Circumferential Stricture Research Articles

A CASE OF COLONIC CANCER ASSOCIATED WITH COLONIC TUBERCULOSIS

A 74-year-old woman was seen at the hospital because of a right lower abdominal pain. Barium enema revealed a narrowing of the hepatic flexure and remarkable shortenig with pseudo diverticula formation of the ascending colon. Colonoscopy demonstrated a whole circumferential stricture in the hepatic flexure and old inflammation in the anal side area from the stricture. Since an biopsy yielded moderated differentiated adenocarcinoma, right hemicolectomy was performed. The resected specimen showed that the tumor was categorized as carcinoma of Borrmann 2 type. A few the scarred area with discoloration was observed in the shortened ascending colon, and so we recognized this change as the old colonic tuberculosis. This case and 51 cases of colonic tuberculosis with a colonic cancer seen in the Japanese literature were reviewed. It took about 30 years to develop colonic cancer in the cases which actually had a previous history of tuberculosis. The causal relation between colonic tuberculosis and colonic cancer is not indisputably interpretated. But it is assessed that colonic cancer affected with tuberculosis may be exist, because macroscopically atypical carcinoma type was frequently observed and “dysplasia” around the cancer was revealed in about 19% of all cases.

Gross morphologic and functional effects of postoperative radiation on free jejunal autografts.

Twenty adult mongrel dogs underwent free jejunal transplants to the neck; 10 either died of or had to be sacrificed as a result of postoperative complications, 5 received a 55-Gy-equivalent dose of radiation after 3 weeks, and 5 were followed as controls. Serial manometric and endoscopic evaluations were performed over a 9-month period. Progressive deterioration of the quality and amplitude of peristalsis of the jejunal autografts was observed only in the radiated group. In addition, all dogs in the radiated group developed severe jejunal circumferential constriction and stricture formation. These delayed effects of irradiation on revascularized jejunal autografts should be considered in planning the method of pharyngoesophageal reconstruction as well as the timing of adjuvant radiotherapy.

Push-through intubation: Effective palliation in 409 patients with cancer of the esophagus and cardia

Between 1980 and 1989, 355 patients with cancer of the esophagus and 54 with cancer of the cardia underwent push-through intubation because of advanced tumor stage oc medical contraindications to tumor resection. In 36 other parents (8.1%), the attempt at transtumoral intubation failed. The hospital mortality rate after intubation was 3.4%. The following complications were observed: hemorrhage in 2.0% of the patients, esophageal perforation in 4.9%, tube dislodgment in 12.7%, and tube obstruction in 4.4%. Early resumption of semisolid oral feeding was possible in 80% of the discharged patients. The actuarial 1-year survival rate was 7.7% and the median survival, 3.9 months. In conclusion, pushthrough intubation represents a valid therapeutic choice, which is indicated mainly for patients with a long, infiltrating, and circumferential stricture of the thoracic esophagus or cardia that is inoperable and for patients with an esophagorespiratory or esophagomediastinal fistula.

Surgical Correction of Strictures of the Large Colon in Three Horses

An extensive stricture of the left dorsal colon in a Thoroughbred colt was resected and the colon was anastomosed. In two horses, circumferential strictures at the pelvic flexure 2.5 to 3 cm long were corrected with a modified Heineke-Mikulicz pyloroplasty technique. The horses were reported to be doing well at 6, 8, and 45 months, respectively.

Palliative bipolar electrocoagulation treatment of malignant gastroesophageal strictures

Seventeen patients with non-resectable circumferential malignant strictures of the esophagus (n = 13) or the gastroesophageal junction (n = 4) were treated with a bipolar electrocoagulation tumor probe (BICAP). None had received prior radiotherapy or chemotherapy. The mean tumor length was 7.2 cm. After treatment swallowing was improved in 86.7% of the patients. The mean duration of response to the first treatment was 18 days. Three major complications (1 fatal hemorrhage, 2 tracheoesophageal fistulae) and two minor complications (chest pain) were observed. The overall actuarial survival rate after 13 months of follow-up was 20%. The BICAP tumor probe can be considered an efficacious and safe device in selected patients with long, circumferential esophageal cancers.

La sonda BICAP para tumores en el tratamiento paliativo del cancer de esofago

The purpose of this study was to present the result of the BICAP tumor probe used for palliation of esophageal cancers. Only patients with a circumferential stricture and esophageal wall thickness of at least 1 cm were included in this study. Thirty patients with dysphagia from an unresectable esophageal cancer were referred for endoscopic palliation. Seven patients who did not meet the selection criteria for BICAP were referred for other therapies. Twenty three patients were included in this study. Initial technical success was achieved in 22 and functional success in 19 (83%). During the follow-up period, maintenance of the functional improvement required new endoscopic or adjuvant treatments in all. The treatment was completed in 11 and the average duration of improvement was 15.9 weeks. No major complications occurred. The main advantages of the BICAP tumor probe over Nd: YAG laser are a faster improvement, and a good efficacy on infiltrative and submucosal cancers. But the BICAP treatment is limited to circumferential strictures with a minimum of about 1 cm esophageal wall thickness.

Fixed transverse folds in the esophagus: a sign of reflux esophagitis.

Scarring from reflux esophagitis is usually manifested by circumferential stricture formation. This article reports 17 cases in which double-contrast esophagography demonstrated fixed transverse folds in the esophagus, presumably secondary to longitudinal scarring from reflux esophagitis. In all cases, pooling of contrast material between the folds produced a series of horizontal, relatively parallel collections of barium in a "stepladder" arrangement. This appearance should be distinguished from linear ulcerations, tertiary esophageal contractions, and the delicate transverse striations that are occasionally observed as a transient phenomenon on the double-contrast examination.