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Histopathological changes in the oesophageal mucosa in Egyptian children with corrosive strictures: A single-centre vast experience
Ayman Eskander,Bahaa Mounir,Carolyne Ghobrial,Dalia Abd EL-Kareem,Mortada HF El-Shabrawi,Nabil A Mohsen,Sara Tarek
- , 2019, DOI: 10.3748/wjg.v25.i7.870
Abstract:
Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation
Jean-Louis Frossard,Paulo Castro Soares,Pavel Dulguerov,Salim Bouayed
- , 2016, DOI: 10.1159/000450678
Abstract: Complete pharyngo-oesophageal stricture (PES) after radiotherapy for head and neck cancer is a relatively rare and difficult complication to manage. Historically this condition has been treated surgically, but endoscopic approaches are now available. We present a 61-year-old man with an epidermoid carcinoma of the supraglottic stage and a micro-invasive epidermoid carcinoma of the oropharynx treated surgically and subsequently by adjuvant radiotherapy. Eight months after the end of the radiotherapy, a complete PES was diagnosed and treated with a combined anterograde-retrograde endoscopic dilation (CARD). The procedure was performed using a transoral anterograde progression with a rigid pharyngoscope and a retrograde progression with an extra-slim nasal endoscope using the percutaneous gastrostomy already in place. Using both transillumination and direct visualisation from both sides of the complete stenosis patency was restored between the neopharynx and the oesophagus. Despite the use of an endoprosthesis, the complete PES recurred and the technique had to be performed a second time. Illustrating the complexity of the case different types of endoprosthesis and several dilations had to be performed for our patient to achieve and maintain a normal oral intake. This case report illustrates that even in complicated recurrent radiation-induced complete PES a CARD can be performed safely and successfully using different types of endoprosthesis
Diagnosis and Management of Biliary Strictures after Deceased-Donor Liver Transplantation Based on Clinical Practice  [PDF]
Jianqiang Chen, Chengyou Du
Surgical Science (SS) , 2024, DOI: 10.4236/ss.2024.153011
Abstract: Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.
Palliation of Malignant Esophageal Obstruction and Fistulas with Metallic Stents: A Tertiary Center Experience  [PDF]
Hana’a Tashkandi, Nisar Haider Zaidi, Abdulrehman Sibiani
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.74028
Abstract: Background: To determine the usefulness of metallic stent in advanced oesophageal malignancies. Methods: In a retrospective study conducted at the Endoscopy Unit of King Abdulaziz University Hospital, patients underwent stent placement, with or without palliative radiotherapy for inoperable esophageal cancer, during the period spanning January 2010 through December 2014. Ethical approval for this study was granted by the King Abdulaziz University Research Ethics Committee. Data were collected from the electronic database of the hospital. All patients underwent OGD before stenting to know site of tumor, length of tumor and degree of stricture. Barium meal and CT scan was also done in some cases to know exact characteristics of tumor. Stent was selected more than 2 cm longer than the length of tumor. Self expanding metallic stents were used in all cases. Confirmation of proper placement of stent was done using fluoroscopy. Complications post stenting were analysed. Results: A total of 15 cases were studied. Males were 53.3% while females were 46.7%. Youngest patient was 39 yr old and eldest was 79 years with mean 64.93 years. Mean height was 159.73 cm and mean weight 54.98 kilogram. Co-morbidities like DM was 20%, DM with HTN was 6.7%, bronchial asthma 13.3% and DM with HTN with IHD and Renal implant in 6.7%. Diagnosis at admission was esophageal squamous cell carcinoma in 33.3%, esophageal adeno-carcinoma in 53.3%, gastric cancer in 6.7%, tracho-esophageal fistula in 6.7%. Stage 3 was 13.3%, and stage 4 was 86.7%. Surgical resection and palliation was done in14.2%, and only palliation was done in 92.9% of cases. SEMS were used in all patients and majority had Niti-S stent placed in 73.3% and Wallflex in 13.3% and Ultraflex in 6.7% and Boston in 6.7% cases. Dysphagia was Indication of stenting in 100% of cases and stricture in 57.1% and stricture and recurrent aspiration in 42.9%. Post stenting complications were early in 20% and late in 40%. Tumor ingrowth was in 20%, GERD in 20%, Mild chest pain and discomfort in 10%, stent migration in 10%, fistula formation in 10%, chest pain and GERD in 10%, and aspiration and pneumonia in 20%. Conclusions: Self expanding metallic stents are invaluable in advanced oesophageal cancer for palliation and alleviation of symptoms and better quality of life. Patients prior to chemoradiotherapy may get benefit of stenting making oesophageal passage patent which may otherwise get occluded by edema caused by radiotherapy.

Upper Gastrointestinal Bleeding at a Public Referal Hospital in Malawi  [PDF]
Gift Mulima, Javeria S. Qureshi, Carol Shores, Salim Tamimi, Helena Klackenberg, ？ke Andrén-Sandberg
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.511077
Abstract: Background: Upper gastrointestinal bleeding (UGIB) is a medical emergency. Timely and appropriate treatment can be lifesaving. Where medical equipment and supplies are inadequate, management of upper gastrointestinal bleeding is challenging. Methods: A retrospective review of charts of patients who were admitted during the year 2010, with a diagnosis of Upper Gastrointestinal Bleeding (UGIB), was done at Kamuzu Central Hospital, Lilongwe, Malawi. A Rockall score was applied to determine mortality risk. Results: A total number of 187 records (119 men and 68 women, mean age of 40.7 ± 15.3 years) were reviewed. The mortality rate was 23.5%, with a non-significant gender difference. Bleeding oesophageal varices were the most common clinical cause of UGIB (42.8%), with more males (63.1%) than females affected. About 40% of patients had no cause of UGIB indicated in their records. 14 (7.5%) patients had a normal oesophagogastroduodenoscopy (OGD). Oesophageal tumor was present in 2.7% of the subjects as a cause of UGIB. Access to endoscopy, for diagnosis and therapeutic intervention, and surgery (Hassab procedure) was available to less than 50% of the patients. Sixteen patients (9.5%) had surgery after endoscopy due to lack of variceal banding materials. Conclusion: Upper gastrointestinal bleeding is an important and common clinical problem at Kamuzu Central Hospital. Oesophageal varices seem to be the commonest cause of UGIB. Inadequacy of resuscitation materials and perhaps timely diagnostic and therapeutic endoscopic and surgical interventions are important limiting factors to favourable patient outcome. Work towards regular provision and supply of interventional resources regarding UGIB management may improve patient outcome.
Iatrogenic Oesophageal Perforations in Neoplastic Lesions: Management with Covered Self-Expanding Prostheses  [PDF]
Mario Anselmi Mendez, Ana MaríA Gemmato Pascazio, Maximiliano Figueroa Silva, Julio Salgado OyarzúN
Open Journal of Gastroenterology (OJGas) , 2021, DOI: 10.4236/ojgas.2021.116010
Abstract: Background:Perforation of the oesophagus is a serious condition. Most of them are iatrogenic and are associated with significant morbidity and mortality, especially with late diagnosis. Aim: To prospectively analyse the results of the endoscopic management of iatrogenic perforations in oesophageal neoplasia, through the immediate insertion of a covered self-expanding prosthesis (CSES). Materials and Methods: Between 01.01.2006 and 12.30.2016, a series of 19 consecutive patients attended the Teaching Unit of Endoscopic Surgery of the Regional de Concepción Hospital, Chile, with the diagnosis of oesophageal neoplasia confirmed by biopsy were prospectively studied. All were subjected to a prior evaluation by the oncology team and subsequently referred for endoscopic palliative management of dysphagia. The average age was 77 ± 9.3 years, 8 (42.1%) were female and 11 (57.9%) were male. In 17 patients (89.5%) the stenosis compromised the oesophagus, in 2 (10.5%) the gastro-oesophageal junction, 16 had a squamous carcinoma (84.2%) and 3 an adenocarcinoma (15.8%). Results: Perforation was diagnosed during the procedure in 18 patients (94.7%) and in 1 (5.3%) 22 hours later. Follow-up was done for a minimum of 90 days or until death. The prostheses were inserted successfully in all cases. The immediate evolution was satisfactory in 12 patients (63.2%). In the rest (36.8%), 18 complications appeared. The most frequent were retrosternal pain, subcutaneous emphysema and fever. The early evolution was satisfactory in 12/19 cases (63.2%). Complication was evidenced in 7 (36.8%), the most frequent was retrosternal pain (36.8%). Fever occurred in 3 (15.8%), pleural effusion in 3 (15.8%) and mediastinitis in 2 of these. The prosthesis was kept in situ as a definitive palliation method for neoplastic dysphagia. In 10 of the 18 cases that survived more than a month, there were late complications (55.6%), none of them associated with the perforation itself. The only death (5.3%) was due to an oesophagus-pleural fistula, associated with an early prosthetic migration. Recovery of the oral
Metastatic Oesophagus Carcinoma Presented with Neck and Arm Pain: A Case Report  [PDF]
？zlem Demircio？lu, Berat Meryem Alkan, Fatma Fidan, Aliye Tosun, Selami Akku？
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.34053
Abstract:

Oesophageal carcinoma is among malignancies with poor prognosis due to the late onset symptoms related with large submucosal involvement, early lymphatic metastasis and its multicentric characteristics, majority of the patients decrease within the first year of diagnosis. However, bone metastasis is uncommon and reported to be 1% to 14% in autopsy series. Herein we report a case that was admitted to our outpatient clinics with severe neck and arm pain as presenting symptoms and diagnosed as metastatic oesophageal carcinoma afterwards.

EUS guided fine needle aspiration is useful in diagnostic evaluation of indeterminate proximal biliary strictures  [PDF]
Naveen B. Krishna, Pavan Tummala, Jennifer L. Labundy, Banke Agarwal
Open Journal of Gastroenterology (OJGas) , 2012, DOI: 10.4236/ojgas.2012.22008
Abstract: Background and Aim: Determination of the etiology of proximal biliary strictures (PBS) still remains a challenge. Even though EUS-FNA is potentially useful, its role in diagnostic evaluation of PBS is still not established due to a lack of sufficient data. We sought to determine the performance characteristics of EUS-FNA in patients with obstructive jaundice (ObJ) and PBS. Patients and Methods: This is a retrospective analysis and included patients with ObJ and PBS with non-diagnostic brush cytology, who underwent EUS-FNA in our university based practice from March 2002 to February 2009. We evaluated the final diagnoses in study patients and the performance characteristics of EUS-FNA for identifying malignant PBS. Final diagnosis was based on surgical pathology or clinical follow-up of at least 12 months. Results: The study included 28 patients (17 male, 11 female) with mean age of 62.4 ± 14.9 years. The strictures ranged from 10 - 70 mm in length. CT scan identified a hilar mass in 9 patients. EUS-FNA identified malignancy in 12 patients. 18 patients were finally diagnosed to have a malignant stricture and 10 patients had a benign stricture. There were 6 false negative diagnoses. The accuracy of EUS-FNA for diagnosis of cholangiocarcinoma was 78.6%, with 66.6% sensitivity, 100% specificity, 62.5% NPV and 100% PPV. Conclusions: EUS-FNA can diagnose malignancy in 66.6% of jaundiced patients with PBS and non-diagnostic brush cytology and may have a role in their further diagnostic evaluation.
Oesophageal injury suspected to be due to doxycycline ingestion
Ceylon Medical Journal , 2011, DOI: 10.4038/cmj.v56i4.3897
Abstract: Doxycycline induced oesophageal injury (DIEI) has contributed to 27% of the global burden of drug induced oesophageal injury. We report 21 cases of DIEI detected over a one year period. Cases were defined as sudden onset – chest pain, dysphagia and odynophagia within a few hours to days after taking doxycycline, confirmed by UGIE, with improvement on withdrawal of doxycycline. The majority was in the 20 - 30 year age group and was female. The commonest symptoms were dysphagia and odynophagia. The mean time to symptoms from ingestion of doxycycline was 2.5 days. Majority of ulcers were in the mid oesophagus. Our case series highlights a preventable adverse drug reaction, which may have been avoided by giving simple advice to the patient. DOI: http://dx.doi.org/10.4038/cmj.v56i4.3897 Ceylon Medical Journal 2011; 56: 162-16
Estenosis ureterointestinales: Tratamiento endourológico
Cansino Alcaide,José Ramón; Pacios Cantero,José Carlos; Alonso y Gregorio,Sergio; Cáceres Jimenez,Felipe; Sánchez Rodriguez,Carlos; Aguilera Bazán,Alfredo; Hidalgo Togores,Luis; Pe？a Barthel,J. Javier De la;
Archivos Espa？oles de Urología (Ed. impresa) , 2005, DOI: 10.4321/S0004-06142005000500009
Abstract: objectives: to review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. methods: we retrospectively reviewed 27 ureteroenteric strictures treated from march 1994 to june 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double j catheter(3 of them antegrade) 8 patients underwent endoscopical incision + double j catheter (5 of them with acucise？ results: 12/21(57,14%) renal units improved and/or remained stable. we emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. conclusions: endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and midterm in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,…
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