Endoscopic Electrocauterization Research Articles

Successful management of pyriform sinus cyst and fistula using endoscopic electrocauterization.

ObjectivesPyriform sinus cyst (PSC) and pyriform sinus fistula (PSF) is a rare congenital malformation that arises from the third or fourth branchial structure. In our study, we describe the safety and the utility of endoscopic electrocauterization against PSC/PSF.MethodsWe retrospectively reviewed the records of patients who underwent endoscopic electrocauterization for PSC/PSF at our hospital. The internal opening of the fistula was identified under general anesthesia using a flexible endoscope (XQ‐260 or H‐290; Olympus, Tokyo, Japan), and the DualKnifeJ (KD‐655L; Olympus) was used to ablate the internal opening.ResultsWe experienced three PSF and three PSC patients. The postoperative course was uneventful in all cases. The patients declared no pain in the neck, and there were no cases showing recurrent nerve paralysis. Five in six cases (83%), the closure of fistula was archived in the first cauterization. One case (16.6%) required repeated cauterization. No recurrence was found during the follow‐up period ( median: 1 year) in any cases.ConclusionsOwing to its rarity in neonates, the diagnosis and treatment of PSC remains complicated and not clearly described. Complete removal of the fistula and the cyst with or without affected thyroid tissue was previously the most commonly used treatment. From our experience, we believe that endoscopic electrocauterization can be the first choice not only for PSF but also for neonatal PSC. In conclusion, endoscopic electrocauterization is feasible even for neonatal PSC. Further investigations including multicenter analyses are needed.

Endoscopic Management of Branchial Fistula: Diagnostic and Therapeutic.

Recurrent neck abscess is a typical feature of branchial anomaly. Open surgical excision has been the primary treatment modality for past decades however several alternative treatment modalities such as endoscopic electrocauterization has recently gained popularity and acceptance universally. This series aims to introduce endoscopic assessment as the first line diagnostic and therapeutic management for branchial fistula.
 5 patients underwent examination under general anesthesia via direct laryngoscopy, endoscopic assessment and cauterization in our centre from 2016 to 2019. They were then followed up at our clinic to assess disease progression.
 Comparison between open neck surgery and endoscopic cauterization of internal sinus tract opening as the primary treatment has reported similar recurrence rate.
 Proposal of endoscopic assessment as the first line investigation and diagnostic tool with the aim of therapeutic cauterization at the same setting. MRI may be needed in scenarios such as failed endoscopic treatment or when open surgery is required.

Etiological characteristics and management of patients with epistaxis in Aksaray

Aim: Epistaxis is a common condition in humans, particularly in patients with hypertension, and is one of the most common presenting symptoms in ear, nose, and throat emergency consultation. The present study aimed to examine the treatment and hospitalization characteristics of the patients who presented with epistaxis in Aksaray city and to propose an optimized and updated protocol.Material and Methods: The present study retrospectively evaluated 758 patients who presented with epistaxis to the Training and Research Hospital in Aksaray between January 2016 and February 2020. The patients were analyzed in terms of age, sex, seasonal characteristics, hospitalization rates, pathogenesis of epistaxis, sites of bleeding, and treatments.Results: The study included 349 females (46.1%) and 409 males (53.9%); mean patient age was 60.9 ± 9.3 years (range: 3–89 years). The most common comorbidity was hypertension (47.3%), and the most common site of bleeding was the anterior region including the Kiesselbach’s plexus (88.2%). Nasal packing (58.5%) and electrocauterization (29.9%) were performed in most cases. The treatment success was defined as no instance of re-visit by the patients to the hospital due to nasal bleeding within 24 h after the procedure; the treatment was successful in 698 patients (92.1%).Conclusion: Most cases of epistaxis are successfully treated using endoscopic electrocauterization on an outpatient basis. Hospitalization is indicated if surgical intervention, posterior packing, or embolization is required and if deterioration of general condition is observed. The present study proposes an updated protocol optimized for the management of epistaxis.

Characteristics and treatment of patients with epistaxis over the last 5 years in Guangzhou

Background: Epistaxis is one of the most common emergencies in the department of otolaryngology, which gives a burden to the health care system. Objectives: This study aimed to investigate the patients’ characteristics of hospital admission with epistaxis and provide an optimized protocol. Methods: This study was a retrospective analysis of patients with epistaxis admitted to The Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China. The data were analyzed in terms of gender, age, seasonal differences, length and expenses of hospitalization, pathogenesis of epistaxis, primary medical management before hospital admission, bleeding sites, and treatment. Results: A total of 387 patients were included, which consisted of 270 males and 117 females with an average of 43 years. Most patients could be identified with underlying diseases, and the most commonly observed bleeding site was Little area (n = 164). Most patients received electrocauterization as a precision medical treatment (n = 288). The duration of hospitalization length ranged from a mean of 5.17–4.48 days, and the expenses of hospitalization ranged from a mean of RMB 4881–4951 yuan over the last 5 years. Conclusion: Most patients with epistaxis could be treated as outpatients by endoscopic electrocauterization, and hospitalization is indicated when patients need improvement of poor general condition, posterior packing, embolization, or surgery. This study enables to provide an optimized protocol for patient with epistaxis.

Endoscopic electrocauterization of pyriform sinus fistula.

To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9days after cauterization and another experienced recurrence after 2years. Mean follow-up for the eight patients was 50months (range 5-96months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Congenital pyriform fossa sinus tracts predispose to neck masses and neck abscesses in pediatric and occasionally adult patients. Traditional management involves open excision with substantial potential morbidity. Endoscopic management allows an alternative, less morbid treatment approach. To evaluate the long-term effectiveness of endoscopic cauterization as definitive treatment for pyriform fossa sinus tracts. Retrospective review of the medical records of 23 children (aged 7 months to 14 years) with pyriform fossa sinus tracts treated with endoscopic cauterization between 1995 and 2013 at a tertiary care children's hospital. Endoscopic electrocauterization of pyriform fossa sinus tract opening. Recurrence of symptoms after endoscopic treatment. Twenty-one of 23 patients experienced no recurrence after their first endoscopic electrocauterization of the sinus tract. The 2 patients with recurrence experienced symptoms within 1 month of cauterization and were treated with either open excision or recauterization. Endoscopic cauterization was able to definitively treat 9 patients whose treatments with incision and drainage or open excision had failed. Mean (range) follow-up for the 15 patients with follow-up was 7.4 (0.10-14.2) years. No procedure-related morbidity was reported. Endoscopic cauterization seems to be an effective and potentially permanent treatment for congenital pyriform fossa sinus tracts.

Elimination of Postoperative Pyloric Stricture by Endoscopic Electrocauterization and Balloon Dilatation in an Infant With Congenital Antral Web

We, herein, report a male infant who presented with recurrent pyloric stricture after two surgeries (web excision and antropyloroplasty), which were done, respectively, at 5 days of age for congenital antral web and 6 months of age for the subsequent pyloric stricture. The patient suffered from anorexia, progressed vomiting, and weight loss gradually after the first and second surgeries, and then, endoscopy revealed severe pyloric deformity and stricture. Poor inflation was noted during endoscopic balloon dilatation because of tight pylorus; a subsequent electrocauterization and balloon dilatation were done, and the patient's clinical symptoms improved significantly 2 weeks later. A follow-up endoscopy was performed 1 month and 12 months after endoscopic therapy, showing steady regression of pyloric stricture. The patient had adequate diet intake and growth in the later 12 months.

Endoscopic electrocauterization of pyriform fossa sinus tracts as definitive treatment

Objective To (1) update the technique of endoscopic electrocauterization of patients with pyriform fossa sinus tracts and (2) evaluate its effectiveness as a definitive treatment. Methods Retrospective case series with nine patients (age range, 3.3–16.1 years) who were diagnosed with pyriform fossa sinus tracts between 2000 and 2007 at a single tertiary care children's hospital and underwent endoscopic electrocauterization of the sinus tract. Data collected including age of diagnosis, presenting symptoms, time from presentation to diagnosis, diagnostic studies, prior and subsequent treatments, length of hospital stay, and recurrence, were reviewed and analyzed with descriptive statistics. Results All nine patients presented with recurrent left or midline neck masses or abscesses. Seven patients (78%) had at least one previous incision and drainage procedures for abscess treatment. All patients had a computed tomography scan with findings suspicious for left-sided pyriform fossa sinus tract. The diagnosis was confirmed with laryngoscopy. For seven patients (78%), endoscopic electrocauterization was definitive treatment with no recurrences to date. Two patients (22%) had recurrent left neck abscesses after endoscopic treatment; these patients ultimately underwent excision of sinus tract with left thyroid lobectomy without complications or further recurrences. Conclusions Endoscopic electrocauterization of pyriform fossa sinus tracts is a safe and definitive treatment for most patients. We advocate this minimally invasive procedure as first line of treatment for pyriform fossa sinus tracts, reserving open excision with or without thyroid lobectomy for failures.

Successful treatment of congenital esophageal web by endoscopic electrocauterization and balloon dilatation

We report a 3-year-old boy who presented with a foreign body impacted in the esophagus and had a poor tolerance of solid food since he was 5 to 6 months old. In the last 2 years, he developed progressive dysphagia, anorexia, vomiting, and poor weight gain. An esophagoscopy and barium esophagogram revealed an esophageal web in the distal third of the esophagus. Three courses of endoscopic balloon dilatation resulted in transient improvement in his dysphagia and vomiting; a follow-up barium esophagogram and esophagoscopy showed limited improvement of the esophageal stenosis. Two courses of endoscopic electrocauterization and balloon dilatation improved the clinical symptoms and esophageal stenosis.

Metastatic Hepatocellular Carcinoma in the Urinary Bladder with Radiation-induced Hemorrhagic Cystitis

Metastatic hepatocellular carcinoma (HCC) to the urinary bladder is very rare. We present the case of a 58-year-old female patient who was diagnosed to have both HCC and cervical cancer. She developed hemorrhagic cystitis 2 years after radiation therapy for cervical cancer. During endoscopic electrocauterization for hemorrhagic cystitis, three small reddish tumors measuring less than 1 cm in diameter and with a raspberry-like appearance were found. Transurethral bladder tumor resection was performed. Pathology confirmed metastatic HCC to the bladder. Due to the similar appearance, these tumors are liable to be misinterpreted as engorged vessels secondary to irradiation if biopsies are not taken. Differential diagnosis by pathology is mandatory for such patients.

Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis.

Transthoracic endoscopic electrocauterization of the sympathetic chain for palmar hyperhidrosis is presented. A retrospective study of 180 patients during a 2-year period was carried out. The duration of follow-up was from 2 to 12 months. General community, referral center, and hospitalized care. This study was carried out in 180 patients (116 female and 64 male). The age distribution was between 13 and 43 years (mean age, 21.6 years). They complained of palmar hyperhidrosis without other underlying diseases. One-stage bilateral surgery except for three patients with unilateral pleural adhesions. Patients were interviewed 1 week after surgery and then they were contacted by a questionnaire about improvement of hyperhidrosis and complications. This procedure shows a success rate in 98% of the patients. No pneumothorax requiring a chest tube drainage and no Horner's syndrome were recorded. The most common side effect was compensatory sweating in 70% of these patients. This procedure is effective, simple, and requires only an overnight study. It is recommended as the method of choice for surgical treatment of upper extremity hyperhidrosis.

Endoscopic electrohemostasis of active upper gastrointestinal bleeding

Emergency esophagogastroduodenoscopy for active upper gastrointestinal bleeding was performed in 160 patients. Endoscopic electrocautery for control of bleeding was considered in the last ninety patients and performed in seventy-one patients. All lesions except esophageal varices were candidates for electrohemostasis. The indications for endoscopic electrocautery were active hemorrhage and precise identification of the bleeding point. The preendoscopic blood loss ranged from 1,500 to 6,000 ml. All seventy-one patients had initial hemostasis and sixty-five (92 per cent) had permanent hemostasis after one treatment. Six patients rebled, and four of these had permanent hemostasis after a second endoscopic electrocauterization. Only two of seventy-one patients had emergency operations for bleeding. There were no complications. Endoscopic electrohemostasis is still an experimental technic which requires further laboratory study and testing before broad general clinical application. This clinical trial suggests that endoscopic electrocautery is an attractive method of controlling active upper gastrointestinal bleeding because it can be safe, effective, and rapid, and is available in most medical communities.