RESUMO
Introducción el homicidio por combinación de métodos de asfixia se observa mayoritariamente en las personas de edad avanzada o con algún impedimento físico capaz de contrarrestar la agresión. Material y métodos se realizó un estudio observacional retrospectivo sobre 634 autopsias, cinco cumplían las características de homicidios por combinación de métodos de asfixia. Resultados dos hombres y 3 mujeres, con edad promedio de 69 años, con estudios toxicológicos negativos, víctimas de un solo agresor, presentaron lesiones cutáneas periorificiales (bucales y nasales), hemorragias musculares en el tórax, fracturas costales, lesiones contusas en la cabeza, interpretadas como de sometimiento. Discusión en la combinación de métodos de asfixia, los hallazgos que deben ser vistos en conjunto son: traumatismos craneoencefálicos para someter a la víctima, lesiones cutáneas en el cuello, la cara, la cara interna de los labios, fracturas costales y lesiones por contrapresión en la espalda, los glúteos o los codos. Contextualizados en conjunto pueden explicar la dinámica de esta modalidad homicida. (AU)
Introduction Homicide by combination of suffocation methods is observed mainly in elderly people or with some physical impediment capable of counteracting the aggression. Material and methods A retrospective observational study was carried out on 634 autopsies. Five met the characteristics of homicides by combination of asphyxiation methods. Results Two men and three women, average age 69 years, with negative toxicological studies, victims of a single aggressor, presented peri orificial skin lesions (mouth and nose), muscle hemorrhages in the thorax, rib fractures, blunt injuries to the head interpreted as like submission. Discussion In the combination of asphyxia methods the findings that must be seen together: Head injuries to subdue the victim, skin lesions on the neck, face, inner face of the lips, rib fractures, and counter-pressure injuries to the back, buttocks, or elbows. Contextualized together, can explain the dynamics of this homicidal modality. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Homicídio/classificação , Asfixia/mortalidade , Estenose Esofágica/mortalidade , Patologia Legal/métodos , Argentina , Estudos RetrospectivosRESUMO
BACKGROUND: Corrosive ingestion is a significant challenge for healthcare systems. Limited data are available regarding the best treatments, and there remains a lack of consensus about the optimal surgical approach and its outcomes. This study aims to review the current literature and show a single institution's experience regarding the surgical treatment of esophageal stenosis due to corrosive substance ingestion. METHODS: A retrospective review that accounted for demographics, psychiatric profiles, surgical procedures, and outcomes was performed. A systematic review of the literature was performed using PubMed. RESULTS: In total, 27 surgical procedures for esophageal stenosis due to corrosive substance ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. Esophagectomies and esophageal bypasses were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. CONCLUSION: Surgical intervention either by esophagectomy or esophageal bypass results in durable relief from dysphagia. However, successful clinical outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
Assuntos
Queimaduras Químicas/terapia , Cáusticos/intoxicação , Estenose Esofágica/terapia , Esofagectomia/estatística & dados numéricos , Comportamento Autodestrutivo/terapia , Terapia Comportamental , Queimaduras Químicas/etiologia , Queimaduras Químicas/mortalidade , Queimaduras Químicas/psicologia , Depressão/complicações , Depressão/epidemiologia , Depressão/psicologia , Depressão/terapia , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/mortalidade , Estenose Esofágica/psicologia , Esôfago/patologia , Esôfago/cirurgia , Humanos , Apoio Nutricional , Equipe de Assistência ao Paciente , Fatores de Risco , Comportamento Autodestrutivo/etiologia , Comportamento Autodestrutivo/mortalidade , Comportamento Autodestrutivo/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Resultado do TratamentoRESUMO
BACKGROUND: The outcomes of the two procedures; self-expandable metal stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding procedures, used in patients with malignant esophageal obstruction, are still controversial. We aimed to compare the outcomes between the two procedures, following propensity score (PS) matching. METHODS: We retrospectively reviewed 568 esophageal cancer patients who underwent SEMS insertion (stent group) or PG (gastrostomy group) at the Samsung Medical Center between January 1996 and December 2018. Procedures for reasons other than malignant obstruction were excluded. We analyzed the datasets after PS matching. Primary outcomes were the post-procedural nutritional status, and need for additional intervention (AI). The secondary outcome was overall survival (OS). RESULTS: In a matched cohort, the gastrostomy group showed less decrease in albumin level after the procedure (-0.15 ± 0.57 vs. stent group; 0.41 ± 0.59, p = 0.021). The gastrostomy group required less need for, and number of, AIs (2.1% vs. stent group; 23.4%, p < 0.001 and 0.04 ± 0.25 vs. stent group; 0.31 ± 0.61, p < 0.001). After matching, there was no significant difference between the two groups in OS. However, PG was associated with OS based on multivariable analysis of the matched cohort (vs. stent group, hazard ratio 0.69, 95% confidence interval 0.5-0.95). CONCLUSIONS: PG tends to provide better post-procedure nutritional status than SEMS insertion in patients with malignant esophageal obstruction.
Assuntos
Neoplasias Esofágicas/complicações , Estenose Esofágica/cirurgia , Gastrostomia/métodos , Stents Metálicos Autoexpansíveis , Idoso , Nutrição Enteral , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/etiologia , Estenose Esofágica/mortalidade , Feminino , Gastrostomia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Período Pós-Operatório , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: The optimal method of esophageal replacement remains controversial. The aim of this study was to evaluate 30-d outcomes of children in the National Surgical Quality Improvement Project Pediatric (NSQIP-P) database who underwent esophageal replacement from 2012 to 2018. METHODS: Demographics, comorbidities, and procedural technique was identified in NSQIP-P and reviewed. Thirty-day outcomes were assessed and stratified by gastric pull-up or tube interposition versus small bowel or colonic interposition. Categorical and continuous variables were assessed by Pearson's chi-square, Fisher's exact, and Wilcoxon rank-sum tests, respectively. Multivariate logistic regression was performed to estimate the effects of procedure technique and clinical risk factors on patient outcomes. RESULTS: Of the 99 cases of esophageal replacement included, 52 (52.5%) utilized a gastric conduit, whereas 47 (47.5%) involved small bowel/colonic esophageal interposition. Overall risk of complications was 52.5%, the most common of which were perioperative transfusion (30.3%), surgical site infection (11.1%), and sepsis (9.1%). Risk of unplanned reoperation was 17.2%, and risk of mortality was 3.0%. Risk for complications, reoperation, and readmission did not differ significantly between those who underwent gastric esophageal replacement and those who underwent small bowel or colonic interposition. Median operative time was shorter in the gastric esophageal replacement group (5.2 versus 8.1 h, P = 0.009). CONCLUSIONS: Among children in NSQIP-P who underwent esophageal replacement from 2012 to 2018, the risk of 30-d complications, unplanned reoperation, and mortality was relatively frequent and was similar across operative techniques. Opportunities exist to improve preoperative optimization, utilization of blood transfusion services, and infectious complications in the perioperative period irrespective of operative technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Assuntos
Atresia Esofágica/cirurgia , Estenose Esofágica/cirurgia , Esofagoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Pré-Escolar , Colo/transplante , Bases de Dados Factuais , Atresia Esofágica/mortalidade , Estenose Esofágica/etiologia , Estenose Esofágica/mortalidade , Estenose Esofágica/patologia , Esofagoplastia/métodos , Esofagoplastia/estatística & dados numéricos , Esôfago/anormalidades , Esôfago/patologia , Esôfago/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Intestino Delgado/transplante , Masculino , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Estômago/transplante , Resultado do TratamentoRESUMO
BACKGROUND: Traditional metal stents are not always suitable for patients with circuitous malignant esophageal stricture. PURPOSE: We aimed to report the safety and effectiveness of stent insertion using self-expanding segmental radioactive metal stent in the palliation of malignant esophageal stricture. MATERIAL AND METHODS: We conducted a retrospective analysis of 22 consecutive patients who underwent insertion of segmental radioactive metal stents from November 2016 to March 2019. Technical success, dysphagia score, and complications were analyzed. Kaplan-Meier analysis was used to analyze the survival time. RESULTS: The stenting procedure was successful in all 22 patients with no procedure-related deaths. Twenty-four segmental radioactive metal stents were successfully implanted. A total of 6 (27.3%) complications were found, mainly 5 (22.7%) stent migrations. The median follow-up period was 3.3 months. Stent removal was required in 4 (12.5%) patients due to complete stent migration. The mean dysphagia score decreased significantly after stent insertion (P<0.0001). During follow up, 13 patients survived with no obvious clinical symptom and nine patients died. The mean survival was 9.9 months. CONCLUSION: The stenting procedure using self-expanding segmental radioactive metal stents is safe and effective in dysphagia palliation of malignant esophageal stricture.
Assuntos
Neoplasias Esofágicas/complicações , Estenose Esofágica/radioterapia , Radioisótopos do Iodo/uso terapêutico , Cuidados Paliativos/métodos , Implantação de Prótese/métodos , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/mortalidade , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/etiologia , Estenose Esofágica/mortalidade , Esofagoscopia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Corrosive ingestion (CI) has short- and long-term consequences. The aim of this study was to assess the outcome of mucosal injury grade ≥ 2A. METHODS: Consecutive patients between January 2008 and January 2015 who presented within 48 h of CI were included. Details of substance ingested, intent, symptoms, injury grade at endoscopy, and treatment were obtained by a review of medical records. Patients aged less than 15 years or injury grade less than 2A were excluded. Patients were followed up using a structured symptom-based questionnaire and barium swallow. RESULTS: A total of 112 patients were admitted with CI during the study period. Eighty-two patients were included in the study. There was no relationship between the presence of symptoms or oral mucosal injury and the grades of gastrointestinal mucosal injury. Grades 2B and 3A were the most common grades of mucosal injury. Five patients died at index hospitalization. Patients were followed up for a median period of 31 months (6-72) during which 11 patients were lost to follow up. During follow up, 2 patients with high-grade injury died as a consequence of CI and 4 died of unrelated causes. Sixteen (26.6%) patients remained symptomatic. Forty-three patients underwent barium swallow. Esophageal stricture was identified in 11 patients, gastric stricture in 8, and combined esophageal and gastric in 2. High-grade esophageal mucosal injury was associated with a high risk of stricture formation (p = 0.02). CONCLUSIONS: CI is associated with high immediate and long-term morbidity and mortality.
Assuntos
Queimaduras Químicas/patologia , Cáusticos/toxicidade , Mucosa Esofágica/lesões , Estenose Esofágica/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras Químicas/mortalidade , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Fatores de Tempo , Adulto JovemRESUMO
The objective of this study was to assess the outcomes for patients with human immunodeficiency virus (HIV) and acquired immune deficiency virus (AIDS) who had esophagectomy done for both benign and malignant conditions. A retrospective chart review of patients with HIV and AIDS undergoing esophagectomy at a rural referral hospital was done for the period of 2009-2014. Patient postoperative complications, outcomes, and follow-up data were charted. All procedures were done by a single lead surgeon. Nine patients met the study criteria, 7 of whom had esophageal cancer, and 2 with strictures. Four patients had received nutritional self-expanding metal stent preoperatively. The mean stent duration was 61 days. Three patients had been on antiretroviral therapy before surgery. Preoperative CD4 counts were available in 7 patients. Eight patients underwent a 3-field esophagectomy and 1 was unresectable. Seven of these patients had successful outcomes, with varying follow-up times. One patient died post procedure while in the hospital. Complications included stricture and anastomotic leak. Although HIV-positive patients face increased risk during surgical procedures, this status should not be a firm contraindication to surgery. Quality nutritional status, antiretroviral use, and overall CD4 count levels remain important parameters in considering surgical treatment for these patients. With careful patient evaluation and planning, esophagectomy in an HIV and AIDS setting is feasible with successful outcomes.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/cirurgia , Esofagectomia , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Tomada de Decisão Clínica , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Estenose Esofágica/complicações , Estenose Esofágica/diagnóstico , Estenose Esofágica/mortalidade , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To examine associations between pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients (age > 65 years) treated for oropharyngeal squamous cell cancer (SCCA). STUDY DESIGN: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data. METHODS: Longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 were evaluated using cross-tabulations, multivariate logistic regression, and survival analysis. RESULTS: Dysphagia (odds ratio [OR] = 1.3, 1.0-1.7), esophageal stricture (OR = 5.5, 2.6-11.9), and airway obstruction (OR = 1.6, 1.1-2.2) increased 1 year after treatment. The odds of airway obstruction, esophageal stricture, and pneumonia increased over subsequent years, with significantly increased risk at 5 years for airway obstruction (OR = 3.0, 1.4-6.4), pneumonia (OR = 4.5, 1.8-11.2), and stricture (OR = 5.5, 1.8-17.6). Pretreatment dysphagia was a significant predictor of long-term dysphagia, airway obstruction, and pneumonia. Chemoradiation, advanced stage disease, high-volume hospital care, male sex, and salvage surgery were significant predictors of long-term gastrostomy use. Long-term dysphagia, gastrostomy or tracheostomy dependence, weight loss, airway obstruction, and pneumonia were associated with poorer survival, with tracheostomy dependence (hazard ratio [HR] = 2.2, 1.7-2.9) and pneumonia (HR = 2.0, 1.7-2.4) associated with the greatest risk of late mortality. CONCLUSION: Airway and swallowing impairment is common after treatment of oropharyngeal SCCA in elderly patients, increases over time, and is associated with poorer survival. Patients with pretreatment dysphagia, advanced stage disease, initial treatment with chemoradiation, and salvage surgery represent a high-risk group with an increased risk of disability and death. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:2084-2093, 2018.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Carcinoma de Células Escamosas/terapia , Transtornos de Deglutição/etiologia , Estenose Esofágica/etiologia , Neoplasias Orofaríngeas/terapia , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/mortalidade , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/mortalidade , Quimiorradioterapia/mortalidade , Transtornos de Deglutição/mortalidade , Estenose Esofágica/mortalidade , Feminino , Gastrostomia/mortalidade , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Medicare , Análise Multivariada , Razão de Chances , Neoplasias Orofaríngeas/complicações , Neoplasias Orofaríngeas/mortalidade , Pneumonia/epidemiologia , Pneumonia/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Terapia de Salvação/mortalidade , Fatores de Tempo , Traqueostomia/mortalidade , Resultado do Tratamento , Estados UnidosRESUMO
AIM: To evaluate toxicity and treatment outcome of high-dose radiotherapy (RT) for cervical esophageal cancer (CEC). METHODS: We reviewed a total of 62 consecutive patients who received definitive RT for stageâI to III cervical esophageal cancer between 2001 and 2015. Patients who received < 45 Gy, treated for lesions below sternal notch, treated with palliative aim, treated with subsequent surgical resection, or diagnosed with synchronous hypopharyngeal cancer were excluded. Treatment failures were divided into local (occurring within the RT field), outfield-esophageal, and regional [occurring in regional lymph node(s)] failures. Factors predictive of esophageal stenosis requiring endoscopic dilation were analyzed. RESULTS: Grade 1, 2, and 3 esophagitis occurred in 19 (30.6%), 39 (62.9%), and 4 patients (6.5%), respectively, without grade ≥ 4 toxicities. Sixteen patients (25.8%) developed post-RT stenosis, of which 7 cases (43.8%) were malignant. Four patients (6.5%) developed tracheoesophageal fistula (TEF), of which 3 (75%) cases were malignant. Factors significantly correlated with post-RT stenosis were stage T3/4 (P = 0.001), complete circumference involvement (P < 0.0001), stenosis at diagnosis (P = 0.024), and endoscopic complete response (P = 0.017) in univariate analysis, while complete circumference involvement was significant in multivariate analysis (P = 0.003). A higher dose (≥ 60 Gy) was not associated with occurrence of post-RT stenosis or TEF. With a median follow-up of 24.3 (range, 3.4-152) mo, the 2 y local control, outfield esophageal control, progression-free survival, and overall survival (OS) rates were 78.9%, 90.2%, 49.6%, and 57.3%, respectively. Factors significantly correlated with OS were complete circumference involvement (P = 0.023), stenosis at diagnosis (P < 0.0001), and occurrence of post-RT stenosis or TEF (P < 0.001) in univariate analysis, while stenosis at diagnosis (P = 0.004) and occurrence of post-RT stenosis or TEF (P = 0.023) were significant in multivariate analysis. CONCLUSION: Chemoradiation for CEC was well tolerated, and a higher dose was not associated with stenosis. Patients with complete circumferential involvement require close follow-up.
Assuntos
Neoplasias Esofágicas/radioterapia , Estenose Esofágica/epidemiologia , Esôfago/efeitos da radiação , Lesões por Radiação/epidemiologia , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Neoplasias Esofágicas/mortalidade , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/etiologia , Estenose Esofágica/mortalidade , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Lesões por Radiação/mortalidade , Radioterapia/métodos , Dosagem Radioterapêutica , Estudos Retrospectivos , Fístula Traqueoesofágica/diagnóstico por imagem , Fístula Traqueoesofágica/epidemiologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/mortalidade , Falha de Tratamento , Resultado do TratamentoRESUMO
AIM: No consensus exists about the optimal surgical technique for esophageal replacement. This study reports the surgical outcomes for the gastric pull-up and the colonic interposition procedures. MATERIALS AND METHODS: A retrospective review of children undergoing esophageal replacement surgery between January 2001 and June 2015 across four different pediatric surgery centers was conducted. Data collected included indications, epidemiology, surgical technique, complications, and outcomes. Patients were divided into group A, those that had a gastric pull-up procedure and group B, those that had a colonic interposition procedure. RESULTS: In total, 50 patients were included; 29 in group A and 21 in group B. Indications included esophageal atresia, caustic ingestion, and infective esophageal stricture. The median age at the time of surgery was 13 months. The mean length of follow-up was 5.2 years. Three patients died giving a mortality rate of 6%; 2 in group A and 1 in group B.In both groups, early postoperative complications included infective complications, such as wound infections, sepsis, and pneumonia (11), anastomotic leak (7), and respiratory complications (7). Late complications included adhesive bowel obstruction (2), anastomotic strictures (4), redundancy (1), and jejunostomy problems (1). Septic complications and anastomotic strictures occurred more frequently in group B. Further surgery was needed in eight patients; this was significantly higher in group B. Full oral feeding was achieved within 6 months in 91.5%. CONCLUSION: The gastric pull-up and colonic interposition have comparable mortality and outcomes. The colonic interposition was associated with a higher rate of early septic complications, anastomotic strictures, and need for further surgery.
Assuntos
Colo/transplante , Atresia Esofágica/cirurgia , Estenose Esofágica/cirurgia , Esofagoplastia/métodos , Estômago/cirurgia , Criança , Pré-Escolar , Atresia Esofágica/mortalidade , Estenose Esofágica/mortalidade , Feminino , Seguimentos , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Caustic substance ingestion (CSI) is a serious medical problem with potentially devastating short- and long-term consequences. Early upper gastrointestinal endoscopy (EaEn) is recommended to evaluate the extent of injury and guide management but there has been controversy about the timing. There is no nationwide study evaluating adherence to EaEn and outcomes following CSI.Nationwide Inpatient Sample database 2003-2011 was used to identify all-age, nonreferral, urgent/emergent admissions with E-International Classification of Diseases Ninth Revision codes for CSI. We evaluated the association of undergoing late endoscopy (LaEn, >48 hours since admission) with poor clinical (death or systemic complications) and economic (cost for admission and length of stay above the 75th percentile) outcomes after controlling for other demographic and clinical factors using a multivariate analysis.We identified 21,682 patients with a median age of 37 years, 51% males, 43% Caucasians, with suicidal ingestion reported in 40%. Endoscopy was performed in 6011 patients (37%). The majority had EaEn (43% within 24, and 40% within 24-48 hours), whereas 17% had LaEn.Compared to EaEn group, the LaEn group was associated with a three-fold increase (OR = 2.7, P < 0.001) in the risk for poor clinical outcome: a fourfold increase (OR = 4.6, P < 0.001) in high cost admissions, and a fivefold increase (OR = 4.9, P < 0.001) in prolonged hospitalization. There was no significant difference in clinical outcomes based on endoscopy within 24, and 24-48 hours of admission.In this retrospective nationwide database analysis, undergoing LaEn was associated with both negative clinical and economic outcomes. More studies are needed to further examine the reasons for delaying endoscopy and subsequent management pathways based on the endoscopic findings. Early endoscopic evaluation could potentially improve the clinical outcomes and reduce costs of these admissions.
Assuntos
Queimaduras Químicas/diagnóstico , Endoscopia do Sistema Digestório/métodos , Estenose Esofágica/diagnóstico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adulto , Queimaduras Químicas/mortalidade , Cáusticos/toxicidade , Bases de Dados Factuais , Diagnóstico Precoce , Endoscopia do Sistema Digestório/economia , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. METHODS AND MATERIALS: Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated. RESULTS: Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. CONCLUSION: With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.
Assuntos
Anastomose Cirúrgica/mortalidade , Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Estenose Esofágica/mortalidade , Esofagectomia/mortalidade , Lesões por Radiação/mortalidade , Comorbidade , Esofagoplastia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Intubação Gastrointestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Terapia Neoadjuvante , Países Baixos/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The optimal clinical management of patients following ingestion of potentially caustic lesions is still undetermined. In particular, the indication for early upper GI endoscopy in this context remains unclear. PURPOSE: To draft recommendations regarding the use of early upper GI endoscopy following hospital admissions of patients after ingestion of potentially caustic agents. METHODS: For this purpose, a retrospective cohort study of patients treated for ingestion of potentially caustic substances during a 13 year-period at the university hospital of Berne was performed. RESULTS: In total, 61 patients with acute ingestion of potentially caustic substances were identified. Overall mortality was 5â%. 11/61 patients had to be admitted to the intensive care unit. Most ingestions were performed in suicidal intention (62â%). In 53â% of these patients, a combined ingestion of several substances occurred. In 33â% of patients, an early upper GI endoscopy was performed within 24 hours after ingestion. The degree of burn depended upon the hazard potential of the respective substance. In patients with ingestion of low risk substances, upper GI endoscopy was only performed when additional risk factors were present. CONCLUSION: Based upon the results of the present study, ingestion of potentially caustic agents requires an individualized strategy whether or not to perform early endoscopy.
Assuntos
Queimaduras Químicas/cirurgia , Cáusticos/intoxicação , Tomada de Decisão Clínica , Endoscopia do Sistema Digestório/mortalidade , Endoscopia do Sistema Digestório/estatística & dados numéricos , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/mortalidade , Queimaduras Químicas/mortalidade , Queimaduras Químicas/patologia , Estenose Esofágica/patologia , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Prognóstico , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the outcomes of a modified laparoscopic intraluminal stenting with the conventional laparatomic technique in patients with esophageal caustic injuries. METHODS: A total of 103 patients with esophageal burns were included in this retrospective analysis. Patients were candidates for esophageal stenting to prevent future stenosis. According to patient preference, stenting was done with either the innovatory stent with the modified technique (52 patients) or the conventional method that required laparotomy (51 patients). The modified technique consists of placing an inflation balloon stent via laparoscopy. Overall mortality and complications after follow-up period (3 months) were compared between the two groups. RESULTS: Two perioperative mortalities were seen, one in each group. Except one patient in the modified technique, all patients returned to normal intake after 3 months of follow-up. However, five patients of the modified group and three in the conventional group developed esophageal strictures (p > 0.05). Gastric outlet obstruction was observed in three patients of the modified group and one in the conventional group (p > 0.05). DeMeester scores showed that there was no gastro-esophageal reflux in both groups (p > 0.05). CONCLUSION: Our results show that the modified technique can reach the efficacy of the conventional method without requiring laparotomy. Thus, far several studies have demonstrated the advantages of laparoscopy over laparotomy. Thus, and in line with the clinical guidelines of the Society of American Gastrointestinal and Endoscopic Surgeons, we recommend using the presented modified technique in patients with caustic esophageal injuries.
Assuntos
Queimaduras Químicas/cirurgia , Estenose Esofágica/cirurgia , Adolescente , Adulto , Idoso , Queimaduras Químicas/mortalidade , Cáusticos , Estenose Esofágica/mortalidade , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Stents , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND AIM: Dysphagia caused by pharyngo-upper esophageal stricture is a complication of treatment for head and neck cancer. Endoscopic balloon dilation (EBD) is in widespread use as an effective and safe treatment for stricture in many areas of the gastrointestinal tract. In the present study, we investigated the efficacy and safety of EBD for pharyngo-upper esophageal strictures that developed after treatment for head and neck cancer. METHODS: From January 2010 to December 2013, the medical records and endoscopic findings of 19 consecutive patients with pharyngo-upper esophageal strictures occurring after surgery and/or chemoradiotherapy for head and neck cancer were retrospectively examined. RESULTS: Mean number of EBD sessions per patient was 6.6 (1-30), and mean maximum diameter of dilation was 15.8 (11-20) mm. Technical success was achieved in 16 of 19 (84.2%) patients, and only two major complications (bleeding and pha ryngeal edema) occurred in a total of 125 dilatation sessions (1.6%). Regarding the influence of chemoradiotherapy on the outcome of EBD, patients who had undergone chemoradiotherapy plus surgery experienced significantly more restenosis during the follow-up period compared to those who had undergone surgery alone (50% vs 0%, P < 0.05). CONCLUSIONS: This retrospective analysis demonstrated the efficacy and safety of exclusive EBD for pharyngo-upper esophageal strictures occurring after treatment for head and neck cancer, indicating that the therapeutic application of EBD could be extended to such strictures. Patients who underwent chemoradiotherapy and surgery experienced more restenosis; hence, such patients should be carefully followed up after EBD treatment.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Dilatação/instrumentação , Estenose Esofágica/terapia , Esofagoscopia/métodos , Neoplasias de Cabeça e Pescoço/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Bases de Dados Factuais , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Dilatação/métodos , Estenose Esofágica/etiologia , Estenose Esofágica/mortalidade , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The treatment tactics and intensive therapy in stenosing esophageal diseases for 222 patients in 2003 - 2015 yrs were analyzed. Expediency of application of the proposed treatment tactics was noted.
Assuntos
Neoplasias Esofágicas/cirurgia , Estenose Esofágica/cirurgia , Esôfago/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Estenose Esofágica/tratamento farmacológico , Estenose Esofágica/mortalidade , Estenose Esofágica/patologia , Esôfago/efeitos dos fármacos , Esôfago/patologia , Feminino , Hidratação , Gastrostomia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/métodos , Análise de SobrevidaRESUMO
BACKGROUND/AIMS: Esophageal stricture due to corrosive ingestion is a common cause of benign esophageal obstruction in developing countries. The immediate and long-term results of surgical bypass using a modification of the left colon conduit, will be reviewed. METHODOLOGY: From 1977 to 2008, 105 patients underwent esophageal bypass for corrosive esophageal strictures using this procedure which has several modifications, detailed in the text, from the conventional left colon conduit. RESULTS: Acids were the most common corrosive implicated (70.5%). Eighty nine patients underwent a bypass based on the left colic vessel through the substernal route. The subcutaneous route was used in the rest for varying reasons. Postoperatively three patients died. Conduit necrosis was seen in only one patient. Postoperative morbidity included pneumothorax in 15, cervical anastomotic stenosis in one, cervical anastomotic leak in 13 (less than 3% the last 75 cases) and recurrent laryngeal nerve palsy in 6 (5.7%). 72 patients had normal swallowing and 33 had only occasional minor difficulty with solid food on follow-up. CONCLUSIONS: Surgical bypass using a modification of the left colon esophagocoloplasty remains a reliable procedure with acceptable morbidity and good relief of dysphagia.
Assuntos
Queimaduras Químicas/cirurgia , Cáusticos/efeitos adversos , Colo/cirurgia , Estenose Esofágica/cirurgia , Esôfago/cirurgia , Adolescente , Adulto , Anastomose Cirúrgica , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/mortalidade , Queimaduras Químicas/fisiopatologia , Criança , Pré-Escolar , Deglutição , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/diagnóstico , Estenose Esofágica/mortalidade , Estenose Esofágica/fisiopatologia , Esôfago/patologia , Esôfago/fisiopatologia , Feminino , Humanos , Índia , Lactente , Masculino , Pessoa de Meia-Idade , Necrose , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND & AIM: Esophageal stenosis can be caused by malignant, postsurgical, benign diseases etc. Endoscopic treatment options consist primarily of balloon dilatation and bougination. Both interventions carry a certain risk of further complications such as perforations. We aimed to evaluate this risk in our patients. METHODS: Frequency, perforation rates, further diagnostics, therapy, outcome and underlying diseases in 368 patients who underwent endoscopic dilatation or bougination in a 10 year period were evaluated. RESULTS: Overall, 1497 endoscopic interventions were performed for treatment of esophageal stricture, causing 8 perforations (0.53% per intervention, 2.17% per patient) and one lethal outcome (0.05% per intervention, 0.27% per patient). In 1286 bouginations, 8 perforations (0.62%) and one death occurred (0.08%), whilst no perforation was noted during 211 balloon dilatations. Outcome of the 8 perforations was greatly influenced by co-morbidities, causing a prolonged hospitalization and the death of one patient. CONCLUSION: Although complication rates are fairly small, patients should be under supervision or in contact for 24-72 hours after each intervention. In cases where perforation is suspected, radiological examinations should be conducted early. The perforation rate and mortality per patient may be used for patient information. Therapy and prognosis depend on the cause of perforation, localization and size of the perforation site as well as concomitant diseases.
Assuntos
Dilatação/efeitos adversos , Perfuração Esofágica/etiologia , Estenose Esofágica/terapia , Esofagoscopia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Dilatação/mortalidade , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/mortalidade , Perfuração Esofágica/terapia , Estenose Esofágica/diagnóstico , Estenose Esofágica/mortalidade , Esofagoscopia/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Adulto JovemRESUMO
Surgical repair of oesophageal atresia may result in anastomotic strictures. These strictures are often treated by balloon dilatation (BD) and currently balloon dilatation (fluoroscopic or endoscopic) is the preferred primary treatment method. Here we review the current evidence of the outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia. We searched the standard databases (January, 1960-May, 2012) to identify all studies that reported outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia in children. Data, reported as median (range), were analysed and compared. Outcomes were success of BD, number of BD sessions, number of oesophageal perforations, need for other surgical interventions and mortality. Five studies were found to be relevant (n = 139; 81 [58%] male children). The total number of dilatation sessions was 401 (2.9 dilatations per child patient). General anaesthesia was used in two (40%) studies; sedation in a further two (40%) studies and one (20%) study used a combination of both. The size of balloon catheter ranged from 4 mm to 22 mm. Seven perforations were reported (1.8% per dilatation session), of which only one (14%) required surgery. No deaths were recorded. Balloon dilatation for anastomotic strictures post-EA repair is safe, and associated with a low perforation and mortality rates. Most perforations are amenable to conservative management.
Assuntos
Cateterismo/mortalidade , Atresia Esofágica/mortalidade , Atresia Esofágica/cirurgia , Perfuração Esofágica/mortalidade , Estenose Esofágica/mortalidade , Estenose Esofágica/cirurgia , Complicações Pós-Operatórias/mortalidade , Angioplastia com Balão , Causalidade , Comorbidade , Dilatação/mortalidade , Perfuração Esofágica/diagnóstico por imagem , Humanos , Prevalência , Radiografia , Fatores de Risco , Taxa de SobrevidaRESUMO
Minimally invasive esophagectomy has emerged as an important procedure for disease management in esophageal cancer (EC) with clear margin status, less morbidity, and shorter hospital stays compared with open procedures. The experience with transhiatal approach robotic esophagectomy (RE) for dissection of thoracic esophagus and associated morbidity is described here. Between March 2007 and November 2010, 40 patients with resectable esophageal indications underwent transhiatal RE at the institute. Clinical data for all patients were collected prospectively. Of 40 patients undergoing RE, one patient had an extensive benign stricture, one had high-grade dysplasia, and 38 had EC. Five patients were converted from robotic to open. Median operative time and estimated blood loss were 311 minutes and 97.2 mL, respectively. Median intensive care unit stay was 1 day (range, 0-16), and median length of hospital stay was 9 days (range, 6-36). Postoperative complications frequently observed were anastomotic stricture (n= 27), recurrent laryngeal nerve paresis (n= 14), anastomotic leak (n= 10), pneumonia (n= 8), and pleural effusion (n= 18). Incidence rates of laryngeal nerve paresis (35%) and leak rate (25%) were somewhat higher in comparison with that reported in literature. However, all vocal cord injuries were temporary, and all leaks healed following opening of the cervical incision and drainage. None of the patients died in the hospital, and 30-day mortality was 2.5% (1/40). Median number of lymph nodes removed was 20 (range, 3-38). In 33 patients with known lymph node locations, median of four (range, 0-12) nodes was obtained from the mediastinum, and median of 15 (range, 1-26) was obtained from the abdomen. R0 resection was achieved in 94.7% of patients. At the end of the follow-up period, 25 patients were alive, 13 were deceased, and 2 patients were lost to follow-up. For patients with EC, median disease-free survival was 20 months (range, 3-45). Transhiatal RE, by experience, is a feasible albeit evolving oncologic operation with low hospital mortality. The benefits include minimally invasive mediastinal dissection without thoracotomy or thoracoscopy. A reasonable operative time with minimal blood loss and postoperative morbidity can be achieved, in spite of the technically demanding nature of the procedure. Broader use of this technology in a setting of high-volume comprehensive surgical programs will almost certainly reduce the complication rates. Robotic tanshiatal esophagectomy with the elimination of a thoracic approach should be considered an option for the appropriate patient population in a comprehensive esophageal program.