OBJECTIVES: To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. METHODS: A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. RESULTS: A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. CONCLUSIONS Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.
Child ; Humans ; Esophageal Stenosis/therapy* ; Constriction, Pathologic/complications* ; Dilatation/methods* ; Caustics ; Retrospective Studies ; Treatment Outcome

PURPOSE: Congenital esophageal atresia (CES) is a rare congenital disease. The severity of symptoms is variable; thus, diagnosis is difficult and tends to be delayed. CES is frequently accompanied by esophageal atresia (EA) with/without tracheoesophageal fistula (TEF). We investigated the characteristics of CES by reviewing our experience with CES patients and researched the differences between CES with EA-TEF and isolated CES. METHODS: A total of 31 patients underwent operations for CES were reviewed retrospectively. The patients were divided into two groups according to the association with EA-TEF, and compared the differences. RESULTS: Sixteen boys and 15 girls were included. The mean age at symptom onset was 8 months old, and the mean age at diagnosis was 21 months old. Nine patients with EA-TEF were included group A, whereas the other 22 patients were assigned to group B. There were no differences in sex, gestational age, associated anomalies and pathologic results between the groups. In group A, the age at diagnosis and age at surgery were younger than in group B despite the age at symptom occurrence being similar. Postoperative complications occurred only in group A. CONCLUSION: In this study, symptoms occurred during the weaning period, and vomiting was the most frequent symptom. CES patients with EA-TEF tended to be diagnosed and treated earlier despite the age at symptom occurrence being similar. CES patients with EA-TEF had more postoperative complications; therefore, greater attention should be paid during the postoperative period.
Child ; Clinical Study* ; Diagnosis ; Esophageal Atresia* ; Esophageal Stenosis* ; Female ; Gestational Age ; Humans ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Tracheoesophageal Fistula* ; Vomiting ; Weaning

Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.
Abdominal Wall ; surgery ; Aged ; Esophageal Stenosis ; etiology ; Female ; Fundoplication ; adverse effects ; methods ; Heartburn ; etiology ; Hernia, Hiatal ; diagnosis ; surgery ; Humans ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; adverse effects ; Postoperative Complications

OBJECTIVE: To evaluate the safety and prognosis for patients with early esophageal cancer and precancerous lesions after endoscopic submucosal dissection (ESD).
 METHODS: A total of 89 patients were admitted to the Department of internal medicine in the First People's Hospital of Anqing from August 2008 to August 2011. All patients were treated with ESD at the early stage of esophageal cancer and precancerous lesions. The patients' laboratory data and relevant medical history were collected. The postoperative complications and long-term effects of ESD were analyzed.
 RESULTS: Eighty-nine patients were followed up with 100% response rate. Among 89 cases, 16 were early esophageal cancer, 38 were high-grade esophageal neoplasia and 35 were low-grade esophageal neoplasia. The one-time whole piece resection rate, complete resection rate and curative resection rate was 93.3% (84/89), 92.1% (82/89) and 92.1% (82/89), respectively. Two cases suffered intraoperative perforation with a rate of 2.2% and these 2 patients performed the intraoperative endoscopic repair; one case suffered the postoperative delayed bleeding with a rate of 1.1% and the patient underwent the conservative treatment; three cases suffered the esophageal stenosis with a rate of 3.4%. All patients were followed-up for 10-58 (36.3±21.2) months. In this period, one case recurred after ESD for 3 years with a rate of 1.1%; two cases were dead. The three-year survival rate was 97.8%.
 CONCLUSION The early esophageal cancer and precancerous lesions can be treated with ESD. The method is safe and the prognosis is good.
Dissection ; Endoscopy ; adverse effects ; Esophageal Neoplasms ; surgery ; Esophageal Perforation ; Esophageal Stenosis ; Humans ; Postoperative Complications ; Postoperative Hemorrhage ; Prognosis

BACKGROUND/AIMS: Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. METHODS: This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). RESULTS: A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. CONCLUSIONS: In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Caustics/*toxicity ; Endoscopy, Digestive System ; Esophageal Diseases/chemically induced/complications/*pathology ; Esophageal Stenosis/complications ; Female ; Gastric Lavage ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Severity of Illness Index ; Tertiary Care Centers ; Young Adult

BACKGROUND/AIMS: Superficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs. METHODS: Between January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated. RESULTS: The en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively. CONCLUSIONS: ESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.
Aged ; Carcinoma in Situ/pathology/*surgery ; Carcinoma, Squamous Cell/pathology/*surgery ; Cohort Studies ; Disease-Free Survival ; Dissection ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation ; Esophageal Stenosis ; Esophagoscopy ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mucous Membrane/pathology/*surgery ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/*pathology ; Operative Time ; *Postoperative Complications ; Postoperative Hemorrhage ; Retrospective Studies ; Treatment Outcome ; Tumor Burden

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option.
Administration, Topical ; Adrenal Cortex Hormones/*therapeutic use ; Adult ; Child ; Deglutition Disorders/etiology ; Diagnosis, Differential ; Eosinophilic Esophagitis/complications/diagnosis/*therapy ; Esophageal Stenosis/etiology/*surgery ; Esophagoscopy ; Esophagus/*pathology ; *Food Habits ; Gastroesophageal Reflux/diagnosis ; Humans

OBJECTIVETo evaluate the efficacy of endoscopic balloon dilatation, stenting and surgery in treating corrosive esophageal stricture of children.

METHODWe retrospectively analyzed the management of 31 children who were treated with endoscopic balloon dilatation, stenting or gastric tube esophagoplasty because of corrosive esophageal stricture between August 2005 and December 2012. Dysphagia was graded into 4 grades according to Stooler grading methods. The efficacy was divided into 3 grades which were very effective, effective and ineffective according to the improvement of dysphagia.

RESULTAmong 31 children with corrosive esophageal stricture, in 22 children the problem was caused by alkali, in 9 by acid; 23 children had long-segment stricture and 8 had short-segment stricture. The number (rates) of cases in whom the endoscopic balloon dilatation was very effective, effective, and ineffective were 12 (38.7%) , 7 (22.6%) , 12 (38.7%) , respectively. The number of cases in whom stenting was effective or ineffective was 1 and 3, respectively. The gastric tube esophagoplasty was very effective and effective in 8 and 2 cases, respectively. Total rates of very effective, effective, and ineffective of 3 treatments were 64.5%, 29%, 6.5% respectively. The efficacy of endoscopic balloon dilatation was better in short-segment stricture and bigger caliber stricture, the efficacy was not so good for other types of strictures. The efficacy of balloon dilatation was not related with the nature of substances (either alkaline or acidic). Compared with very effective group, the ineffective group with longer course of disease before dilatation (t = -2.091, P = 0.048) , smaller stricture calibre (t = 2.855, P = 0.009) , longer stricture segment (t = -3.405, P = 0.003) and longer dilatation time (t = -2.103, P = 0.047) , had statistical significance.

CONCLUSIONEndoscopic balloon dilatation was the preferred treatment for corrosive esophageal stricture of children. The efficacy was better in shorter course of disease, short-segment stricture and bigger caliber stricture, for other situations the efficacy was not so good. The efficacy of balloon dilatation was not related with the nature of substances.Stent or surgery can be considered if efficacy of balloon dilatation was not so good.Gastric tube esophagoplasty is an effective treatment for complicated corrosive esophageal stricture.

Burns, Chemical ; complications ; therapy ; Child ; Child, Preschool ; Deglutition Disorders ; etiology ; surgery ; therapy ; Dilatation ; instrumentation ; methods ; Esophageal Stenosis ; etiology ; surgery ; therapy ; Female ; Gastroscopy ; Humans ; Infant ; Male ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo identify the risk factors of benign cervical anastomotic strictures after esophagectomy.

METHODSClinical data of 946 esophageal cancer patients undergoing esophagectomy with cervical anastomosis between 2003 and 2012 were analyzed retrospectively. Benign stricture was defined as dysphagia for which endoscopic dilation of the anastomosis was needed. Histologically proven malignant stricture was not regarded as benign stricture. χ(2) test and logistic regression model were used for univariate and multivariate analysis respectively.

RESULTSA total of 146 patients(16.5%) developed benign stricture during follow-up. Univariate analysis showed that the patients with cardiovascular disease (P=0.001), diabetes mellitus(P=0.041), gastric tube reconstruction(P=0.050), end-to-end anastomosis (P=0.013), or postoperative anastomotic leakage(P=0.008) had higher stricture rate. Multivariate analysis revealed that cardiovascular disease(P=0.004), gastric tube reconstruction (P=0.026), end-to-end anastomosis(P=0.043), and postoperative anastomotic leakage(P=0.001) were independently predictive factors for development of benign stricture.

CONCLUSIONSThe benign cervical stricture rate after esophagetomy with cervical gastric anastomosis is quite high. In order to prevent benign stricture formation, end-to-end anastomosis should be avoid. Blood pressure should be controlled for those with cardiovascular disease. Endoscopic dilation in an earlier stage postoperatively should be considered for those who develop anastomotic leakage.

Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; Constriction, Pathologic ; etiology ; Deglutition Disorders ; etiology ; Esophageal Neoplasms ; complications ; surgery ; Esophageal Stenosis ; etiology ; Esophagectomy ; adverse effects ; Follow-Up Studies ; Humans ; Postoperative Complications ; etiology ; Reconstructive Surgical Procedures ; adverse effects ; Retrospective Studies ; Risk Factors

Bronchi ; abnormalities ; Child, Preschool ; Choristoma ; complications ; Esophageal Stenosis ; congenital ; etiology ; Female ; Humans ; Trachea ; abnormalities