Corrosive Esophageal Stricture Research Articles

Результаты эзофагопластики у детей с рубцовыми послеожоговыми стенозами пищевода

Результаты эзофагопластики у детей с рубцовыми послеожоговыми стенозами пищевода

Лечение химических ожогов пищевода у детей

Objective . To study the treatment efficacy of chemical burns of the esophagus in children with different grades of lesion. Material and methods . For the last seven years in Dnipropetrovsk Regional Children’s Clinical Hospital there were 192 children on treatment with a diagnosis of chemical burn of the esophagus, out of them 108 (56.25%) boys and 84 (43.75%) girls, and prevailed children aged 1-3 years who made up 102 (53.1%). Among damaging agents caused esophageal burns were more often caustic ones 95 (49.47%). In most cases, there was grade II of lesion of esophageal burns in 71 (36.98%) children. Treatment of post-burn esophagitis includes detoxification, stomach lavage, pain management, antibiotic therapy, short course of corticosteroids. Estimation of the patient’s status provided during the first twenty-four hours. Further the restoration of esophageal patency was conducted with the use of instrumental methods of treatment. The main method of corrosive strictures of esophagus was gullet bougienage and dilation. Results . The patients of the study group were treated using bougie over guidewire dilators. Application of this methodology in treatment of patients with the esophageal burns allowed considerably reduce the amount of cicatrical esophageal stenosis, as well as such complications as perforations and mediastinitis. Conclusion . Proper provision of primary care and the selection of correct diagnostic and treatment tactics of patients with chemical burns of the esophagus helps to reduce complications and disability in children with this pathology.

Topical Mitomycin C Application Is Effective Even in Esophageal Strictures Resistant to Dilatation Therapy in Children.

Several treatment techniques may be used in the treatment of esophageal strictures. The purpose of this study was to present the effects of topical mitomycin C (TMC) as an useful adjunct to dilatation therapy in esophageal strictures. A retrospective analysis of patients who underwent TMC between February 2015 and July 2016 was performed. Dysphagia score, periodic dilatation index, and number of dilatations were compared before and after intervention to investigate the efficacy of TMC. TMC was performed on 20 patients with a median age of 3.5 years (2 to 17 y). The diagnosis was corrosive esophageal strictures in 14 patients, anastomotic strictures in 5 patients, and congenital esophageal stricture in 1 patient. The length of the stricture was long in 10 patients (50%). The median dysphagia score decreased from 2 (1 to 3) to 0 (0 to 2) after application (P<0.001). The median number of dilatation sessions decreased from 5 (1 to 41) to 1 (0 to 11) after intervention (P<0.001). The median periodic dilatation index decreased from 1 (0.66 to 1.34) to 0 (0 to 1.33) after TMC (P<0.001). Regular esophageal dilatation was not necessary in 16 patients after application (80%). The length of the stricture did not affect the efficacy of TMC. The success of treatment was lower in patients with a long treatment period before TMC (>3 y) (50%). No complications were seen in a median follow-up period of 16 months (7 to 22 mo). TMC application has a significant positive effect as an adjunct to dilatation therapy in most of the patients with different types of esophageal strictures. It should be performed as a safe and efficient treatment option even in patients who were resistant to dilatation therapy.

Utilization of Gastric Conduit in the Management of Combined Corrosive Esophageal and Stomach Stricture.

Corrosive stricture of esophagus may be associated with variable involvement of stomach. We analyzed the outcome of gastric conduit used in the management of corrosive esophageal stricture with concomitant antro-pyloric stricture. Among 101 esophageal replacements performed, 53 patients had combined esophagus and stomach strictures. Colon was used as a conduit in 43 patients, while stomach was used in ten patients. Indications, perioperative complications and early/late outcomes of patients with gastric pull-up were reviewed and compared with those undergone colon pull-up. The indications of using gastric conduit were impromptu in four patients [colonic conduit ischemia (n=2) and an oversight of antro-pyloric stricture after forming the gastric conduit (n=2)]. Six patients had preconceived gastric conduit (distal antro-pyloric stricture with distended stomach). The median age was 29years (range 16-50), and median BMI was 15.4kg/m2 (range 14.5-20.1). The stomach was drained using loop gastrojejunostomy (n=7) or Roux-en-Y gastrojejunostomy (n=3). One patient died due to sepsis secondary to anastomotic leak. Median hospital stay was 9days (range 7-22). At median follow-up of 25months (range 14-80), the remaining nine patients are able to have solid diet and have gained weight. The level of esophageal stricture was low (p=0.01), and duration of surgery (p=0.02) and median hospital stay (p=0.04) were significantly less in patients with gastric conduit plus drainage as compared to patients undergone colonic pull-up. Gastric conduit in a subject with distal antro-pyloric stricture can be used safely along with gastrojejunostomy in selected patients of corrosive esophageal stricture.

An audit of the management of oesophageal stricture in children in Durban, KwaZulu-Natal Province, South Africa

Objective . To determine the outcome of the endoscopic management of oesophageal strictures (OSs) of varying aetiology in children in a tertiary centre. Methods . A retrospective chart review was conducted of all children aged <14 years at department of paediatric surgery who underwent endoscopic dilatation of OSs at Inkosi Albert Luthuli Central Hospital in Durban, KwaZulu-Natal Province, South Africa, between July 2002 to December 2010. Management status at 3 years after presentation was used to define outcome. Results. A total of 39 patients aged between 1 month and 13 years were reviewed, and 18 (46%) were males. Thirty-six (92.3%) were black South Africans, and 11 (28%) were HIV-infected. Among the types of strictures, postoperative (35%) and corrosive (30.8%) OSs were more prevalent than HIV-related (20.5%) OSs. The mean number of dilatations needed per patient was 7.3, and those patients with corrosive OSs needed more dilatation sessions (median (interquartile range)) than others (10 (5 - 14) v. 6.5 (5 - 10)). Out of 287 attempted dilatations, oesophageal perforations occurred in 8 (2.8%) cases. Mitomycin C was applied topically in 4 (10.3%) patients, with excellent results. A good response to endoscopic treatment was seen in 27 (69%) cases. The worst outcome was noted in HIV-infected patients. Conclusion. Endoscopic treatment of OSs in children yields good results and has a low rate of treatable complications. Patients should be treated on an individual basis, even if they have strictures of the same aetiology.

1141 Fully Covered Self-Expandable Metallic Stent for Treatment of Esophageal Perforation After Bougie Dilation in a Patient With Corrosive Esophageal Stricture

1141 Fully Covered Self-Expandable Metallic Stent for Treatment of Esophageal Perforation After Bougie Dilation in a Patient With Corrosive Esophageal Stricture

Indigenous Method and Safety of Mitomycin C in Refractory Corrosive Esophageal Strictures

Indigenous Method and Safety of Mitomycin C in Refractory Corrosive Esophageal Strictures

Tu1319 - Anastomotic Strictures Following Esophagectomy for Corrosive Esophageal Strictures are More Difficult to Treat than Those Following Other Etiologies

Tu1319 - Anastomotic Strictures Following Esophagectomy for Corrosive Esophageal Strictures are More Difficult to Treat than Those Following Other Etiologies

Corrosive-Induced Carcinoma of Esophagus: Esophagographic and CT Findings.

The purpose of this study was to evaluate the esophagographic and CT findings of corrosive esophageal cancer. The records of all patients who presented with corrosive esophageal strictures at one institution between June 1989 and April 2015 were retrospectively identified. The search yielded the records of 15 patients with histopathologically proven esophageal cancer. Esophagograms (13 patients) and chest CT images (14 patients) were interpreted independently by two reviewers. Esophagographic findings included the location of tumor, morphologic type, presence and length of mucosal irregularity, presence of asymmetric involvement, and presence of rigidity. CT findings included presence and type of esophageal wall thickening, pattern of enhancement, presence of periesophageal infiltration, and presence of hilar or mediastinal lymphadenopathy. Esophagography showed that the tumor was involved with the stenotic portion in 10 of the 13 patients (76.9%). The most common morphologic feature was a polypoid mass, in 10 patients. In 12 patients (92.3%), mucosal irregularities were observed; the mean affected length was 4.92 cm. Asymmetric involvement and rigidity were observed in nine patients (69.2%). On CT scans, eccentric wall thickening was observed in 10 of the 14 patients (71.4%), homogeneous enhancement in nine (64.2%), and periesophageal infiltration in 11 (78.5%). Esophagography commonly shows corrosive esophageal cancer as a polypoid mass with long-segment mucosal irregularities at the stenotic portion, asymmetric involvement, and rigidity. CT shows eccentric esophageal wall thickening with homogeneous enhancement and periesophageal infiltration, which are suggestive of the development of malignancy in patients with corrosive esophageal strictures.

Instrumental esophageal perforation: A case series

Esophageal perforation is a rare but dreadful surgical emergency. The main etiology is iatrogenic trauma, mostly related to endoscopic instrumentation. The treatment is controversial; however, surgery remains the mainstay. In this article, 3 cases of instrumental perforation of esophagus are described. In all cases, diagnosis was based on clinical, radiographic, and endoscopic findings. The first case was a 4-year-old girl with a corrosive stricture of esophagus who received 8 sessions of dilatation over 1 year; the last session resulted in perforation. Unfortunately, she was not referred to thoracic surgery at once but kept in gastroenterology department for several days, and hence, empyema developed. Conservative treatment was employed first followed by elective gastric pull-up via laparotomy and left neck incision 3 months later. She regained normal swallowing of fluid and semisolid food but developed a chronic neck sinus that required few drainage operations. The second case was of a 54-year-old man with dysphagia and a normal esophagus who developed perforation during rigid esophagoscopy. The perforation was immediately detected and an urgent primary repair was performed via left thoracotomy. The third case was of a 24-year-old man with persistent achalasia cardia despite 2 trans-abdominal esophagomyotomies. Perforation occurred during second session of pneumatic balloon dilatation but was directly referred to a thoracic surgeon who performed an urgent esophagectomy. All patients survived. We conclude that a good outcome of this potentially fatal condition is possible with early diagnosis and intervention provided by an expert surgical team.

Erosion of esophageal stent into left main bronchus causing airway compromise.

Covered or uncovered self-expanding metal stents are currently used for the palliative treatment of neoplastic esophageal strictures or compressions and esophageal leaks or fistulas due to malignancies. Erosion of esophageal stents into the respiratory tract is a rare complication and that too has been reported mostly as an early complication within few days or weeks. Here, we present the case of a 31-year-old female, who presented with a late complication of an esophageal stent eroding into the left main bronchus causing respiratory distress. She was stented for a benign corrosive esophageal stricture following caustic soda ingestion 3 years ago. She underwent a thoracotomy and closure of esophagobronchial fistula along with laparoscopic esophagectomy and gastric pull through. Postoperatively, patient developed an anastomotic leak which was corrected by placing a temporary stent.

Gastric tube esophagoplasty for pediatric esophageal replacement

BackgroundEsophageal replacement in children is indicated in cases of esophageal atresia with or without fistula, in case of long gap esophageal atresia or failed primary repair. Intractable post corrosive esophageal stricture is considered also a major indication for replacement. MethodsThis is a cohort retrospective study of esophageal replacement cases by gastric tube carried out at the pediatric surgery department at Cairo University between 2011 and 2015. We reported 50 patients (30 boys and 20 girls); the ages ranged from 7months to 9years. Esophageal atresia cases were 27 while caustic esophageal stricture cases were 23. Isoperistaltic gastric tube technique was done in 45 patients while antiperistaltic (reversed) gastric tube technique was done in 5 cases. Retrosternal route was chosen in 38 patients while transhiatal route was chosen in 12 patients. ResultsLeakage and stricture were the most common complications. We had 5 cases of mortality, which were caused mainly by chest related complications. We had excellent to good results during long term follow up in terms of weight gain, swallowing pattern, quality of life, and overall satisfaction ConclusionGastric tube is a satisfactory surgical method for esophageal replacement in children. Level of EvidenceIII.

The Efficacy of Intralesional Steroid Injection in the Treatment of Corrosive Esophageal Strictures in Children.

Esophageal dilatation can be insufficient in the treatment of severe corrosive esophageal strictures. In this study, we aimed to present the efficacy of intralesional steroid injection as an adjunct to dilatation therapy. Retrospective analysis of children who underwent intralesional steroid injection between 2004 and 2014 was performed. Patients' age, type of corrosive substance, length of stricture, number of injection and dilatation sessions and complications were reviewed. The success was evaluated by the comparison of number, frequency, and requirement of dilatation therapy before and after injection. Intralesional steroid injection was performed to 32 children with a mean age of 3.6±2.5 years. The types of corrosive agents were alkali (24) or acid (8). Mean number of injection sessions was 2.5±1.1(1 to 6). Mean number of dilatation sessions was decreased from 10±8.8 to 5.4±4.6 after injection (P=0.003). Mean frequency of dilatations was extended from 3.6±0.9 weeks to 8.7±3.9 weeks (P=0.000). Dilatation treatment was successfully terminated in 25 of 27 children with short-segment strictures after injection (92%). Whereas all of the children with long-segment strictures could not resolved and finally required esophageal replacement (5 patients). One patient had transient cushingoid phenotype as a complication. There was not seen any major complication-like perforation. The mean follow-up period was 6±3 years. Intralesional steroid injection is an effective adjunct to dilatation in most of the children with short-segment strictures. It should be performed as a safe and efficient treatment option in patients with short-segment corrosive esophageal strictures resistant to dilatation therapy.

Ivor Lewis 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. Results: 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%.Conclusion: 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.

Management of Acquired Tracheoesophageal Fistula Complicating Endoscopic Management for Corrosive Esophageal Stricture

Management of Acquired Tracheoesophageal Fistula Complicating Endoscopic Management for Corrosive Esophageal Stricture

腐食性食道炎後狭窄に対する拡張術の1治験例

The patient was a 78-year-old female who had ingested an acidic detergent (Sunpole™) with suicidal intent. She underwent partial gastrectomy and enterostomy to treat perforations in the gastric remnant (from previous cancer surgery) . She was successfully treated in an intensive care unit, but later she developed esophageal stricture due to corrosive esophagitis and was transferred to our hospital. Mucosal damage was discovered in the esophagus beginning at the cervical region. Her medical history included, along with stomach cancer, a total laryngectomy. These observations suggested that esophageal reconstruction would require invasive and complicated surgery that would involve intestinal tissues. We also considered her advanced age and illiteracy, and decided to use conservative esophageal dilation. During six dilation sessions within half a year, her oral food intake increased gradually. Here, we detail this successful dilation procedure for corrosive esophageal stricture.

Stomach pullup for burnt out esophagus, an experience of 44 cases

Gastric pull-up with cervical anastomosis is a safe procedure, which can be performed for the treatment of non-dilatable corrosive esophageal stricture.

Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion.

Endoscopic dilatation of corrosive esophageal strictures is effective, but some patients are refractory to it and require long-term repeated dilatations. The present study was carried out to analyze whether rigorous schedule of endoscopic bougie dilatation along with intralesional injection of triamcinolone in patients refractory to endoscopic dilatation alone could decrease the number and frequency of endoscopic dilatations. The inclusion criterion for this prospective study was patients with refractory corrosive esophageal stricture of any age group. Refractory benign esophageal stricture is defined as an anatomic fibrotic esophageal restriction with inability to achieve dilatation of ≥14 mm or to maintain dilatation for 4 weeks once ≥14 mm diameter is achieved. The patients were followed up prospectively for 1 year. Patients with refractory strictures were subjected to weekly bougie dilatation (Savary-Gilliard) of the strictures along with injections of intralesional triamcinolone (40 mg/mL, 1 mL diluted in 1 mL of saline, 0.5 mL injected per quadrant of stricture) for consecutive 5 weeks, referred to as rigorous schedule. Further dilatation was done on an 'on-demand' basis. Eleven patients were enrolled for the study. Dysphagia score improved from pre-intervention score of 3.54 ± 0.52 to 0.45 ± 0.52 post-intervention (P < 0.001). The maximum dilatation achieved pre-intervention was 9.90+1.04 mm Savary-Gilliard and post-intervention significantly improved to 14.7 + 0.7 mm Savary-Gilliard (P < 0.001). The periodic dilatation index defined as number of dilatations per month also significantly improved from pre-intervention score of 2.54 ± 1.06 to post-intervention score of 0.19 + 0.13 (P < 0.001). No adverse effects were reported by the patients. Rigorous weekly schedule of bougie dilatation and intralesional triamcinolone in combination is safe and effective in achieving significant dilatation, reducing the frequency dilatations, maintaining dilatation and improving dysphagia till 1 year of follow-up.

Endoscopic cicatrectomy for corrosive esophageal strictures just below the piriform fossa

Corrosive esophageal strictures have been primarily treated using balloon dilatation or endoscopic bougienage. However, many patients experience recurrence after dilatation, and surgical interventions such as esophageal replacement have been attempted. We have performed endoscopic cicatrectomy using a laryngoscope for corrosive esophageal stricture just below the piriform fossa to minimize surgical invasiveness. In this case reported, repeated balloon dilatation therapy failed, and the combination of endoscopic cicatrectomy and intralesional triamcinolone acetonide injections proved most effective even though multiple cicatrectomies were required. If esophageal strictures are close to the piriform fossa, endoscopic cicatrectomy could be one useful surgical option.

Corrosive injury of the upper gastrointestinal tract: review of surgical management and outcome in 14 adult cases.

Caustic ingestion is responsible for a spectrum of upper gastrointestinal tract injury from self-limited to perforation. This study conducted to evaluate clinical characteristics as well as surgical outcomes in patients with caustic ingestion. Between Nov1993 to march 2011, 14 adults with a clinical evidence of corrosive ingestion were admitted into our institutions (Omid and Ghaem hospitals). Patients evaluated for etiology of erosion, location, type of surgery, morbidity and mortality after surgery. 14 patients (10men and 4 women) with a age range between18-53 years were evaluated. In 6 patients, the injury was accidental and in 8 patients ingestion was a suicide attempt. Ingested agent included nitric acid in 4 patients, hydrochloric acid in 7 patients, sulfuric acid in 2 patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in 13 cases, stomach in 7 cases and the pharynx in 3 cases. Acute abdomen was developed In 2 patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in 2 patients, esophageal resection and replacement surgery in 9 patients and gastroenterostomy in one patient performed to relieve esophageal stricture. Two patients died of mediastinitis after esophageal replacement surgery. Postoperative strictures were developed in 2 survived patients with hypopharyngeal reconstruction that was managed by per oral bougienage in one patient and KTP Laser and stenting in the other patient. Esophageal resection with replacement was safe and good technique for severe corrosive esophageal stricture with low mortality and morbidity.