Background: The development of esophageal stricture during treatment with high dose chemotherapeutic agents is well known and documented in the literature. With the introduction of proton pumps inhibitors (PPI), the g...Background: The development of esophageal stricture during treatment with high dose chemotherapeutic agents is well known and documented in the literature. With the introduction of proton pumps inhibitors (PPI), the gastroesophageal reflux disease (GERD) induced stricture has shown significant improvement. The aim of this report is to remind of the fact that the chemotherapy induced strictures show poor response and their treatment is still a challenge. Case presentation: Here, we reported a boy with Down syndrome and congenital heart disease who developed acute lymphoblastic leukemia and subsequent esophageal stricture during treatment with a PPI. Conclusion: It is important to be aware of this potential complication of gastroesophageal reflux or antineoplastic treatment, even in cases thought to be adequately treated with a proton pump inhibitor, and that the start of PPI’s is also the start of an evaluation of the use of this medication.展开更多
BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.Thi...BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.展开更多
BACKGROUND Endoscopic balloon dilatation (EBD) has become the first line of therapy for benign esophageal strictures (ESs);however,there are few publications about the predictive factors for the outcomes of this treat...BACKGROUND Endoscopic balloon dilatation (EBD) has become the first line of therapy for benign esophageal strictures (ESs);however,there are few publications about the predictive factors for the outcomes of this treatment.AIM To assess the predictive factors for the outcomes of EBD treatment for strictures after esophageal atresia (EA) repair.METHODS Children with anastomotic ES after thoracoscopic esophageal atresia repair treated by EBD from January 2012 to December 2016 were included.All procedures were performed under tracheal intubation and intravenous anesthesia using a three-grade controlled radial expansion balloon with gastroscopy.Outcomes were recorded and predictors of the outcomes were analyzed.RESULTS A total of 64 patients were included in this analysis.The rates of response,complications,and recurrence were 96.77%,8.06%,and 2.33%,respectively.The number of dilatation sessions and complications were significantly higher in patients with a smaller stricture diameter (P=0.013 and 0.023,respectively) and with more than one stricture (P=0.014 and 0.004,respectively).The length of the stricture was significantly associated with complications of EBD (P=0.001).A longer interval between surgery and the first dilatation was related to more sessions and a poorer response (P=0.017 and 0.024,respectively).CONCLUSION The diameter,length,and number of strictures are the most important predictive factors for the clinical outcomes of endoscopic balloon dilatation in pediatric ES.The interval between surgery and the first EBD is another factor affectingresponse and the number of sessions of dilatation.展开更多
In the past, the esophagus diseases causing the patient to unable to intake oral diet such as esophageal strictures, leaks, tracheoesophageal fistulas, etc. were managed by surgical interventions and parenteral nutrit...In the past, the esophagus diseases causing the patient to unable to intake oral diet such as esophageal strictures, leaks, tracheoesophageal fistulas, etc. were managed by surgical interventions and parenteral nutrition to meet the demand of the body. After the development of technique of stent placement in esopahgus, there was revolutionary change in the management of such conditions promoting patients to take diet orally and improve their nutritional status as well as quality of life. Different types of commercial stents are available in the market with their own pros and cons. Our aim of this study was to review the different stents being used currently in the clinical practice, comparing the stents on their therapeutic outcome and complications, optimal timing of removal of stents for benign conditions and the methods studied by different clinicians to lower the rate of complications and reinterventions.展开更多
In the report,we describe a case of refractory benign esophageal strictures from esophageal cancer after an operation for the placement of three partially covered self-expanding metal stents (SEMSs),which were all emb...In the report,we describe a case of refractory benign esophageal strictures from esophageal cancer after an operation for the placement of three partially covered self-expanding metal stents (SEMSs),which were all embedded in the esophageal wall.Using the stentin-stent technique,the three embedded SEMSs were successfully removed without significant complications.To the best of our knowledge,few cases of the successful removal of multiple embedded esophageal SEMSs have been reported in the literature.This case also highlights that the stent-in-stent technique is effective for removing multiple embedded esophageal SEMSs.展开更多
BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition,characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery(SMA).Most cases of SMAS are assoc...BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition,characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery(SMA).Most cases of SMAS are associated with weight loss,and the most frequent clinical manifestations are nausea,vomiting,postprandial fullness,and abdominal pain.Treatment of SMAS is usually conservative,consisting mainly of adequate nutritional support,but in refractory cases surgery may be necessary,with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.CASE SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion,who suffered significant weight loss after replacement of his jejunostomy tube.He was admitted to the hospital due to pain and abdominal distension.A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery,thus establishing the diagnosis of SMAS.Due to the presence of the esophageal stricture,the patient was incapable of emesis;however,passage of a nasogastric tube for decompression was not possible.Considering the risk of gastric perforation due to distention,we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.CONCLUSION Diagnosis of SMAS can be challenging in patients with esophageal stenosis,and risk of gastric perforation may preclude conservative treatment.展开更多
<b><span style="font-family:Verdana;">Background:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span...<b><span style="font-family:Verdana;">Background:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Esophageal strictures are considered to be </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">one </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">of the most </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">challenging matters for gastroenterologist, general and thoracic surgeons in diagnosis and management. They can be grouped into three general categories: intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease (CD) is a very rare cause of esophageal stricture. The prevalence of esophageal CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when complications have occurred as Strictures, fissures, esophagobronchial fistulas, and mediastinal abscesses. </span><b><span style="font-family:Verdana;">Case Report: </span></b><span style="font-family:Verdana;">Thirty-nine years old Kurdish patient, referred to our department for evaluation. Although many con</span><span style="font-family:Verdana;">sultations during the last two years, the Pt was still undiagnosed. She had</span><span style="font-family:Verdana;"> progressive dysphagia, and weight loss of about 25 kg. She had no other digestive or extra digestive complaint, nor caustic ingestion history and nor drug his</span><span style="font-family:Verdana;">tory.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Chest CT scan and UGI Contrast study revealed diffuse smooth an</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">d </span><span style="font-family:Verdana;">regular esophageal stenosis.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Attempts to do upper endoscopy and biops</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y failed due to severe stenosis. Prolonged medical history and radiologic signs exclude malignancy, so esophagectomy with stomach pull-through was done by the aid of VATS and laparoscopy with excellent results. Pathological finding of the resected esophagus suggested the diagnosis of Crohn’s disease CD.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusions: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">CD is a rare cause of esophageal stricture and still to be a challenging early diagnosis due to the low specificity of clinical manifestations (aphthous ulcers), histologic findings (absence of granulomas), and endoscopic findings. So many patients have been diagnosed with complications (esophageal strictures, fistulas) which needed surgical treatment, adding greater morbidity and mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the morbidity and mortality and improving the quality of life for those patients.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophage...BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures.Additional interventions should be considered in high-risk patients.展开更多
文摘Background: The development of esophageal stricture during treatment with high dose chemotherapeutic agents is well known and documented in the literature. With the introduction of proton pumps inhibitors (PPI), the gastroesophageal reflux disease (GERD) induced stricture has shown significant improvement. The aim of this report is to remind of the fact that the chemotherapy induced strictures show poor response and their treatment is still a challenge. Case presentation: Here, we reported a boy with Down syndrome and congenital heart disease who developed acute lymphoblastic leukemia and subsequent esophageal stricture during treatment with a PPI. Conclusion: It is important to be aware of this potential complication of gastroesophageal reflux or antineoplastic treatment, even in cases thought to be adequately treated with a proton pump inhibitor, and that the start of PPI’s is also the start of an evaluation of the use of this medication.
文摘BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.
基金Supported by the Shenzhen Innovation and Technology Committee,No.JCYJ20180228175150018the Guangdong Medical Research Foundation(CN),No.A2018550
文摘BACKGROUND Endoscopic balloon dilatation (EBD) has become the first line of therapy for benign esophageal strictures (ESs);however,there are few publications about the predictive factors for the outcomes of this treatment.AIM To assess the predictive factors for the outcomes of EBD treatment for strictures after esophageal atresia (EA) repair.METHODS Children with anastomotic ES after thoracoscopic esophageal atresia repair treated by EBD from January 2012 to December 2016 were included.All procedures were performed under tracheal intubation and intravenous anesthesia using a three-grade controlled radial expansion balloon with gastroscopy.Outcomes were recorded and predictors of the outcomes were analyzed.RESULTS A total of 64 patients were included in this analysis.The rates of response,complications,and recurrence were 96.77%,8.06%,and 2.33%,respectively.The number of dilatation sessions and complications were significantly higher in patients with a smaller stricture diameter (P=0.013 and 0.023,respectively) and with more than one stricture (P=0.014 and 0.004,respectively).The length of the stricture was significantly associated with complications of EBD (P=0.001).A longer interval between surgery and the first dilatation was related to more sessions and a poorer response (P=0.017 and 0.024,respectively).CONCLUSION The diameter,length,and number of strictures are the most important predictive factors for the clinical outcomes of endoscopic balloon dilatation in pediatric ES.The interval between surgery and the first EBD is another factor affectingresponse and the number of sessions of dilatation.
文摘In the past, the esophagus diseases causing the patient to unable to intake oral diet such as esophageal strictures, leaks, tracheoesophageal fistulas, etc. were managed by surgical interventions and parenteral nutrition to meet the demand of the body. After the development of technique of stent placement in esopahgus, there was revolutionary change in the management of such conditions promoting patients to take diet orally and improve their nutritional status as well as quality of life. Different types of commercial stents are available in the market with their own pros and cons. Our aim of this study was to review the different stents being used currently in the clinical practice, comparing the stents on their therapeutic outcome and complications, optimal timing of removal of stents for benign conditions and the methods studied by different clinicians to lower the rate of complications and reinterventions.
基金Supported by Shandong Provincial Science and Technology Committee of China,No.2014GGH218034
文摘In the report,we describe a case of refractory benign esophageal strictures from esophageal cancer after an operation for the placement of three partially covered self-expanding metal stents (SEMSs),which were all embedded in the esophageal wall.Using the stentin-stent technique,the three embedded SEMSs were successfully removed without significant complications.To the best of our knowledge,few cases of the successful removal of multiple embedded esophageal SEMSs have been reported in the literature.This case also highlights that the stent-in-stent technique is effective for removing multiple embedded esophageal SEMSs.
文摘BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition,characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery(SMA).Most cases of SMAS are associated with weight loss,and the most frequent clinical manifestations are nausea,vomiting,postprandial fullness,and abdominal pain.Treatment of SMAS is usually conservative,consisting mainly of adequate nutritional support,but in refractory cases surgery may be necessary,with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.CASE SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion,who suffered significant weight loss after replacement of his jejunostomy tube.He was admitted to the hospital due to pain and abdominal distension.A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery,thus establishing the diagnosis of SMAS.Due to the presence of the esophageal stricture,the patient was incapable of emesis;however,passage of a nasogastric tube for decompression was not possible.Considering the risk of gastric perforation due to distention,we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.CONCLUSION Diagnosis of SMAS can be challenging in patients with esophageal stenosis,and risk of gastric perforation may preclude conservative treatment.
文摘<b><span style="font-family:Verdana;">Background:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Esophageal strictures are considered to be </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">one </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">of the most </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">challenging matters for gastroenterologist, general and thoracic surgeons in diagnosis and management. They can be grouped into three general categories: intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease (CD) is a very rare cause of esophageal stricture. The prevalence of esophageal CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when complications have occurred as Strictures, fissures, esophagobronchial fistulas, and mediastinal abscesses. </span><b><span style="font-family:Verdana;">Case Report: </span></b><span style="font-family:Verdana;">Thirty-nine years old Kurdish patient, referred to our department for evaluation. Although many con</span><span style="font-family:Verdana;">sultations during the last two years, the Pt was still undiagnosed. She had</span><span style="font-family:Verdana;"> progressive dysphagia, and weight loss of about 25 kg. She had no other digestive or extra digestive complaint, nor caustic ingestion history and nor drug his</span><span style="font-family:Verdana;">tory.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Chest CT scan and UGI Contrast study revealed diffuse smooth an</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">d </span><span style="font-family:Verdana;">regular esophageal stenosis.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Attempts to do upper endoscopy and biops</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y failed due to severe stenosis. Prolonged medical history and radiologic signs exclude malignancy, so esophagectomy with stomach pull-through was done by the aid of VATS and laparoscopy with excellent results. Pathological finding of the resected esophagus suggested the diagnosis of Crohn’s disease CD.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusions: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">CD is a rare cause of esophageal stricture and still to be a challenging early diagnosis due to the low specificity of clinical manifestations (aphthous ulcers), histologic findings (absence of granulomas), and endoscopic findings. So many patients have been diagnosed with complications (esophageal strictures, fistulas) which needed surgical treatment, adding greater morbidity and mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the morbidity and mortality and improving the quality of life for those patients.
基金Supported by Jiangsu Province Chinese Medicine Science and Technology Development Program,No.ZT202119.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures.Additional interventions should be considered in high-risk patients.