Asunto(s)
Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Esofagoscopía , Humanos , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/diagnóstico por imagen , Carcinoma de Células Escamosas de Esófago/terapia , Carcinoma de Células Escamosas de Esófago/patología , Carcinoma de Células Escamosas de Esófago/diagnóstico , Esofagoscopía/métodos , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patologíaRESUMEN
The endoscopic treatment of gastroesophageal reflux disease (GERD) has evolved significantly in the past 20 years. Current practices include devices specifically designed for GERD. Newer techniques aim to use less extra equipment, to be less costly, and to use accessories readily available in endoscopy units, as well as using standard endoscopes to apply such techniques. It is of utmost importance to properly select the patients for endoscopic therapy, and it should be done in a multidisciplinary approach.
El tratamiento endoscópico de la enfermedad por reflujo gastroesofágico (ERGE) ha evolucionado significativamente en los últimos 20 años. Las prácticas actuales incluyen dispositivos diseñados específicamente para la ERGE. Las técnicas más nuevas tienen como objetivo utilizar menos equipos adicionales, ser menos costosos y utilizar accesorios fácilmente disponibles en las unidades de endoscopia, así como utilizar endoscopios estándar para aplicar dichas técnicas. Es de suma importancia seleccionar adecuadamente a los pacientes para la terapia endoscópica, y debe hacerse en un enfoque multidisciplinario.
Asunto(s)
Reflujo Gastroesofágico , Reflujo Gastroesofágico/cirugía , Reflujo Gastroesofágico/terapia , Humanos , Esofagoscopía/métodos , Fundoplicación/métodos , Selección de Paciente , Endoscopía Gastrointestinal/métodosAsunto(s)
Resección Endoscópica de la Mucosa , Acalasia del Esófago , Fístula , Miotomía , Humanos , EsofagoscopíaRESUMEN
INTRODUCTION: Currently there is little information in Latin America on the clinical outcome and manometric evolution of patients with Achalasia undergoing peroral endoscopic myotomy (POEM). PRIMARY OUTCOME: Evaluate the manometric and clinical changes in adult patients with achalasia after peroral endoscopic myotomy at a referral center in Bogotá, Colombia. METHODS: Observational, analytical, longitudinal study. Adult patients with achalasia according to the Chicago 4.0 criteria were included. Sociodemographic, clinical and manometric variables were described. To compare the pre- and post-surgical variables, the Student's or Wilcoxon's t test was used for the quantitative variables according to their normality, and McNemar's chi-square for the qualitative variables. RESULTS: 29 patients were included, 55.17% (n=16) women, with a mean age at the time of surgery of 48.2 years (±11.33). The mean post-procedure evaluation time was 1.88±0.81 years. After the procedure, there was a significant decrease in the proportion of patients with weight loss (37.93% vs 21.43% p 0.0063), chest pain (48.28% vs 21.43, p 0.0225) and the median Eckardt score (8 (IQR 8 -9) vs 2(IQR 1-2), p <0.0001). In addition, in fourteen patients with post-surgical manometry, significant differences were found between IRP values (23.05±14.83mmHg vs 7.69±6.06mmHg, p 0.026) and in the mean lower esophageal sphincter tone (9.63±7.2mmHg vs 28.8±18.60mmHg, p 0.0238). CONCLUSION: Peroral endoscopic myotomy has a positive impact on the improvement of symptoms and of some manometric variables (IRP and LES tone) in patients with achalasia.
Asunto(s)
Acalasia del Esófago , Manometría , Cirugía Endoscópica por Orificios Naturales , Humanos , Acalasia del Esófago/cirugía , Acalasia del Esófago/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Colombia , Estudios Longitudinales , Adulto , Cirugía Endoscópica por Orificios Naturales/métodos , Miotomía/métodos , Esofagoscopía/métodosRESUMEN
BACKGROUND: Achalasia is an esophageal motility disorder, with clinical presentation of dysphagia and regurgitation. This is a chronic condition with no cure. Current treatment options aim to reduce lower esophageal sphincter tone by pharmacological, endoscopic or surgical means, with the aim of improving patients' symptoms. Peroral endoscopic myotomy (POEM) is an alternative endoscopic surgery to Heller cardiomyotomy, in which the procedure is performed orally, by endoscopy, offering efficacy comparable to surgical myotomy, with relative ease and minimal invasion, without external incisions. AIMS: To study the safety of POEM by analyzing its results, adverse events and perioperative complications and the main ways to overcome them, in addition to evaluating the effectiveness of the procedure and the short-term postoperative quality of life. METHODS: A qualitative and quantitative, observational and cross-sectional study that analyzed patients who underwent the POEM in a reference center, from December 2016 to December 2022, maintaining the technical standard of pre-, peri- and postoperative protocol. RESULTS: A total of 94 patients were included in the study, and only three had postoperative complications. The average early postoperative Eckardt score was 0.93 and the late 1.40, with a mean improvement of 7.1 in early results and 6.63 in late results (p<0.05). CONCLUSIONS: POEM can be reproduced with an excellent safety profile, significant relief of symptoms and improvement in esophageal emptying, and in quality of life.
Asunto(s)
Acalasia del Esófago , Miotomía , Cirugía Endoscópica por Orificios Naturales , Humanos , Estudios Transversales , Acalasia del Esófago/cirugía , Esfínter Esofágico Inferior/cirugía , Esofagoscopía/métodos , Miotomía/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Calidad de Vida , Resultado del TratamientoRESUMEN
Barrett's esophagus(BE)is a precursor to adenocarcinoma of the esophagogastric transition. Thus, endoscopic surveillance is essential for the early diagnosis of dysplasia and neoplasm, allowing proper therapeutic. However, during the COVID-19 pandemic, surveillance frequently failed. We present a case of a male, caucasian, 65 years old, patient with early adenocarcinoma in BE. Submitted an endoscopic resection, but due to the COVID-19 pandemic patient lost the follow-up endoscopic exams. Returned with a T3N1 adenocarcinoma esophagus in resection area. The present report illustrates the consequences of the failure in follow-up after submucosal resection in COVID-19 pandemic context.
Asunto(s)
Adenocarcinoma , Esófago de Barrett , COVID-19 , Neoplasias Esofágicas , Masculino , Humanos , Anciano , Esófago de Barrett/cirugía , Esófago de Barrett/patología , Estudios de Seguimiento , Pandemias , Esofagoscopía , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Adenocarcinoma/cirugía , Adenocarcinoma/patologíaRESUMEN
Despite endoscopic eradication therapy being an effective and durable treatment for Barrett's esophagus-related neoplasia, even after achieving initial successful eradication, these patients remain at risk of recurrence and require ongoing routine examinations. Failure of radiofrequency ablation and argon plasma coagulation is reported in 10-20% of cases.
Asunto(s)
Adenocarcinoma , Esófago de Barrett , Neoplasias Esofágicas , Ablación por Radiofrecuencia , Humanos , Esófago de Barrett/cirugía , Esófago de Barrett/patología , Fundoplicación , Adenocarcinoma/cirugía , Esofagoscopía , Neoplasias Esofágicas/cirugía , Resultado del TratamientoRESUMEN
El esófago de Barrett (EB) se define como la condición en la cual una mucosa columnar metaplásica predispuesta a neoplasia reemplaza la mucosa escamosa del esófago distal. La guías actuales recomiendan que el diagnóstico requiere el hallazgo de metaplasia intestinal (MI) con células caliciformes de al menos 1 cm de longitud. El EB afecta aproximadamente al 1% de la población general y hasta en 14% de los pacientes con enfermedad por reflujo gastroesofágico (ERGE). El EB es precursor del adenocarcinoma esofágico (ACE), neoplasia en aumento en países occidentales. Los principales factores de riesgo descritos para ACE asociado a EB son: sexo masculino, edad > 50 años, obesidad central y tabaquismo. El riesgo anual de ACE en EB sin displasia, displasia de bajo (DBG) y alto grado es 0,1-0,3%, 0,5% y 5-8%, respectivamente. El tratamiento del EB no displásico consiste en un cambio de estilo de vida saludable, quimioprevención mediante inhibidores de la bomba de protones y vigilancia endoscópica cada 3 a 5 años. Se recomienda que a partir de la presencia de DBG los pacientes sean referidos a un centro experto para la confirmación del diagnóstico, estadio y así definir su manejo. En pacientes con EB y displasia o cáncer incipiente, el tratamiento endoscópico consiste en la resección y ablación, con un éxito cercano al 90%. El principal evento adverso es la estenosis esofágica que es manejada endoscópicamente.
Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). BE is a precursor of esophageal adenocarcinoma (EAC), which has increased in western countries. The main risk factors described for EAC associated with BE are male sex, age > 50 years, central obesity and tobacco use. Annual risk of EAC in patients with BE without dysplasia, low grade (LGD) and high-grade dysplasia is 0,1-0,3%, 0,5% y 5-8%, respectively. Treatment of non-dysplastic BE consists mainly of a healthy lifestyle change, chemoprevention with proton pump inhibitors and surveillance endoscopy every 3 to 5 years. It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.
Asunto(s)
Humanos , Masculino , Esófago de Barrett/diagnóstico , Esófago de Barrett/etiología , Esófago de Barrett/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiología , Adenocarcinoma/patología , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/terapia , Factores de Riesgo , EsofagoscopíaRESUMEN
BACKGROUND: Esophageal duplication cysts are rare congenital tumors usually diagnosed and treated during childhood. Most of them are located in the mediastinum and appear as a mass besides the esophagus. Unfortunately, symptoms are non-specific and depend on the size and location of the mass; therefore, they can easily be missed. If symptoms appear, surgical resection is necessary to prevent troublesome complications. CASE PRESENTATION: We present the case of a 60-year-old woman who presented with severe progressive dysphagia and epigastric pain. After further evaluation, a paraesophageal cystic mass was found, and surgery was required. Non-communicating esophageal duplication cyst was the final diagnosis. CONCLUSION: Esophageal duplication cysts are a rare pathology in adults; their symptoms will vary depending on their size and location. Preoperative diagnosis is difficult as symptoms are non-specific and can be missed. If severe dysphagia, pain, or any other complication appears, surgery should not be delayed.
Asunto(s)
Trastornos de Deglución , Quiste Esofágico , Adulto , Femenino , Humanos , Persona de Mediana Edad , Trastornos de Deglución/etiología , Quiste Esofágico/complicaciones , Quiste Esofágico/diagnóstico , Quiste Esofágico/cirugía , Esofagoscopía , DolorRESUMEN
INTRODUCTION: achalasia is a chronic disease. Since there is no curative treatment, diagnosed patients have pharmacological and/or surgical techniques available, aimed at minimizing the condition. POEM appears as a promising new type of palliative treatment with good rates of symptom improvement. OBJECTIVE: evaluate the profile of POEM at the Clinical Hospital of the Federal University of Pernambuco (HC - UFPE) and correlate it with the world scenario. METHODS: data collection was performed retrospectively from September 2017 to October 2019 with all patients undergoing POEM at the HC - UFPE. Sociodemographic, clinical, and hospital variables were evaluated before and three months after the procedure. RESULTS: of 27 patients (52.41 ± 19.24 years old) who underwent the procedure, 66.7% had idiopathic etiology and 33.3% had etiology secondary to Chagas disease. 48% patients underwent previous procedures, of which seven used some type of medication for symptom control, two underwent pneumatic endoscopic dilation, and four underwent Heller cardiomyotomy with partial fundoplication. 62.5% of the evaluated patients had type II achalasia before the procedure. Seven (25.9%) patients presented the following adverse events: four presented bleeding, two pneumoperitoneum, and one both complications, all being treated conservatively. The Eckardt score reduced from 8.37 ± 1.45 to 0.85 ± 1.06 (p-value <0.001). CONCLUSION: clinical improvement of symptoms and the patient profile followed the worldwide trend, with emphasis on the etiology secondary to Chagas disease, endemic in Brazil. Gastroesophageal reflux remains the main post-operative symptom.
Asunto(s)
Acalasia del Esófago , Miotomía , Cirugía Endoscópica por Orificios Naturales , Humanos , Adulto , Persona de Mediana Edad , Anciano , Acalasia del Esófago/cirugía , Acalasia del Esófago/etiología , Estudios Retrospectivos , Endoscopía , Miotomía/efectos adversos , Miotomía/métodos , Atención a la Salud , Resultado del Tratamiento , Cirugía Endoscópica por Orificios Naturales/métodos , Esofagoscopía/métodosRESUMEN
Foreign body (FB) ingestion is an important emergency in low- to middle-income countries. Our study sought to identify which clinical and radiological findings best predict upper gastrointestinal FB impaction. Amongst 149 adolescents and adults presenting to two Jamaican hospitals between 2018 and 2020, FB's were found at 31% of telescopic laryngoscopies and 60% of rigid oesophagoscopies. Commonest sites of impaction were the tonsils at laryngoscopy (15/46) and proximal oesophagus at oesophagoscopy (17/22). Odds of pharyngeal impaction were higher with fish bone ingestion, persistent discomfort, perceived location of discomfort above the cricoid cartilage and symptoms noted during a meal. Persistent discomfort and FB shadow on X-ray imaging produced higher odds of oesophageal impaction. Simple clinical and radiological assessments are useful in predicting FB impaction in resource-limited settings.
Asunto(s)
Países en Desarrollo , Cuerpos Extraños , Animales , Humanos , Esófago/diagnóstico por imagen , Esofagoscopía , Cuerpos Extraños/diagnóstico por imagen , Ingestión de Alimentos , Estudios RetrospectivosRESUMEN
Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.
Asunto(s)
Estenosis Esofágica , Adulto , Niño , Humanos , Dilatación/métodos , Estenosis Esofágica/etiología , Estenosis Esofágica/terapia , Esofagoscopía/métodos , Resultado del TratamientoRESUMEN
Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). BE is a precursor of esophageal adenocarcinoma (EAC), which has increased in western countries. The main risk factors described for EAC associated with BE are male sex, age > 50 years, central obesity and tobacco use. Annual risk of EAC in patients with BE without dysplasia, low grade (LGD) and high-grade dysplasia is 0,1-0,3%, 0,5% y 5-8%, respectively. Treatment of non-dysplastic BE consists mainly of a healthy lifestyle change, chemoprevention with proton pump inhibitors and surveillance endoscopy every 3 to 5 years. It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.
Asunto(s)
Adenocarcinoma , Esófago de Barrett , Neoplasias Esofágicas , Humanos , Esófago de Barrett/terapia , Esófago de Barrett/diagnóstico , Esófago de Barrett/etiología , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Factores de Riesgo , Adenocarcinoma/etiología , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Lesiones Precancerosas/terapia , Lesiones Precancerosas/diagnóstico , Masculino , EsofagoscopíaRESUMEN
BACKGROUND: Advanced achalasia cardia (AC) represents the end stage in the natural history of AC. Role of per oral endoscopic myotomy (POEM) in this technically difficult subset is emerging. METHODS: Retrospective review of the patients who had undergone POEM for advanced AC with sigmoid esophagus. We assessed the technical success, clinical success and adverse event rate. Pre and post POEM Eckardt score (ES), integrated relaxation pressure-4sec (IRP-4), lower oesophageal sphincter pressure (LESP) and height and width of barium column at 5 minutes were noted. RESULTS: Of the 85 patients who underwent POEM for AC, 10 patients had advanced AC with sigmoid esophagus of which eight were sigmoid and two were advanced sigmoid. The clinical and technical success was 100% with significant reduction of ES, IRP-4, LESP and height and width of barium column at 5 minutes. One patient had a minor adverse event in the form of mucosal injury that was closed with hemoclips. At a median follow up of 17 months there was no recurrence. CONCLUSION: Our study demonstrates POEM to be a safe and effective modality of treatment in this technically difficult subset of AC with sigmoid morphology.
Asunto(s)
Acalasia del Esófago , Miotomía , Cirugía Endoscópica por Orificios Naturales , Humanos , Acalasia del Esófago/cirugía , Acalasia del Esófago/etiología , Esfínter Esofágico Inferior/cirugía , Estudios de Seguimiento , Bario , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Esofagoscopía , Manometría , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy, has emerged as a promising minimally invasive technique for the management of this condition. AIM: To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia. METHODS: Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria (dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis (as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium esophagogram), pressure at the LES, the occurrence of adverse events (AEs), length of stay (LOS), and quality of life (QoL). RESULTS: There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up (P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group (P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group (185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group. CONCLUSION: POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux.
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Acalasia del Esófago , Esofagitis Péptica , Reflujo Gastroesofágico , Laparoscopía , Miotomía , Cirugía Endoscópica por Orificios Naturales , Adulto , Bario , Acalasia del Esófago/diagnóstico , Acalasia del Esófago/etiología , Acalasia del Esófago/cirugía , Esfínter Esofágico Inferior/cirugía , Esofagitis Péptica/etiología , Esofagoscopía/efectos adversos , Esofagoscopía/métodos , Fundoplicación/efectos adversos , Fundoplicación/métodos , Reflujo Gastroesofágico/etiología , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Miotomía/efectos adversos , Miotomía/métodos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos , Calidad de Vida , Resultado del TratamientoRESUMEN
Abstract Introduction: Typically, when esophageal perforation secondary to barotrauma is mentioned as the causal pathophysiological mechanism of perforation, the literature refers to spontaneous esophageal perforation or Boerhaave syndrome as an entity. It involves the longitudinal and transmural rupture of the esophagus (previously healthy) secondary to an abrupt increase in intraluminal esophageal pressure, frequently triggered during vomiting. However, in the medical literature, some reports list mechanisms of barotrauma other than this entity. Case report: A 64-year-old female patient with a history of surgically managed gastric adenocarcinoma (total gastrectomy and esophagoenteral anastomosis) presented with stenosis of the esophagojejunal anastomosis, which required an endoscopic dilatation protocol with a CRETM balloon. The third session of endoscopic dilation was held; in removing the endoscope, we identified a deep esophageal laceration with a 4 cm long perforation at the level of the middle esophagus (8 cm proximal to the dilated anastomosis), suspecting the mechanism of barotrauma as the causal agent. She required urgent transfer to the operating room, where we performed thoracoscopic esophagectomy, broad-spectrum empiric antimicrobial coverage, and enteral nutrition by advanced tube during in-hospital surveillance. The control esophagram at seven days showed a small leak over the anastomotic area, which was managed conservatively. Imaging control at 14 days showed a decrease in the size of the leak, with good evolution and tolerance to the oral route. The patient was later discharged.
Resumen Introducción: típicamente, cuando se menciona la perforación esofágica secundaria a barotrauma como el mecanismo fisiopatológico causal de la perforación, la literatura se refiere a la perforación esofágica espontánea o síndrome de Boerhaave como entidad, la cual hace referencia a la ruptura longitudinal y transmural del esófago (previamente sano) secundaria a un aumento abrupto de la presión intraluminal esofágica, que se desencadena frecuentemente durante el vómito. Sin embargo, en la literatura médica existen algunos reportes que mencionan otros mecanismos de barotrauma diferentes a esta entidad. Reporte de caso: se presenta el caso de una paciente de 64 años con antecedente de adenocarcinoma gástrico manejado quirúrgicamente (gastrectomía total y anastomosis esofagoenteral), quien presentaba estenosis de anastomosis esofagoyeyunal, que requirió un protocolo de dilatación endoscópica con balón CRETM. Se llevó a una tercera sesión de dilatación endoscópica, en la que durante la extracción del endoscopio se identificó una laceración esofágica profunda con perforación de 4 cm de longitud a nivel del esófago medio (8 cm proximal a anastomosis dilatada), y se sospechó del mecanismo de barotrauma como agente causal. Requirió traslado urgente a sala de cirugía, en la que se realizó esofagorrafia por toracoscopia, cubrimiento antimicrobiano empírico de amplio espectro y nutrición enteral por sonda avanzada durante la vigilancia intrahospitalaria. El esofagograma de control a los 7 días mostró una pequeña fuga sobre el área anastomótica, la cual se manejó de manera conservadora. El control imagenológico a los 14 días evidenció una disminución del tamaño de la fuga, con una evolución satisfactoria y tolerancia a la vía oral, y posteriormente se dio el egreso.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Barotrauma/complicaciones , Esofagoscopía/métodos , Perforación del Esófago/cirugía , Perforación del Esófago/etiología , Perforación del Esófago/diagnóstico por imagenRESUMEN
Background: Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory or recurrent strictures do occur and remain a challenge to the endoluminal treatment. The aim of this report was to communicate a recurrent esophageal stricture resolution in a cat treated with balloon dilatation and steroid injections in Ciudad de Buenos Aires, Argentina. Case Description: A 1-year-old spayed mix-breed female cat was consulted to the Veterinary Endoscopy Service for recurring regurgitation after two previous esophageal dilations. The cat had received doxycycline for Mycoplasma spp. infection and 20 days after the treatment consulted for dysphagia and regurgitation. Upper esophagogastroscopy (UGE) was performed with an Olympus CV-160 8.7 mm diameter endoscope; an annular 7 mm stricture was observed 3 cm caudal to the cranial esophagus sphincter. Three balloon dilatations procedures were performed with a Boston Scientific Controlled Radial Expansion (CRE) balloon 8-10-12 mm of 1 minute each. Because of ongoing clinical signs, another UGE was performed 15 days from the first procedure: a 3 mm stricture was encountered, balloon dilatation was repeated with 6-10-12 mm diameter, and a four-quadrant triamcinolone was injected in the submucosa. Clinically, the cat could eat with no alterations until day 20, where it started with mild dysphagia. Another UGE was performed, and the known stricture conserved a 11 mm diameter and balloon dilatation 12-15-16.5 mm with triamcinolone injection was repeated 30 days after the previous procedure. The cat could eat kibbles with no clinical signs in an 11-month follow-up. Conclusion: The alternative to triamcinolone injection after balloon dilatation presented in this clinical report was successful and it could be a therapeutic option for recurrent esophageal strictures in cats as it is in human medicine.
Asunto(s)
Enfermedades de los Gatos , Trastornos de Deglución , Estenosis Esofágica , Animales , Enfermedades de los Gatos/tratamiento farmacológico , Gatos , Constricción Patológica/complicaciones , Constricción Patológica/tratamiento farmacológico , Constricción Patológica/veterinaria , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/etiología , Trastornos de Deglución/veterinaria , Dilatación/efectos adversos , Dilatación/métodos , Dilatación/veterinaria , Estenosis Esofágica/complicaciones , Estenosis Esofágica/veterinaria , Esofagoscopía/efectos adversos , Esofagoscopía/veterinaria , Femenino , Inyecciones Intralesiones/veterinaria , Esteroides , Triamcinolona/uso terapéuticoRESUMEN
BACKGROUND & AIMS: Despite the significant advances made in the diagnosis and treatment of Barrett's esophagus (BE), there is still a need for standardized definitions, appropriate recognition of endoscopic landmarks, and consistent use of classification systems. Current controversies in basic definitions of BE and the relative lack of anatomic knowledge are significant barriers to uniform documentation. We aimed to provide consensus-driven recommendations for uniform reporting and global application. METHODS: The World Endoscopy Organization Barrett's Esophagus Committee appointed leaders to develop an evidence-based Delphi study. A working group of 6 members identified and formulated 23 statements, and 30 internationally recognized experts from 18 countries participated in 3 rounds of voting. We defined consensus as agreement by ≥80% of experts for each statement and used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the quality of evidence and the strength of recommendations. RESULTS: After 3 rounds of voting, experts achieved consensus on 6 endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesion location, extraluminal compressions, and quadrant orientation), 13 definitions (BE, hiatus hernia, squamous islands, columnar islands, Barrett's endoscopic therapy, endoscopic resection, endoscopic ablation, systematic inspection, complete eradication of intestinal metaplasia, complete eradication of dysplasia, residual disease, recurrent disease, and failure of endoscopic therapy), and 4 classification systems (Prague, Los Angeles, Paris, and Barrett's International NBI Group). In round 1, 18 statements (78%) reached consensus, with 12 (67%) receiving strong agreement from more than half of the experts. In round 2, 4 of the remaining statements (80%) reached consensus, with 1 statement receiving strong agreement from 50% of the experts. In the third round, a consensus was reached on the remaining statement. CONCLUSIONS: We developed evidence-based, consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.