esophagus

摘要： BACKGROUND There are few reports of a fractured esophageal self-expanding metallic stent(SEMS)and the lasso retrieval technique,forming a guidewire loop by directing the guidewire back up the external stent for retrieval.CASE SUMMARY A 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer.Benign anastomotic stenosis was diagnosed,and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation.About 13.5 mo after stenting,dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed.One-third of the stent was removed and the fractured stent remained in the proximal esophagus.A suction tube was introduced through the guidewire and then the guidewire was grabbed,acting like a“lasso”on tightening.The remaining fractured stent was successfully removed by slowly pulling back the guidewire,with no fragments of stent wires retained.CONCLUSION The guidewire lasso technique is a simple,effective method of removing esophageal SEMS in rare cases of stent fracture.

摘要： BACKGROUND Neuroendocrine carcinoma(NEC)of the esophagus is rare and highly aggressive,and lacks biological features.Currently,there are no established standard treatments for this cancer.In this report,we describe a patient with large-cell NEC of the esophagus who was successfully treated using endoscopic submucosal dissection(ESD)combined with adjuvant chemotherapy.CASE SUMMARY A 55-year-old woman presented with intermittent mild dysphagia for 2 mo.Gastroscopy revealed a disc-shaped protruding lesion about 18 mm×18 mm in size on the upper esophagus.Endoscopic ultrasonography demonstrated that the bulged lesion originated from the muscularis mucosa.We assessed en bloc resections using ESD for therapeutic diagnosis to devise a safe and appropriate treatment.Histopathological examination revealed a poorly differentiated neoplasm comprising of large cells with marked nuclear atypia and multifocal necrosis.In addition,the specimens had a negative horizontal margin and vertical margins.Depth of invasion was classified as submucosa 2(SM2)without lymphovascular invasion.These histopathological results were consistent with a diagnosis of esophageal NEC,large cell type.Adjuvant therapy has been considered for ESD patients with SM2/SM3 lesions and patients with poorly differentiated lesions.After comprehensive consideration,we initiated combination treatment,i.e.,ESD plus adjuvant chemotherapy.The patient remained disease-free at the 2-year follow-up.CONCLUSION En bloc resection approach using ESD may play a vital role as a diagnostic and therapeutic modality for esophageal NEC.

摘要： BACKGROUND Aortoesophageal fistula(AEF)induced by esophageal fishbones is a rare complication of esophageal foreign bodies and is very difficult to treat.Although the current view suggests that endovascular stent-graft treatment is useful for AEF,whether a subsequent thoracic operation is necessary remains controversial.The purpose of this report is to describe our experience using endovascular stentgraft treatment without combined thoracic operations for the treatment of AEF in two specific cases.CASE SUMMARY We presented two cases of patients complaining of retrosternal discomfort treated in our department for an aortoesophageal fistula caused by the accidental ingestion of a fishbone.The two patients were effectively managed with combined means of endoscopic,medical(broad-spectrum antibiotic therapy,fasting,gastrointestinal decompression,etc.)and endovascular stent-graft treatment.The main difference in treatment was that the first patient presented with hematemesis after endoscopic removal of the fishbone.Subsequently,the patient underwent endovascular stent-graft treatment.The second case was managed with endoscopic removal of the fishbone with simultaneous endovascular stent-graft treatment,without any signs of hematemesis or melena.Both patients had successful postoperative management and were discharged home.Long-term follow-up is ongoing.CONCLUSION The treatment decision-making process should depend on the patients’specific situations.Our practice indicates that endovascular stent-graft treatment without combined thoracic operations could be a valuable alternative in selected patients.

摘要： BACKGROUND Bezoar is a mass of hardened external material found in the gastrointestinal(GI)tract.It may form anywhere in the GI tract,but esophageal bezoar is rare because of the short esophageal transit time.Psyllium seed husk is an indigestible natural derivative that is widely used as an herbal laxative.Herein,we report a case of acute esophageal obstruction caused by a bezoar after ingestion of psyllium seed husk powder.CASE SUMMARY A 76-year-old male with Parkinson’s disease visited the emergency department with swallowing difficulty approximately 10 h after ingesting psyllium seed husk powder.Symptoms began a few hours after ingestion and progressed to severe dysphagia.There were no abnormal findings on simple radiography.However,a computed tomography scan revealed an approximately 2.0 cm×2.5 cm mass located near the gastro-esophageal junction.After grinding,the mass was removed using an endoscopic capture net.Esophageal bezoars may cause life-threatening complications.Patients with Parkinson’s disease may have esophageal motility dysfunction,which may increase esophageal transit time.Since our patient had Parkinson’s disease,this effect may have contributed to the formation of the bezoar.CONCLUSION Attention should be paid to using bulk-laxatives,and an appropriate specified regimen will be needed when marketed as a dietary supplement.

摘要： BACKGROUND Myoepithelial carcinoma(MC)is a rare malignant neoplasm that mainly occurs in the salivary gland.MC can be confused with many other tumors when arising outside the salivary glands because it presents with a wide spectrum of cytomorphological and immunohistochemical features.To the best of our knowledge,esophageal MC has not been previously reported.The purpose of this study was to describe the imaging and clinicopathological features of esophageal MC to improve the understanding of the disease.CASE SUMMARY Three men and one woman diagnosed with esophageal MC were enrolled in this study.The primary clinical symptom was dysphagia.The mass was mainly located in the middle esophagus.Laboratory tests revealed that two patients who underwent tumor abnormal protein were positive.Radical resection was performed for all patients with no adjuvant therapy.Hematoxylin-eosin staining showed infiltrative growth of epithelial cells with hyperchromatic and pleomorphic nuclei toward the periphery.Immunohistochemistry showed that all patients were positive for P63,and most patients were positive for SOX-10,AE1/AE3,P40,and calponin.The Ki-67 values were all higher than 60%.Patient one died one month after discharge from an unknown cause.Patient two lost to follow-up.At patient three’s four-month review,enhanced computed tomography(CT)showed anastomosis recurrence and bilateral lung metastases.He abandoned treatment and lost to follow-up.Patient four attended review appointments regularly and remained in a good general condition.CONCLUSION Here,we present the first report of esophageal MC and review the relevant literature.Esophageal MC is more likely to occur in the middle esophagus in older patients with male dominance.A fungating type observed on CT scanning may help narrow down the differential diagnosis.Cystic change or necrosis may occur in larger lesions.The final diagnosis should be made according to the pathological examination.The treatment for MC is surgical resection,and the efficacy of chemotherapy needs to be determined with future studies.

摘要： 2009年,芝加哥国际高分辨率食管测压(high-resolution esophageal manometry,HREM)工作组出版了芝加哥分类(the Chicago Classification,CC)第1版,其后有2次更新,2015年发布了CC版本3.0(CCv3.0)。随着新的HREM指标的出现,有关HREM的临床应用和研究发展迅速。与之前的分类相比,2021年的CCv4.0有4个关键的更新。①需要进一步的测压和非测压检查评估,以得出一个结论性胃食管交界处流出道梗阻(esophagogastric junction outflow obstruction,EGJOO)的诊断;②EGJOO、远端食管痉挛(distal esophageal spasm,DES)和高收缩食管(hypercontractile esophagus,HE)是3种测压表现形式,必须伴有吞咽困难和/或非心源性胸痛等食管梗阻性症状才能被认为与临床相关。

摘要： BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on.The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor,and there are too many complications postoperatively.AIM To test MCA technology to reconstruct the esophagus in dogs,prior to studying the feasibility and safety of MCA in humans.METHODS Thirty-six dogs were randomized into either the study or control group(n=18 per group).The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device,while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl.We used interrupted single-layer inverting sutures.The anastomosis time,gross appearance,weight and pathology of the anastomosis were evaluated at one month,three months and six months postoperatively.RESULTS The anastomosis time of the MCA group was shorter than that of the hand-sewn group(7.5±1.0 min vs 12.5±1.8 min,P<0.01).In the MCA group,X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus.In the hand-sewn group,dogs did not undergo X-ray examination.One month after the surgeries,the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group(11.63±0.71 kg vs 12.73±0.80 kg,P<0.05).At 3 mo and 6 mo after the operation,the dogs’weights were similar between the two groups(13.75±0.84 kg vs 14.03±0.82 kg,14.93±0.80 kg vs 15.44±0.47 kg).The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.CONCLUSION MCA is an effective and safe method for esophageal reconstruction.The anastomosis time of the MCA group was less than that of the hand-sewn group.This study shows that MCA technology may be applied to human esophageal reconstruction,provided these favorable results are confirmed by more publications.

摘要： BACKGROUND Tuberculosis is endemic in Senegal.While its extra-pulmonary localization is rare,esophageal tuberculosis,particularly the isolated form,is exceptional.We report here a case of isolated esophageal tuberculosis in an immunocompetent patient.CASE SUMMARY A 58-year-old man underwent consultation for mechanical dysphagia that had developed over 3 mo with non-quantified weight loss,anorexia,and fever.Upper digestive endoscopy showed extensive ulcerated lesions,suggesting neoplasia.The diagnosis was confirmed by histopathology,which showed gigantocellular epithelioid granuloma surrounding a caseous necrosis.Thoracoabdominal computed tomography scan did not show another localization of the tuberculosis.The outcome was favorable with treatment.CONCLUSION Esophageal tuberculosis should be considered when dysphagia is associated with atypical ulcerated lesions of the esophageal mucosa,in an endemic area.

摘要： BACKGROUND Gastrointestinal(GI)hemangioma has a low incidence among systemic hemangiomas,and some GI hemangiomas occur in the intestine,stomach,and esophagus.Polidocanol has been increasingly used in sclerotherapy.However,this paper reports that minimally invasive treatment of multiple hemangiomas with large diameters can achieve satisfactory results by multipoint injection.CASE SUMMARY A 46-year-old female patient was hospitalized in another hospital for cough.We accidentally found thickening of the lower esophagus by chest computed tomography.The patient was eventually diagnosed with multiple GI hemangiomas and underwent a series of examinations including esophagogastroduodenoscopy(EGD),endoscopic ultrasound,and magnetic resonance imaging.We calculated the dose of polidocanol according to the volumes of the hemangiomas,fixed the target vein with the help of a transparent cap,and then administered polidocanol via multipoint injection into the hemangiomas under endoscopic guidance.EGD and endoscopic ultrasound showed that the hemangiomas disappeared.The color of the esophageal mucosa returned to normal 1 mo after sclerotherapy.CONCLUSION Sclerotherapy may be a safe and effective method for treating multiple hemangiomas of the alimentary canal.

摘要： Voluntary or accidental ingestion of a caustic product is increasingly encountered in our country. Caustic esophageal stenosis is the most common sequel. Its treatment involves instrumental dilation and/or surgery which is particularly heavy. The aim of this study was to study the epidemiological, clinical and therapeutic aspects of caustic esophageal strictures in our context. The retrospective study took place from December 2013 to December 2017 in the Hepato-Gastroenterology department of the Gabriel Touré university hospital in Bamako. We included patients with caustic esophageal stenosis referred to the gastrointestinal endoscopy unit for dilation. 67 patients admitted for caustic stenosis were included. The mean age of our patients was 20.76 ± 19.9 years with extremes of 1 and 70 years and a sex ratio of 1.9. In 50.7% of cases, the product ingested was basic in nature. The clinical symptomatology was dominated by dysphagia (100%), vomiting (100%), the emaciated (60%) and cough (40%). In 59 (88%) patients, the stenosis was unique and multiple in 8 (12%). The KILLIAN mouth as the sole site of the stenosis was found in 40.3% of patients. The number of sessions was ≤ 3 in 16.4% and >3 in 83.6% with a mean of 4.59 ± 1.57 sessions. The evolution was favorable in 95.5% of our patients. However, we recorded three (3) cases of death all following a perforation. Conclusion: Caustic esophageal stenosis, a consequence of ingestion of caustics, is increasingly observed in our context. Endoscopic dilation occupies an important place in its management.

摘要： Primary small-cell carcinoma of the esophagus is a rare malignant esophageal cancer. Although surgery is relatively successful in eradicating the local tumor, the post-resection five year survival rate for primary small-cell carcinoma of the esophagus is lower than primary squamous cell carcinoma of the esophagus. The purpose of this study is to analyze the clinic manifestation, pathological feature and treatment of primary small-cell carcinoma of the esophagus. Methods: A total of 73 cases with primary small-cell carcinoma of the esophagus treated by surgery from 1984 to 2003were analyzed retrospectively.Results: The overall resection rate was 94.5﹪. The radical resection rate was 89.0﹪ and operative mortality was 1.4﹪. Those who survived for 1 year, 3 year and 5 year were 50.7﹪, 13.7﹪ and 8.2﹪, respectively.Conclusions Primary small-cell carcinoma of the esophagus was a rare malignant tumor with poor prognosis. Surgical resection is the main method for the patients in stage I or II of primary small-cell carcinoma of the esophagus. Postoperative chemotherapy is appeared to offer benefit for these patients. For those in stage Ⅲ or IV should be managed with chemotherapy and radiation therapy.