Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases.
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Twenty animals with benign esophageal strictures are presented. Most of the esophageal strictures were thought to be related to gastroesophageal reflux during ovariohysterectomy and were located at the distal portion of the thoracic esophagus (caudal to the base of the heart). For the dilation procedure, the endoscope tip or a balloon catheter was used and the outcome was generally considered to be good. The endoscope tip was an adequate instrument for dilation in some cases. (+info)
Double endoscopic intraluminal operation for upper digestive tract diseases: proposal of a novel procedure.
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BACKGROUND AND OBJECTIVE: Endoscopic treatment of digestive tract diseases, such as early esophageal and gastric neoplasia, has become increasingly popular in recent years as an alternative to surgical procedures in the hope of providing an improved quality of life for these patients. However, one of the limitations of a conventional endoscopic mucosal resection, such as an aspiration mucosectomy and a strip biopsy, has been the size of the lesions to be resected. Both an aspiration mucosectomy and strip biopsy are useful variants for removing flat lesions measuring less than 20 mm in maximal diameter. To overcome such limitations, we devised a double endoscopic intraluminal operation (DEILO), which enables us to resect mucosal lesions by using 2 fine endoscopes and monopolar shears. METHODS: DEILO was performed on patients with esophageal and gastric lesions measuring up to 40 mm in diameter. This novel technique is characterized by the use of 2 endoscopes (one for lifting the lesion and the other for cutting the lesions) inserted into the esophagus or stomach through an overtube. A mucosal resection is then performed by dissecting the mucosal margin with newly developed monopolar shears, thereby separating the mucosa from the submucosa. RESULTS: A total of 25 lesions in the esophagus (8 lesions) and stomach (17 lesions) were resected by DEILO. The sizes of the esophageal lesions ranged from 8 to 40 mm in diameter (mean, 21.1 mm) whereas gastric lesions ranged from 8 to 30 mm (mean, 13.3 mm) in diameter, and histopathologic examinations revealed the resection margin to be clear and without any tumor. No complications or instances of recurrence were observed in this series. CONCLUSIONS: DEILO is considered to be feasible for the mucosal resection of esophageal and gastric lesions measuring more than 10 mm in diameter without submucosal invasion, whereas conventional endoscopic mucosal resection is indicated for such lesions measuring less than 10 mm in size. (+info)
A novel diagnostic tool for detecting oesophageal pathology: the PillCam oesophageal video capsule.
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BACKGROUND: Gastro-oesophageal reflux disease is a common entity. Erosive oesophagitis, ulcers and Barrett's oesophagus, which is found in up to 10% of gastro-oesophageal reflux disease patients, characterize severe gastro-oesophageal reflux disease. Patients with Barrett's oesophagus have 0.5% per patient-year risk of developing oesophageal adenocarcinoma. Currently, it appears that a minority of those at risk for Barrett's oesophagus undergo screening in part because of the costs associated with endoscopy as well as risks of sedation. A new ingestible PillCam oesophageal capsule developed may offer an alternative office-based approach to visualize the oesophagus without sedation. AIM: To compare the oesophageal capsule to conventional upper endoscopy for detection of oesophageal pathologies. METHODS: A newly developed capsule, which acquires video images from both ends of the device at a 4 frame/s rate, was ingested by 17 fasting patients with suspected oesophageal disorders. An ingestion procedure aimed to lengthen capsule transit time in the oesophagus was utilized. Subsequently, a standard upper endoscopy was carried out. The investigator interpreting the capsule findings was blinded to the endoscopy results and vice versa. Patients with dysphagia, known Zenker's diverticulum, intestinal obstruction, cardiac pacemaker or pregnancy were excluded. RESULTS: Twelve of the 17 patients examined had oesophageal findings using the endoscope as the gold standard. Capsule endoscopy identified oesophageal pathology in all 12 of these patients and an additional pathology in one patient that was missed during endoscopy. For the purpose of this study, this finding was regarded as a false-positive. The mean oesophageal passage time was 189 +/- 280 s. The positive predictive value of the oesophageal capsule for any oesophageal pathology was 92% and the negative predictive value was 100%. Oesophageal capsule sensitivity was 100% and specificity 80%. There were neither swallowing difficulties nor complications subsequent to ingestion in any subjects. Seventy-three percentage of patients preferred the oesophageal capsule procedure on conventional endoscopy. Only one patient preferred oesophagogastroduodenoscopy. CONCLUSIONS: This pilot study has shown that oesophageal capsule endoscopy is an accurate, convenient, safe and well-tolerated method to screen patients for significant oesophageal disorders. No sedation is required, which may allow simple, office-based screening and assessment. Further, large-scale studies are necessary to more fully assess this novel diagnostic tool. (+info)
Removal of press-through-packs impacted in the upper esophagus using an overtube.
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Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. However, removals of foreign bodies in the upper esophagus are very difficult, especially if they have sharp edges, such as press-through-packs (PTPs). We experienced four cases of the impacted PTPs in the upper esophagus which was successfully extracted endoscopically with the overtube. Because two edges of PTPs were so firmly impacted in the esophageal wall in all cases, the PTPs were not movable in the upper esophagus. However, after insertion of the overtube, PTPs became movable and were successfully extracted and no serious complications occurred after extraction of PTPs. In one case, insertion of the overtube rapidly expanded the upper esophagus and PTP progressed to the gastric cavity and it could be extracted with the endoscopic protector hood. The endoscopic removal with the overtube was a simple, safe and effective technique for the removal of the impacted PTPs in upper esophagus. (+info)
The management of foreign bodies in the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO).
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Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: a proposal for developing countries.
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AIM: To assess the cost savings of reloading the multiband ligator in endoscopic esophageal variceal ligation (EVL) used on the same patient for subsequent sessions. METHODS: This single centre retrospective descriptive study analysed patients undergoing variceal ligation at a tertiary care centre between 1st January, 2003 and 30th June, 2006. The multiband ligator was reloaded with six hemorrhoidal bands using hemorrhoidal ligator for the second and subsequent sessions. Analysis of cost saving was done for the number of follow-up sessions for the variceal eradication. RESULTS: A total of 261 patients underwent at least one session of endoscopic esophageal variceal ligation between January 2003 and June 2006. Out of 261, 108 patients (males 67) agreed to follow the eradication program and underwent repeated sessions. A total of 304 sessions was performed with 2.81 sessions per patient on average. Thirty-two patients could not complete the program. In 76 patients (70%), variceal obliteration was achieved. The ratio of the costs for the session with reloaded ligator versus a session with a new ligator was 1:2.37. Among the patients who completed esophageal varices eradication, cost saving with reloaded ligator was 58%. CONCLUSION: EVL using reloaded multiband ligators for the follow-up sessions on patients undergoing variceal eradication is a cost saving procedure. Reloading the ligator thus is recommended especially for developing countries where most of the patients are not health insured. (+info)
The Sengstaken-Blakemore tube: uses and abuses.
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Due to its complications including oesophageal and gastric ulceration and perforation, the Sengstaken-Blakemore tube is used far less commonly in this new millennium where endoscopic intervention is available. We discuss in a 53-year-old Indian woman an unusual life-saving use of the Sengstaken-Blakemore tube in preventing fatal exsanguination from an aortoesophageal fistula, as well as rare but devastating consequences of the insertion and residence of the Sengstaken-Blakemore tube, including acute airway obstruction and bronchoesophageal fistula. (+info)
Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum.
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A Killian-Jamieson diverticulum (KJD) is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap (the Killian-Jamieson space) below the cricopharyngeal muscle and lateral to the longitudinal muscle of the esophagus. To date, only surgical treatment has been recommended for a symptomatic KJD due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury. Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices. We present here a case of a symptomatic KJD that was successfully treated with the flexible endoscopic diverticulotomy using two new devices. An isolated-tip needle-knife papillotome (Iso-Tome) was used for the dissection of the tissue bridge of the diverticulum. And a flexible overtube with a modified distal end (a fitted overtube) was used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our successful experience suggests that the flexible endoscopic diverticulotomy with the use of appropriate endoscopic devices can be a safe and effective method for the treatment of a symptomatic KJD. (+info)