DOCSLIB.ORG

Complications of Esophageal Strictures Dilatation in Children

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Complications of Esophageal Strictures Dilatation in Children Original Article Complications of esophageal strictures dilatation in children A tertiary-center experience Osama Bawazir, FRCSC,FRCSI, Mohammed O. Almaimani, MD. ABSTRACT 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading اإلفصاح عناألهداف: نتائج التوسيع باملنظار لضيق املريء عند األطفال cause of stricture was esophageal atresia. ومضاعفاته وعالجها. حيث أنه تختلف نتائج توسع املريء ًوفقا للمسببات األساسية. Results: The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal املنهجية: شملت الدراسة 46 ًمريضا خضعوا لتوسع املريء بني عامي 2014م و diameter was significantly increased after dilation (9 م. 2019خضع جميع املرضى لدراسة األشعه بالصبغه للمريء قبل التوسيع باملنظار versus 12 [10-12.8]) mm; p<0.001). Topical [11-7] لتحديد مكان التضيق وعدده وطوله. باإلضافة إلى ذلك، مت توثيق نوع املوسعات mitomycin-C was used as adjuvant therapy in 3 )البالون مقابل املوسعات شبه الصلبة(، وعدد جلسات التوسيع، والفاصل الزمني patients (6.5%). Esophageal perforation was reported بينهما، ومدة املتابعة. وكانت مقاييس نتائج الدراسة هي احلاجة إلى توسع إضافي وحتسني األعراض. كان متوسط العمر 2.47 سنة ، و 26مريضا من اإلناث. عسر in 2 cases (4.3%). Patients needed a median of 3 البلع كان هو العرض الرئيسي، وكان السبب الرئيسي للتضيق هو رتق املريء. dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation النتائج:كانت طريقة العالج الرئيسية هي توسع البالون باملنظار )العدد = 29، .was 2.18 years 25-75th percentiles: 0.5-4.21 %63(. ازداد قطر املريء بشكل ملحوظ بعد التوسيع )9 ]11-7[ مقابل 12 ]12.8-10[ مم ؛ قيمة p .) <0.001استخدم ميتوميسني-سي املوضعي كعالج Conclusion: Esophageal dilatation is effective for the مساعد في 3 مرضى )%6.5(.مت اإلبالغ عن انثقاب املريء في حالتني )4.3%(. 1 5 25 75 3 ;management of children with esophageal stricture يحتاج املرضى إلى جلسات توسيع باملتوسط )النسبة املئوية - : - ( ، وكانت املدة املتوسطة بني التوسيع األول واألخير 2.18 سنة )املئني 25-75: however, repeated dilatation is frequent, especially .)0.5-4.21 in patients with corrosive strictures. Complications are not common, and open surgery is not frequently اخلالصة:توسع املريء عالج فعال لألطفال الذين يعانون من تضيق املريء. ومع .required ذلك ، فإنهم عادة يحتاجون الي التوسيع املتكرر ، خاصة في املرضى الذين يعانون من التضيق الناجت عن املواد احلارقه. املضاعفات ليست شائعة، ونادر ما نلجأ الي Keywords: esophageal strictures, endoscopic اجلراحة املفتوحة. dilatation, bougies Objectives: To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes Saudi Med J 2020; Vol. 41 (7): 720-725 of esophageal dilatation differ according to the doi: 10.15537/smj.2020.7.25166 underlying etiology. From the Department of Surgery (Bawazir), Faculty of Medicine, Methods: The study included 46 patients who Umm Al-Qura Universit and King Faisal Specialist Hospital & underwent esophageal dilatation between 2014- Research Centre and from the Department of Surgery (Almaimani), 2019. All patients underwent a contrast study of the Maternity and Children Hospital, Makkah, Kingdom of Saudi Arabia. esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. Received 16th May 2020. Accepted 12th June 2020. In addition, the type of dilators (balloon versus semi- Address correspondence and reprint request to: Dr. Osama Bawazir, rigid dilators), the number of dilatation sessions, the Department of Surgery, Faculty of Medicine, Umm Al-Qura University, interval between them, and the duration of follow- Makkah, Kingdom of Saudi Arabia. E-mail: [email protected] up were also documented. The median age was ORCID ID: orcid.org/0000-0002-4213-7377 720 Saudi Med J 2020; Vol. 41 (7) www.smj.org.sa OPEN ACCESS Esophageal dilatation compl in children ... Bawazir & Almaimani ediatric esophageal strictures have different etiology patients underwent a contrast study of the esophagus Pthan adults.1,2 Its most common cause is surgical before endoscopic dilation to determine the location, complications of esophageal atresia or esophageal burns, number, and length of the narrowing. In addition, the which mainly occurs in children under the age of 5 type of dilators (balloon versus semi-rigid dilators), the years.3 Esophageal stenosis in children can be caused by number of dilatation sessions, the interval between them, gastroesophageal reflux disease (GERD), eosinophilic and the duration of follow-up were also documented. esophagitis, caustic ingestion, congenital esophageal The study was approved by the Institutional stenosis (CES), and anastomotic strictures after 4 Biomedical Ethical Committee, Faculty of Medicine, tracheoesophageal fistula repair. All these diseases have Umm Al Qura University (Institutional review number similar clinical presentations, the main being dysphagia, HAP0-02-K-012-2020-04-374), and the consents and vomiting. These children often have long-term to participate were waived. All procedures performed morbidity and require multiple procedures to improve in this study involving human participants were in their symptoms. The inability to thrive is the main consequence of this clinical condition as it decreases accordance with the ethical standards of the institutional oral intake.5 Patients with esophageal stenosis may need or national research committee and with the 1964 intensive treatment for many years to control their Helsinki Declaration and its later amendments or symptoms. Most of these patients undergo dilatation comparable ethical standards. that has been shown to treat symptoms effectively.6 Procedure. Gradual esophageal dilatations were Previously, constriction was treated with rigid dilation; performed using balloon catheters of an appropriate size however, the management has evolved toward balloon for the patient’s weight, age, and severity of stenosis. The dilation because the radial force applied can reduce the size of the balloon used depends on the judgment of the risk of esophageal damage and stenosis recurrence.7 attending surgeon. The balloon catheter was inserted Various dilators are now available. Fixed-diameter through the stenosis after placing a guidewire under push dilators as semi-rigid dilators (bougienage without endoscopic guidance and inflating it with normal saline; guidewire) and radially expanding balloon dilators that it was then gradually increased by 3 mm by dilatation run over a guidewire or through the endoscope channel for a maximum of 2 increments in a single session. are the most commonly used devices. However, there is The correct positioning of the dilator to the size of the a lack of consensus regarding the most preferred device.2 stenosis area was confirmed by endoscopy. The dilator In recent years, esophageal stents are recommended was held in place for one minute before proceeding to for some cases. The efficiency of esophageal stenosis the next dilation size. The extinction of the stenosis dilatation can be checked directly by endoscopy or under a direct endoscopic view was an indication of indirectly by fluoroscopic examination. However, successful dilation. In patients suspected of esophageal fluoroscopically-guided dilatation carries the risk of injury (namely, blood in the balloon or the pocket), a radiation exposure, especially in children. Surgery careful endoscopic examination was performed after is usually reserved for resistant types of esophageal dilatation of the stenosis, and if there was any suspicion strictures, such as long strictures and cases of congenital of injury, contrast study was conducted to check for stenosis.8 Multiple studies have analyzed esophageal dilatation and have obtained variable results.9,10 Thus, esophageal perforation. Most GERD patients continued the present study aimed to report the outcomes of to receive medical treatment for these conditions with endoscopic dilatation of esophageal strictures in the dilatation. Topical triamcinolone and mitomycin-C children, its complications, and management. injection were used if the child needed more than 2 dilations. Methods. This study is a retrospective analysis of all Outcomes. Clinical response was assessed according pediatric patients who underwent esophageal dilatation to the degree of improvement in symptoms and the need at our center between April 2014 and December 2019. for additional dilatation. The reaction was considered Data was extracted from the patients’ records, including complete when the symptoms completely disappeared demographics, clinical presentation, endoscopic results, without the need for additional enlargement; satisfactory treatment modality, and postoperative outcomes. All if there was a partial improvement in symptoms; and insufficient if the symptoms did not improve despite multiple dilation sessions. Statistical analysis. The 25th, 50th (median), and 75th Disclosure. Authors have no conflict of interests, and the percentiles were calculated for the continuous variables work was not supported or funded by any drug company. and proportions for categorical variables. The paired t-test was used to compare the first and last esophageal www.smj.org.sa Saudi Med J 2020; Vol. 41 (7) 721 Esophageal dilatation compl in children ... Bawazir & Almaimani diameters. A p-value<0.05 was considered significant. Table 1 - Baseline data and patients’ characteristics (N=46). All analyses were performed using Stata 16 (Stata Corp, College Station, Texas, USA). Characteristics n (%) Female 26 (56.5) Results. We performed esophageal dilatation
Load more

Recommended publications
  • Endoscopic Balloon Dilatation Is an Effective Management Strategy for Caustic-Induced Gastric Outlet Obstruction: a 15-Year Single Center Experience
    Published online: 2019-01-04 Original article Endoscopic balloon dilatation is an effective management strategy for caustic-induced gastric outlet obstruction: a 15-year single center experience Authors Rakesh Kochhar1,SarthakMalik1, Yalaka Rami Reddy1, Bipadabhanjan Mallick1, Narendra Dhaka1, Pankaj Gupta1, Saroj Kant Sinha1,ManishManrai1,SumanKochhar2,JaiD.Wig3, Vikas Gupta3 Institutions ABSTRACT 1 Department of Gastroenterology, Postgraduate Background and study aims Thereissparsedataonthe Institute of Medical Education and Research (PGIMER), endoscopic management of caustic-induced gastric outlet Sector 12, Chandigarh 160012, Punjab, India obstruction (GOO). The present retrospective study aimed 2 Department of Radiodiagnosis, Government Medical to define the response to endoscopic balloon dilatation College and Hospital, Sector 32, Chandigarh, Punjab, (EBD) in such patients and their long-term outcome. India Patients and methods The data from symptomatic pa- 3 Department of Surgery, Postgraduate Institute of tients of caustic-induced GOO who underwent EBD at our Medical Education and Research, Sector 12, Chandigarh tertiary care center between January 1999 and June 2014 160012, Punjab, India were retrieved. EBD was performed using wire-guided bal- loons in an incremental manner. Procedural success and submitted 16.2.2018 clinical success of EBD were evaluated, including complica- accepted after revision 30.5.2018 tions and long-term outcome. Results A total of 138 patients were evaluated of whom Bibliography 111 underwent EBD (mean age: 30.79±11.95 years; 65 DOI https://doi.org/10.1055/a-0655-2057 | male patients; 78 patients with isolated gastric stricture; – Endoscopy International Open 2019; 07: E53 E61 33 patients with both esophagus plus gastric stricture). © Georg Thieme Verlag KG Stuttgart · New York The initial balloon diameter at the start of dilatation, and ISSN 2364-3722 the last balloon diameter were 9.6±2.06mm (6– 15mm) and 14.5±1.6mm (6– 15mm), respectively.
    [Show full text]
  • UK Guidelines on Oesophageal Dilatation in Clinical Practice
    Gut Online First, published on February 24, 2018 as 10.1136/gutjnl-2017-315414 Guidelines UK guidelines on oesophageal dilatation in Gut: first published as 10.1136/gutjnl-2017-315414 on 24 February 2018. Downloaded from clinical practice Sarmed S Sami,1 Hasan, N Haboubi,2 Yeng Ang,3,4 Philip Boger,5 Pradeep Bhandari,6 John de Caestecker,7 Helen Griffiths,8 Rehan Haidry,9 Hans-Ulrich Laasch,10 Praful Patel,5 Stuart Paterson,11 Krish Ragunath,12 Peter Watson,13 Peter D Siersema,14 Stephen E Attwood15 ► Additional material is ABSTRACT 1.3 Obtain oesophageal biopsy specimens in published online only. To view These are updated guidelines which supersede the young patients with dysphagia or history please visit the journal online of food impaction to exclude eosinophilic (http:// dx. doi. org/ 10. 1136/ original version published in 2004. This work has gutjnl- 2017- 315414). been endorsed by the Clinical Services and Standards oesophagitis (GRADE of evidence: moder- Committee of the British Society of Gastroenterology ate; strength of recommendation: strong). For numbered affiliations see 1.4 Perform barium swallow in patients with end of article. (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone suspected complex strictures (such as Correspondence to extensive revision by the 16 members of the Guideline post-radiation therapy or history of Professor Stephen E Attwood, Development Group with representation from individuals caustic injury) in order to establish the Department of Surgery, Durham across all relevant disciplines, including the Heartburn location, length, diameter and number University, Durham DH13HP, UK; Cancer UK charity, a nursing representative and a of strictures (GRADE of evidence: low; seaattwood@ gmail.
    [Show full text]
  • Gastrointestinal Manifestations of Systemic Sclerosis Isabel M
    Cur gy: ren lo t o R t e a s e m McFarlane et al., Rheumatology (Sunnyvale) 2018, a u r c e h h 8:1 R Rheumatology: Current Research DOI: 10.4172/2161-1149.1000235 ISSN: 2161-1149 Review Article Open Access Gastrointestinal Manifestations of Systemic Sclerosis Isabel M. McFarlane*, Manjeet S. Bhamra, Alexandra Kreps, Sadat Iqbal, Firas Al-Ani, Carla Saladini-Aponte, Christon Grant, Soberjot Singh, Khalid Awwal, Kristaq Koci DO, Yair Saperstein, Fray M. Arroyo-Mercado, Derek B. Laskar and Purna Atluri Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, State University of New York, Hospitals Kings County Hospital Brooklyn, USA *Corresponding author: Isabel M. McFarlane, Clinical Assistant Professor of Medicine Associate Program Director Residency Program, Department of Medicine, Division of Rheumatology SUNY Downstate, Brooklyn, USA, Tel: 718-221-6515; Email: [email protected] Received date: January 26, 2018; Accepted date: March 27, 2018; Published date: March 30, 2018 Copyright: ©2018 McFarlane IM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Systemic sclerosis (SSc) is a rare autoimmune disease characterized by fibroproliferative alterations of the microvasculature leading to fibrosis and loss of function of the skin and internal organs. Gastrointestinal manifestations of SSc are the most commonly encountered complications of the disease affecting nearly 90% of the SSc population. Among these complications, the esophagus and the anorectum are the most commonly affected. However, this devastating disorder does not spare any part of the gastrointestinal tract (GIT), and includes the oral cavity, esophagus, stomach, small and large bowels as well as the liver and pancreas.
    [Show full text]
  • 58. Complications of Upper Gastrointestinal Endoscopy
    58. Complications of Upper Gastrointestinal Endoscopy Brian J. Dunkin, M.D., F.A.C.S. A. General Considerations Flexible upper gastrointestinal endoscopy is a safe procedure with a com- plication rate well below 2% and a mortality rate of 0.004%. The incidence of complications increases when biopsy, polypectomy, or other invasive diagnostic or therapeutic maneuvers are performed. Proper preparation for esophagogastroduodenoscopy (EGD) begins with a thorough history and physical examination. Both physician and patient should understand the indications for the procedure and possible complications. Patients who undergo EGD are frequently older and may have multiple medical prob- lems or be taking medications that increase the risk of complications. General risk factors include advancing age, history of cardiac disease, or history of chronic obstructive pulmonary disease. Specific problems that are likely to be encountered and the manner in which they increase risk are given in Table 58.1. 1. Cardiopulmonary complications. Although the overall complication rate from EGD is low, 40% to 46% of serious complications are car- diopulmonary, related to hypoxemia, vasovagal reflexes, and relative hypotension. a. Hypoxemia is common. Up to 15% of patients experience a decrease in oxygen saturation below 85% during EGD. i. Cause and prevention. Hypoxemia is due to sedation and to encroachment upon the airway. ii. Recognition and management. Routine monitoring of oxygen saturation gives the diagnosis (remember that hyper- carbia is usually present before oxygen desaturation is observed). Supplemental oxygen should be administered but may result in carbon dioxide retention if chronic obstructive pulmonary disease is present. Constant observation by a second individual who monitors vital signs, oxygen satura- tion, and level of consciousness (and reminds the patient to take periodic deep breaths) can help minimize this problem.
    [Show full text]
  • Successful Esophageal Replacement Surgery in a 3-Year Old with Post-Corrosive Esophageal Stricture
    CASE REPORT Successful Esophageal Replacement Surgery in a 3-Year Old with Post-corrosive Esophageal Stricture Cleopas Mutua Kaumbulu,1Awori Mark Nelson,2Rohini Patil,1 Ahmed Mohamed Rafik,2 James Ndung’u Muturi2 1.Gertrude's Children's Hospital 2.Kenyatta National Hospital Correspondence to: Dr. Kaumbulu Cleopas; Email:[email protected]. Summary Accidental caustic ingestion in children, though entirely dilatation and needed to be managed surgically; he preventable, continues to be present in developing subsequently had a good outcome, which is rare in countries. Gastrointestinal injuries following caustic developing countries. ingestion in children range from mild to fatal. Presentation of such children to the medical facility could be early or sometimes late with complications. Keywords: Post-corrosive esophageal stricture, Management is based on the type of injury and could Esophageal replacement surgery range from medical conservative management to complex Ann Afr Surg. 2020; 17(2):80-84 surgical procedures. Such complex surgeries are almost DOI: http://dx.doi.org/10.4314/aas.v17i2.9 unavailable in developing countries. We present a 3-year Conflicts of Interest: None old who presented to our facility with an esophageal Funding: None stricture following accidental caustic ingestion four © 2020 Author. This work is licensed under the Creative months prior to presentation. He had a failed stricture Commons Attribution 4.0 International License. Introduction Accidental caustic ingestion in children is a worldwide oral sores. A chest x-ray at that point was unremarkable. problem (1), but most of the cases are unreported and the Endoscopy showed erosions of the esophagus and the true incidence of the condition is not known (2).
    [Show full text]
  • Recurrent Esophageal Candidiasis: a Case Report of Different Complications
    7 Case Report Page 1 of 7 Recurrent esophageal candidiasis: a case report of different complications Siok Siong Ching1, Teik Wen Lim2, Ya-Lyn Annalisa Ng1 1Department of Surgery, Changi General Hospital, Singapore; 2Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia Correspondence to: Dr. Siok Siong Ching. Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889. Email: [email protected]. Abstract: A 71-year-old male patient presented with recurrent acute dysphagia in 2017 on a background of previous episodes of upper esophageal food bolus obstruction and mild gastro-esophageal reflux disease several years ago. He was diagnosed with acute erosive esophagitis from candidiasis and chronic gastritis with intestinal metaplasia. These were treated with anti-fungal therapy and a proton pump inhibitor. A year later, he had recurrent dysphagia and found to have upper esophageal stricture and diffuse esophagitis with ulceration and hyperkeratosis. The same treatments were given but his problems recurred again another year later. Recurrent candidiasis was confirmed on esophageal biopsy and fungal culture. He was treated with a third course of anti-fungal therapy with good resolution of dysphagia symptom, esophagitis, and stricture, both clinically and endoscopically. Intramural pseudodiverticulosis of the upper esophagus was also evident during endoscopy and barium swallow study. Hyperkeratosis was persistent. He is planned for surveillance endoscopy for persistent esophageal hyperkeratosis and chronic gastritis with intestinal metaplasia. Ulceration, stricture, intramural pseudodiverticulosis and hyperkeratosis are the less common complications of esophageal candidiasis that we have seen all occurring on this patient. These may be further complicated by perforation or fistula formation from the inflammation and strictures, and mitotic lesion from hyperkeratosis.
    [Show full text]
  • Safety and Outcome Using Endoscopic Dilation for Benign Esophageal Stricture Without Fluoroscopy
    Published online: 2019-09-26 Original Article Safety and outcome using endoscopic dilation for benign esophageal stricture without fluoroscopy E. R. Siddeshi, M. V. Krishna1, Deepak Jaiswal1, M. Murali Krishna1 Departments of Medical Gastroenterology, and 1General Medicine, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India Abstract Aim: The aim was to investigate the use of Savary‑Gilliard marked dilators in tight esophageal strictures without fluoroscopy. Materials and Methods: Four hundred and six patients with significant dysphagia from benign strictures due to a variety of causes were dilated endoscopically. Patients with achalasia, malignant lesions, and external compression were excluded. The procedure consisted of two parts. First, Savary‑Gilliard or zebra guide wire was placed through video endoscopy and then dilatation was performed without fluoroscopy. In general, “the rule of three” was followed. Effective treatment was defined as the ability of patients, with or without repeated dilatations, to maintain a solid or semisolid diet for more than 12 months. Results: One thousand and twenty‑four dilatations sessions in a total of 408 patients were carried out. The success rate for placement of a guide wire was 100% and for dilatation 97% without the use of fluoroscopy, after 6 months–24 years of follow‑up. The number of sessions per patient was between one and seven, with an average of three sessions. The ability of patients, after one or more sessions of dilatations to maintain a solid or semisolid diet for more than 12 months was obtained in 386 patients (95.8%). All patients improved clinically without complications after the endoscopic procedure without fluoroscopy, but we noted 22 failures.
    [Show full text]
  • Esophageal Intramural Pseudodiverticulosis and Concomitant Eosinophilic Esophagitis: a Case Series
    Hindawi Publishing Corporation Canadian Journal of Gastroenterology and Hepatology Volume 2016, Article ID 1761874, 5 pages http://dx.doi.org/10.1155/2016/1761874 Research Article Esophageal Intramural Pseudodiverticulosis and Concomitant Eosinophilic Esophagitis: A Case Series Michael A. Scaffidi,1 Ankit Garg,1 Brandon Ro,1 Christopher Wang,1 Tony T. C. Yang,1 Ian S. Plener,1 Andrea Grin,2 Errol Colak,3 and Samir C. Grover1 1 Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada 2Laboratory Medicine and Pathobiology, St. Michael’s Hospital, Toronto, ON, Canada 3Department of Medical Imaging, St. Michael’s Hospital, Toronto, ON, Canada Correspondence should be addressed to Samir C. Grover; [email protected] Received 8 January 2016; Revised 16 June 2016; Accepted 26 July 2016 Academic Editor: Michael Beyak Copyright © 2016 Michael A. Scaffidi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Esophageal intramural pseudodiverticulosis (EIPD) is an idiopathic benign chronic disease characterized by flask- like outpouchings of the esophageal wall. It is unknown whether there is a genuine association between EIPD and eosinophilic esophagitis (EoE). Aims. To investigate a possible relationship between EIPD and EoE. Methods. Patients with radiographic or endoscopic evidence of pseudodiverticulosis were identified from the database at a single academic center. Cases were analyzed in three areas: clinical information, endoscopic findings, and course. Results. Sixteen cases of esophageal pseudodiverticulosis were identified. Five patients had histologic evidence of eosinophilic esophagitis. Patients with EoE had pseudodiverticula in themid- to-distal esophagus while those with EIPD had pseudodiverticula predominantly in the proximal esophagus ( < 0.001).
    [Show full text]
  • The Role of Endoscopy in the Evaluation and Management Of&Nbsp
    GUIDELINE The role of endoscopy in the evaluation and management of dysphagia This is one of a series of statements discussing the use of alone, in contrast to patients with motility disorders who GI endoscopy in common clinical situations. The Stan- present with both liquid and solid food dysphagia.3 Struc- dards of Practice Committee of the American Society tural disorders include inflammatory and malignant condi- for Gastrointestinal Endoscopy (ASGE) prepared this up- tions. Benign inflammatory strictures result from collagen date of a previous ASGE guideline.1 In preparing this and fibrous tissue deposition in patients with severe or guideline, a search of the medical literature was per- chronic inflammation in the esophagus,4 whereas malig- formed by using PubMed for the period 1990-2013. Addi- nant strictures result from intrinsic luminal tumor growth tional references were obtained from the bibliographies or extrinsic esophageal compression. of the identified articles and from recommendations of The most common causes of esophageal dysphagia are expert consultants. When few or no data exist from listed in Table 2. Peptic strictures, a sequela of GERD, well-designed prospective trials, emphasis is given to re- have been reported to account for up to 80% of all benign sults from large series and reports from recognized ex- esophageal strictures.5 However, their incidence appears to perts. Guidelines for appropriate use of endoscopy are have decreased in the last decade because of the wide- based on a critical review of the available data and spread use of proton pump inhibitors. With the reported in- expert consensus at the time that the guidelines are crease in its prevalence, eosinophilic esophagitis (EoE) is drafted.
    [Show full text]
  • UK Guidelines on Oesophageal Dilatation in Clinical Practice
    Guidelines UK guidelines on oesophageal dilatation in clinical practice Sarmed S Sami,1 Hasan, N Haboubi,2 Yeng Ang,3,4 Philip Boger,5 Pradeep Bhandari,6 John de Caestecker,7 Helen Griffiths,8 Rehan Haidry,9 Hans-Ulrich Laasch,10 Praful Patel,5 Stuart Paterson,11 Krish Ragunath,12 Peter Watson,13 Peter D Siersema,14 Stephen E Attwood15 ► Additional material is ABSTRACT 1.3 Obtain oesophageal biopsy specimens in published online only. To view These are updated guidelines which supersede the young patients with dysphagia or history please visit the journal online of food impaction to exclude eosinophilic (http:// dx. doi. org/ 10. 1136/ original version published in 2004. This work has gutjnl- 2017- 315414). been endorsed by the Clinical Services and Standards oesophagitis (GRADE of evidence: moder- Committee of the British Society of Gastroenterology ate; strength of recommendation: strong). For numbered affiliations see 1.4 Perform barium swallow in patients with end of article. (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone suspected complex strictures (such as Correspondence to extensive revision by the 16 members of the Guideline post-radiation therapy or history of Professor Stephen E Attwood, Development Group with representation from individuals caustic injury) in order to establish the Department of Surgery, Durham across all relevant disciplines, including the Heartburn location, length, diameter and number University, Durham DH13HP, UK; Cancer UK charity, a nursing representative and a of strictures (GRADE of evidence: low; seaattwood@ gmail. com patient representative. The methodological rigour and strength of recommendation: strong). Received 5 October 2017 transparency of the guideline development processes 2.
    [Show full text]
  • 14-Struyve.Pdf
    CASE REPORT 433 Pneumomediastinum as a complication of esophageal intramural pseudodiver- ticulosis M. Struyve1,2, C. Langmans2,3, G. Robaeys1,2,4 (1) Department of Gastroenterology, University Hospitals Gasthuisberg, Leuven, Belgium ; (2) Department of Gastroenterology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium ; (3) Department of Internal Medicine, University Hospitals Gasthuisberg, Leuven, Belgium ; (4) Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. Abstract Prior medical history revealed intermittent dysphagia the past two years with an episode of acute dysphagia one Dysphagia is a common complaint of patients seen at the year ago due to a food impaction that was endoscopically outpatient clinic as well as at the emergency room. We report esophageal intramural pseudodiverticulosis (EIPD) as a cause removed. The esophagogastroduodenoscopy (EGD) at of dysphagia that is less known by physicians and it is rarely that time showed a benign esophageal stricture in the described in the literature. EIPD is characterized by multiple, distal esophagus. Biopsy specimens that were taken from segmental or diffuse, flask-like outpouchings in the esophageal wall corresponding to dilated and inflamed excretory ducts of the the stricture at that time showed active esophagitis and the submucosal esophageal glands. The underlying etiology remains presence of mycosis. The patient had been successfully unclear. Esophageal strictures, esophageal candidiasis and treated with proton pump inhibitors and antimycotics gastroesophageal reflux disease are often associated. The diagnosis can be made by upper gastrointestinal endoscopy, but barium for respectively four and two weeks and there was no esophagography is the modality of choice. Complications of EIPD recurrence of severe dysphagia until today.
    [Show full text]
  • 2019 Seoul Consensus on Esophageal Achalasia Guidelines
    J Neurogastroenterol Motil, Vol. 26 No. 2 April, 2020 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm20014 JNM Journal of Neurogastroenterology and Motility Review 2019 Seoul Consensus on Esophageal Achalasia Guidelines Hye-Kyung Jung,1 Su Jin Hong,2 Oh Young Lee,3* John Pandolfino,4 Hyojin Park,5 Hiroto Miwa,6 Uday C Ghoshal,7 Sanjiv Mahadeva,8 Tadayuki Oshima,6 Minhu Chen,9 Andrew S B Chua,10 Yu Kyung Cho,11 Tae Hee Lee,12 Yang Won Min,13 Chan Hyuk Park,14 Joong Goo Kwon,15 Moo In Park,16 Kyoungwon Jung,16 Jong Kyu Park,17 Kee Wook Jung,18 Hyun Chul Lim,19 Da Hyun Jung,20 Do Hoon Kim,18 Chul-Hyun Lim,21 Hee Seok Moon,22 Jung Ho Park,23 Suck Chei Choi,24 Hidekazu Suzuki,25 Tanisa Patcharatrakul,26 Justin C Y Wu,27 Kwang Jae Lee,28 Shinwa Tanaka,29 Kewin T H Siah,30 Kyung Sik Park,31 and Sung Eun Kim16; The Korean Society of Neurogastroenterology and Motility 1Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; 2Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea; 3Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea; 4Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 5Division of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; 6Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan; 7Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; 8Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 9Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; 10Gastro Centre, Ipoh, Malaysia; 11Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St.
    [Show full text]