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Dysphagia Oct 2023Dysphagia occurs temporarily or permanently following esophageal replacement in at least half of the cases. Swallowing disorder, in addition to severe decline in the...
Dysphagia occurs temporarily or permanently following esophageal replacement in at least half of the cases. Swallowing disorder, in addition to severe decline in the quality of life, can lead to a deterioration of the general condition, which may lead to death if left untreated. For this reason, their early detection and treatment are a matter of importance. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with a stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck and 28 cases with a Roux loop reconstruction located to the thorax. Based on the literature data and own experience, the following were found to be the causes of dysphagia in the order of frequency: anastomotic stenosis, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant, and malignant tumor in the organ used for replacement. Causes may overlap each other, and their treatment may be conservative or surgical. The causes of many dysphagic complications might be prevented by improving the anastomosis technique, by better preservation the blood supply of the substitute organ, by consistently applying a functional approach, and by regular follow-up.
Topics: Humans; Deglutition Disorders; Quality of Life; Postoperative Complications; Stomach; Esophageal Stenosis
PubMed: 36719515
DOI: 10.1007/s00455-023-10557-2 -
Medicine Jan 2023Endoscopic injection sclerotherapy (EIS) is a common treatment for patients with liver cirrhosis and esophageal varices. It can effectively treat variceal rupture and...
RATIONALE
Endoscopic injection sclerotherapy (EIS) is a common treatment for patients with liver cirrhosis and esophageal varices. It can effectively treat variceal rupture and bleeding caused by liver cirrhosis. However, EIS has many complications, including postoperative bleeding, retrosternal pain, esophageal ulcers, esophageal stenosis, and ectopic embolism. Intramural hematoma of the esophagus (IHE) is a rare complication of EIS that can lead to chest tightness, chest pain, and dysphagia.
PATIENTS CONCERNS
A 55-year-old man developed severe nausea and vomiting accompanied by chest pain after EIS.
DIAGNOSIS
Comprehensive imaging features, the patient was diagnosed as IHE.
INTERVENTIONS
A vascular clamp was used for hemostasia, and a feeding tube was placed in the patient's jejunum.
OUTCOMES
After the removal of the jejunal feeding tube and the intake of a semiliquid diet, the patient had no episodes of chest pain, chest tightness, or dysphagia and was discharged after 2 days of observation.
LESSONS
Although IHE rarely occurs after EIS, we should not overlook its risk. The occurrence of IHE is not directly related to the number of EISs received or the degree of liver cirrhosis but is more likely related to postoperative nausea and vomiting. Therefore, timely medication and observation are particularly important for patients with nausea and vomiting after endoscopic treatment.
Topics: Male; Humans; Middle Aged; Sclerotherapy; Deglutition Disorders; Esophageal and Gastric Varices; Liver Cirrhosis; Hematoma; Chest Pain; Vomiting; Gastrointestinal Hemorrhage
PubMed: 36705374
DOI: 10.1097/MD.0000000000032752 -
Medical Science Monitor : International... Jan 2023BACKGROUND Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report...
Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland.
BACKGROUND Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report reduction in postoperative complications in the stapler group. This retrospective study aimed to compare short- and long-term surgical outcomes between the groups with stapled and hand-sewn esophago-jejunal anastomosis (EJA) during open TG for gastric cancer. MATERIAL AND METHODS The study included 72 adult patients with gastric cancer who underwent TG in the Department of Digestive Tract Surgery in Katowice between May 2018 and December 2021. The patients were divided into 2 groups according to the technique of EJA: stapled (44 cases) or hand-sewn (28 cases). We compared the groups in terms of the duration of the surgery, length of hospital stay, and occurrence of complications (focusing on anastomotic leakage, stricture and abdominal abscess). RESULTS There were no significant differences in duration of the surgery (P=0.6), blood loss (P=0.7), or length of postoperative hospital stay (P=0.2) among the groups. Early postoperative complications rates were 9.1% (4/44) in the stapler group and 17.9% (5/28) in the hand-sewn group (P=0.27). The most frequent complication was anastomotic leakage, with 2 cases in each group (P=0.76). The mean follow-up time was 1.8±0.9 (0.3-3.6) years. During this period the anastomotic stricture occurred in 7 (15.9%) cases with stapled anastomosis and in 5 (17.9%) cases with hand-sewn anastomosis (P=0.52). CONCLUSIONS In this study there were no significant differences in mortality, morbidity, and surgery duration between stapled and hand-sewn esophago-jejunal anastomosis in total gastrectomy.
Topics: Adult; Humans; Stomach Neoplasms; Retrospective Studies; Anastomotic Leak; Constriction, Pathologic; Poland; Gastrectomy; Anastomosis, Surgical; Postoperative Complications
PubMed: 36698295
DOI: 10.12659/MSM.938759 -
Diagnostics (Basel, Switzerland) Dec 2022Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is... (Review)
Review
Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is extremely important to recognize distinctive endoscopic findings and accurately detect increased eosinophilia in gastrointestinal tissues. However, endoscopic findings of EoGE in the small intestine remain poorly understood. Therefore, we conducted a literature review of 16 eligible papers. Redness or erythema was the most common endoscopic finding in the small bowel, followed by villous atrophy, erosion, ulceration, and edema. In some cases, stenosis due to circumferential ulceration was observed, which led to retention of the capsule during small bowel capsule endoscopy. Although many aspects of small bowel endoscopic findings in EoGE remain elusive, the findings presented in this review are expected to contribute to the further development of EoGE practice.
PubMed: 36611405
DOI: 10.3390/diagnostics13010113 -
World Journal of Gastrointestinal... Nov 2022Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have...
BACKGROUND
Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have not been documented well.
AIM
In this paper, we report unusual patients who manifested jejunal limb stricture near the esophageal hiatus without anastomotic stenosis during long-term observation after surgery.
METHODS
From April 2009 until May 2020, we retrospectively reviewed 211 patients underwent LTG following by OEJ for gastric carcinoma and took a standard surveillance program. We aimed to characterize a novel complicated disorder observed in these patients to assist treatment and prevention.
RESULTS
Five patients (2.4%) had unusual jejunal limb stricture after LTG and OEJ, occurring at a mean of 10 mo after initial radical LTG. All five patients had disturbed oral intake and marked weight loss, and two had aspiration pneumonia. Various diagnostic modalities and intraoperative findings in each patient revealed an intact anastomosis, bent or tortuous jejunal limb resulting from loose fibrous adhesions on the left crus at the esophageal hiatus and no cancer recurrence. All five patients were successfully treated by reoperation for adhesiolysis, division of the left crus and rearrangement of the jejunal limb.
CONCLUSION
Disturbed passage through the jejunal limb near the hiatus can occur after some types of OEJ following LTG. We speculate that it may result from a short remnant esophagus, excessive mobilization of the jejunal limb that permits bending or tortuosity and adhesions on the left crus at the hiatus. Prevention for this complication is possible during the original LTG procedure.
PubMed: 36504516
DOI: 10.4240/wjgs.v14.i11.1285 -
Frontiers in Pediatrics 2022Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare X-linked recessive immunodeficiency caused by mutations in the forkhead box...
Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare X-linked recessive immunodeficiency caused by mutations in the forkhead box protein 3 () gene. IPEX is characterized by the onset of intractable diarrhea, type 1 diabetes mellitus (T1DM), and eczema in the early stages of life. The typical clinic triad for IPEX is not always seen. Here, we report a 15-year-old male patient with atypical IPEX syndrome complicated with severe eosinophilic gastritis (EG) and pyloric stenosis. The patient had noticeable eczema during the first year of life and had a history of food allergies. At the age of 3 years, the patient was diagnosed with EG, (HP) infection, pyloric stenosis with recurrent vomiting, and failure to thrive. The patient did not respond to long-term symptomatic treatments in the following years, including methylprednisolone, proton pump inhibitors (PPI), L-glutamine and sodium gualenate granules, anti-HP therapy, and balloon dilation. At the age of 12 years, the patient received surgical interventions, including a laparoscopic jejunostomy feeding tube placement, gastrojejunal anastomosis bypass, and jejunal-jejunal end-to-side anastomosis. Intractable diarrhea and T1DM were not present in the patient. At the age of 14 years, the patient was diagnosed with IPEX syndrome due to a c.748-750del (p.Lys250del) mutation in the leucine zipper domain of the FOXP3 protein. The patient underwent matched sibling peripheral blood hematopoietic stem cell transplantation (HSCT) and showed good evolution after 3 months of HSCT. In summary, this case report provides information of unusual gastrointestinal findings in IPEX syndrome and highlights the need for increased awareness and early diagnosis of IPEX syndrome, which is vital for improving the patient's outcome.
PubMed: 36479284
DOI: 10.3389/fped.2022.1039341 -
Asian Journal of Surgery Oct 2023An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double...
Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy.
AIM
An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion.
METHODS
118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed.
RESULTS
There were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P < 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P < 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P < 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P < 0.05).
CONCLUSIONS
The Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.
Topics: Humans; Gastric Stump; Jejunum; Gastrostomy; Quality of Life; Stomach Neoplasms; Gastrectomy; Esophagus; Anastomosis, Surgical; Treatment Outcome
PubMed: 36456439
DOI: 10.1016/j.asjsur.2022.11.067 -
PloS One 2022Recurrent obscure gastrointestinal bleeding (OGIB) in patients with chronic kidney disease is a challenge often faced by physicians, given the need for repeated...
Clinical characteristics and risk factors for rebleeding in uremic patients with obscure gastrointestinal bleeding undergoing deep enteroscopy: A multi-center retrospective study in Taiwan.
BACKGROUND/PURPOSE
Recurrent obscure gastrointestinal bleeding (OGIB) in patients with chronic kidney disease is a challenge often faced by physicians, given the need for repeated hospitalizations, multiple extensive examinations, limited treatment options, and high medical costs. The purpose of this study was to identify the clinical characteristics of uremic patients undergoing deep enteroscopy for OGIB and analyze the risk factors for rebleeding in these patients after undergoing single-balloon enteroscopy (SBE).
METHODS
Out of 765 patients with OGIB who underwent 1004 procedures of SBE in four teaching hospitals, 78 uremic patients with OGIB were enrolled. Clinical characteristics and endoscopic findings were collected, and multiple variables were analyzed to determine the risk of rebleeding after SBE.
RESULTS
The diagnostic yield was 75.6%, and the rebleeding rate was 29.5% in the enrolled uremic patients. The most common etiology was angiodysplasia (74.6%) and the most common site was the jejunum (50.8%). The endoscopic intervention rate was 62.8% and most patients were treated with argon plasma coagulation (75.6%). Among the eight patients with valvular heart disease (VHD), four (50%) had severe aortic stenosis, and the remaining had non-aortic stenosis-VHD. VHD (p < 0.05) and angiodysplasia (p < 0.05) were both associated with a higher rebleeding rate.
CONCLUSION
VHD may be an independent risk factor associated with rebleeding after SBE in uremic patients with OGIB. Moreover, uremic patients with angiodysplasia-related bleeding appear to have a higher rebleeding rate than those with alternative causes of bleeding.
Topics: Humans; Retrospective Studies; Taiwan; Constriction, Pathologic; Gastrointestinal Hemorrhage; Angiodysplasia; Risk Factors; Colonic Diseases; Autonomic Nervous System Diseases; Heart Valve Diseases
PubMed: 36449459
DOI: 10.1371/journal.pone.0277434 -
Current Oncology (Toronto, Ont.) Nov 2022Robotic surgery is increasingly gaining importance. While initial results suggest an advantage of the robotic over the minimally invasive approach in patients with...
Robotic surgery is increasingly gaining importance. While initial results suggest an advantage of the robotic over the minimally invasive approach in patients with gastric cancer, definitive proof of its superiority has yet to be provided. There are numerous approaches to recreate a gastric reservoir after a total gastrectomy. However, a major disadvantage of most conventional reconstructions are long term effects such as dumping syndrome, afferent loop syndrome and poor nutrition intake with severe impact on the patient quality of life. The jejunal pouch reconstruction is a beneficial reconstruction, which provides a larger reservoir capacity after gastrectomy and prevents anastomotic stenosis and dumping syndrome. The completely intercorporeal approach with a Pfannenstiel incision instead of an unfavorable midline incision can potentially decrease delayed complications such as incision hernias. With the increased deployment of robotic surgery, a complete intercorporeal reconstruction is now possible without major increase in operating time or further technical weak points. We provide for the first time a detailed technical explanation of the completely intercorporeal robotic jejunal pouch reconstruction after gastrectomy.
Topics: Humans; Anastomosis, Roux-en-Y; Quality of Life; Robotic Surgical Procedures; Gastrectomy; Jejunum
PubMed: 36421331
DOI: 10.3390/curroncol29110678 -
Internal Medicine (Tokyo, Japan) Jul 2023Heyde's syndrome is a disease in which patients with aortic stenosis (AS) bleed from angiodysplasia. An 80-year-old woman with a history of severe AS was referred to our...
Heyde's syndrome is a disease in which patients with aortic stenosis (AS) bleed from angiodysplasia. An 80-year-old woman with a history of severe AS was referred to our hospital with melena and anemia. The patient underwent jejunal resection after repeated blood transfusions. A pathological examination revealed angiodysplasia, and the patient's plasma lacked high-molecular-weight von Willebrand factor (VWF) multimers, leading to the diagnosis of Heyde's syndrome. The patient underwent transcatheter aortic valve implantation (TAVI) one year after the diagnosis, and the VWF index recovered. This is a valuable case in which the pathological analysis of angiodysplasia associated with Heyde's syndrome was possible.
Topics: Female; Humans; Aged; Aged, 80 and over; von Willebrand Factor; Gastrointestinal Hemorrhage; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement; Colonic Diseases; Angiodysplasia; von Willebrand Diseases
PubMed: 36418102
DOI: 10.2169/internalmedicine.0888-22