esophagitis, differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate Helicobacter pylori infection. Key Words: Peptic ulcer disease, esophagitis, dysphagia, esophageal foreign body, GERD, H. Pylori, button battery

Esophageal stricture in lichen planus

AbstractLichen planus (LP) is a rare cause of esophageal stricture. It is usually associated with oral mucosal involvement, and the diagnosis has to be considered in these patients who present with dysphagia. We present a case of esophageal stricture secondary to LP.