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Latorre-Rodríguez AR, Mittal SK. Brief guidelines for beginners on how to perform and analyze esophageal high-resolution manometry. Gastroenterol Hepatol 2024; 47:661-671. [PMID: 38266818 DOI: 10.1016/j.gastrohep.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
High-resolution manometry (HRM) is a diagnostic tool for surgeons, gastroenterologists and other healthcare professionals to evaluate esophageal physiology. The Chicago Classification (CC) system is based on a consensus of worldwide experts to minimize ambiguity in HRM data acquisition and diagnosis of esophageal motility disorders. The most updated version, CCv4.0, was published in 2021; however, it does not provide step-by-step guidelines (i.e., for beginners) on how to assess the most important HRM metrics. This paper aims to summarize the basic guidelines for conducting a high-quality HRM study including data acquisition and interpretation, based on CCv4.0, using Manoview ESO analysis software, version 3.3 (Medtronic, Minneapolis, MN).
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Affiliation(s)
- Andrés R Latorre-Rodríguez
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Grupo de Investigación Clínica, Bogotá D.C., Colombia
| | - Sumeet K Mittal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA.
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Conca F, Rosso N, López Grove R, Savluk L, Santino JP, Ulla M. Esophageal tumors: The keys to diagnosis by pneumo-computed tomography. Radiologia (Engl Ed) 2023; 65:546-553. [PMID: 38049253 DOI: 10.1016/j.rxeng.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/28/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. CONCLUSION Malignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.
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Affiliation(s)
- F Conca
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - N Rosso
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - R López Grove
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - L Savluk
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J P Santino
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Ulla
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Alcalá-González LG, Jimenez-Masip A, Relea-Pérez L, Barber-Caselles C, Barba-Orozco E. Underlying etiology associated with the diagnosis of absent contractility on high resolution esophageal manometry. Gastroenterol Hepatol 2023; 46:10-16. [PMID: 35278504 DOI: 10.1016/j.gastrohep.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/29/2021] [Accepted: 03/01/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Absent contractility is considered a disorder of peristalsis. The literature about the etiology and clinical characteristics is scarce and the evidence on systemic diseases associated with this esophageal disorder is limited. Therefore, we aimed to determine the etiology of absent contractility in our population using the clinical algorithm recently described in the literature. METHODS We conducted a retrospective, descriptive study at a single tertiary hospital of all patients diagnosed of absent contractility between May 2018 and February 2020. Data on demographic characteristics, medication, comorbidities, and laboratory and paraclinical tests were recorded from clinical records. RESULTS A total of 72 patients with absent contractility were included for analysis. There was a predominance of female sex (n=43, 59.7%), with a mean age of 55.4 (±15.0) years. We identified a systemic disorder associated with absent contractility in 64 (88.9%) patients. From these, 31 (43.1%) patients were diagnosed with a systemic autoimmune disease, 26 (36.1%) patients were considered to have absent contractility secondary to pathological exposure to acid-reflux and 15 (20.8%) patients were diagnosed with other non-autoimmune systemic disorders. In the remaining eight (11.1%) patients, there were no underlying systemic disorders that could justify the diagnosis of absent contractility. CONCLUSIONS A systematic approach to search for an underlying cause in patients diagnosed with absent contractility is warranted. Up to 90% of patients with absent contractility have a systemic disorder associated with this condition.
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Affiliation(s)
- Luis Gerardo Alcalá-González
- Department of Gastroenterology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Facultad de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Alba Jimenez-Masip
- Department of Gastroenterology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Lucia Relea-Pérez
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Claudia Barber-Caselles
- Department of Gastroenterology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Facultad de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Elizabeth Barba-Orozco
- Neurogastroenterology Motility Unit, Department of Gastroenterology, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Hani A, Zuluaga C, Costa V, Leguizamo AM, Puentes G, Ardila AF, Achem SR. Jackhammer esophagus: Prevalence and demographic, clinical, and manometric characteristics. Rev Gastroenterol Mex (Engl Ed) 2020; 85:421-427. [PMID: 31917034 DOI: 10.1016/j.rgmx.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND AIMS Jackhammer esophagus is a recently identified motility disorder. Experience with the novel pathologic condition has been reported in different studies but there is little information on the subject in Latin America. Our case series conducted in Bogota, Colombia, describes the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics. MATERIALS AND METHODS A retrospective, observational, cross-sectional study included consecutive patients diagnosed with jackhammer esophagus that were referred for high-resolution esophageal manometry. Their clinical and manometric records were reviewed, and the pertinent information for the present study was collected. RESULTS Within the study period, 6,445 patients were evaluated with esophageal manometry, 27 of whom were diagnosed with jackhammer esophagus (prevalence of 0.42%). The majority of those patients were women (n=17, 63%) in the sixth decade of life. The most common symptom was regurgitation (n=17, 63%), followed by dysphagia (n=15, 56%). The mean distal contractile integral was 9,384 (5,095-18,546) mmHg·s·cm. Dysphagia was more common in patients >60 years of age (79%, p <.01) and regurgitation was more frequent in patients <60 years of age (92%, p <.03). CONCLUSIONS The present study is the first to characterize the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics in Latin American patients. The prevalence of jackhammer esophagus in our study population was considerably lower than that reported in international case series. Our findings suggest that there are important geographic differences in the epidemiology and clinical presentation of jackhammer esophagus, compared with data from other international centers.
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Affiliation(s)
- A Hani
- Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C Zuluaga
- Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - V Costa
- Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - A M Leguizamo
- Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - G Puentes
- Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - A F Ardila
- Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - S R Achem
- Departamento de Gastroenterología, Mayo College of Medicine, Mayo Clinic, Jacksonville, Florida, EE. UU..
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Panichelli L, Salinas W, Napolitano D, Signorini F, Muñoz J. Intramural esophageal bronchogenic cyst. CIR CIR 2020; 88:94-97. [PMID: 32963406 DOI: 10.24875/ciru.20001701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antecedentes Los quistes broncogénicos esofágicos son sacos cerrados originados de brotes anormales del tubo -traqueobronquial primitivo. Estas lesiones suelen ser asintomáticas, por lo que pueden hallarse incidentalmente o pueden causar síntomas por compresión de estructuras adyacentes. Son lesiones muy poco comunes; se han publicado unos 23 casos en adultos. Caso clínico Presentamos el caso de un varón de 44 años con un cuadro de tos de larga duración, sin otro síntoma. Para descartar las causas más comunes de sus síntomas se realizan estudios que objetivan la presencia de una lesión intramural de 40 × 43 mm. Se realiza videotoracoscopia para su resección y estudio, resultando ser un quiste broncogénico. Background Bronchogenic cysts are close sacks originated from abnormal development of the tracheobronchial tree. These lesions are usually asymptomatic or can cause symptoms, by compression of adjacent structures. This pathology is so unusual that there are only about 23 cases published in adults. Case report We report a case of a 44 year-old man with persistent cough, without other symptom. The most common causes for his symptoms were ruled out, so imaging studies were made, showing at the medial portion of the esophagus, located intramural a 40 × 43 mm ovoid lesion. Resected by video-assisted thoracoscopy for its study. With findings attributable to bronchogenic cyst.
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Affiliation(s)
- Lucas Panichelli
- Servicio de Cirugía General, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Walter Salinas
- Servicio de Cirugía General, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Daniel Napolitano
- Servicio de Cirugía General, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Franco Signorini
- Servicio de Cirugía General, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Juan Muñoz
- Servicio de Cirugía General, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Morales-Maza J, Cisneros-Correa J, Del Angel-Millán G, Rodríguez-Quintero JH, León-Cabral P, Cortés-González R. Total esophageal replacement by transmediastinal transposition of the stomach in a gastrointestinal stromal tumor of the thoracic esophagus: a rare surgical case report. CIR CIR 2019; 87:682-687. [PMID: 31631187 DOI: 10.24875/ciru.19000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. A rare site of localization of these tumors is the esophagus. Evidence-based consensus regarding the type of surgery for patients with esophageal GIST remains unclear. Clinical case A female without history of diseases experienced dysphagia, weight loss (6 kg) and malaise. Computed tomography revealed thickening of the esophagus. During the endoscopic ultrasonography a localized lesion was observed in the esophagus that depended on the muscularis propria. We opted to treat with an esophagectomy with replacement by transmediastinal transposition of the stomach. Patient recovered well from the surgery and she was discharged home in stable condition in post-operative day seven. At 6 months she has no symptoms. Conclusion This case illustrates the clinical presentation of an esophageal GIST which represents only 1% of all sites where GISTs have been reported; open surgery was successfully performed with minimal morbidity, complete resolution of symptoms and improvement of the patient's quality of life. Esophagectomy with replacement by transmediastinal transposition of the stomach should be performed when the center has experience to do so with minimal morbidity and mortality.
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Affiliation(s)
- Jesús Morales-Maza
- Departamento de Cirugía General. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Julio Cisneros-Correa
- Departamento de Cirugía General. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Gabriela Del Angel-Millán
- Departamento de Cirugía General. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Jorge H Rodríguez-Quintero
- Departamento de Cirugía General. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Pablo León-Cabral
- Departamento de Cirugía General. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Rubén Cortés-González
- Departamento de Cirugía Oncológica. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Munitiz V, Ortiz A, Ruiz de Angulo D, F Martinez de Haro L, Parrilla P. Results of the different surgical options for the treatment of cancer of the esophagogastric junction: Review of the evidence. Cir Esp 2019; 97:445-50. [PMID: 31027834 DOI: 10.1016/j.ciresp.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/21/2022]
Abstract
There is significant controversy in the management of cardiac cancer. It seems unanimous that Siewert type I tumors be operated on as cancer of the esophagus and Siewert type III as gastric cancer. However, for "true" cancer of the gastric cardia or Siewert II, the authors do not agree. There is the obvious need for free proximal and distal margins, as well as correct lymphadenectomy. For some, esophagectomy is necessary to perform correct radical oncological surgery, but other authors defend that an abdominal approach is sufficient to perform total gastrectomy and distal esophagectomy. Recent and older papers published do not clarify this issue, and their results are contradictory. Chemotherapy prior to surgery can reduce the size of the tumor and the presence of lymphadenopathies.
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Ceniceros-Cabrales AP, Sánchez-Fernández P. [Esophageal bronchogenic cyst: an uncommon cause of dysphagia in adults. Case report and literature review]. CIR CIR 2018; 86:187-190. [PMID: 29809178 DOI: 10.24875/ciru.m18000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Backgronund Bronchogenic cysts result from abnormal budding of the primitive tracheobronchial tube and are rare congenital cystic lesions. The location of the cyst depends on the embryological stage of abnormal budding. Although periesophageal bronchogenic cysts have been frequently reported, a completely intramural cyst is very rare. Clinical case A 42-year-old female patient, a three-month course with retrosternal pain associated with food intake, accompanied by intermittent dysphagia to solids. Esophagogram, high resolution thoracic tomography and endoscopic ultrasound are performed, concluding a probable esophageal bronchogenic cyst. Resection is performed by video-assisted thoracic surgery, without complications. Patient presents with adequate evolution and complete remission of the symptomatology. Conclusion Bronchogenic cysts of the esophageal wall are extremely uncommon lesions. Its surgical treatment is indicated to be symptomatic; video-assisted thoracoscopic surgery resection is of choice, with excellent long-term results and minimal morbidity.
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Affiliation(s)
- Ana P Ceniceros-Cabrales
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Patricio Sánchez-Fernández
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Alonso Lárraga JO, Flores Carmona DY, Hernández Guerrero A, Ramírez Solís ME, de la Mora Levy JG, Sánchez Del Monte JC. Fully covered stents versus partially covered stents for palliative treatment of esophageal cancer: Is there a difference? Rev Gastroenterol Mex (Engl Ed) 2018; 83:228-233. [PMID: 29496269 DOI: 10.1016/j.rgmx.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND AIMS Malignant dysphagia is difficulty swallowing resulting from esophageal obstruction due to cancer. The goal of palliative treatment is to reduce the dysphagia and improve oral dietary intake. Self-expandable metallic stents are the current treatment of choice, given that they enable the immediate restoration of oral intake. The aim of the present study was to describe the results of using totally covered and partially covered esophageal stents for palliating esophageal cancer. MATERIALS AND METHODS A retrospective study was conducted on patients with inoperable esophageal cancer treated with self-expandable metallic stents. The 2 groups formed were: group A, which consisted of patients with a fully covered self-expandable stent (SX-ELLA®), and group B, which was made up of patients with a partially covered self-expandable stent (Ultraflex®). RESULTS Of the 69-patient total, 50 were included in the study. Group A had 19 men and 2 women and their mean age was 63.6 years (range 41-84). Technical success was achieved in 100% (n=21) of the cases and clinical success in 90.4% (n=19). Group B had 24 men and 5 women and their mean age was 67.5 years (range 43-92). Technical success was achieved in 100% (n=29) of the cases and clinical success in 89.6% (n=26). Complications were similar in both groups (33.3 vs. 51.7%). CONCLUSION There was no difference between the 2 types of stent for the palliative treatment of esophageal cancer with respect to technical success, clinical success, or complications.
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Affiliation(s)
- J O Alonso Lárraga
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México.
| | - D Y Flores Carmona
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - A Hernández Guerrero
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - M E Ramírez Solís
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - J G de la Mora Levy
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - J C Sánchez Del Monte
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
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Garcia-Perez R, Munitiz V, Martinez-Caceres CM, Ruiz de Angulo D, Ortiz A, F Martinez de Haro L, Navas D, Parrilla P. Histopathological and Immunohistochemical Analysis of the Use of Collagen Dressing as a Reinforcement of Esophagic Anastomosis in a Rat Experimental Model. Cir Esp 2017; 95:588-593. [PMID: 29117903 DOI: 10.1016/j.ciresp.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/11/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION One of the most severe complications after esophaguectomy is anastomotic dehiscence. The use of collagen sponges could be an effective way to resolve this complication. Our objective was to perform an experimental model of esophageal anastomosis in rats to study these mechanisms. METHODS A total of 50 Sprague-Dawley rats were used divided into 2 groups, Tachosil® group (n=25) and control group (n=25). After the section of the abdominal esophagus a single-layer esophago-gastric anastomosis was performed reinforced with 1cm of Tachosil® wrapping the anastomosis in group 1. A functional study was performed using manometry as well as histopathological and immunohistochemical studies for angiogenic, fibrogenic and growth factors. RESULTS The mortality in our series was 8% in the collagen dressing group, compared to 36% in the control group. When esophageal manometry was performed, the dehiscence pressure was higher in the reinforced anastomosis, On microscopical analysis, in the collagen dressing group a profuse inflammatory reaction with abundant neutrophils and macrophages surrounded by a connective matrix with fibroblasts and blood vessels was observed, The expression of VEGF, FGF1 and FGF2 was noticeably higher in the collagen dressing group. CONCLUSIONS These results show that the application of collagen dressing facilitates tissue reparation phenomena, and therefore could be very useful as a reinforcement of esophago-gastric anastomosis to prevent dehiscence.
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Affiliation(s)
- Rocio Garcia-Perez
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Vicente Munitiz
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España.
| | - Carlos Manuel Martinez-Caceres
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - David Ruiz de Angulo
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Angeles Ortiz
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Luisa F Martinez de Haro
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Diana Navas
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Pascual Parrilla
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
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Pérez Y López N, Lugo-Zamudio G, Barbosa-Cobos RE, Wong-Lam A, Torres-López E. Frequency of motor alterations detected through manometry in patients with esophageal symptoms and scleroderma. Rev Gastroenterol Mex 2017; 82:193-5. [PMID: 28268032 DOI: 10.1016/j.rgmx.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/26/2016] [Accepted: 10/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Scleroderma can present with esophageal involvement causing important morbidity. AIMS To describe the manometric findings and clinical characteristics of patients with scleroderma and esophageal symptoms. MATERIALS AND METHODS Patients with scleroderma and esophageal symptoms were evaluated through esophageal manometry within the time frame of one year. Descriptive statistics were carried out and the continuous variables were expressed as means and standard deviation. Frequencies were expressed as percentages. RESULTS The study included 24 female patients with a mean age of 53.5 years and mean disease progression of 7.84 years. The most frequent findings were short and hypotonic lower esophageal sphincter (mean length 1.58cm and mean tone 9.49mmHg) and ineffective esophageal motility (mean non-transmitted waves 92.91%, mean effective primary peristalsis 40.05%, and mean amplitude 13.11mmHg). The most frequent symptom was dysphagia. CONCLUSIONS Scleroderma is associated with lower esophageal sphincter alterations and symptomatic ineffective esophageal motility.
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Encinas de la Iglesia J, Corral de la Calle MA, Fernández Pérez GC, Ruano Pérez R, Álvarez Delgado A. Esophageal cancer: anatomic particularities, staging, and imaging techniques. Radiologia 2016; 58:352-65. [PMID: 27469407 DOI: 10.1016/j.rx.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/30/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.
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Affiliation(s)
| | | | - G C Fernández Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | - R Ruano Pérez
- Servicio de Medicina Nuclear, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - A Álvarez Delgado
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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13
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Thoguluva Chandrasekar V, Vennalaganti P, Sharma P. Management of Barrett's esophagus: From screening to newer treatments. Rev Gastroenterol Mex 2016; 81:91-102. [PMID: 26964773 DOI: 10.1016/j.rgmx.2015.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/15/2015] [Indexed: 02/07/2023]
Abstract
Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.
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Affiliation(s)
| | - P Vennalaganti
- Department of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas city, Missouri, EE. UU
| | - P Sharma
- Department of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas city, Missouri, EE. UU..
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14
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Rodríguez-D'Jesús A, Gordillo J, Uchima H, Araujo I, Saperas E, Elizalde I, Fernández-Esparrach G. [Prevalence and epidemiology of Barrett's esophagus in the province of Barcelona]. Gastroenterol Hepatol 2014; 37:397-401. [PMID: 24674710 DOI: 10.1016/j.gastrohep.2014.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. OBJECTIVES To determine the prevalence of BE and its epidemiological characteristics in our population. PATIENTS AND METHODS We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. RESULTS Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9 ± 15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. CONCLUSION The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.
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Affiliation(s)
| | - Jordi Gordillo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Esteban Saperas
- Servicio de Digestivo, Hospital General de Catalunya, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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15
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Granel-Villach L, Fortea-Sanchis C, Martínez-Ramos D, Paiva-Coronel GA, Queralt-Martín R, Villarín-Rodríguez A, Salvador-Sanchis JL. [Boerhaave's syndrome: a review of our experience over the last 16 years]. Rev Gastroenterol Mex 2014; 79:67-70. [PMID: 24656512 DOI: 10.1016/j.rgmx.2013.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Report our experience in the diagnosis and treatment of Boerhaave syndrome by retrospective study from 1997 to 2013. PATIENTS AND METHODS A retrospective study was conducted covering the time frame of 1997 to 2013. RESULTS There were a total of 5 men (71%) and 2 women (29%) and the mean age was 54 years (range: 33-80 years). Diagnosis was made through computed tomography scan in 5 cases (71%) and esophagogram in 2 cases (19%). Six patients (86%) had emergency surgery, whereas one case (14%) was managed conservatively. The surgical technique employed was primary suture and repair in 4 patients (67%) and esophageal resection and subsequent cervical esophagostomy in 2 patients (33%). CONCLUSIONS Boerhaave's syndrome is a clinically rare entity with an elevated mortality rate. Therefore, a high degree of suspicion is necessary for making the diagnosis and providing early treatment that can result in improved outcome.
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Affiliation(s)
- L Granel-Villach
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España.
| | - C Fortea-Sanchis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España
| | - D Martínez-Ramos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España
| | - G A Paiva-Coronel
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España
| | - R Queralt-Martín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España
| | - A Villarín-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España
| | - J L Salvador-Sanchis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, España
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