Esophageal Anastomotic Stricture Research Articles

Esophageal perforations, anastomotic leaks, and strictures: The role of prostheses

Misfortunes deriving from esophageal anastomotic leaks, perforations, and strictures are surgical problems of major magnitude, especially when a delay in treatment exceeds 12 hours. To this date, there is not unanimity in the approach to these problems. The costs in hospital expense, morbidity, and mortality are such that methods thought to improve outcome should be given careful consideration. The author presents personal experience with intraluminal stenting under various circumstances with Celestin and Hood prostheses that seems to support their use in esophageal surgery as others have found in colon surgery. Further study of this method is suggested.

Treatment of a Ruptured Anastomotic Esophageal Stricture Following Bougienage with a Dacron-Covered Nitinol Stent

Treatment of a Ruptured Anastomotic Esophageal Stricture Following Bougienage with a Dacron-Covered Nitinol Stent

胆管用同軸ダイレーターを利用して拡張した食道切除後の高度吻合部狭窄の2例

胆管用同軸ダイレーターを利用して拡張した食道切除後の高度吻合部狭窄の2例

食道吻合部狭窄に対する内視鏡的拡張術の適応と限界

1982年から1991年2月までに経験した91例の食道吻合部狭窄症例を対象とし, ブジーとバルーンダイレイターを併用した内視鏡的拡張術の適応と限界を検討した.良性狭窄84例での有効例は80例95%で, このうち長期に経過を観察できたものはいずれも拡張術から離脱し, それに要した拡張術の平均回数は3.7回であり, 食道切除で縫合不全のある症例では施行回数が多かった.拡張不能例は瘻孔形成例で瘻孔を拡大した1例のみであった.拡張困難例は3例でいずれも狭窄部の長いものであった.吻合部付近の癌再発による悪性狭窄7例では拡張不能2例, 拡張困難4例, 早期死亡1例で成績は不良であった.本法による合併症は輸血が必要な出血2例, 一過性の発熱2例, 頸部皮下膿瘍1例, 瘻孔拡大1例, の計6例6.6%で重篤なものは無く, 再手術を必要としたのは1例のみで, 死亡例はなかった.以上より食道吻合部良性狭窄に対し本法は安全で有効な方法と考えられた.

Endoscopic balloon hydrodilatation and endoprosthetic treatment of esophageal and esophageal anastomotic strictures.

In 37 patients with benign stenosis of the esophagus and esophageal anastomoses, the method of dilatation using special balloon catheters under endoscopic control was employed, and adequate dilatation of the stenotic region accomplished. In comparison with balloon dilators, bougies exert forces along the radial axis, and no tension is applied to the esophagus along the longitudinal axis. To obtain prolonged remission and decrease the number of "supporting" dilatations of esophageal benign stenosis and esophageal anastomoses, temporary intubation of the esophagus with a silicone prosthesis was performed in 7 patients. Further clinical application, and a study of the long-term results of endoscopic balloon hydro-dilatation and endoprosthesis for treating esophageal and anastomotic esophageal strictures, will help to elaborate more precise indications for the combined use of these methods.

An improved stringing method for retrograde dilatations of causic esophageal strictures

Retrograde dilatation performed with Tucker dilators is the safest known method of treating severe caustic strictures of the esophagus. Placing the string guide is sometimes difficult however, and the string taped to the cheek between dilatations causes cosmetic and psychological problems. The stringing method described by Andrassy et al [1] for dilatation of anastomotic esophageal strictures has been adapated by us for the treatment of caustic strictures. The success rate of the method has been 93,7%. Using this method, it is possible to prevent the placement difficulties and string complications in Tucker retrograde esophageal dilatation.

BALLOON DILATION FOR POSTOPERATIVE ESOPHAGEAL STRICTURE

The present article reports our use of a balloon catheter for dilation of esophageal stricture in three cases of postoperative esophageal anastomotic stricture. Case 1 was a patient with esophageal carcinoma who underwent esophagogastrostomy, followed by postoperative severe anastomotic stricture with axis deviation in which the length of the stricture was long, resulting in dilation by balloon catheter in combination with endoscopic laser incision. Case 2 was a patient with esophageal carcinoma who underwent esophagogastrostomy. A moderate ring-like stricture, in which the length of the stricture was short without axis deviation, occurred postoperatively, resulting in dilation by balloon catheter alone. Case 3 was a patient with carcinoma of the larynx who underwent total laryngectomy, followed by esophageal reconstruction by means of a skinroll. After surgery, anastomotic stricture occurred, resulting in dilation by balloon catheter in combination with mercury bougie. Balloon catheter is safe and easy to insert and has the advantage of facilitating a definite setting in the area of the stricture. However, while it is difficult to bring about satisfactory dilation of severe cicatrricial stricture by balloon catheter alone, its combination with laser incision or other methods seems to yield more effective dilation. For light or moderate stricture, balloon catheter was the first choice and was thought to bring about satisfactory results.

Transluminal dilation of esophageal strictures in infants following atresia repair

Multiple studies have reported a variety of prograde and retrograde dilation techniques for management of anastomotic strictures in infants and children following repairs for tracheoesophageal fistula and esophageal atresia. These techniques have involved rigid bougies which create undesired axial forces on anastomoses or elastic balloons and may result in ineffective radial force on strictures as a result of balloon distention in directions of least resistance. Recent studies have described the application of nonelastic balloon catheter dilation of benign esophageal strictures in adults.1,2 We have employed a similar technique in the management of severe anastomotic esophageal strictures in infants. This procedure avoids bougienage risks, need for general anesthesia, and gastrostomy for retrograde methods.

Endoscopy in Esophageal Atresia and Tracheoesophageal Fistula

Between 1970 and 1979 152 infants born with the anomaly of esophageal atresia with or without tracheoesophageal fistula or of congenital tracheoesophageal fistula without atresia were treated at the Royal Alexandra Hospital for Children, Sydney. Recent developments in endoscopic equipment and new techniques of anesthesia allow detailed examination of the respiratory tract and esophagus with minimum trauma and maximum safety. Symptomatology relating to the airway and to the esophagus after surgical repair often occurs in patients who may have tracheomalacia, esophageal anastomotic stricture, esophageal reflux and sometimes recurrent or residual fistula. A definite diagnosis of tracheomalacia can be made by finding the typical triad of anteroposterior narrowing of the tracheal lumen, weakening of the semicircular-shaped cartilages and forward ballooning of the widened posterior membranous tracheal wall. Careful examination of the trachea and esophagus allows identification of an elusive recurrent fistula or an H-type fistula. As the primary results of surgery for esophageal atresia and tracheoesophageal fistula improve, long-term problems are becoming increasingly important. The role of the pediatric endoscopist is vital in the care of these patients.

Endoscopic Cutting Method in the Treatment of Esophageal Anastomotic Stricture in Children

Endoscopic Cutting Method in the Treatment of Esophageal Anastomotic Stricture in Children

Gastroesophageal fundoplication for reflux following repair of esophageal atresia. Experience with nine patients.

Esophageal dysmotility and gastroesophageal reflux (GER) are common sequelae that may persist for many years in infants and children who have undergone repair of esophageal atresia and tracheoesophageal fistula (TEF). The slow clearance of refluxed gastric contents appears to cause a high incidence of aspiration, a high incidence of esophageal anastomotic stricture or leak, and a slow response to dilation of esophageal anastomotic strictures. Nissen transabdominal gastroesophageal fundoplication was performed in nine children (seven who were less than 4 months of age) subsequent to repair of esophageal atresia because of recurrent severe symptoms due to regurgitation. On the basis of this favorable experience with nine infants and children, we believe that an aggressive surgical approach should be taken in the management of symptomatic GER in patients at a young age following repair of esophageal atresia and TEF who fail to respond to an adequate trial of medical treatment.