Surgical treatment of caustic esophageal strictures in adults

Harlak, Ali; Yiğit, Taner; Çoşkun, Kağan; Özer, Tahir; Menteş, Öner; Güleç, Bülent; Kozak, Orhan

doi:10.1016/j.ijsu.2012.12.010

Cited by 34 publications

(28 citation statements)

References 14 publications

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“…Además, el tubo gástrico invertido facilita un proceso de deglución más fisiológico y permite un mayor aclaramiento esofá- El injerto puede ser ascendido gracias a su gran longitud a través del mediastino posterior, retroesternal o incluso de forma subcutánea, aunque esta última vía presenta un alto riesgo de obstrucción debido a la compresión de las prominencias óseas, como se empleó en nuestros pacientes. Es importante definir que el tiempo quirúrgico y el sangrado son similares al del ascenso gástrico convencional (14,15).…”

Section: Resultsunclassified

Técnica del tubo gástrico invertido como opción para la reconstrucción esofágica, en un hospital de tercer nivel en Bogotá, Colombia: presentación de dos casos y revisión de la literatura

Buitrago

Santos

Vargas

2017

Rev. Colomb. Gastroenterol.

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Introducción: las principales lesiones a nivel de la hipofaringe y el esófago son debidas a quemaduras por cáusticos y al cáncer esofágico. Estas pueden presentarse y comprometer las dos estructuras de un 17% a un 23%, lo que genera la necesidad de una gran resección y, a su vez, el reto de una gran reconstrucción. En este estudio presentamos nuestra serie de casos empleando la técnica del tubo gástrico invertido y unarevisión de la literatura con discusión crítica de los aspectos principales de este procedimiento.Métodos: pacientes en quienes se llevó a cabo reconstrucción esofágica mediante la técnica del tubo gástrico invertido, desde enero de 2010 hasta enero de 2015.Resultados: un paciente presentó estenosis de la anastomosis cervical, la cual fue manejada con dilataciones endoscópicas. Ninguno de los pacientes tuvo disfagia con las modificaciones en la dieta o síntomas clínicos de síndrome de Dumping o retardo en el vaciamiento gástrico.Sin embargo, los dos pacientes presentaron reflujo gástrico y requirieron un inhibidor de la bomba de protones (IBP).Discusión: el tubo gástrico invertido no se utiliza a menudo para la reconstrucción después de una esofagectomía total. Su ventaja sobre la técnica convencional de ascenso gástrico, la interposición de colon o el tubo gástrico invertido supercargado es que es una operación de una etapa y un procedimiento simple que requiere solamente una anastomosis. Puede ser transferido a la región cervical o incluso al esófago faríngeo para crear una anastomosis.Conclusiones: esta técnica permite la creación de un conducto más largo para la reconstrucción esofágica, con una tasa de complicaciones baja y ausencia de mortalidad.

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Section: Resultsunclassified

Técnica del tubo gástrico invertido como opción para la reconstrucción esofágica, en un hospital de tercer nivel en Bogotá, Colombia: presentación de dos casos y revisión de la literatura

Buitrago

Santos

Vargas

2017

Rev. Colomb. Gastroenterol.

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“…In a study done by Harlak et al on 28 patients of corrosive strictures, 53.57% of patients suffered from excessive weight loss. [9] On barium swallow, 30% had lower esophageal strictures, 40% had mid esophageal, while 30% had strictures at multiple sites. 70% had long strictures while 60% had mucosal irregularities.…”

Section: Discussionmentioning

confidence: 97%

A Clinical Study of the Use of Savary‑Gilliard Dilators in Corrosive Esophageal Strictures without the Use of Fluoroscopy: A Reality in Resource‑Limited Settings in a Developing Country

Bhatt

Kakrani

2018

Journal of Digestive Endoscopy

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Context: Corrosive compounds are either acids or alkalis, and their ingestion can cause esophageal strictures which may be tortuous and multiple. Aims: The aim of study was to assess therapeutic efficacy and safety of dilatation using Savary‑Gilliard dilators in these patients without the use of fluoroscopy. Settings and Design: A cross‑sectional observational study, conducted for 18 months in a tertiary care teaching hospital in Western India. Subjects and Methods: Ten dysphagic patients who had a history of corrosive ingestion 2 months or more before presentation, who had documented esophageal strictures on endoscopy were included. Barium swallow and endoscopy confirmed the site, length, and number of strictures. Dilatation with Savary‑Gilliard dilators was done without the use of fluoroscopy with the help of guide wire in “rule of threes.” Patients were followed up immediately and for 12 months. Descriptive statistics, mean, and SD were applied in EPI info version 7 software. Results: The mean age of 29 + 6.5 years and 70% were females. About 80% had dysphagia Grades III and IV. On endoscopy, 40% had strictures at multiple sites and 60% of patients had strictures more than 5 cm in length. 50% strictures were very tight. Number of patients in whom there was the passage of one dilator more than the stricture in the first session were 80%. A mean of 8.28 sessions of dilatation were required. Adequate dysphagia relief was achieved in 8 (80%) patients, while there were 2 failures. A total of 180 dilatations were performed on these 10 patients of corrosive strictures over a period of 12 months. One minor perforation occurred in this study. Conclusions: In resource‑limited settings such as India, dilatation without fluoroscopy can be considered as effective and safe initial management for corrosive strictures.

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“…However, the operation using colon conduit for reconstruction requires at least three anastomoses and may be correlated with a higher early morbidity [5]. On the other hand, some authors recommend using the stomach as a reconstructed organ when it is available because of its good blood supply and the more simple surgical technique due to the need for a single anastomosis [5,16]. However, the length has a limit for the use of stomach.…”

Section: Discussionmentioning

confidence: 99%

Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

et al. 2014

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amount consumed [1]. Corrosive ingestion may lead to serious acute complications, such as esophageal or gastric perforation, respiratory insufficiency and death. Long-term complications include scarring and stricture formation [2]. Pharyngeal anastomosis is necessary in about 10 % of these patients [3].The scarred esophagus is traditionally either resected or bypassed using a colon conduit for the esophagus [1,4], because the stomach is usually also injured by the corrosive substance. However, using a gastric conduit has also been shown to have relatively good short-and long-term outcomes [5]. However, there have been few reports that have used a gastric conduit for esophageal replacement following pharyngo-laryngo-esophagectomy for such corrosive injuries. We herein report a rare case of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy during laparotomy after gastroduodenoscopy to treat a corrosive injury. Case reportA 44-year-old male accidentally ingested an unidentified liquid. He was admitted to a local emergency hospital. He was diagnosed to have corrosive pharyngo-esophagitis associated with gastritis due to the toxic chemical substances by upper gastrointestinal endoscopy. Conservative medical treatments were started in the intensive care unit. The patient developed gradually worsening dyspnea due to upper airway stenosis. A tracheotomy was therefore performed 15 days after the accident. Dysphagia also gradually progressed, and the patient was transferred to our hospital for the purpose of surgical intervention 91 days after the accident.The laryngeal fiberscope revealed severe deformity of the larynx and hypopharynx. Both sides of epiglottis and Abstract We herein present the case of a 44-year-old male who was successfully treated with pharyngo-laryngoesophagectomy for severe corrosive esophagitis associated with pharyngitis. He accidentally ingested an unidentified liquid and subsequently developed esophagitis and progressive pharyngolaryngitis. Since he also developed dyspnea, he initially underwent a tracheotomy at an emergency hospital. Afterward, dysphagia due to hypopharingoesophageal stricture gradually developed, and the patient was referred to our hospital. Therefore, under laparotomy, a feeding tube was inserted into the jejunostomy, and the gastroendoscope inserted via the anterior gastric wall revealed that the gastric mucosa along the greater curvature was intact. Based on this information, it was concluded that the patient could undergo reconstruction with a gastric tube following pharyngo-laryngo-esophagectomy, and this was successfully accomplished 3 months later.

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Surgical treatment of caustic esophageal strictures in adults

Abstract: Although it comes with high anastomotic stenosis rates, transhiatal esophagectomy and gastric pull-up with cervical anastomosis is a safe procedure, which can be performed for the treatment of corrosive esophageal stricture.

Cited by 34 publications

References 14 publications

Técnica del tubo gástrico invertido como opción para la reconstrucción esofágica, en un hospital de tercer nivel en Bogotá, Colombia: presentación de dos casos y revisión de la literatura

Técnica del tubo gástrico invertido como opción para la reconstrucción esofágica, en un hospital de tercer nivel en Bogotá, Colombia: presentación de dos casos y revisión de la literatura

A Clinical Study of the Use of Savary‑Gilliard Dilators in Corrosive Esophageal Strictures without the Use of Fluoroscopy: A Reality in Resource‑Limited Settings in a Developing Country

Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

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