1.Malignant Strictures Involving the Esophagogastric Junction: Palliative Treatment with Balloon Dilation Combined with Chemotherapy and/or Radiotherapy.
Hyoek Jin HONG ; Gi Young KO ; Ho Young SONG ; Yong Soo CHO ; Kyu Bo SUNG
Journal of the Korean Radiological Society 2001;45(2):155-159
PURPOSE: To overcome the limitations of expandable metallic stent placement by using balloon dilation combined with chemotherapy or radiation therapy in the treatment of malignant esophageal strictures involving the esophagogastric junction (EGJ). MATERIALS AND METHODS: Fluoroscopically guided balloon dilation was performed in 14 patients with strictures due to squamous cell carcinoma (n=5) or adenocarcinoma (n=9). After balloon dilation all patients underwent chemotherapy or radiation therapy. RESULTS: There were no technical failures or major complications. After dilation, dysphagia improved in 13 (92%) of 14 patients, and the long-term success rate was 50%. Six of the seven patients in whom the condition recurred underwent further balloon dilation (n=4) or placement of an expandable metallic stent (n=2). Ten of the 13 who were followed up died after diffuse metastasis. Prior to their eventual death (mean survial, 20 weeks), the dysphagia experienced by seven (70%) of these ten improved, and thus they required no further treatment. CONCLUSION: Balloon dilation combined with chemotherapy or radiation therapy seems to be a safe and effective secondary therapy for patients with dysphagia due to malignant stiricture involving the EGJ.
Adenocarcinoma
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Carcinoma, Squamous Cell
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Constriction, Pathologic*
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Deglutition Disorders
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Drug Therapy*
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Esophagogastric Junction*
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Humans
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Neoplasm Metastasis
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Palliative Care*
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Radiotherapy*
;
Stents
2.Prospective Randomized Trial of Intravenous Ciprofloxacin for Prevention of Bacterial Infection in Cirrhotic Patients with Esophageal Variceal Bleeding.
Sung Noh HONG ; Beom Jin KIM ; Sun Young LEE ; Choon Young LEE ; Min Kyu RYU ; Moon Seok CHOI ; Joon Hyoek LEE ; Poong Lyul RHEE ; Kwang Cheol KOH ; Jae J KIM ; Seung Woon PAIK ; Jong Chul RHEE ; Kyoo Wan CHOI
The Korean Journal of Hepatology 2002;8(3):288-296
BACKGROUND/AIMS: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding.The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding. METHODS: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t. RESULTS: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups. CONCLUSIONS: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.
Adult
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Aged
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Anti-Infective Agents/*administration & dosage
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*Antibiotic Prophylaxis
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Bacterial Infections/*prevention & control
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Ciprofloxacin/*administration & dosage
;
Endoscopy
;
English Abstract
;
Esophageal and Gastric Varices/complications/*surgery
;
Female
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Gastrointestinal Hemorrhage/*complications
;
Human
;
Infusions, Intravenous
;
Ligation
;
Liver Cirrhosis/*complications
;
Male
;
Middle Aged
;
Postoperative Complications/*prevention & control
;
Prospective Studies