silicon and Esophageal-Stenosis

A benign gastroesophageal anastomotic stricture occurs in up to 42% of patients after transhiatal esophagectomy for esophageal cancer. Management of anastomotic strictures may require extended periods of serial endoscopic dilation, with significant risk, cost, and inconvenience for the patient.. To determine if placement of removable self-expandable polyester silicon-covered (Polyflex) stents (SEPSs) prolonged the interval between endoscopic interventions in the management of persistent anastomotic stricture.. Retrospective cohort study.. National Cancer Institute designated comprehensive cancer center.. Eight patients after a transhiatal esophagectomy referred for management of benign persistent anastomotic strictures.. Serial balloon and bougie dilations and SEPS placement.. The interval between endoscopic interventions and the number of endoscopic interventions before and after SEPS placement.. Over a 365-day period, 13 SEPS were placed in 8 patients with benign persistent anastomotic strictures after a transhiatal esophagectomy. A SEPS placement delayed the interval between endoscopic interventions from a mean of 7 days before stent insertion to 62 days after insertion (P < .008). The median number of preinsertion interventions was 4 and was reduced to 1 after insertion (P < .005).. The small number of patients.. A SEPS placement did not result in stricture resolution or stabilization after SEPS removal. The SEPS migration rate was much higher in our patients with postesophagectomy anastomotic strictures than previously reported for other types of strictures. However, a SEPS placement did significantly delay the interval between endoscopic interventions in patients with persistent gastroesophageal anastomotic strictures after transhiatal esophagectomy. SEPS placement should be considered as an alternative to continued serial dilation in patients with persistent anastomotic strictures after transhiatal esophagectomy.

Topics: Aged; Anastomosis, Surgical; Coated Materials, Biocompatible; Cohort Studies; Equipment Design; Esophageal Stenosis; Esophagectomy; Esophagogastric Junction; Female; Humans; Male; Middle Aged; Polyesters; Retrospective Studies; Silicon; Stents; Treatment Outcome

Total laryngectomy or laryngopharyngectomy are commonly performed for the treatment of laryngeal cancer or hypopharyngeal cancer. However pharyngocutaneous fistula and cervical esophageal stenosis have been reported as postoperative complications of these procedures. We used a silicon pharyngeal tube in cases that developed pharyngocutaneous fistula and cervical esophageal stenosis. The pharyngeal tube was useful for controlling aspiration pneumonia and for starting oral feeding in a case of pharyngocutaneous fistula after a total laryngectomy. It was also helpful for starting oral feeding in a case with cervical esophageal stenosis after total laryngopharyngectomy and free jejunum interposition. This patient was able to maintain a good quality of life until re-operation. Adverse effects from the insertion of the tube included a foreign body sensation and pharyngeal pain that was tolerable with the use of NSAIDs for a short time. Silicon pharyngeal tubes are useful for the treatment of pharyngocutaneous fistula and cervical esophageal stenosis.

Topics: Aged; Cutaneous Fistula; Digestive System Fistula; Esophageal Stenosis; Glottis; Humans; Intubation; Laryngeal Neoplasms; Male; Pharyngeal Diseases; Pharyngectomy; Pharynx; Postoperative Complications; Quality of Life; Silicon

The influence of an indwelling transanastomotic silicon tube on healing esophageal anastomosis in puppies was studied by making resin casts of the reconstructed esophagus. These casts demonstrated stenosis but no difference in the group with a transanastomotic tube was seen. Stenotic index of the puppies varied from 0.7 to 0.97 (no stenosis = 1). An important observation made during the study was the presence of shelfing of scar tissue on the posterior esophageal wall. This was the site of mucosal ulceration, granuloma formation, and fibrous scarring where interrupted 0000 silk knots had been tied intraluminally. The anterior wall had a linear scar, where the knots were tied extraluminally. Extraluminal knots would be part of the technique to achieve a minimal amount of scar tissue at the site of the esophageal anastomosis.

Topics: Animals; Casts, Surgical; Dogs; Esophageal Atresia; Esophageal Stenosis; Esophagus; Intubation; Models, Biological; Resins, Plant; Silicon; Sutures

Topics: Artificial Organs; Cardia; Esophageal Neoplasms; Esophageal Stenosis; Humans; Middle Aged; Pneumomediastinum, Diagnostic; Radiography; Retropneumoperitoneum; Silicon; Stomach Neoplasms