Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 310
Filtrar
1.
Laryngoscope ; 134(11): 4620-4624, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38994882

RESUMEN

OBJECTIVE(S): Treatment for Zenker's diverticulum and cricopharyngeal dysfunction has evolved to include flexible endoscopic approaches. Currently, no flexible modalities combine the precision cutting of CO2 laser and the hemostasis of knife electrocautery. We present the first series describing fiber-based 445nm blue light (BL) laser for endoscopic cricopharyngeal myotomy/Zenker's diverticulotomy. We describe usage characteristics and laser parameters with rigid esophagoscopy to determine the feasibility of use with flexible endoscopy. METHODS: Retrospective review and literature review. RESULTS: The first nine cases of endoscopic diverticulotomy (n = 5) and cricopharyngeal myotomy (n = 4) with BL were reviewed. Rigid exposure was achieved with the Dohlman Slimline diverticuloscope. Mean age was 75.6 years. Average diverticulum depth was 0.89 cm ±1.0 cm. Pulsed mode was used in seven cases with mean of 6.86 W, 54 ms pulse on, and 286 ms pulse pause and overall mean of 6.00 W and 405 J. Complete myotomy with intact buccopharyngeal fascia and without bleeding limiting view was achieved in all patients. One of two patients in whom continuous wave setting was used developed subcutaneous emphysema following vigorous cough on POD0; this resolved after 7 days nothing per oral (NPO). Eight patients were started on oral intake without evidence for leak. Pulsed mode with fiber-to-tissue contact provided effective muscle cutting without disruption of buccopharyngeal fascia. Literature review yielded three articles examining flexible approach with laser for Zenker's and none with BL. CONCLUSION: BL provides safe and effective fiber-based cutting and hemostasis in endoscopic cricopharyngeal myotomy/Zenker's diverticulotomy. Future use in flexible endoscopic approaches appears feasible, though continuous wave should be avoided. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:4620-4624, 2024.


Asunto(s)
Esofagoscopía , Miotomía , Músculos Faríngeos , Divertículo de Zenker , Humanos , Divertículo de Zenker/cirugía , Miotomía/métodos , Miotomía/instrumentación , Estudios Retrospectivos , Anciano , Esofagoscopía/métodos , Esofagoscopía/instrumentación , Masculino , Femenino , Músculos Faríngeos/cirugía , Terapia por Láser/métodos , Terapia por Láser/instrumentación , Anciano de 80 o más Años , Resultado del Tratamiento , Prueba de Estudio Conceptual , Estudios de Factibilidad
2.
Best Pract Res Clin Gastroenterol ; 69: 101899, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38749578

RESUMEN

An oesophageal stricture refers to a narrowing of the oesophageal lumen, which may be benign or malignant. The cardinal feature is dysphagia, and this may result from intrinsic oesophageal disease or extrinsic compression. Oesophageal strictures can be further classified as simple or complex depending on stricture length, location, diameter, and underlying aetiology. Many endoscopic options are now available for treating oesophageal strictures including dilatation, injectional therapy, stenting, stricturotomy, and ablation. Self-expanding metal stents have revolutionised the palliation of malignant dysphagia, but oesophageal dilatation with balloon or bougienage remains first-line therapy for most benign strictures. The increase in endoscopic and surgical interventions on the oesophagus has seen more benign refractory oesophageal strictures that are difficult to treat, and often require advanced endoscopic techniques. In this review, we provide a practical overview on the evidence-based management of both benign and malignant oesophageal strictures, including a practical algorithm for managing benign refractory strictures.


Asunto(s)
Dilatación , Estenosis Esofágica , Esofagoscopía , Humanos , Estenosis Esofágica/terapia , Estenosis Esofágica/cirugía , Estenosis Esofágica/etiología , Esofagoscopía/instrumentación , Dilatación/métodos , Stents , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/cirugía , Cuidados Paliativos , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Resultado del Tratamiento , Algoritmos
3.
Int J Surg ; 110(4): 2055-2064, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38668658

RESUMEN

BACKGROUND AND AIM: Current treatments for refractory benign esophageal strictures (BESs) often take several years and have poor effects. The authors propose a novel method of self-help inflatable balloon (SHIB) and evaluate its efficacy and safety. METHODS: A prospective, multicenter study was conducted from January 2019 to March 2022. All enrolled patients were diagnosed with refractory BESs and received SHIB. The primary endpoint was the clinical success rate at 12 months after removing SHIB. The secondary endpoints were the number of days of placing SHIB, and changes from baseline in BMI and health-related quality of life at 1, 3, 6, and 12 months. RESULTS: The clinical success rate was 51.2% (21/41) with the median days of placing SHIB being 104.0 days (range: 62.0-134.5 days), which was higher in the endoscopic group compared to the caustic and surgery groups (63.3 vs. 28.6% vs. 0, P=0.025). All patients (100%) showed significant improvement in dysphagia scores during placing SHIB. Although 20 patients (48.8%) experienced recurrent stricture, the median stricture length was decreased (P<0.001) and the median intervention-free interval was prolonged (P<0.001). In all patients, the mean BMI at and health-related quality of life at 1, 3, 6, and 12 months were significantly increased compared with baseline (P<0.05). On multivariate analysis, stricture etiology and wearing time were independent predictors of recurrent stricture. CONCLUSIONS: The SHIB has high efficacy and safety in treating refractory BESs of different origins, especially for endoscopic resection. Stricture etiology and wearing time were independent predictors of recurrent stricture.


Asunto(s)
Estenosis Esofágica , Calidad de Vida , Humanos , Estenosis Esofágica/terapia , Estenosis Esofágica/cirugía , Masculino , Estudios Prospectivos , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto , Anciano , Esofagoscopía/métodos , Esofagoscopía/instrumentación
4.
Laryngoscope ; 134(9): 4114-4117, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38613455

RESUMEN

A 15-year-old male with previous open tracheoesophageal fistula (TEF) repair presented with a large, short recurrent TEF. The TEF was denuded with cautery on the tracheal side and the patient was intubated with a cuffed endotracheal tube. Suspension microesophagoscopy allowed excellent exposure of the TEF from the esophageal side, which was cauterized. Four sutures were placed endoscopically from the esophageal side, and the TEF remained closed 6 months postoperatively. Laryngoscope, 134:4114-4117, 2024.


Asunto(s)
Esofagoscopía , Técnicas de Sutura , Fístula Traqueoesofágica , Humanos , Fístula Traqueoesofágica/cirugía , Masculino , Técnicas de Sutura/instrumentación , Adolescente , Esofagoscopía/métodos , Esofagoscopía/instrumentación
5.
Am J Gastroenterol ; 116(11): 2235-2240, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34543257

RESUMEN

INTRODUCTION: "Push" or "pull" techniques with the use of snares, forceps, baskets, and grasping devices are conventionally used to manage esophageal food bolus impaction (FBI). A novel cap-assisted technique has recently been advocated to reduce time taken for food bolus (FB) removal. This study aimed to compare the effectiveness of the cap-assisted technique against conventional methods of esophageal FB removal in a randomized controlled trial. METHODS: Consecutive patients with esophageal FBI requiring endoscopic removal, from 3 Australian tertiary hospitals between 2017 and 2019, were randomized to either the cap-assisted technique or the conventional technique. Primary outcomes were technical success and FB retrieval time. Secondary outcomes were technical success rate, en bloc removal rate, procedure-related complication, length of hospital stay, and cost of consumables. RESULTS: Over 24 months, 342 patients with esophageal FBI were randomized to a cap-assisted (n = 171) or conventional (n = 171) technique. Compared with the conventional approach, the cap-assisted technique was associated with (i) shorter FB retrieval time (4.5 ± 0.5 minutes vs 21.7 ± 0.9 minutes, P < 0.001), (ii) shorter total procedure time (23.0 ± 0.6 minutes vs 47.0 ± 1.3 minutes, P < 0.0001), (iii) higher technical success rate (170/171 vs 160/171, P < 0.001), (iv) higher rate of en bloc removal (159/171 vs 48/171, P < 0.001), and (v) lower rate of procedure-related mucosal tear and bleeding (0/171 vs 13/171, P < 0.001). There were no major adverse events or deaths within 30 days in either group. The total cost of consumables was higher in the conventional group (A$19,644.90 vs A$6,239.90). DISCUSSION: This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI.


Asunto(s)
Esofagoscopía/métodos , Esófago/cirugía , Alimentos/efectos adversos , Cuerpos Extraños/cirugía , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Análisis Costo-Beneficio/estadística & datos numéricos , Esofagoscopía/efectos adversos , Esofagoscopía/economía , Esofagoscopía/instrumentación , Esófago/diagnóstico por imagen , Esófago/patología , Femenino , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/etiología , Cuerpos Extraños/patología , Hospitales de Alto Volumen/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Centros de Atención Terciaria/estadística & datos numéricos , Resultado del Tratamiento
6.
Laryngoscope ; 131(5): 1168-1174, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33034397

RESUMEN

OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN: Blinded modified Delphi consensus process. SETTING: Tertiary care center. METHODS: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE: 5. Laryngoscope, 131:1168-1174, 2021.


Asunto(s)
Competencia Clínica/normas , Consenso , Esofagoscopía/educación , Internado y Residencia/normas , Cirujanos/normas , Niño , Técnica Delphi , Esofagoscopios , Esofagoscopía/instrumentación , Esófago/diagnóstico por imagen , Esófago/cirugía , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/cirugía , Humanos , Cirujanos/educación , Cirujanos/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos
8.
Lancet ; 396(10247): 333-344, 2020 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-32738955

RESUMEN

BACKGROUND: Treatment of dysplastic Barrett's oesophagus prevents progression to adenocarcinoma; however, the optimal diagnostic strategy for Barrett's oesophagus is unclear. The Cytosponge-trefoil factor 3 (TFF3) is a non-endoscopic test for Barrett's oesophagus. The aim of this study was to investigate whether offering this test to patients on medication for gastro-oesophageal reflux would increase the detection of Barrett's oesophagus compared with standard management. METHODS: This multicentre, pragmatic, randomised controlled trial was done in 109 socio-demographically diverse general practice clinics in England. Randomisation was done both at the general practice clinic level (cluster randomisation) and at the individual patient level, and the results for each type of randomisation were analysed separately before being combined. Patients were eligible if they were aged 50 years or older, had been taking acid-suppressants for symptoms of gastro-oesophageal reflux for more than 6 months, and had not undergone an endoscopy procedure within the past 5 years. General practice clinics were selected by the local clinical research network and invited to participate in the trial. For cluster randomisation, clinics were randomly assigned (1:1) by the trial statistician using a computer-generated randomisation sequence; for individual patient-level randomisation, patients were randomly assigned (1:1) by the general practice clinics using a centrally prepared computer-generated randomisation sequence. After randomisation, participants received either standard management of gastro-oesophageal reflux (usual care group), in which participants only received an endoscopy if required by their general practitioner, or usual care plus an offer of the Cytosponge-TFF3 procedure, with a subsequent endoscopy if the procedure identified TFF3-positive cells (intervention group). The primary outcome was the diagnosis of Barrett's oesophagus at 12 months after enrolment, expressed as a rate per 1000 person-years, in all participants in the intervention group (regardless of whether they had accepted the offer of the Cytosponge-TFF3 procedure) compared with all participants in the usual care group. Analyses were intention-to-treat. The trial is registered with the ISRCTN registry, ISRCTN68382401, and is completed. FINDINGS: Between March 20, 2017, and March 21, 2019, 113 general practice clinics were enrolled, but four clinics dropped out shortly after randomisation. Using an automated search of the electronic prescribing records of the remaining 109 clinics, we identified 13 657 eligible patients who were sent an introductory letter with 14 days to opt out. 13 514 of these patients were randomly assigned (per practice or at the individual patient level) to the usual care group (n=6531) or the intervention group (n=6983). Following randomisation, 149 (2%) of 6983 participants in the intervention group and 143 (2%) of 6531 participants in the usual care group, on further scrutiny, did not meet all eligibility criteria or withdrew from the study. Of the remaining 6834 participants in the intervention group, 2679 (39%) expressed an interest in undergoing the Cytosponge-TFF3 procedure. Of these, 1750 (65%) met all of the eligibility criteria on telephone screening and underwent the procedure. Most of these participants (1654 [95%]; median age 69 years) swallowed the Cytosponge successfully and produced a sample. 231 (3%) of 6834 participants had a positive Cytosponge-TFF3 result and were referred for an endoscopy. Patients who declined the offer of the Cytosponge-TFF3 procedure and all participants in the usual care group only had an endoscopy if deemed necessary by their general practitioner. During an average of 12 months of follow-up, 140 (2%) of 6834 participants in the intervention group and 13 (<1%) of 6388 participants in the usual care group were diagnosed with Barrett's oesophagus (absolute difference 18·3 per 1000 person-years [95% CI 14·8-21·8]; rate ratio adjusted for cluster randomisation 10·6 [95% CI 6·0-18·8], p<0·0001). Nine (<1%) of 6834 participants were diagnosed with dysplastic Barrett's oesophagus (n=4) or stage I oesophago-gastric cancer (n=5) in the intervention group, whereas no participants were diagnosed with dysplastic Barrett's oesophagus or stage I gastro-oesophageal junction cancer in the usual care group. Among 1654 participants in the intervention group who swallowed the Cytosponge device successfully, 221 (13%) underwent endoscopy after testing positive for TFF3 and 131 (8%, corresponding to 59% of those having an endoscopy) were diagnosed with Barrett's oesophagus or cancer. One patient had a detachment of the Cytosponge from the thread requiring endoscopic removal, and the most common side-effect was a sore throat in 63 (4%) of 1654 participants. INTERPRETATION: In patients with gastro-oesophageal reflux, the offer of Cytosponge-TFF3 testing results in improved detection of Barrett's oesophagus. Cytosponge-TFF3 testing could also lead to the diagnosis of treatable dysplasia and early cancer. This strategy will lead to additional endoscopies with some false positive results. FUNDING: Cancer Research UK, National Institute for Health Research, the UK National Health Service, Medtronic, and the Medical Research Council.


Asunto(s)
Esófago de Barrett/diagnóstico , Esofagoscopía/instrumentación , Factor Trefoil-3/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Esófago de Barrett/etiología , Esófago de Barrett/patología , Biomarcadores/análisis , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad
9.
Curr Gastroenterol Rep ; 22(9): 44, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32651682

RESUMEN

PURPOSE OF REVIEW: Functional lumen impedance (FLIP) technology has become commercially available to assess structural and motor abnormalities of the esophagus. Increasing numbers of papers have described novel findings with this technology. This review examines the validity of the FLIP technique, how it compares with existing diagnostic modalities, and evidence to date on diagnostic accuracy. RECENT FINDINGS: FLIP studies require deep sedation at the time of endoscopy to complete. They assess a simulated state of esophageal obstruction in only a distal part of the esophagus rather than deglutitive motor function of the entire esophagus. The available normative dataset is small and not matched to the older age of patients typically being evaluated. The test-retest agreement in health and disease is unknown, as is the operator dependence on performing and interpreting findings. Studies to date have largely excluded patients with structural disorders, which FLIP cannot reliably distinguish from motor disorders. FLIP is an expensive technology that has been made clinically available without its true utility being established. For FLIP to be deemed a device ready for widespread clinical use, additional studies on validity, diagnostic accuracy, and outcomes need to be performed. Prospective clinical studies need to include all patients and assess the incremental cost-effectiveness of FLIP over more innovative use of existing technology, such as high-resolution manometry with provocative challenges.


Asunto(s)
Trastornos de la Motilidad Esofágica/diagnóstico , Esofagoscopía/instrumentación , Esofagoscopía/métodos , Esófago/fisiopatología , Anatomía Transversal , Fenómenos Biomecánicos , Impedancia Eléctrica , Enfermedades del Esófago/diagnóstico , Enfermedades del Esófago/fisiopatología , Trastornos de la Motilidad Esofágica/fisiopatología , Esófago/fisiología , Humanos , Presión , Estudios de Validación como Asunto
10.
Dig Dis Sci ; 65(9): 2473-2482, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32671586

RESUMEN

Recent innovations in esophageal diagnostic testing have enhanced gastroenterology clinical practice by facilitating more nuanced and advanced evaluation of esophageal symptoms. Among these pivotal advances is the FDA-approved functional lumen imaging probe (FLIP), which utilizes impedance planimetry via volumetric distension of a catheter-mounted balloon at the time of sedated upper endoscopy, to acquire esophageal dimensions and pressures. In real time, FLIP can display cross-sectional areas (CSA) and distensibility indices (ratios of CSA to intra-balloon pressures) throughout the esophagus, most notably at the esophagogastric junction, as well as secondary peristaltic esophageal body contractile patterns. As the use of FLIP has progressively spread and permeated into the practice of clinical gastroenterology since its introduction, increasing data on and experiences with its applications have accumulated to guide its utility in clinical practice. In this current review developed for gastroenterologists and foregut surgeons across clinical practice, we provide an introduction to FLIP technology and metrics and discuss the clinical scenarios in which performance of or referral for FLIP may be helpful in the evaluation and management of patients with commonly encountered esophageal symptoms and disorders. Specifically, we discuss the potential applications and limitations of FLIP as a complementary diagnostic modality in patients with non-obstructive dysphagia, established or suspected achalasia spectrum disorders, eosinophilic esophagitis, gastroesophageal reflux disease and those undergoing esophageal surgery.


Asunto(s)
Catéteres , Enfermedades del Esófago/diagnóstico , Esofagoscopía/instrumentación , Esófago/fisiopatología , Peristaltismo , Transductores de Presión , Diseño de Equipo , Enfermedades del Esófago/fisiopatología , Humanos , Valor Predictivo de las Pruebas , Procesamiento de Señales Asistido por Computador
11.
World J Gastroenterol ; 26(17): 2030-2039, 2020 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-32536772

RESUMEN

Radiofrequency ablation (RFA) is very effective for eradication of flat Barrett's mucosa in dysplastic Barrett's esophagus after endoscopic resection of raised lesions. However, in a minority of the time, RFA may be ineffective at eradication of the Barrett's mucosa. Achieving complete eradication of intestinal metaplasia can be challenging in these patients. This review article focuses on the management of patients with dysplastic Barrett's esophagus refractory to RFA therapy. Management strategies discussed in this review include optimizing the RFA procedure, optimizing acid suppression (with medical, endoscopic, and surgical management), cryotherapy, hybrid argon plasma coagulation, and EndoRotor resection.


Asunto(s)
Esófago de Barrett/terapia , Neoplasias Esofágicas/prevención & control , Esofagoscopía/métodos , Esófago/patología , Reflujo Gastroesofágico/terapia , Antiácidos/uso terapéutico , Coagulación con Plasma de Argón/métodos , Esófago de Barrett/etiología , Esófago de Barrett/patología , Terapia Combinada/métodos , Criocirugía/métodos , Esofagoscopía/instrumentación , Esófago/diagnóstico por imagen , Esófago/cirugía , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/patología , Humanos , Ablación por Radiofrecuencia/métodos , Resultado del Tratamiento
13.
Curr Gastroenterol Rep ; 22(3): 10, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32040644

RESUMEN

PURPOSE OF REVIEW: The functional luminal imaging probe (FLIP) uses high-resolution planimetry to provide a three-dimensional image of the esophageal lumen by measuring diameter, volume, and pressure changes. The goal of this review is to summarize the most recent advances in applying the (FLIP) to esophageal disorders. RECENT FINDINGS: The FLIP has been studied in esophageal disease states including gastroesophageal reflux disease (GERD), achalasia, and eosinophilic esophagitis. It has also been used in the investigation of dysphagia. The FLIP is a valuable tool for the diagnosis of esophageal diseases as well as guiding treatments and predicting treatment response. As further research is done, the FLIP may become the initial test for the patient with undifferentiated dysphagia at the time of their index endoscopy.


Asunto(s)
Enfermedades del Esófago/diagnóstico , Esofagoscopía/instrumentación , Esófago/diagnóstico por imagen , Esófago/fisiopatología , Enfermedades del Esófago/diagnóstico por imagen , Enfermedades del Esófago/etiología , Enfermedades del Esófago/fisiopatología , Humanos , Imagenología Tridimensional , Manometría , Tamaño de los Órganos , Presión
14.
Turk J Gastroenterol ; 31(1): 58-64, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-32009615

RESUMEN

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of recurrent esophageal carcinoma is technically difficult to perform due to submucosal fibrosis that develops after definitive chemoradiation therapy. Therefore, our aim was to evaluate the usefulness of clip-with-thread traction for ESD of esophageal lesions with submucosal fibrosis. MATERIALS AND METHODS: Four endoscopists excised 16 lesions by ESD in an ex vivo pig training model. Mock lesions (30 mm in diameter) were created, including a 10-mm area of submucosal fibrosis in the center of each lesion. Each endoscopist performed two ESDs with traction (ESD-T) and two without traction (ESD-N). The primary outcome was the time required for submucosal dissection. Secondary outcomes were the rate of en bloc (complete) resection and perforation during the procedure, and the total amount of solution injected. RESULTS: All esophageal ESDs were completed. The median dissection time was significantly shorter for the ESD-T group (median 12.5 min, interquartile range 10.2-14.5) when comparing to the ESD-N group (median 18.0 min, interquartile range 14.6-19.2) (P=0.040). The en bloc resection rate was 100% in both groups, with a rate of complete resection of 87.5% and a rate of perforation of 37.5% for both groups. The median amount of solution injected was not significantly different between the ESD-T (18.0 ml) and ESD-N (20.5 ml) groups (P=0.526). CONCLUSION: Clip-with-thread traction improved the performance of ESD for lesions with submucosal fibrosis. However, the method might not reduce the risk of perforation, which remains an important clinical issue to resolve.


Asunto(s)
Resección Endoscópica de la Mucosa/instrumentación , Neoplasias Esofágicas/cirugía , Esofagoscopía/instrumentación , Esófago/patología , Instrumentos Quirúrgicos , Tracción/instrumentación , Animales , Resección Endoscópica de la Mucosa/educación , Resección Endoscópica de la Mucosa/métodos , Neoplasias Esofágicas/patología , Esofagoscopía/educación , Esofagoscopía/métodos , Esófago/cirugía , Fibrosis , Modelos Animales , Porcinos , Tracción/educación , Tracción/métodos , Resultado del Tratamiento
15.
Dis Esophagus ; 33(4)2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-32008045

RESUMEN

Magnetically controlled capsule endoscopy (MCE) system has been used to screen gastric lesions. However, the visualization performance of MCE in the esophagus has not been investigated systematically. String method improved the ability of capsule endoscopy (CE) for esophageal observing; however, the string attachment is complicated and cannot be detached with the CE inside the esophagus. We used a modified string, called detachable string attached to MCE. The aim of the study was to compare the observation performance of MCE with and without the detachable string. A total of 238 participants with upper gastrointestinal symptoms and a healthy check who refused esophagogastroduodenoscopy examination were retrospectively divided into the detachable string MCE group and the MCE alone group from June 2016 to May 2018. A suction cap with a thin, hollow string was attached to the MCE system in the detachable string group. Circumferential visualization of the esophagus including the upper, middle, and lower esophagus and Z-line, and esophageal focal lesion, as well as the recording time, safety and tolerability of the procedure, were assessed. The circumferential visualization of the upper, middle, and lower esophagus and Z-line was more efficient in the detachable string MCE group than in the MCE alone group (P < 0.001). In all, 31 esophageal lesions were detected in the detachable string MCE group, which was more than that in the MCE alone group (10, P < 0.001). The mean recording time was 305 seconds in the string MCE group, which was longer than that in the MCE alone group (48.5 seconds, P < 0.001). In seven participants (6.1%) in the detachable string MCE group, the capsule could not be separated from the string. Detachable string MCE showed better performance in terms of observation of the esophagus. Detachable string MCE can be used to screen for esophageal diseases as an alternative method in the future.


Asunto(s)
Endoscopía Capsular/métodos , Enfermedades del Esófago/diagnóstico por imagen , Esofagoscopía/métodos , Esófago/diagnóstico por imagen , Magnetismo/métodos , Adulto , Anciano , Endoscopía Capsular/instrumentación , Esofagoscopía/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
16.
Rev Esp Enferm Dig ; 112(1): 79, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31909631

RESUMEN

After observing a case of a temporomandibular joint dislocation after an upper endoscopy, we carried out a literature review to find out how frequent it is and suggest the sedation as a possible risk factor to such complication.


Asunto(s)
Esofagoscopía/efectos adversos , Luxaciones Articulares/etiología , Articulación Temporomandibular/lesiones , Anestesia/efectos adversos , Esofagoscopía/instrumentación , Femenino , Humanos , Luxaciones Articulares/diagnóstico por imagen , Persona de Mediana Edad , Articulación Temporomandibular/diagnóstico por imagen
18.
Am J Otolaryngol ; 41(1): 102325, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31727337

RESUMEN

OBJECTIVES: The objective of this study is to analyze and report the institution's experience using the Enseal bipolar tissue sealing device to perform endoscopic Zenker's diverticulotomy. Safety and early functional outcomes are presented as primary endpoints of the study. MATERIALS & METHODS: This is a retrospective study of consecutive patients with Zenker's diverticulum (ZD) treated via a transoral approach using a rigid endoscope and a bipolar tissue sealer between 2011 and 2019. Demographic data, ZD size, complications and preoperative versus postoperative symptoms were assessed. The Eating Assessment Tool-10 (EAT-10) questionnaire was used to evaluate functional outcomes, and statistical comparisons were made using the student's t-test. RESULTS: Nineteen ZD patients were identified who underwent rigid endoscopic diverticulotomy using a bipolar tissue sealer. The mean age was 71 years and 74% were male. The mean diverticulum size was 3.1 cm. There were no intraoperative or postoperative complications identified. Average pre-operative EAT-10 score was 21 and post-operative EAT-10 score was 12 at one to two weeks after surgery (p = .05). CONCLUSIONS: Evidence from this preliminary study of endoscopic Zenker's diverticulotomy using the Enseal device indicates that it is both safe and effective. Several features of the device, including its narrow profile, articulation and rotation capability, rapid repeatable activation, and low risk of collateral thermal injury, make it an appealing option for endoscopic Zenker's diverticulotomy.


Asunto(s)
Electrocoagulación/instrumentación , Esofagoscopía/instrumentación , Divertículo de Zenker/cirugía , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
19.
J Dig Dis ; 21(1): 20-28, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31756284

RESUMEN

OBJECTIVE: To investigate the effectiveness and safety of transparent cap-assisted endoscopy in removing foreign bodies in the esophagus. METHODS: Patients with foreign body lodged in the esophagus who received a transparent cap-assisted or conventional endoscopy between October 2004 and July 2018 were retrospectively enrolled. Propensity score matching was performed. The success rate of the endoscopic procedure, procedure time, clearness of endoscopic view and adverse event rate were compared between the two groups. RESULTS: Of the 838 patients who had a foreign body lodged in the esophagus, 728 (86.9%) underwent endoscopic intervention. After matched by prospensity score, 224 patients each received either transparent cap-assisted endoscopy or conventional endoscopy. No difference was noted between the two groups in terms of the success rate (100% vs 99.1%, P = 0.499). Transparent cap-assisted endoscopy was associated with shorter procedure time for removing jujube pits ([4.24 ± 2.81] min vs [7.62 ± 8.15] min, P = 0.001), fish bones ([2.99 ± 2.15] min vs [6.49 ± 6.54] min, P < 0.001) and other sharp objects ([4.29 ± 3.36] min vs [10.60 ± 19.79 min], P = 0.027) and higher rates of clear endoscopic views in extracting jujube pits, fish bones, poultry bones and other sharp objects (98% vs 43.4%, 97.5% vs 74.1%, 100% vs 81.3% and 100% vs 82.7%; all P < 0.05). No significant differences in the rates of adverse event were observed between the groups (P = 1.000). CONCLUSION: Transparent cap-assisted endoscopic technique is effective and safe for removing sharp foreign bodies in the esophagus.


Asunto(s)
Esofagoscopía/instrumentación , Esófago/cirugía , Cuerpos Extraños/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Esofagoscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos
20.
Medicine (Baltimore) ; 98(48): e18105, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31770232

RESUMEN

RATIONALE: The ingestion of a foreign body (FB) with complete impaction of the esophagus is not common. Here we report a rare case of successful retrieval of a spherical stone in the esophagus of a man with mental retardation, using gallbladder grasping forceps and rigid endoscope. PATIENT CONCERNS: A mental retarded man came to the emergency department presenting with recurrent nausea, vomiting, and dysphagia after swallowing a spherical stone. He had previously undergone an FB extraction under general anesthesia by fiberoptic esophagoscopy, which failed. DIAGNOSIS: The diagnosis of FB ingestion was confirmed by anteroposterior plain film x-ray of the chest and chest computed tomography (CT), which showed the ingested spherical FB in the upper esophagus. INTERVENTIONS: After multiple failed attempts using other instruments, the FB was successfully removed with gallbladder grasping forceps through a rigid esophagoscope. OUTCOMES: The patient was discharged without any complications. The nasogastric tube was extubated at the 10-day follow-up. LESSONS SUBSECTIONS AS PER STYLE: For esophageal retrieval of uncommon FBs, the instrument used is crucial. We report our experience retrieving a large and spherical FB in the upper esophagus using gallbladder grasping forceps. This proved to be an effective strategy, eliminating the need for thoracotomy.


Asunto(s)
Esofagoscopía/instrumentación , Esófago/lesiones , Cuerpos Extraños/cirugía , Instrumentos Quirúrgicos , Adulto , Esofagoscopía/métodos , Esófago/cirugía , Humanos , Discapacidad Intelectual/complicaciones , Masculino
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...