Esophagocardioplasty with gastric patch in the treatment of achalasia

Result of operative treatment in 196 cases of achalasia was reviewed. The procedures employed include cardiolysis, Heller's extramucosal myotomy, Wendel's cardioplasty, Heyrovsky's esophagocardiostomy, with and without pyloroplasty, cardiac resection and esophagocardioplasty with gastric patch. Follow-up study on 166 cases revealed that the result was classified as good in 99 cases or 59.6 per cent and improved in 46 cases or 27.7 per cent. Overall satisfactory result was obtained in 87.3 per cent. When the result was broken down to groups following three classifications, i. e. according to X-ray, endoscopic and manometric findings, the interesting correlation emerged. Heller's myotomy and esophagocardioplasty with gastric patch gave best results in early stage of achalasia, while in later stage the latter procedure seems to be the operation of choice.     

Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum

OBJECTIVES/HYPOTHESIS: Endoscopic staple-assisted esophagodiverticulostomy (ESED) is a newly described method of surgically correcting Zenker's diverticulum. Initial reports on the ease and success of the surgery have been quite enthusiastic, making it seem the procedure of choice. We initiated the procedure in an algorithm of treatment of Zenker's diverticulum, to further explore the feasibility and outcome of this new technique. STUDY DESIGN: This is a case series of 23 patients with Zenker's diverticulum who have undergone surgical repair. For each patient, an attempt at ESED was made. If unsuccessful, an open approach was then taken. RESULTS: Seven of 23 patients (30%) were unable to be treated with ESED because of inability to expose the diverticulum or unfavorable anatomy of the diverticulum itself. Of the remaining 16 patients, ESED was successful in resolving the symptoms of diverticulum in 14 (87%). Two patients (13%) were somewhat improved but had persistent dysphagia. No significant complications occurred. All patients resumed oral diet within the first 24 hours after surgery. CONCLUSION: Esophagodiverticulostomy is an excellent method of surgically correcting Zenker's diverticulum in many patients, but anatomical considerations may prevent its use, making open approaches of continued importance in a surgeon's armamentarium.     

1732例纤维食管镜的临床应用价值

本院自1983年1月～1987年底行纤维食管镜检查1732例,除良性病变外,检出食管癌862例,贲门癌369例;活检阳性率分别为88.6％和84％。本文认为内镜检查须进一步提高肉眼识别力,消灭视觉死角,对不同类型肿物选取不同位置及深度进行咬检以提高活检阳性率。活检病理阴性或可疑时不应轻易否定内镜诊断。本文强调内镜和X线检查互补的重要性,认为早期诊断最重要的手段是镜检;而管腔严重狭窄或阻塞者常需X线造影来弥补其不足。指出早期诊断必须“四环”紧密配合。即症状 X线 镜检 病理,才能极大地发挥内镜检查的优越性。     

In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees

Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure.     

Long-term outcome of esophageal mucosal squamous cell carcinoma without lymphovascular involvement after endoscopic resection

BACKGROUND.

Esophageal cancer is an aggressive cancer with a reported 3‐year survival of 20%. However, early‐stage esophageal cancer can be cured by endoscopic resection (ER). The long‐term survival of esophageal mucosal squamous cell carcinoma after ER was investigated by calculating the standard mortality rate (SMR).

METHODS.

From January 1995 to December 2004, 110 patients with 138 esophageal mucosal squamous cell carcinomas without lymphovascular involvement were treated by ER. Long‐term survival after ER was compared with that in the general population by calculating SMR. Subgroup analysis of patients without second primary cancer diagnosed within 1 year before ER (subgroup A) was also performed.

RESULTS.

A total of 108 patients (98.2%) were followed‐up completely, with a mean observation period of 4.7 (0.4–11.3) years. The cumulative 5‐year survival rate of all patients and subgroup A was 79.5% and 86.6%, respectively. Overall mortality (SMR, 1.68; 95% confidence interval [CI], 1.05–2.55) and mortality from malignant tumor (SMR, 3.14; 95% CI, 1.79–5.09) was significantly higher than that in the general population. SMR of esophageal cancer was high, although it was not significantly different from that in the general population (SMR, 4.82; 95% CI, 0.06–26.81). In subgroup A overall mortality (SMR, 0.86; 95% CI, 0.41–1.57) was similar to that in the general population.

CONCLUSIONS.

High overall mortality in patients with esophageal mucosal cancer after ER was mainly due to elevated mortality from second primary cancer. Favorable mortality in subgroup A indicates the efficiency of ER as a curative treatment for esophageal mucosal cancer. Cancer 2008. © 2008 American Cancer Society.     

The transnasal esophagoscopy documentation dilemma

OBJECTIVE: To determine radiographically the anatomic length difference between the nasal and oral aerodigestive tracts and to clarify gaps in the literature regarding standardized landmark measurements and documentation techniques in transnasal esophagoscopy, as opposed to traditional transoral esophagoscopy. STUDY DESIGN: This is a prospective radiographic cohort study. METHODS: Digital computerized tomography measurement techniques were used to determine the difference in length between the nasal and oral aerodigestive tracts. Using sagittal plane images from consecutive patients, the mean nares-cricoid (NC) distance, upper incisor-cricoid (IC) distance, and their mean differences were determined. Male, female, and overall distances and differences were calculated. Standard deviations, 95% confidence intervals, and 90% prediction intervals were also calculated. Mean difference data were applied to reported standard oral esophagoscopy landmark measurements to convert to standard landmark measurements from the nares. RESULTS: Overall mean NC and IC distances were 175.4 mm and 147.5 mm, respectively. For males, these mean distances were 185.5 mm and 155.0 mm, respectively. For females, these mean distances were 165.3 mm and 140.0 mm, respectively. Overall mean NC to IC difference was 27.9 mm. The mean NC to IC difference for males and females was 30.5 mm and 25.2 mm, respectively. CONCLUSIONS: Historically, landmark and report measurements in esophagoscopy have been measured and standardized from the upper incisor. This study demonstrates and clarifies the inherent anatomic length difference of the nasal and oral aerodigestive tracts and the resultant documentation dilemma produced by transnasal esophagoscopy techniques. These data provide easy conversion of esophagoscopy measurements reported from the incisors or nares, providing better communication between endoscopists of different disciplines and techniques.