Endoscopic Esophageal Dilation Research Articles

Diet Outcome in Patients With Hypopharyngeal Defects Repaired With Different Reconstruction Flaps: A Comparative Study.

To assess potential risk factors influencing diet outcomes after reconstruction of subtotal hypopharyngeal defects using free patch- or tube-shaped anterolateral thigh (ALT) fasciocutaneous flaps. Retrospective cohort study. First-level referral hospital. Between January 2011 and December 2020, we studied hypopharyngeal cancer patients who underwent the reconstruction of hypopharyngeal defects using free patch- or tube-shaped ALT fasciocutaneous flaps. The choice between patch- or tube-shaped ALT flaps depended on the defect's nature, favoring patch-shaped for subtotal defects and tube-shaped for circumferential defects. A restricted diet was characterized by a history of enterostomy or endoscopic esophageal dilation treatment postreconstruction. We analyzed patients with restricted diets at 1- and 3-year follow-up visits. Ninety-eight patients were enrolled; 39 patch-shaped flaps, and 59 tube-shaped flaps. No significances were noted in demographics, postoperative radiotherapy (RT) or chemotherapy, rates of free flap reoperation/salvage, or complications. However, a significant difference emerged in diet outcomes at the 1-year follow-up (P = .005). The rate of a restricted diet was 6.08 times higher in patients with tube-shaped flaps compared to patch-shaped flaps (95% confidence interval [CI]: 1.95-18.94). Stratifying based on postoperative RT revealed a 5.47 times higher rate of a restricted diet in tube-shaped flap recipients compared to patch-shaped flap recipients (95% CI: 1.44-20.48). No significances were observed in 5-year survival rates. Concerning postoperative RT, patch-shaped flaps exhibited a lower incidence of a restricted diet compared to tube-shaped flaps. Preservation of the posterior mucosa may play a crucial role in preventing RT-induced esophageal stricture.

Clinical analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children

To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.

Plummer-Vinson syndrome in primary Sjögren syndrome: a case-based review

This study aimed to describe a patient with Sjögren syndrome who developed Plummer-Vinson syndrome, and to review the literature and describe shared aspects of this rare association. A systematic screening of articles was conducted in PubMed/MEDLINE, LILACS, SciELO, Scopus, Web of Science, and Cochrane, dating 1940 to 2020. All the articles included the association between Sjögren syndrome and Plummer-Vinson syndrome. No language restriction was applied. The following terms were used: "Sjögren syndrome" or "sicca syndrome" and "Plummer-Vinson syndrome" or "Paterson-Kelly syndrome." We performed our analysis by adding our present case, with a total of 4 cases. Three out of four were female (75%), age varied from 56 to 58years old. In 2 cases, Sjögren syndrome preceded Plummer-Vinson syndrome diagnosis, and in 1 report, Plummer-Vinson syndrome appeared before Sjögren syndrome. Disease duration varied from 7 to 20years. In two cases, autoantibodies were available, and antinuclear antibodies and anti-Ro/SS-A were positive in both, and anti-La/SS-B in one of them was associated with anti-dsDNA; however, no data regarding lupus was available in the article. Treatment involved iron supplementation in 3/3. Two out of three received parenteral iron supplementation, and in these two cases, mechanical esophageal dilatation was needless. In the other case, an additional endoscopic esophageal dilatation was necessary to receive the oral iron supplement. All 3 cases had a good outcome. This case illustrates a patient with Sjögren syndrome who developed the rare Plummer-Vinson syndrome. In Sjögren syndrome, the presence of iron-deficiency anemia, dysphagia, and weight loss should alert the physician to search for associated Plummer-Vinson syndrome.

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.

The impact of the initial wave of COVID-19 pandemic on children under endoscopic esophageal dilatation protocol: a single center study

PurposeCOVID-19 pandemic has adversely affected the medical services offered for non-COVID related pathologies all over the world. This led to most of the elective services being postponed. In this study, we investigated the impact of the initial wave of COVID-19 pandemic on patients with esophageal strictures that were listed on the endoscopic dilatation program.MethodsMedical records were reviewed from March–September 2020 (study group). The study period was divided into three intervals guided by the number of confirmed cases with COVID-19 and the measures taken during the lockdowns in the corresponding periods. Case burden, dilatation sessions, dysphagia score, and further interventions were reviewed. Case burden and dilatation sessions were compared to equivalent periods in 2019 (control group).ResultsThe study group included 13 patients that had 19 dilatation sessions in contrast to 29 patients that had 98 sessions in the comparative group. In the study group, eight cases experienced deterioration in their dysphagia score, while further interventions were performed on four of them.ConclusionTo avoid morbidities during the pandemic, high-risk patients should be precisely identified and actively followed. Parents and caregivers should be reassured and encouraged to seek medical advice as quickly as possible whenever the need arises.

Management of Eosinophilic Esophagitis: Dietary and Nondietary Approaches

Eosinophilic esophagitis (EoE) is an allergen-driven chronic inflammatory condition, characterized by symptoms related to esophageal dysfunction and confirmed histologically by esophageal mucosal eosinophilia. Since its first description in the 1990s, the incidence and prevalence of EoE have been on the rise. It is known to affect all ages of various ethnic backgrounds and both sexes; however, it is most seen in White males. Children with EoE often present with abdominal pain, nausea, vomiting, and failure to thrive, whereas adults with EoE typically present with dysphagia and food impaction. Diagnosis of EoE requires histologic confirmation of elevated esophageal eosinophils in a symptomatic patient, and only after secondary causes have been excluded. Because EoE is a chronic and progressively fibrostenotic disease, treatment goals include resolution of symptoms, induction and maintenance of disease remission, and prevention and possibly reversal of fibrostenotic complications, while minimizing treatment-related adverse effects and improving quality of life. Treatment strategies include the "3 D's"-drugs, diet, and dilation. Standard drug therapies include proton-pump inhibitors and topical corticosteroids. Dietary therapies include elemental diet, allergy testing-directed elimination diet, and empiric elimination diets. Endoscopic esophageal dilation for EoE strictures can alleviate esophageal symptoms but has no effect on mucosal inflammation. Recent progress in EoE research has made possible evidence-based clinical guidelines. Ongoing pharmacologic trials show promise for novel biologic agents in the treatment of refractory EoE.

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.

Rare Coexisting Pyloric Stenosis, Oesophageal Peptic Stricture and Hiatal Hernia

Introduction: Our purpose is to report the clinical presentation of a rare coexistence of pyloric stenosis, peptic esophageal stricture associated with hiatal hernia, and discuss the therapeutic strategy decided with criterion of decision-making and outcome. Presentation of Case: We experienced a case of 67-year-old man with history of duodenal ulcer presenting a co-existing pyloric stenosis, peptic esophageal stricture and hiatal hernia. Clinical presentation consisted of an evolving gastrooesophageal reflux disease GERD symptoms along with gastric discomfort. Further exploration characterized a benign stricture between middle and lower esophagus with sliding hiatal hernia, a stasis stomach attaining pelvic area, and a second post-bulbar stenosis with double bubble aspect. The therapeutic strategy decided was medical preparation with subsequent endoscopic esophageal dilatation, followed by a Roux-en-Y diversion with antrectomy surgery and bilateral vagotomy. Evolution was uneventful. Conclusion: To our knowledge we report the first case of duodenal ulcer with pyloric stenosis associated with esophageal peptic stenosis and hiatal hernia reviewed in literature. The condition can be arguably considered as a complication of gastric emptying delay due to pyloric stenosis, and triggered by the duodenal ulcer disease in addition to hiatal hernia. Association of endoscopic dilation and Roux-Y gastrojejunostomy diversion after antrectomy and bivagotomy in our case meets all the requirements. Indeed the approach enables further exploration of the stomach comforting the histological diagnosis of benign strictures, treat the surgical stricture, reduce volume of toneless dilated stomach, and treat GERD. Nissen fundoplication is not indicated.

Gastric Wall Emphysema: A Benign Finding After Intractable Retching - Two Case Reports

The presence of air in the gastric wall is being diagnosed more often nowadays especially in the era of CT scan. In addition to life-threatening conditions as ischemia, benign causes are probably more common. We present two case reports in which air pockets were seen in the gastric wall after repeated attacks of retching. Patient 1: 60-year-old male presented with 2 days history of retching and abdominal pain. He denied significant vomiting or fevers. Medical history was significant for dysphagia that was treated with endoscopic esophageal dilation, atrial fibrillation and diabetes mellitus. Physical exam showed dehydration with epigastric tenderness. Lab work was significant for leucocytosis (16000/μl) and lactic acid of 2.8mmol/l. CT scan showed gastric distension and emphysemia with air in the portal vein system. He was admitted to the intenstive care unit and was treated with iv antibiotics and iv fluids. Insertion of a nasogastric tube lead to dramatic resolution of symptoms. Upper endoscopy revealed esophageal stricture and mucosal disruption of gastric mucosa. Patient was discharged after two days. Patient 2: 41-year-old female presented with a severe episode of headache, bilious vomiting, bouts of retching. She has a medical history of migraine, atrial fibrillation and diabetes mellitus. Her headaches have not been well controlled. She was tachycardic with diffuse abdominal tenderness. Her white cell count was 14800/μl and potassium was 3meq/l. CT scan showed submucosal gas throughout the body and fundus of the stomach. The patient was treated with iv fluids. Nasogastric tube was placed. Upper endoscopy showed diffuse gastric erythema and submucosal hemorrhages. The rest of her hospital course was unremarkable and she was discharged after tolerating regular diet. The phenomenon of air infiltration of the stomach wall may occur due to increased intragastric pressure and severe distension, especially when the patient develops aerophagia during retching maneuvers, while being unable to expel air (e.g. by belching). The presence of a valve-like mechanism as in esophageal stricture or gastric outlet obstruction may increase the stomach volume and accentuates the air leak into the portal vein system. Though more serious etiologies should be excluded, we recommend that gastric decompression and iv fluids should remain as the mainstay of therapy, since most of the cases will resolve spontaneously with no need for surgical interventions.2703_A Figure 1. Gastric emphysema and air in portal system in patient 12703_B Figure 2. Gastric distension and emphysema in patient 2

A Rare Case of Chilaiditiʼs Sign Associated with Cervical Neuropathy

Chilaiditi's sign, the colonic interposition between the liver and diaphragm, is an uncommon radiographic finding.1 While it has been previously observed in the setting of cirrhosis, chronic obstructive pulmonary disease, obesity, near-term pregnancy, mental disorder, and primary lung cancers, its etiology is unknown.2 We describe a case of a man with cervical neuropathy and esophageal strictures as a consequence of radiation therapy and a total laryngectomy for head and neck carcinomas, who was found to have Chilaiditi's sign following an endoscopic esophageal dilation. A 70-year-old man was referred to our clinic for endoscopic dilation of known esophageal strictures in the setting of progressive dysarthria, dysphagia, and weight loss. He was initially treated with radiation therapy for nasopharyngeal carcinoma at age 47, and at age 55, he underwent a total laryngectomy and additional radiation for supraglottic laryngeal carcinoma. During the next fifteen years, he developed progressive dysarthria and weakness of the neck, shoulder, and rotator-cuff muscles secondary to nerve impingement from extensive fibrosis, lymphedema, and neck scarring. He developed dysphagia due to recurrent esophageal strictures, responsive to periodic endoscopic dilations. A repeat, uneventful endoscopic esophageal dilation was performed, after which he returned to clinic three days later with complaints of subjective fevers and heartburn. He denied abdominal pain, nausea, vomiting, or melena. His examination was notable for vitals within normal range and decreased breath sounds in the right lung base. A CT with oral contrast revealed an increase in the elevation of the right hemi-diaphragm with interposition of the colon between the liver and right hemi-diaphragm, consistent with Chilaiditi's sign (Figures 1-3). He was managed conservatively given lack of dyspnea and resolution of his fevers and heartburn. The etiology of Chilaiditi's sign is unknown and rarely discussed in the literature. Our case highlights a potential association between Chilaiditi's sign and cervical nerve damage as a result of post-laryngectomy and radiation-induced fibrosis. Fibers from the C3, C4, and C5 nerve roots innervate the muscles of the upper extremity and neck and also compose the phrenic nerve. Our patient's cervical neuropathy and its potential effects on diaphragmatic function may serve as a causative link between the two findings.1498_A Figure 1. Coronal CT slice of the colonic interposition between liver and diaphragm1498_B Figure 2. Second coronal CT slice of Chilaiditi's sign1498_C Figure 3. Axial CT slice demonstrating Chilaiditi's sign

PS01.043: FACTORS EFFECT THE RESULT OF ESOPHAGEAL DILATION WITH INTRALESIONAL STEROID INJECTION IN SEVERE CORROSIVE STRICTURE PATIENTS

Abstract Background Endoscopic esophageal dilation has been the primary therapy in severe corrosive stricture. There is a few study on effectiveness of intralesional steroid injection combined with esophageal dilation. The author studied factors that may give positive or negative effect results of dilation, and may extend the indication of dilation before definite surgery. Methods The authors reviewed the complete medical records as the retrospective study of patients those underwent intralesional steroid injection combined with esophageal dilation due to severe corrosive stricture. Primary outcome is the success rate of treatment by intralesion steroid injection combined with endoscopic esophageal stricture dilation. Secondary outcome is the risk that effect result of treatment. Statistical analysis was performed using STATA version 12 for Fisher's exact, students t-test, and relative risk regression, p-value of &lt; 0.05 isconsidered as statistical significant. Results There are 55 patients was enrolled and presented with at least grade 4 of dysphagia, Marchand's grade III and IV from imaging stress review, and received intralesional steroid injection combined with endoscopic esophageal dilation. We divided patients into two groups, (1) a success esophageal dilation group (76.36%; mean number of dilation is 6 sessions/year), and (2) a failure esophageal dilation group whounderwent reconstruction surgery (23.64%). Patient characteristics including gender, age, time from transfer to the first dilation, type of corrosive agent, grading of dysphagia, number, length of lesion(s), and site of lesion(s). This study showed that gender, age, type of substance, number or length of stricture(s) had no significant difference about the result of treatment. Significant success factors are timing from first swallowing to first dilation (within 8 weeks, 78.57% success), no gastric deformity combined with esophageal stricture (90.48% success), and failure factor is the occurrence of complication during the period of treatment (69.23%) that mainly related to long segment of stricture more than 5 centimeters. Conclusion We gained high success rate in Marchand's grade III and IV by steroid injection combined with esophageal dilation. Predictors indicate that specific factor caused failure of treatment. The author extends the indication for endoscopic intervention in severe esophageal stricture before decision to do reconstructive surgery. Disclosure All authors have declared no conflicts of interest.

Recurrent esophageal stricture from previous caustic ingestion treated with 40-year self-dilation: case report and review of literature

BackgroundCorrosive esophageal strictures are common. The severity of the strictures depends on type, quantity, duration of contact and concentration of the caustic substance ingested. Endoscopic balloon dilation and endoscopic bougienage are a cornerstone in the management of the benign esophageal strictures and are the most widely used treatments, but are expensive and invasive procedures.Case PresentationWe report the case of an 82-year-old patient with a corrosive esophageal stricture treated for over 40 years by means of home self-bougienage. The procedure has been carried out for the longest lapse of time described in literature, with an excellent control of symptoms. In the case reported, after being carried out for more than 40 years, self-dilation allowed good quality of life and symptoms management, ensuring an excellent nutritional status.ConclusionsFollowing an adequate patient training, self-dilatation can be a safe and effective option of treatment, avoiding frequent expensive hospital admissions for endoscopic esophageal dilatation.

Perceived facilitators and barriers to physical exercise adherence in esophageal cancer patients after surgery.

94 Background: To achieve optimal effects of exercise interventions in esophageal cancer patients, high adherence is needed. Knowledge on facilitators and barriers can help improving exercise adherence. Hence, the aim of this study is to evaluate perceived facilitators and barriers to physical exercise adherence in esophageal cancer patients in the first year after surgery. Methods: Semi-structured interviews were conducted with patients (n = 16) who were randomised to the exercise group of the Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) Study. Patients participated in a 12-week supervised combined aerobic and resistance exercise program twice weekly, and were advised to be physically active at least 30 minutes each day. Physiotherapists registered attendance at the supervised sessions and compliance (i.e., performing the exercises according to protocol). Transcribed interviews were analysed using a thematic content approach. Results: Median attendance was 97.9%, interquartile range (IQR): 91.7 – 100%. Median compliance to both components of the exercise program was high: 89.6% (IQR 75.5 – 95.8%) for aerobic exercise and 88.0% (IQR 73.8 – 93.6%) for resistance exercise. The most important perceived facilitators were patients’ own attitudes towards exercise (i.e. motivation, commitment and personal goals) and supervision by a physiotherapist. There were only few perceived barriers, of which the most frequently mentioned were logistic factors (i.e. holidays, conflicting activities and weather circumstances) and impaired physical condition due to regular endoscopic esophageal dilation therapy or general physical complaints, such as fatigue. Conclusions: Esophageal cancer patients after surgery are well capable to perform physical exercise with moderate-to-high intensity. The most important perceived facilitators for the high adherence rates are patients’ own attitudes towards exercise and supervision by a physiotherapist. Completion of the exercise program was only minimally affected by perceived barriers as logistic factors and physical complaints. This information can help in designing future exercise programs for clinical practice.

Factors associated with complications during endoscopic esophageal dilation.

endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. to assess the safety of esophageal dilation and the factors associated with the development of complications. a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.

Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation.

Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation.

Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis.

Background:Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear.Aims:Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE.Methods: Study Selection Criteria:Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis.Data collection and extraction:Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies.Statistical Method:Pooled proportions were calculated using fixed- and random-effects model. I2 statistic was used to assess heterogeneity among studies.Results:Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I2 (inconsistency) was 0% (95% confidence interval [CI] = 0–49.8) and Egger: bias was 0.06 (95% CI = −0.30 to 0.42).Conclusions:In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population.

Background/AimsEsophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown.MethodsWe used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation.ResultsThere were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated.ConclusionsInpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures.

A case of type 1 multiple endocrine neoplasia with esophageal stricture successfully treated with endoscopic balloon dilation and local steroid injection combined with surgical resection of gastrinomas

BackgroundIn type 1 multiple endocrine neoplasia (MEN1), esophageal diseases association with excessive gastrin secretion in Zollinger-Ellison syndrome (ZES) sometimes develop. Here, we reported a case of MEN1/ZES, who developed dysphagia due to reflux esophagitis with severe esophageal stricture. Treatment for his esophageal stricture and ZES was discussed.Case presentationA 43-year-old man with progressive dysphagia and diarrhea was referred to the teaching hospital. He had a history of recurrent duodenojejunal perforations despite the anti-secretory medication. Blood examinations revealed elevated serum gastrin, calcium, and parathyroid hormone. Upper gastrointestinal endoscopy demonstrated a severe esophageal stricture, multiple gastroduodenal ulcer scars, and a duodenal submucosal tumor. Enhanced computed tomography showed multiple hypervascular tumors within the pancreas and duodenum, suggestive of MEN1. Genetic examination demonstrated a pathogenic MEN1 mutation. Repetitive endoscopic esophageal dilatation with intralesional corticosteroid injection, coupled with pancreatoduodenectomy were performed to improve the patient’s symptoms and to treat pancreatic tumors. The histology of multiple tumors in the duodenum and pancreas were all consistent with neuroendocrine tumors. His hypergastrinemia subsided and he remained asymptomatic in his gastrointestinal tract after these treatments.ConclusionFor esophageal stenosis in case of MEN1/ZES, anti-secretory therapy and endoscopic dilatation with corticosteroid injection could be recommended. However, in refractory cases with repetitive and/or severe complications due to high acid secretion, surgical treatment could be considered as an option.

Clinical Improvement in Eosinophilic Esophagitis Patients Treated with Endoscopic Esophageal Dilation: A Meta-analysis and Systematic Review

Clinical Improvement in Eosinophilic Esophagitis Patients Treated with Endoscopic Esophageal Dilation: A Meta-analysis and Systematic Review

A Meta-analysis and Systematic Review: Is Endoscopic Esophageal Dilation a Safe Approach in Managing Eosinophilic Esophagitis?

A Meta-analysis and Systematic Review: Is Endoscopic Esophageal Dilation a Safe Approach in Managing Eosinophilic Esophagitis?