Esophageal stricture surgery: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 4: Line 4:


==Overview==
==Overview==
The mainstay of treatment for [[esophageal stricture]] is medical therapy and dilation. Self-expandable plastic or metal [[Stent|stents]] placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of [[dysphagia]], extraesophageal manifestations and long term [[side effects]] of medical therapy
The mainstay of treatment for [[esophageal stricture]] is dilation. Proton pump inhibitors or H2 antagonists are recommended among all patients  who develop esophageal stricture due to gastroesophageal reflux disease. Self-expandable plastic or metal [[Stent|stents]] placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of [[dysphagia]], extraesophageal manifestations and long term [[side effects]] of medical therapy


==Surgery==
==Surgery==

Revision as of 21:03, 7 November 2017

Esophageal stricture Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Esophageal stricture from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Procedure
Surgical Management

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Esophageal stricture surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Esophageal stricture surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Esophageal stricture surgery

CDC on Esophageal stricture surgery

Esophageal stricture surgery in the news

Blogs on Esophageal stricture surgery

Directions to Hospitals Treating Esophageal stricture

Risk calculators and risk factors for Esophageal stricture surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

The mainstay of treatment for esophageal stricture is dilation. Proton pump inhibitors or H2 antagonists are recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Self-expandable plastic or metal stents placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of dysphagia, extraesophageal manifestations and long term side effects of medical therapy

Surgery

5Nxz-OD2ogY|500}}

The most common cause of esophageal stricture is gastroesophageal reflux disease. Treatment for esophageal stricture is combination of dilation and  proton pump inhibitors or H2 antagonist therapy.[1]

  • Cautious dilation [2]
  • Dilators[2] [3][4]
    • Mechanical ( bougie) that can be done with
      • Guidewire such as savary-gilliard and eder-puestow olive dilators
      • Nonguidewire such as maloney and hurst dilator 
    • Balloon dilators
  • Self-expandable plastic or metal stents placement for patients with refractory esophageal stricture [5][6]
  • Self dilation at home  with bougie dilators [7]
FIRiPny4n6Y|500}}









Indications for surgery[14]

  • Inability to dilate the stricture
  • Frequent recurrence of dysphagia
  • Esophagitis refractory to medical therapy
  • Extraesophageal manifestations such as aspiration pneumonia
  • Long term side effects of medical therapy in young patients.


References

  1. Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
  2. 2.0 2.1 Nostrant TT (2005). "Esophageal Dilation / Dilators". Curr Treat Options Gastroenterol. 8 (1): 85–95. PMID 15625037.
  3. Shemesh E, Czerniak A (1990). "Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures". World J Surg. 14 (4): 518–21, discussion 521–2. PMID 2382455.
  4. Cox JG, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, Hoare RC, Dyet JF, Bennett JR (1994). "Balloon or bougie for dilatation of benign esophageal stricture?". Dig. Dis. Sci. 39 (4): 776–81. PMID 7818628.
  5. Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ (2004). "Complications of stent placement for benign stricture of gastrointestinal tract". World J. Gastroenterol. 10 (2): 284–6. PMC 4717021. PMID 14716840.
  6. Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M, Venezia G, Rizzetto M, Saracco G (2004). "Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures". Gastrointest. Endosc. 60 (4): 513–9. PMID 15472671.
  7. Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA (2013). "Self-dilation as a treatment for resistant, benign esophageal strictures". Dig. Dis. Sci. 58 (11): 3218–23. doi:10.1007/s10620-013-2822-7. PMID 23925823.
  8. Pregun I, Hritz I, Tulassay Z, Herszényi L (2009). "Peptic esophageal stricture: medical treatment". Dig Dis. 27 (1): 31–7. doi:10.1159/000210101. PMID 19439958.
  9. Tang SJ, Singh S, Truelson JM (2010). "Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos)". Surg Endosc. 24 (1): 210–4. doi:10.1007/s00464-009-0535-y. PMID 19517185.
  10. 10.0 10.1 Kujawski K, Stasiak M, Rysz J (2012). "The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer". Med. Sci. Monit. 18 (5): CR323–9. PMC 3560635. PMID 22534713.
  11. Siersema PD (2008). "Treatment options for esophageal strictures". Nat Clin Pract Gastroenterol Hepatol. 5 (3): 142–52. doi:10.1038/ncpgasthep1053. PMID 18250638.
  12. Yang CW, Lin HH, Hsieh TY, Chang WK (2015). "Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study". BMC Palliat Care. 14: 58. doi:10.1186/s12904-015-0056-5. PMC 4635529. PMID 26542798.
  13. Csendes A, Braghetto I (1992). "Surgical management of esophageal strictures". Hepatogastroenterology. 39 (6): 502–10. PMID 1483661.
  14. Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.

Template:WH Template:WS