Congenital esophageal stenosis(CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic...Congenital esophageal stenosis(CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscularthickening, tracheobronchial remnants(TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography(EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation.展开更多
BACKGROUND Herein,we report a case in whom two foreign bodies entered the upper mediastinal cavity from the cervical root and subsequently the esophagus.Surgery is the preferred treatment method,and operational proced...BACKGROUND Herein,we report a case in whom two foreign bodies entered the upper mediastinal cavity from the cervical root and subsequently the esophagus.Surgery is the preferred treatment method,and operational procedures depend on the size and location of the foreign body relative to the mediastinal vessels.Rigid esophagoscopy combined with angle endoscopic surgery was selected to avoid surgical trauma and complications.CASE SUMMARY A 63-year-old male patient with a 6-mo old history of neck trauma presented with a black-brown foreign body in the lateral wall of the esophagus.Neck and chest computed tomography(CT)revealed that two superior mediastinal foreign bodies penetrated the esophagus diagonally.We removed two foreign bodies through an esophagoscope.Owing to the rigid working channel of esophagoscope and good exposure of endoscope,the risk of injury to the adjacent vital tissues was minimized.Postoperative comprehensive therapies,including antibiotic administration and nutritional support,resulted in a prompt postoperative recovery.Postoperative CT confirmed the absence of a residual foreign body and neck and chest infections.In addition,upper gastrointestinal angiography and gastroscopy revealed the absence of an evident esophageal perforation.The patient received an oral diet and did not experience any complication at the time of discharge from the hospital.CONCLUSION Rigid esophagoscopy combined with angle endoscopy is an effective,minimally invasive treatment for penetrating neck injuries.展开更多
文摘Congenital esophageal stenosis(CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscularthickening, tracheobronchial remnants(TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography(EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation.
基金Natural Science Foundation of Anhui Province,No.1608085MH189Anhui Province Academic and Technical Leaders Reserve Candidates Grant,No.2018H160
文摘BACKGROUND Herein,we report a case in whom two foreign bodies entered the upper mediastinal cavity from the cervical root and subsequently the esophagus.Surgery is the preferred treatment method,and operational procedures depend on the size and location of the foreign body relative to the mediastinal vessels.Rigid esophagoscopy combined with angle endoscopic surgery was selected to avoid surgical trauma and complications.CASE SUMMARY A 63-year-old male patient with a 6-mo old history of neck trauma presented with a black-brown foreign body in the lateral wall of the esophagus.Neck and chest computed tomography(CT)revealed that two superior mediastinal foreign bodies penetrated the esophagus diagonally.We removed two foreign bodies through an esophagoscope.Owing to the rigid working channel of esophagoscope and good exposure of endoscope,the risk of injury to the adjacent vital tissues was minimized.Postoperative comprehensive therapies,including antibiotic administration and nutritional support,resulted in a prompt postoperative recovery.Postoperative CT confirmed the absence of a residual foreign body and neck and chest infections.In addition,upper gastrointestinal angiography and gastroscopy revealed the absence of an evident esophageal perforation.The patient received an oral diet and did not experience any complication at the time of discharge from the hospital.CONCLUSION Rigid esophagoscopy combined with angle endoscopy is an effective,minimally invasive treatment for penetrating neck injuries.
