How much progress have we made?: a 20-year experience regarding esophageal stents for the palliation of malignant dysphagia

Summary Esophageal stents are widely used for the palliation of malignant esophageal obstruction. Advances in technology have made esophageal stenting technically feasible and widespread for such obstruction, but complications remain frequent. We present outcomes of a large cohort undergoing esophageal stent placement for malignant esophageal obstruction at a tertiary care cancer center. Patients who underwent placement of esophageal stents for malignancy-related esophageal obstruction between 1 January 2001 and 31 July 2020 were identified. Exclusion criteria included stents placed for benign stricture, fistulae, obstruction of proximal esophagus (proximal to 24 cm from incisors), or post-surgical indications. Patient charts were reviewed for demographics, procedure and stent characteristics, complications, and follow-up. A total of 242 patients underwent stent placement (median age: 64 years, 79.8% male). The majority, 204 (84.3%), had esophageal cancer. During the last two decades, there has been an increasing trend in the number of esophageal stents placed. Though plastic stents were previously used, these are no longer utilized. Complications are frequent and include early complications of pain in 68 (28.1%) and migration in 21 (8.7%) and delayed complications of recurrent symptoms of dysphagia in 46 (19.0%) and migration in 26 (10.7%). Over the study period, there has not been a significant improvement in the rate of complications. During follow-up, 92 (38%) patients required other enteral nutrition modalities after esophageal stent placement. No patient, treatment, or stent characteristics were significantly associated with stent complication or outcome. Esophageal stent placement is an increasingly popular method for palliation of malignant dysphagia. However, complications, particularly pain, migration, and recurrent symptoms of dysphagia are common. Almost 40% of patients may also require other methods of enteral access after esophageal stent placement. Given the high complication rates and suboptimal outcomes, removable stents should be considered as first-line in the case of poor palliative response.

Indigestible Foreign Bodies in the Rumen-reticulum of Cattle Slaughtered at Batna Slaughterhouse, Algeria: A Postmortem Study

Background: To determine the prevalence of indigestible foreign bodies in rumen-reticulum of cattle. Identify the types and the common diseases associated with their occurrence. 289 cattle were examined at Batna (Algeria) municipal abattoir. Methods: About 289 cattle were examined immediately after slaughtering to determine the presence or absence of the foreign bodies in their rumen-reticulum and different lesions were recorded. Result: From total of 289 cattle examined 151 (52.24%) were found positive for various types of foreign bodies in their rumen and/or reticulum. From each 56 (19.37%) and 95 (52.24%) were positive for vulnerable bodies and non-vulnerable foreign bodies respectively. The types of foreign bodies detected were: wire segments, needles, nails, hair clips, coins, corks, ropes, cloth, pebbles, sand, glass pieces, trichobezoar, plastic bags. The plastics were the most common found in 61 (23.92%) males and 34 (79.06%) females. The most common lesions in rumen of cattle with Foreign bodies were traumatic reticuloperitonitis, perirecticular abscess, esophageal obstruction, non penetrating reticulum and/or ruminal foreign bodies were respectively 3.79%, 12.65%, 1.26% and 82.27%. The study revealed that the plastics in rumen my play an important role in the pathologenesis of cattle.

Trans-oral Trans-Sheath Forceps Biopsy For Patients With Severe Esophageal Obstruction Under Fluoroscopy

Background: To investigate the safety and effectiveness of trans-oral trans-sheath forceps biopsy (TTFB) for patients with severe esophageal obstruction under fluoroscopy.Methods: From November 2016 to November 2019, 35 patients with level Ⅲ or Ⅳ dysphagia and a Karnofsky score of less than 60 were enrolled to undergo TTFB and esophageal nutrition tube insertion or stenting simultaneously. Data on diagnostic performance, early complications, and radiation dose were collected, and Karnofsky scores before and after the procedures were compared.Results: The technical success of TTFB was 100%. The sensitivity, specificity and accuracy were 92.3% (24/26), 77.8% (7/9), and 88.6% (31/35), respectively. Complications occurred in two cases (5.7%). The mean procedure duration and irradiation dose were 23.2 min and 7.2 mSv, respectively. The Karnofsky scores significantly increased after 2-4 weeks (t = -8.9, P < 0.01).Conclusions: TTFB is a safe and effective method for patients with severe esophageal obstruction under fluoroscopy, especially in those who cannot undergo or refuse endoscopy.

Simultaneous Esophageal and Tracheal Obstructions Caused by a Pair of Magnetic Beads in a Child: A Case Report

Esophageal and tracheal foreign body ingestion trigger common pediatric emergencies. In this case report, we describe a pediatric patient with simultaneous tracheal and esophageal obstruction caused by foreign bodies. A child aged 2 years and 1 month swallowed a pair of metallic magnetic beads at the same time; one bead entered the trachea and the other bead entered the esophagus. We suspected that the two magnetic beads were mutually attracted and thus became trapped in their respective lumina. The tracheal foreign body was uneventfully removed; this dislodged the esophageal foreign body, which was then excreted. There were no serious complications in the present case, but parents and medical personnel should be mindful of the potential hazards associated with ingestion of multiple magnetic foreign bodies. A high index of suspicion is appropriate. Investigations must be carefully planned. Treatment should not be delayed; the consequences of delay may be serious.

Endoscopic Reconstruction of an Oral Feeding Route Using a Rendezvous Approach

<b><i>Background:</i></b> The approach to esophageal obstruction or discontinuity remains challenging and often involves complex reconstructive surgeries. The rendezvous endoscopic technique might be interesting in cases of complete esophageal obstruction. <b><i>Case Presentation:</i></b> Herein we describe a successful case of endoscopic recanalization of the esophageal lumen in a patient with a long-standing esophageal discontinuity resulting from several surgeries and chemoradiation for a squamous cell carcinoma of the hypopharynx, ending in a major cervical amputation, construction of a neopharynx, and definitive surgical closure of the superior esophagus with a PEG placement. With a rendezvous technique (peroral and through the gastrostomy) and under radiographic guidance, puncture from the neopharynx into the distal esophagus was performed, followed by balloon dilation and covered metal stent placement in order to reconstruct a neoesophagus. Five weeks later, the stent was removed (using a stent-in-stent technique). No complications occurred. The patient has been able to eat soft food and is being kept under regular endoscopic surveillance to control/treat a luminal stenosis of the neoesophagus. <b><i>Conclusions:</i></b> This case report illustrates a successful endoscopic treatment of post-surgical complete esophageal obstruction. This approach should be considered in the therapeutic armamentarium of these difficult clinical settings.

Esophageal Obstruction in Buffaloes (Bubalus bubalis) Resulting from the Ingestion of Potato Tubers

Total 32 emergency cases of buffaloes with esophageal obstruction resulting from the ingestion of potato tubers during their grazing are described. Treatment comprised immediate rumen trocarisation by a 14g syringe, premedication with IM xylazine (0.05 mg/kg), and passing a designed stout flexible tube to dislodge the obstruction to the rumen. The results were 100% successful recovery without any complications.

657 ROUTINE ESOPHAGRAMS FOLLOWING HIATUS HERNIA REPAIR MINIMISES REOPERATIVE MORBIDITY: A MULTICENTER COMPARATIVE COHORT STUDY

Hiatus hernia repairs are common. Early complications such as re-herniation, esophageal obstruction and perforation, although infrequent, incur significant morbidity. Here, we determine whether routine postoperative esophagrams following hiatus hernia repair may expedite the surgical management of these complications, reduce reoperative morbidity, and improve functional outcomes. Methods Analysis of a prospectively-maintained database of 1829 hiatus hernia repairs undertaken in 14 hospitals from 1 January 2000 to 30 September 2020. 1571 (85.9%) patients underwent a postoperative esophagram which was reviewed. An early (&lt;14 days) reoperation was performed in 44 (2.4%) patients. Results Compared to those without an esophagram, patients who received one prior to reoperation (n = 37) had a shorter time to diagnosis (2.4 vs. 3.9 days, p = 0.041) and treatment (2.4 vs. 4.3 days, p = 0.037) of their complications. This was associated with decreased open surgery (10.8% vs. 42.9%, p = 0.034), gastric resection (0.0% vs. 28.6%, p = 0.022), postoperative morbidity (13.5% vs. 85.7%, p &lt; 0.001), ICU admission (16.2% vs. 85.7%, p &lt; 0.001), and length-of-stay (7.3 vs. 18.3 days, p = 0.009). Furthermore, patients who underwent early reoperations for asymptomatic re-herniation had less complications and superior functional outcomes at one-year follow-up than those who needed surgery for symptomatic recurrences later on. Conclusion Postoperative esophagrams decreases the morbidity associated with early and late reoperations following hiatus hernia repair, and should be considered for routine use.