1/14. Are self-expanding metal mesh stents useful in the treatment of benign esophageal stenoses and fistulas? An experience of four cases.OBJECTIVE: The aim of this study was to review the long-term results of treating benign esophageal fistula and stenosis using self-expanding metal stents. methods: We treated four patients using covered mesh or coiled stents. We removed the stents electively in two patients (one endoscopically and one during planned partial esophagectomy) and unexpectedly in one patient who developed bleeding. One stent migrated and required laparotomy for removal. RESULTS: Placement of self-expanding metal stents successfully sealed the benign fistula in two patients and reestablished swallowing in two other patients with complicated achalasia. Two patients were swallowing normally on long-term follow-up, one died of the underlying disease, and one required gastrostomy. CONCLUSION: Temporary use of self-expanding metal stents as a feasible option for treating benign esophageal stenosis and fistula in patients who have failed other conventional treatments.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/14. Endoluminal stenting of the aorta as treatment of aortoesophageal fistula due to primary aortic disease.A 78-year-old woman with severe chronic obstructive pulmonary disease was admitted to the emergency room with hematemesis. With use of esophagoscopy, chest computed tomographic scanning, and aortography, we found a large descending aortic aneurysm and a penetrating ulcer of the proximal descending aorta. We determined that the patient had an aortoesophageal fistula and pseudoaneurysm that had originated from a ruptured penetrating ulcer of the mid-descending aorta. We deployed two 100-mm stent grafts to seal the ruptured thoracic aorta. Six months later, the pseudoaneurysm was almost completely resolved, with no infection or endoleak. We advocate the use of endoluminal aortic stenting for aortoesophageal fistulas of aortic origin, particularly in patients with severe concomitant disease.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
3/14. Successful treatment of intractable esophagothoracic fistula using covered self-expandable stent.This report concerns the successful treatment with a covered self-expandable stent of an intractable thoracoesophageal fistula after total esophagectomy for esophageal cancer. Total esophagectomy was performed on a 68-year-old man who presented with a huge esophageal cancer in the lower esophagus. Massive leakage was observed on the 5th day postoperatively. Since high fever and coughing continued, he was diagnosed as having esophagothoracic fistula and pyothorax, after which fenestration of the right chest wall was performed. Although the patient's general condition was getting better, stenosis near the anastomosis (esophagogastrostomy) and the esophagothoracic fistula were resistant to treatment with balloon dilatation and repeated endoscopic mucotomy. Further treatment, consisting of glue or fibrin sealant injection was not effective. After a covered self-expandable stent had been placed endoscopically, however, the fistel was completely cured in 2 months. This new endoscopic approach thus represents a promising option for the treatment of intractable esophagothoracic fistula.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
4/14. Endoscopic placement of fibrin sealant as a treatment for a long-standing Boerhaave's fistula.A 64-year-old man suffered a spontaneous rupture of the esophagus (Boerhaave's syndrome) after an episode of severe retching. He underwent attempted primary repair of the esophageal defect, but unfortunately the repair failed with the development of a persistent esophago-bronchial fistula resistant to extended conservative management. Three hundred and nineteen days after the initial rupture, the fistula was successfully treated with endoscopic placement of fibrin glue. We believe this to be the first reported case of fibrin sealant being used in the treatment of a long-standing fistula resulting from Boerhaave's syndrome.- - - - - - - - - - ranking = 5keywords = seal (Clic here for more details about this article) |
5/14. Bronchoesophageal fistula after endovascular repair of ruptured aneurysm of the descending thoracic aorta.Aortoesophageal fistula secondary to thoracic aneurysm is rare and is usually fatal without prompt surgical intervention. A 79-year-old man with significant comorbidities and previous cancer surgery was admitted on an emergency basis because of the suspicion of a ruptured thoracic aortic aneurysm. Computed tomographic scan followed by angiography demonstrated a ruptured thoracic aneurysm with aortoesophageal fistula. An endovascular stent graft repair was performed with successful exclusion of both aneurysm and fistula. On postoperative day 6, dyspnea and an isolated episode of hemoptysis occurred. endoscopy revealed the presence of a bronchoesophageal fistula, which necessitated double exclusion of the esophagus and feeding jejunostomy. At 6 months, clinical, bronchoscopic, and computed tomographic scan follow-up showed complete sealing of the aneurysm and resolution of the bronchoesophageal fistula. At 9 months, the patient was still alive but refused to undergo substernal gastric bypass in an attempt to restore oral feeding. Endovascular repair seems promising as an emergent and palliative treatment of aortoesophageal fistula. To the best of our knowledge, this is the first case in which a bronchoesophageal fistula developed after successful endovascular repair of aortoesophageal fistula. The pathogenesis of this complications remains unclear.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
6/14. Malignant oesophago-pleuro-pericardial fistula in a patient with oesophageal carcinoma.Pericardial and cardiac fistulae secondary to oesophageal or gastric tumours are a rare complication. We report about a 50-year-old male patient with a 10-month history of distal oesophageal carcinoma with lung and liver metastases who was referred to our hospital after 6 cycles of palliative chemotherapy at the beginning of March 2004. The patient presented with dysphagia, dyspnea, tachycardia, and hypotension. Purulent pericardial and bilateral pleural effusion was diagnosed, and the patient was treated with antibiotics, repeated pleurocentesis and pericardial drainage with daily polihexanide lavage. Oesophagogastroduodenoscopy, Peritrast swallow and computed tomographic scans of chest revealed a malignant oesophago-pleuro-pericardial fistula. A total of three coated, expandable metal stents were inserted into the oesophagus, which sealed successfully the fistula. Unfortunately, the patient succumbed to his carcinoma three months later.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
7/14. Crohn's disease of the esophagus: treatment of an esophagobronchial fistula with the novel liquid embolic polymer "onyx".Esophageal involvement in Crohn's disease is very rare. In only a small subgroup of these patients -- up to date fourteen cases have been described in the literature -- the course of the illness may be complicated by esophageal fistula formation. The therapy for fistulizing esophageal Crohn's disease so far has been disappointing, recurrence and progression are likely, and surgery still is the primary treatment modality for refractory patients. We here present a case of severe Crohn's disease with an esophagobronchial fistula and the successful closure of the fistula tract with the novel liquid polymer sealant "Onyx". This approach offers a new option for the treatment of this rare complication of Crohn's disease and should be considered if surgery is not possible.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
8/14. A new endoscopic method for treatment of malignant oesophagobronchial fistulas.A short malignant oesophagobronchial fistula which could not be sealed using adhesive agents was successfully treated using a new endoscopic technique. The procedure provided good palliation and the results withstood the test of time in the patient. The method, which is described in detail, provides a useful modification to existing methods.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
9/14. The sternocleidomastoid myoperiosteal flap for esophagopharyngeal reconstruction and fistula repair: clinical and experimental study.Despite advances in head and neck surgery, reconstruction of the pharynx and cervical esophagus continues to be troublesome. Classic pedicled flaps are often too bulky and difficult to position for repair of pharyngeal and esophageal fistulas. An ideal flap would be local, well-vascularized, compact, and capable of being sutured into a tension-free, water-tight seal. In selected cases, the sternocleidomastoid myoperiosteal flap can meet these requirements in a single-stage procedure for repair of fistulas as well as selected cases of primary pharyngeal reconstruction. The use of this flap is described in five patients. Two patients underwent laryngectomy with partial pharyngectomy that left inadequate mucosa for primary closure. A sternocleidomastoid myoperiosteal flap was used to add width to the remaining mucosa. Both patients healed within 3 weeks and remained stricture free. Three other patients who underwent radiation followed by tumor resection and standard primary closure of the pharynx developed fistulas. Two fistulas were repaired successfully with the sternocleidomastoid myoperiosteal flap, and both patients were able to eat a general diet on the eighth postoperative day. Reconstruction was also performed in dogs to histologically evaluate the epithelialization capacity of the periosteum. There was total epithelialization of the flap at 4 weeks after reconstruction.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
10/14. Patch esophagoplasty with musculocutaneous flaps as treatment of complications after esophageal reconstruction.A musculocutaneous flap is a simple and effective treatment for the complications which can follow esophageal reconstruction at the cervical portion, such as stricture, fistula, and infection of costal cartilages. After the strictured segment is opened or resected, the resultant esophageal defect can be replaced with the skin patch of a musculocutaneous flap. Then the muscle component of the musculocutaneous flap can be used to form a seal around the previously infected lesion site, an area with the potential for recurrent infection and leakage in subsequent operations. Seven patients were treated this way with satisfactory results.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
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