Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastri...Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. It was successfully treated with transposition of a pedicled pectoralis major muscle flap.展开更多
Pneumatic dilation(PD)is considered to be a safe and effective first line therapy for achalasia.The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a...Pneumatic dilation(PD)is considered to be a safe and effective first line therapy for achalasia.The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation.It has been reported that delayed management of perforation for more than 24 h is associated with high mortality.Surgery is the treatment of choice within 24 h,but the management of delayed perforation remains controversial.Hereby,we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia.She completely recovered after intensive medical care.A review of the literature is also discussed.展开更多
Tracheoesophageal fistula （TEF） or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atr...Tracheoesophageal fistula （TEF） or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.展开更多
AIM： To investigate factors predicting failure of percutaneous endoscopic gastrostomy （PEG） to eliminate gastroesophageal reflux （GER）. METHODS： Twenty-nine consecutive mechanically ventilated patients were inve...AIM： To investigate factors predicting failure of percutaneous endoscopic gastrostomy （PEG） to eliminate gastroesophageal reflux （GER）. METHODS： Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%. RESULTS： Seventeen patients responded （RESP group） and 12 did not respond （N-RESP） to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER （%） values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 （0.6-3.8） vs 8.1 （7.4-9.2, P 〈 0.001）]. Reflux esophagitis and the gastroesophageal flap valve （GEFV） grading differed significantly between the two groups （P = 0.031 and P = 0.020, respectively）. Histology revealed no significant differences between the two groups.CONCLUSION： Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.展开更多
ESPITE the strong association between gastroesophageal reflux disease （GERD） and asthma has been undisputedly established and widely recognized by experts in advanced countries. Yet few topics in medicine are as con...ESPITE the strong association between gastroesophageal reflux disease （GERD） and asthma has been undisputedly established and widely recognized by experts in advanced countries. Yet few topics in medicine are as controversial as the causal relationship between GERD and asthma： some argue that GERD causes asthma, while others think the other way around is true, still quite a few believe that bronchodilator medications are to blame. This controversy continues to be a conundrum or more piece of the puzzle.1 We would like to share two thoughts which might be a belated revelation with scholars and experts and invite them for further cooperative studies： the GERD-derived respiratory distress is not asthma, but GERD pure and simple; and the pathogenesis of respiratory distress is not asthma, but laryngotracheal irritation/spasm/suffocation.展开更多
文摘Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. It was successfully treated with transposition of a pedicled pectoralis major muscle flap.
文摘Pneumatic dilation(PD)is considered to be a safe and effective first line therapy for achalasia.The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation.It has been reported that delayed management of perforation for more than 24 h is associated with high mortality.Surgery is the treatment of choice within 24 h,but the management of delayed perforation remains controversial.Hereby,we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia.She completely recovered after intensive medical care.A review of the literature is also discussed.
文摘Tracheoesophageal fistula （TEF） or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.
文摘AIM： To investigate factors predicting failure of percutaneous endoscopic gastrostomy （PEG） to eliminate gastroesophageal reflux （GER）. METHODS： Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%. RESULTS： Seventeen patients responded （RESP group） and 12 did not respond （N-RESP） to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER （%） values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 （0.6-3.8） vs 8.1 （7.4-9.2, P 〈 0.001）]. Reflux esophagitis and the gastroesophageal flap valve （GEFV） grading differed significantly between the two groups （P = 0.031 and P = 0.020, respectively）. Histology revealed no significant differences between the two groups.CONCLUSION： Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.
文摘ESPITE the strong association between gastroesophageal reflux disease （GERD） and asthma has been undisputedly established and widely recognized by experts in advanced countries. Yet few topics in medicine are as controversial as the causal relationship between GERD and asthma： some argue that GERD causes asthma, while others think the other way around is true, still quite a few believe that bronchodilator medications are to blame. This controversy continues to be a conundrum or more piece of the puzzle.1 We would like to share two thoughts which might be a belated revelation with scholars and experts and invite them for further cooperative studies： the GERD-derived respiratory distress is not asthma, but GERD pure and simple; and the pathogenesis of respiratory distress is not asthma, but laryngotracheal irritation/spasm/suffocation.
