Triple intramural dexamethasone injections increase the efficiency of endoscopic bougienage of esophageal re-stenosis and anastomosis

Purpose of the study. To analyze retrospectively our own experience of using intramural dexamethasone injections during endoscopic bougienage of recurrent or very tight (refractory) benign cicatricial strictures of the esophagus and esophageal anastomoses.Materials and methods. From 2013 to March 2021, this method was applied in 43 patients (26 — men, 17 — women) with peptic (11), cicatricial (8), burn (6) esophageal strictures and strictures of anastomoses (18) prone to restenosis. Dexamethasone was injected into the constricted area with a needle passed through the endoscope biopsy channel as an addition to supportive bougienage.Results. After dexamethasone injections, 41 (95.3%) of 43 patients achieved a satisfactory lumen diameter, at which the symptoms of dysphagia disappeared for a long time without relapse. In most patients, the lumen in the stricture zone stabilized at a diameter of 8–18 mm (average 13 mm). With strictures of the esophagus, it was possible to achieve a diameter of 8–14 mm (average 11 mm), and with strictures of the anastomoses — 10–18 mm (average 14 mm).Conclusion. With the tendency of stricture to restenosis, the standard algorithm for endoscopic bougienage, developed in the endoscopy department of the “Petrovsky National Research Center of Surgery”, was supplemented with intramural injections of dexamethasone. This combined endoscopic treatment made it possible to increase the diameter of the bougie and the intervals between bougienage due to the stabilization of the scar frame and to complete the endoscopic treatment with a satisfactory result in 95.3% of patients.

Download Full-text

PS01.095: BENIGN ESOPHAGEAL STRICTURE: A RECAP OF OUR EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.095 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 76-76

Author(s):

Keat How Teoh ◽

Kelvin Voon ◽

Shyang Yee Lim ◽

Premnath Nagalingam

Keyword(s):

Endoscopic Treatment ◽

Esophageal Stricture ◽

Endoscopic Dilatation ◽

Line Treatment ◽

First Line ◽

Benign Esophageal Stricture ◽

Anastomotic Strictures ◽

Esophageal Strictures ◽

The Mean ◽

First Line Treatment

Abstract Background Caustic injury remains the commonest cause of benign esophageal strictures in Asia. Others include gastroesophageal reflux, iatrogenic, radiation, autoimmune or idiopathic causes. Treatment goals are relief of dysphagia and prevention of recurrence. This study aims to evaluate the experience with benign esophageal stricture in Penang Hospital, a tertiary hospital in Northern region of Malaysia. Methods A retrospective review of 12 patients with benign esophageal strictures between year 2012 - 2017. Results The mean age was 53.5 and two thirds were female. Half of these patients were of Chinese ethnicity while the other half were Indian. The commonest cause was caustic ingestion (41.7%), followed by reflux stricture (25%) and anastomotic stricture (25%). There was one case of dystrophic epidermolysis bullosa. More than half of the patients had complex and multiple strictures. 41.7% of patients had proximal strictures that were located within 20cm from the incisors. Endoscopic dilatation was the first line treatment with either Savary Gilliard or balloon dilators. A total of 97 dilatation sessions were done with a mean dilatation frequency of 2.3 ± 1.5 times for anastomotic strictures, 8 ± 8.2 times for reflux strictures and 8.0 ± 6.6 times for corrosive strictures. The mean dilatation interval was 2.5 ± 1.2 weeks. 58.3% of patients had successful endoscopic treatment. The success rate was higher in non-corrosive stricture (83% vs 40%). There was one dilatation related complication in which the patient had pneumomediastinum without overt mediastinitis. This however, resolved with conservative management. 41.7% of patients had refractory strictures that failed endoscopic dilatation. Surgery including esophagectomy (40%), revision of anastomosis (20%) and gastrostomy (40%) were done for this group of patients. Proximal strictures, complex strictures and multiple strictures were associated with failed endoscopic dilatation (P < 0.05). Conclusion Endoscopic dilatation is the first line treatment for benign esophageal strictures. Surgery is reserved for refractory strictures with failed endoscopic treatment. Predictor scoring systems for refractory stricture and individualized approaches are the key to success. Disclosure All authors have declared no conflicts of interest.

Download Full-text

The endoscopic treatment of benign esophageal strictures by balloon dilatation *

Diseases of the Esophagus ◽

10.1046/j.1442-2050.1999.00018.x ◽

1999 ◽

Vol 12 (1) ◽

pp. 28-29 ◽

Cited By ~ 5

Author(s):

J. Drábek ◽

R. Keil ◽

I. Námeŝný

Keyword(s):

Endoscopic Treatment ◽

Balloon Dilatation ◽

Esophageal Strictures

Download Full-text

Management of esophageal strictures after endoscopic resection for early neoplasia

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820985298 ◽

2021 ◽

Vol 14 ◽

pp. 175628482098529

Author(s):

Einas Abou Ali ◽

Arthur Belle ◽

Rachel Hallit ◽

Benoit Terris ◽

Frédéric Beuvon ◽

...

Keyword(s):

Endoscopic Resection ◽

Endoscopic Treatment ◽

Esophageal Stricture ◽

Rare Event ◽

Median Number ◽

High Rate ◽

Endoscopic Dilatation ◽

Tertiary Referral Center ◽

Esophageal Neoplasia ◽

Esophageal Strictures

Background: Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. Methods: We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. Results: Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett’s neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0–4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2–7); range 1–17; p = 0.02], and in the case of circumferential resection [4.0 (3.0–7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. Conclusion: Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.

Download Full-text

LAPAROSCOPIC TRANSPERITONEAL URETEROURETEROSTOMY COMBINED WITH RETROGRADE FLEXIBLE URETEROSCOPY ASSISTANCE FOR URETERAL STRICTURE- CASE SERIES OF SEVEN PATIENTS

Journal of IMAB - Annual Proceeding (Scientific Papers) ◽

10.5272/jimab.2021273.3947 ◽

2021 ◽

Vol 27 (3) ◽

pp. 3947-3949

Author(s):

Deyan Anakievski ◽

Keyword(s):

Endoscopic Treatment ◽

Case Series ◽

Flexible Ureteroscopy ◽

Invasive Technique ◽

Ureteral Stricture ◽

Ureteral Reconstruction ◽

First Choice ◽

Choice Of Treatment ◽

Long Time ◽

Laparoscopic Transperitoneal

Most strictures of the ureters are detected and usually occur in the part of the ureter when the calculus has been trapped for a long time, after ESWL or as a complication of transureteral lithotripsy after the introduction of the holmium laser. The treatment of these strictures variesand depends on many parameters, the most important being the type of stricture, severity, length and location. In many cases, endoscopic treatment with stenting is the first choice of treatment performed retro or antegrade. In case of failure or contraindication for endoscopic treatment, ureteral reconstruction can be performed by open, laparoscopic or robotic techniques. Laparoscopic ureteroureterostomy is a preferred minimally invasive technique for the treatment of benign ureteral strictures.

Download Full-text

Langzeitspeicherung von Teileverbunden in der Mikroproduktion*/Long-time storage for linked parts in micro production

wt Werkstattstechnik online ◽

10.37544/1436-4980-2018-07-08-43 ◽

2018 ◽

Vol 108 (07-08) ◽

pp. 525-529

Author(s):

P. Rückert ◽

A. Onken ◽

K Tracht

Keyword(s):

Plastic Deformation ◽

Production Process ◽

Collaborative Research ◽

Functional Structure ◽

Research Center ◽

Protective Material ◽

Long Time ◽

Micro Parts ◽

Rule Out

Das Speichern ist ein essenzieller Prozessschritt bei der Fertigung von Mikrobauteilen im Teileverbund. Um eine plastische Verformung der Verbunde auszuschließen, wird in Wickelprozessen Zwischenmaterial zum Schutz von Bauteilen eingebunden. Aus der Funktionsstruktur dieses Prozesses wird ein morphologischer Kasten abgeleitet, um systematisch Speicher für Teileverbunde zu gestalten. Das dargestellte Konzept wird auf die entsprechenden Prozesse zum Speichern von Verbundbauteilen im Sonderforschungsbereich 747 übertragen und Grenzparameter im Prozess analysiert.   The storage of parts is an essential part of the production process of linked micro parts. To rule out a plastic deformation, protective material is integrated in winding processes. A morphological matrix is derived from the functional structure of this process to systematically design the storage of linked parts. The developed concept is transferred to the corresponding processes for the storage of linked parts in the Collaborative Research Center 747 and part deformations are analyzed.

Download Full-text

Endoscopic treatment of cicatricial esophageal strictures using ionized argon plasma (with commentary)

Khirurgiya Zhurnal im N I Pirogova ◽

10.17116/hirurgia20161016-20 ◽

2016 ◽

pp. 16

Author(s):

T. V. Skazhutina ◽

V. L. Tsepelev ◽

A. V. Stepanov

Keyword(s):

Endoscopic Treatment ◽

Argon Plasma ◽

Esophageal Strictures

Download Full-text

Investigación social sobre las artes marciales extremo-orientales en Polonia

Revista de Artes Marciales Asiáticas ◽

10.18002/rama.v5i1.125 ◽

2012 ◽

Vol 5 (1) ◽

pp. 77

Author(s):

Wojciech J. Cynarski

Keyword(s):

Martial Arts ◽

Historical Perspective ◽

Scientific Study ◽

Research Center ◽

Cultural Phenomenon ◽

Long Time ◽

Pedagogical Research

The present study summarizes the achievements of the polish researchers about the socio-cultural phenomenon of martial arts, shown from the historical perspective of these practices in Poland and the long-time tradition of local martial practices, as well as from the author’s thirty-year of practice and research in martial arts field. The main directions of the multidisciplinary, sociological, historical and pedagogical research are considered, in addition to the institutionalization of scientific activities related to the martial arts such as the organization of periodic conferences and the publication of specific journals. Particularly, the achievements of the Rzeszów’s Research Center, which is becoming an international cornerstone in the scientific study of the martial arts, are detailed.

Download Full-text