An oesophageal benign stricture: Endoscopy treatment limitation and surgical management in a heifer

A 4-month-old female red Holstein Friesian heifer was referred with intermittent meteorism and regurgitation associated with poor weight gain. The subject showed a fair physical condition with an increased respiratory rate, normal food prehension, mastication, and swallowing activity. The blood gas analysis showed mild respiratory acidosis. An oral gastric tube introduction followed by an endoscopy confirmed the provisional diagnosis of benign oesophageal stenosis. An endoscopic balloon and bouginage did not result in any stricture release, probably due to the degree of fibrosis of the stenotic ring. A surgical approach with a mucosectomy was performed, which restored the normal oesophageal function. Based on the authors’ knowledge, this is the first description of a bovine oesophageal mucosectomy as a definitive surgical treatment for a stricture after the failure of both balloon dilation and a bougienage technique.

Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation ± endoscopic resection: results from the national Dutch database in a 10-year period

ObjectiveRadiofrequency ablation (RFA)±endoscopic resection (ER) is the preferred treatment for early neoplasia in Barrett’s oesophagus (BE). We aimed to report short-term and long-term outcomes for all 1384 patients treated in the Netherlands (NL) from 2008 to 2018, with uniform treatment and follow-up (FU) in a centralised setting.DesignEndoscopic therapy for early BE neoplasia in NL is centralised in nine expert centres with specifically trained endoscopists and pathologists that adhere to a joint protocol. Prospectively collected data are registered in a uniform database. Patients with low/high-grade dysplasia or low-risk cancer, were treated by ER of visible lesions followed by trimonthly RFA sessions of any residual BE until complete eradication of BE (CE-BE). Patients with ER alone were not included.ResultsAfter ER (62% of cases; 43% low-risk cancers) and median 1 circumferential and 2 focal RFA (p25-p75 0–1; 1–2) per patient, CE-BE was achieved in 94% (1270/1348). Adverse events occurred in 21% (268/1386), most commonly oesophageal stenosis (15%), all were managed endoscopically. A total of 1154 patients with CE-BE were analysed for long-term outcomes. During median 43 months (22–69) and 4 endoscopies (1–5), 38 patients developed dysplastic recurrence (3%, annual recurrence risk 1%), all were detected as endoscopically visible abnormalities. Random biopsies from a normal appearing cardia showed intestinal metaplasia (IM) in 14% and neoplasia in 0%. A finding of IM in the cardia was reproduced during further FU in only 33%, none progressed to neoplasia. Frequent FU visits in the first year of FU were not associated with recurrence risk.ConclusionIn a setting of centralised care, RFA±ER is effective for eradication of Barrett’s related neoplasia and has remarkably low rates of dysplastic recurrence. Our data support more lenient FU intervals, with emphasis on careful endoscopic inspection. Random biopsies from neosquamous epithelium and cardia are of questionable value.Netherlands trial register numberNL7039.

Oesophageal stenosis caused by giant multilevel anterior cervical osteophytosis

Dysphagia secondary to osteoarticular disorders is a rare entity. In this report, we present the case of a 76-year-old female patient with progressive dysphagia and recurrent aspiration pneumonia caused by large anterior cervical osteophytes. Osteophytectomy was performed without spinal fusion. The patient reported significant improvement post-operatively, and no recurrence was detected at the 1-year follow-up. Cervical osteophytosis should be suspected as a cause of dysphagia, especially in elderly patients with degenerative osteoarthritic disease when other causes have been excluded.

Combined approach dilatation of complete oesophageal stenoses

<p class="abstract"><strong>Background:</strong> Upper oesophageal stenosis is a well-recognised complication in the treatment of head and neck malignancies that can result in significant morbidity. Simple strictures can be managed by anterograde dilatation. Combined approach dilatation can overcome more complex and even complete stenosis.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective analysis of prospectively gathered data for four patients who have had combined approach dilatation to overcome complete oesophageal stenosis. Outcomes determined using standardised swallowing outcome measurement tools. </p><p class="abstract"><strong>Results:</strong> A functional oesophageal lumen was restored in four patients with complete oesophageal stenosis, with a demonstrable improvement in validated swallowing outcome measures.</p><p class="abstract"><strong>Conclusions:</strong> Combined approach oesophageal dilatation can be safely and effectively utilised to overcome complete stenosis of the upper oesophagus secondary to radiotherapy/chemo-radiotherapy. Extending the indications for this procedure to post-surgical strictures is not advisable due to increased risk of serious complication.</p>

Occurrence of Acute Oesophageal Necrosis (Black Oesophagus) in a Single Tertiary Centre

Acute oesophageal necrosis (AON) is a rare condition characterised by the endoscopic finding of diffuse, circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction. This observational study aimed to assess the occurrence, clinical characteristics and outcomes of AON in a consecutive endoscopic cohort in a single tertiary university centre. A retrospective analysis of endoscopic data of upper gastrointestinal endoscopy (UGE) was carried out from 2008 to 2018. Out of 25,970 UGE, 16 patients (0.06%) had AON; 75.0% were men with a median age of 75 years. Almost all patients underwent diagnosis during emergency UGE performed for gastrointestinal bleeding, but one patient was diagnosed during elective UGE for persistent vomiting and diarrhoea. All patients reported one or more pre-existing comorbidities and concomitant acute events. Two patients had AON as the first presentation of Zollinger–Ellison syndrome (ZES). One patient developed an oesophageal stenosis, and another patient presented a relapse of AON. Mortality was 50%, but no patient died as a direct consequence of AON. AON is a rare cause of gastrointestinal bleeding diagnosed mainly during emergency UGE. Our study showed that ZES might manifest with this critical presentation, and endoscopists must be aware of this evidence.

A nyelés képességének helyreállítása lúgivás utáni nyelőcsőszűkületben

The authors discuss their experience in the surgical treatment of caustic stenosis in the upper gastrointestinal tract. They present operative solutions using isoperistaltic transverse colonic segment in oesophageal stenosis caused by gastric outlet obstruction, or when these two presented together. Further indications for the above were bronchial or tracheo-oesophageal fistulas and oesophageal perforation. Late adaptation of the colonic grafts were measured by radiokinematography and histochemistry. The overall morbidity was 4.9%. Postoperative salivary fistulas closed spontaneously. Late postoperative complications (13.5%) were treated successfully. The multihaustral motility of the graft prevented the reflux, while the altered mucopolysaccharides of the colonic mucosa prevented the ulcer formation. Orv Hetil. 2019; 160(16): 613–618.