Occurrence Of Strictures Research Articles

ID: 3526513 RISK FACTORS FOR STENOSIS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION OF LARGE LESIONS OF THE RECTUM

The development of stenosis in the rectum after endoscopic submucosal dissection (ESD) is one of the most frequently delayed complication, ranging from 4.2 to 19.7 % of the resections of large rectal lesions. Circumferential mucosal defect greater than 90% seems to be only independent predictor of stenosis. Morphology and size have not shown relation with the occurrence of strictures.

ID: 3520631 RISK FACTORS FOR STRICTURES IN CHILDREN AND ADOLESCENTS WITH EOSINOPHILIC ESOPHAGITIS

Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus,resulting in tissue remodeling and fibrosis and strictures may be an end result.Strictures are more common in adults with EoE, but does occur in children and adolescents.We sought out to find the risk factors associated with occurrence of strictures in EoE pediatric patients.

Incidence of and Risk Factors for Colorectal Strictures in Ulcerative Colitis: A Multicenter Study

Ulcerative colitis (UC) is increasingly recognized as a progressive disease and patients with long-standing disease can develop colorectal stricture. Few data about its incidence in UC are available, while risk factors for colorectal strictures in UC remain to be determined. We assessed the incidence of and risk factors for developing colorectal strictures in a large UC population. All adult patients followed at Nancy University hospital and at the centre hospitalier de Luxembourg for UC, between January 2004 and July 2019, were eligible for inclusion in this multicenter retrospective cohort study. A total of 439 patients with UC were included. Median follow-up duration was 9.6 years. Incidence of colorectal stricture was 3.6%. The cumulative probability of developing this complication was 1% at 5 years and 2.3% at 10 years. Median age at stricture diagnosis was 47.9 years (41.0; 63.0), and median time from UC diagnosis to onset of stricture was 11.5 years (5; 15.3). Montreal A3 classification (age > 40 years) (P = .008) and steroids use (HR = 4.1; 95% CI, 1.1-16.1) were independent risk factors for stricture, whereas mesalamine-treated patients carried a lower risk (HR = 0.3; 95% CI, 0.1-0.9). Dysplasia was found in 6 patients with strictures (42.9%) and among them 5 developed a colorectal cancer (33.3%). Patients with Montreal A3 classification and those exposed to steroids have a higher risk for strictures, while use of mesalamine lowers this risk. These factors should be assessed in daily clinical practice to prevent stricture occurrence in these patients.

Efficacy of a modified short fully covered self-expandable metal stent for perihilar benign biliary strictures.

Endoscopic management of a benign biliary stricture (BBS) on the hilum is complicated and challenging. Although the placement of a fully covered self-expandable metal stent (FCSEMS) is possible to increase effectiveness, stent migration and stent-induced adverse events are problematic. We aimed to evaluate the usefulness of a modified short FCSEMS with a long lasso in patients with a difficult perihilar BBS. Patients with perihilar BBS within 2cm from the hilar confluence that failed initially with plastic stents were enrolled. A modified short FCSEMS was deployed and then removed 5-6months later. The primary outcome was clinical success. Other technical success, adverse events, endoscopic success of stent removal, and recurrence of stricture during the follow-up period were measured. Endoscopic intraductal placement was technically successful in all patients (n=19). Combined contralateral plastic stent placement was performed in 13 patients (68.4%). The median duration of stent placement was 163days (range, 138-196days). Endoscopic stent removal was successful in all patients except one spontaneous distal migration. Stricture resolution without de novo focal stricture occurrence was 100%. Endoscopic stone removal after stricture improvement was successful in all 13 patients with bile duct stones above the stricture. During a follow-up period (median 635days) after stent removal, only one recurrence developed. Temporary placement of a modified intraductal short FCSEMS with or without a contralateral plastic stent improved perihilar BBS in patients that primarily failed by plastic stents. Combined biliary stones were also successfully removed after stricture resolution.

Factors influencing the occurrence of biliary stricture above the confluence in major bile ducts injuries: Analysis of a case series

Backgroundbile duct injury is a complication that occurs mainly after cholecystectomy. Outcomes of biliary repair surgery are worse when the stricture level is above the biliary confluence. MethodA single centred retrospective study was carried out on patients operated in our department for biliary stricture after a major bile duct injury over the period from January 2010 to May 2018. Only patients operated for biliary stricture were included. This study aimed to determine the independent factors influencing the occurrence of a stricture above de biliary confluence. Univariate and multivariate binary regression was used for data analysis. ResultsFifty-three patients were included, they were 43 women and 10 men, sex-ratio was 0.23. Thirty-one patients had Grade E3–E4-E5 stricture (58,5%), and patients who had a failure of a previous repair surgery accounted for 36% (n = 19) of our patients.After univariate and multivariate analysis, only laparoscopic cholecystectomy (OR = 7.58, CI = [1.47–38, 91], P = 0.015) and failure of anterior biliary repair surgery (OR = 7, 12, CI = [1.29–39.42], P = 0.025) were independent factors associated with more frequent occurrence of biliary strictures above the confluence. ConclusionFailure of biliary repair surgery makes the pre-existing biliary stricture progress and compromises subsequent surgery's outcomes. It is important to refer all cases of bile duct injury to specialized centers to increase the chances of success of the first biliary repair surgery.

Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome.

Background: Different arterial segments throughout the vascular system develop similar grades of atherosclerosis concomitantly. Urethral ischemia has been proposed as a cause of urethral stricture. Therefore, we aimed to investigate the relationship between coronary artery disease severity using a SYNTAX score and urethral stricture occurrence after urethral catheterization in patients with non–ST-segment-elevation acute coronary syndrome (ACS). Methods: This retrospective study consisted of 306 men with urethral catheters that were diagnosed with ACS and underwent coronary angiography between January 2016 and January 2018 in Kars Kafkas University and Osmaniye Government Hospital, Turkey. Hospital records were reviewed to collect the follow-up data of the patients regarding the occurrence of urethral stricture after urethral catheterization. The study population was divided into 2 groups according to urethral stricture development, and both groups were compared statistically. Results: SYNTAX scores were significantly higher in patients with urethral stricture than in those without urethral stricture (14.86±7.11 vs. 29.25±9.79; P<0.001). The SYNTAX score (OR=1.27; 95% CI: 1.16–1.39; P<0.001), diabetes, and serum albumin were found to be the independent predictors of urethral stricture. The receiver operating characteristic curve analysis showed that the cutoff value of the SYNTAX score for urethral stricture prediction was greater than 22.5, with 76.7% sensitivity and 85.1% specificity (AUC=0.88, 95% CI: 0.84–0.91; P<0.001). Conclusion: Coronary artery disease severity graded according to the SYNTAX score is an independent predictor of urethral stricture occurrence in ACS patients with a urethral catheter inserted.

Caustic Ingestion in Children: 1 Year Experience in 3 Italian Referral Centers.

Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management. All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed. We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26 of 44 (59.1%) patients, whereas acid agents were ingested by 18 of 44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r: 0.45) and a higher probability of early esophageal stricture occurrence (r: 0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms whereas no esophageal injury was found in asymptomatic patients. Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.

Eosinophilic Esophagitis in Esophageal Atresia.

Recent studies have reported a higher prevalence of eosinophilic esophagitis in children with esophageal atresia. Under recognition of eosinophilic esophagitis in these patients may lead to excessive use of antireflux therapy and an escalation of interventions, including fundoplication, as symptoms may be attributed to gastroesophageal reflux disease. In addition, long-term untreated eosinophilic esophagitis may lead to recurrent strictures due to transmural esophageal inflammation, necessitating repeated dilatations. Eosinophilic esophagitis should be considered when children with esophageal atresia show persistent symptoms on standard antireflux treatment, increasing dysphagia, and recurrent strictures. Treatment has been found to not only significantly reduce intraepithelial eosinophil count, but also to improve symptoms, and to lower the occurrence of strictures and the need for dilatations. Future prospective studies are warranted in this area.

STRICTUREPLASTY AS AN ORGAN-SAVING METHOD IN PATIENTS WITH SMALL BOWEL CROHN'S DISEASE (case report)

Crohn's disease (CD) is a complex, chronic recurrent disease with transmural, segmental, granulomatous inflammation in all parts of the gastrointestinal tract with high risk of local and systemic complications. The disease is progressive, despite a wide range of modern conservative and surgical approaches. One of the most common causes of surgery for CD is strictures, which are result of prolonged, non-specific inflammation and later cicatricial changes in the intestinal wall. The occurrence of strictures is a serious clinical problem, due to the lack of effective methods of diagnosis and treatment. In fact, there are two type of surgery – resection of the affected area and organ-saving procedure. At the same time, when performing extensive resections of the small bowel, the patient loses a large area of absorption surface, which often leads to the short bowel syndrome. Recently, the majority of foreign experts prefer organ-saving procedure – strictureplasty. In this paper, we present a case of successful application of this procedure for complicated form of Crohn's disease.

Role of Preoperative Viral Load and Presence of Hepatocellular Carcinoma in the Biliary Complications After Liver Transplantation Due to Hepatitis C Virus

BackgroundChronic hepatitis C virus (HCV) infection is a global health problem, and the need for liver transplants is ever-growing. For optimal surgical success, risk factors must be identified and HCV viral load must be reduced to a minimum to avoid complications. In this study, we aimed to investigate the role of HCV viral load on the post-transplant biliary complications. MethodBetween 2004 and 2018, the cases of 114 liver transplant recipients with HCV infection were retrospectively reviewed. Data collection included demographic variables, preoperative and postoperative amount of serum HCV RNA copies, preoperative diagnosis of hepatocellular carcinoma (HCC), and postoperative biliary complications in the early and late period. After missing values were excluded, the remaining 97 patients were divided into 2 groups according to preoperative HCV RNA status (Group A: HCV RNA [+] and Group B: HCV RNA [-]). ResultsDemographic parameters were similar among both groups. There were 67 patients in Group A and 30 patients in Group B. The overall rate of biliary complications was higher in Group A without statistical significance (20% [n = 14] vs 13% [n = 4], respectively, P = .573). Biliary stricture occurrence in the late period was also higher in Group A. In HCC (+) patients (n = 26), biliary complications were significantly higher compared to HCC (-) patients (34% vs 12%, P = .018). However, in patients with biliary complications, the rate of multiple duct anastomoses was higher with no statistical significance (45% vs 26%, respectively, P = .14). ConclusionThe biliary complications on patient survival has been previously established, and this is mostly evident in those patients with viral etiology and hepatocellular carcinoma. As was also suggested in our study, hepatocellular carcinoma and positive viral status should be considered as predisposing factors for postoperative biliary complications after liver transplantation. However, the rate of multiple duct anastomoses should also be taken into consideration. New standards of antiviral medications and bridge therapy for HCC may improve transplant outcomes.

Is There a Role for pH Impedance Monitoring in Identifying Eosinophilic Esophagitis in Children with Esophageal Atresia?

To evaluate clinical, endoscopic, and pH-impedance measures in a cohort of children with esophageal atresia and concomitant eosinophilic esophagitis (EoE) and compared it with disease-matched controls, to identify predictive factors for the development of EoE and esophageal stricture. We reviewed 63 patients with esophageal atresia assessed for refractory upper gastrointestinal symptoms between January 2015 and September 2017 at 2 tertiary referral centers. All patients underwent upper gastrointestinal endoscopy and pH-impedance monitoring. Based on esophageal histology, patients were classified as (1) esophageal atresia without evidence of esophagitis; (2) esophageal atresia with evidence of esophagitis (including esophageal eosinophilia not meeting the criteria for EoE); (3) esophageal atresia with concomitant EoE. Age and sex matched patients with gastroesophageal reflux disease were used as disease controls. The presence of atopy and peripheral eosinophilia at baseline were significantly associated with EoE (P<.05). Although there was a tendency toward an increased number of strictures in patients with esophageal atresia-EoE, this did not reach statistical significance (P=.06). Higher esophageal acid exposure time and lower baseline impedance values were significantly associated with eosinophilic infiltration (P<.05 and P<.01, respectively). Using logistic regression analysis, the presence of mucosal eosinophilia was the most predictive factor for stricture formation (P<.05). A history of atopy and the presence of peripheral eosinophilia in patients with esophageal atresia are predictive factors for the development of EoE, which in turn is a predictive factor for stricture occurrence. Higher esophageal acid exposure time and lower baseline impedance are associated with esophageal eosinophilic infiltration, suggesting their value in selecting which patients with esophageal atresia should undergo endoscopic examination.

Application of a self-assembling peptide matrix prevents esophageal stricture after circumferential endoscopic submucosal dissection in a pig model.

IntroductionCircumferential endoscopic submucosal dissection (ESD) allows to treat large esophageal superficial neoplasms, however with a high occurrence of severe esophageal strictures. In a previous work, we demonstrated that the application of a prototype of self-assembling peptide (SAP) matrix on esophageal wounds after a circumferential-ESD delayed the onset of esophageal stricture in a porcine model. The aim of this work was to consolidate these results using the commercialized version of this SAP matrix currently used as a hemostatic agent.Animals and methodsEleven pigs underwent a 5 cm-long circumferential esophageal ESD under general anesthesia. Five pigs were used as a control group and six were treated with the SAP. In the experimental group, 3.5 mL of the SAP matrix were immediately applied on the ESD wound. Stricture rates and esophageal diameter were assessed at day 14 by endoscopy and esophagram, followed by necropsy and histological measurements of inflammation and fibrosis in the esophageal wall.ResultsAt day 14, two animals in the treated group had an esophageal stricture without any symptom, while all animals in the control group had regurgitations and an esophageal stricture (33 vs. 100%, p = 0.045). In the treated group, the mean esophageal diameter at day 14 was 9.5 ± 1 mm vs. 4 ± 0.6 mm in the control group (p = 0.004). Histologically, the neoepithelium was longer in the SAP treated group vs. the control (3075 μm vs. 1155μm, p = 0.014). On immunohistochemistry, the expression of alpha smooth muscle actin was lower in the treated vs. control group.ConclusionApposition of a self-assembling peptide matrix immediately after a circumferential esophageal ESD reduced by 67% the occurrence of a stricture at day 14, by promoting reepithelialization of the resected area.

Predictors of Postoperative Stricture After Endoscopic Submucosal Dissection for Large Superficial Esophageal Squamous Cell Neoplasms

Introduction: Endoscopic submucosal dissection (ESD) has been widely accepted for resecting superficial esophageal squamous cell neoplasms (ESCNs). The aim of this study was to evaluate the predictors for postoperative stricture after ESD for large ESCNs (>3/4 circumferential mucosal defect). Methods: We consecutively enrolled 63 patients with large ESCNs(Histologic depth<sm1) who underwent ESD at the Chinese PLA General Hospital were enrolled. Patients were grouped as post-ESD stricture group and no post-ESD stricture group according to stricture occurrence or not after ESD. The demographic characteristics of the patients and the tumor and technical factors were analyzed for investigating predictive factors of postoperative stricture. Results: All the ESD procedures were successfully performed for 63 patients of which 25(39.4%) taking prophylactic methods for preventing post-ESD stricture. The rates of postoperative stricture for different circumferential defects of ≥3/4 to <7/8, ≥7/8 to <4/4 and 4/4 were 38.2%(13/34), 50.0%(6/12) and 76.5%(13/17) respectively. The total stricture rate was 50.8%(32/63). Patients with post-ESD stricture had a significantly higher degree of circumferential mucosal defect(P=0.036), larger longitudinal tumor size ((5.72±2.16) versus (4.24±1.61) cm, P = 0.003) and more patients with presence of muscle injury(9 vs 2, P = 0.023).There was no significant differences in age, sex, tumor location, macroscopic type, procedure time, the longitudinal diameter of specimens, the circumferential diameter of specimens, en bloc resection, histological depth and taking prophylactic measures (P>0.05). After multivariate analysis, circumferential mucosal defect (≥ 7/8) and not taking prophylactic measures are predictors for stricture development in patients with large ESCNs after ESD. Conclusion: Circumferential mucosa defect >7/8 is the main factor leading to the stricture of the esophagus after ESD for large early ESCNs. For patients with post- operative circumferential mucosa defect >3/4, appropriate preventive measures can effectively reduce the incidence of postoperative stricture after ESD.354_A Figure 1. Groups according to circumferential mucosal defect. Patients who underwent ESD or ESTD for large superficial esophageal squamous cell carcinoma(ESCC):Group A, ≥3/4 and <7/8; Group B, ≥7/8 and <4/4; Group C, entire circumferential mucosal defect(4/4)354_B Figure 2. Stricture was encountered after submucosal dissection (ESD) involving total circumferential resection. A. Chromoendoscopy with iodine staining revealed a discolored area in the lower esophagus. B. Entire (4/4) circumferential mucosal defect after ESD. C. Resected sleeved specimen with the lesion in an en bloc resection, the length of which was approximately 4.5 cm. D. A fully covered esophageal stent was implanted for prevention of stricture. E. Endoscopy displayed stricture 63 days after ESD. F. Endoscopic balloon dilatation is performed against the postoperative stricture. G. The stricture site was dilated after balloon dilatation, a 9.8-mm-diameter esophagogastroduodenoscopy (EGD) could be passed through this lumen. H. The lumen 7 months after ten EBD treatments.354_C Figure 3. The detailed data of the 63 patients enrolled in the study.

Mini-invasive reconstruction technique of the bulbomembranous urethra

The paper presents the technique of the reconstruction of the bulbar and membranous urethra in the occurrence of strictures and sphincter-stenosis. The method uses an autologous graft and has potential advantages over the bulboprostatic anastomosis. Objective. To develop a method of helping patients with existing urethral anastomoses, with a damaged neck of the bladder and a risk of subsequent incontinence, wishing to maintain the erectile function. Materials and methods. 35 patients underwent 36 reconstructions of the urethra from August 2013 to July 2017, 11 - after previous urethral plastics, 14 - after prostate surgery (4 - after radical prostatectomy), 7 - suffered from a urethral distraction defect. The age of the patients was 58.17 ± 12.2 years. The median follow-up period was 525 (341; 813) days. The average length of urethral strictures was 15 (10; 15) mm. The average diameter of the urethra in the stricture zone was 1.4 ± 0.56 mm. Reconstruction with the use of a buccal mucosa graft is performed intraurethrally through corpus spongiosum using magnifying optics. Results. The overall efficacy of the primary reconstruction in 35 patients was 94.2 %; the repeated reconstruction in two patients was successful. All patients underwent the comprehensive monitoring of the results, the average follow-up period was 654 days, the average relapse-free period was 447 days. All patients preserved continence and erectile function Conclusion. The proposed technique showed a high efficiency in reconstruction of the bulbar and membranous urethra.

THE NEWEST TENDENCIES OF MEDICAL TACTICS AND OPERATIVE TREATMENT OF ESOPHAGEAL STRICTURES

Analysis of surgical treatment of 177 patients with cicatrical esophageal strictures for the period from 2003 to 2015 years was conducted. Diagnostic and treatment algorithm and developed technology of reconstructive surgery were applied for the patients of the main group (77). Endovascular preparation of colic graft, the infusion therapy to prevent ischemic disorders of transplant, plastic by stomach in clinical modification and plastic by ileocecal segment were suggested. The results of treatment of benign strictures of the esophagus and the results of treatment after surgery for esophageal cancer were assessed during immediate postoperative period. Occurring complications were divided into nonspecific and specific. The most common non-specific complications were observed in case of malignant strictures than in benign ones though there is no reliable difference between them. The level of postoperative specific complications, namely, the failure of anastomosis and strictures of esophageal-organ anastomoses is significantly higher in patients with malignant strictures genesis. The use of diagnostic and treatment algorithm and the developed treatment technology for the patients of the main group has enabled to reduce the level of anastomotic failure from 14.00% to 5.19% (p<0.05) and occurrence of strictures of esophageal-organ anastomoses from 20.00% to 10.39% (p<0.01).

Bilioenteric anastomotic stricture in patients with benign and malignant tumors: prevalence, risk factors and treatment

Stricture formation at the bilioenteric anastomosis is a rare but important postoperative complication. However, information on this complication is lacking in the literature. In the present study, we aimed to assess its prevalence and predictive factors, and report our experience in managing bilioenteric anastomotic strictures over a ten-year period. A total of 420 patients who had undergone bilioenteric anastomosis due to benign or malignant tumors between February 2001 and December 2011 were retrospectively reviewed. Univariate and multivariate modalities were used to identify predictive factors for anastomotic stricture occurrence. Furthermore, the treatment of anastomotic stricture was analyzed. Twenty-one patients (5.0%) were diagnosed with bilioenteric anastomotic stricture. There were 12 males and 9 females with a mean age of 61.6 years. The median time after operation to anastomotic stricture was 13.6 months (range, 1 month to 5 years). Multivariate analysis identified that surgeon volume (≤30 cases) (odds ratio: -1.860; P=0.044) was associated with the anastomotic stricture while bile duct size (>6 mm) (odds ratio: 2.871; P=0.0002) had a negative association. Balloon dilation was performed in 18 patients, biliary stenting in 6 patients, and reoperation in 4 patients. Five patients died of tumor recurrence, and one of heart disease. Bilioenteric anastomotic stricture is an uncommon complication that can be treated primarily by interventional procedures. Bilioenteric anastomosis may be performed by a surgeon in his earlier training period under the guidance of an experienced surgeon. Bile duct size >6 mm may play a protective role.

MP46-08 URETHRAL STRICTURES ARE NOT AS FREQUENT AS THOUGHT AFTER ARTIFICIAL URINARY SPHINCTER CUFF EROSION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-08 URETHRAL STRICTURES ARE NOT AS FREQUENT AS THOUGHT AFTER ARTIFICIAL URINARY SPHINCTER CUFF EROSION Ramiro Madden-Fuentes, Stephanie Sexton, and Andrew Peterson Ramiro Madden-FuentesRamiro Madden-Fuentes More articles by this author , Stephanie SextonStephanie Sexton More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1447AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Erosion of the artificial urinary sphincter (AUS) cuff is an uncommon problem after implantation of the AUS. The degree of injury secondary to the device erosion may lead to formation of scar around and within the urethra however the rate of secondary clinically significant strictures have not been well reported. We hypothesized that the stricture formation rate after an erosion was almost 100% in these patients and conducted a review of our single center experience to establish the natural incidence of stricture after erosion of the AUS cuff. METHODS We conducted an internal review board approved review of males >18 years old with a history of AUS cuff erosion between January 1st, 2006 and January 31st 2013. Basic demographic, clinical and operative data were recorded. The degree of urethral erosion was stratified into 4 groups for comparison: 1) <25% circumference, 2) 25-50% circumference, 3) >50% and <100% circumference, 4) 100% circumference. A stricture was defined as clinically significant if it required intervention such as urethroplasty, direct visual internal urethrostomy, or dilation. Patients with less than 1 month follow up were excluded for stricture rate analysis. RESULTS A total of 55 males with a history of AUS cuff erosion were identified. The mean patient age was 73.6 (±9.4). The mean device age was 50.5 months (range 1-160). Of the cohort, 47 were initially implanted at our institution and 8 elsewhere. An associated infection was noted in 20 patients. Of 55 patients, 13 (24%) had a prior history of AUS erosion. Of the 55 patients, 21 were in group 1, 13 in group 2, 7 in group 3, 5 in group 4, and the degree of erosion was not documented in 9. The median follow up after erosion in these patients was 9 months. Four patients did not have sufficient follow up to assess stricture rate (less than 1 month). The median length of catheterization was 30 days after removal of the AUS. The degree of erosion did not correlate with a longer period of catheterization (p=0.5). Of the patients with follow up, the overall rate of stricture in this cohort was 25%. The degree of erosion did not correlate with the risk of stricture occurrence (p=0.8). However, in the circumferential erosion group (n=5), 2 underwent a urethroplasty at the time of cuff removal. An infected and eroded cuff did not appear to correlate with a higher risk of stricture formation (p=0.7) CONCLUSIONS Erosion of the AUS cuff into the urethra leads to a urethral stricture in 25% of patients. However, the degree of erosion, prolonged urinary extravasation, or associated infection did not correlate with development of a urethral stricture. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e621-e622 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ramiro Madden-Fuentes More articles by this author Stephanie Sexton More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Eosinophilic Esophagitis in Children with Esophageal Atresia.

Recent studies have reported a higher prevalence of eosinophilic esophagitis in children with esophageal atresia. Under recognition of eosinophilic esophagitis in these patients may lead to excessive use of antireflux therapy and an escalation of interventions, including fundoplication, as symptoms may be attributed to gastroesophageal reflux disease. In addition, long-term untreated eosinophilic esophagitis may lead to recurrent strictures due to transmural esophageal inflammation, necessitating repeated dilatations. Eosinophilic esophagitis should be considered when children with esophageal atresia show persistent symptoms on standard antireflux treatment, increasing dysphagia, and recurrent strictures. Treatment has been found to not only significantly reduce intraepithelial eosinophil count, but also to improve symptoms, and to lower the occurrence of strictures and the need for dilatations. Future prospective studies are warranted in this area.

Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation.

Retrospective investigation. To investigate the occurrence, characteristics and clinical consequences of urethral strictures in men with neurogenic lower urinary tract dysfunction (NLUTD) using intermittent catheterization (IC) for bladder evacuation. Spinal cord injury rehabilitation center. The patient database was screened for men with NLUTD who had presented for a routine video-urodynamic investigation between 2008 and 2012. Patient characteristics, bladder diary details, the occurrence of urethral strictures and performed urethrotomy procedures were collected from patient charts. Urethral strictures were classified using the Wiegand scoring system modified for men with NLUTD. The occurrence rate of urethral strictures (that is, 25% confidence interval (CI) 21-30%) was significantly (P=0.0001) higher in men using IC (n=415) than in men using other bladder evacuation methods (that is, 14% CI 11-17%) (n=629). Urethral strictures had occurred after a median 5.9 years (range 0.5-48.9 years) of IC. There was no significant (P>0.08) effect of tetraplegia or catheter type on the stricture occurrence rate. Approximately one-third of the men suffering from urethral strictures underwent internal urethrotomies. The radiographic stricture severity score was not associated with the need for surgical correction of the stricture. The radiographic recurrence rate of urethral strictures in operated men was 100%, a median 14 years after the first urethrotomy. The occurrence rate of urethral strictures is significantly higher in men using IC than in men using other bladder evacuation methods. Every fourth men using IC may be affected by urethral strictures. However, only every third stricture may require a surgical intervention.

Su1487 Risk Factors for Esophageal Stricture After Triamcinolone Injection Following Endoscopic Submucosal Dissection for Superficial Esophageal Carcinoma

Su1487 Risk Factors for Esophageal Stricture After Triamcinolone Injection Following Endoscopic Submucosal Dissection for Superficial Esophageal Carcinoma