Pub Date : 2021-01-07DOI: 10.19080/ARGH.2021.16.555937
J. Aluru
In our institute, laparoscopic splenectomy was performed in 27 patients over a period of 7 years for two major indications: hypersplenism and refractory variceal bleeding. 19 patients had Extra Hepatic Portal Venous Obstruction (EHPVO) and 8 patients had Non-Cirrhotic Portal Fibrosis ( NCPF). All the patients had hypersplenism, with thrombocytopenia( < 50,000/cu.mm),leukopenia (< 4000/Cu mm)as well in 9 (33% )of the patients, and anemia ( Hb<10gm) in 8(30%) . Variceal bleeding requiring Endoscopic Variceal Ligation (EVL) were found in 23 patients,17 in the EHPVO group and 6 in the NCPF group . 4 patients were females and 23 were male. The age range was from 12 to 37 years, the mean being 24 years. The laparoscopic procedure was successful in 25, but 2 patients needed conversion to left subcostal laparotomy because of extensive and giant collaterals around the hilum of the spleen; these conversions happened in the first three years of our laparoscopic splenectomy experience, with no conversions in the subsequent 4 years. Even in the presence of a relative contraindication like portal hypertension, laparoscopic splenectomy is still a viable proposition in the vast majority of cases. Technical considerations , like deployment of powerful energy sources, vascular staplers and preliminary splenic artery ligation are discussed in this article.
{"title":"Laparoscopic Splenectomy in Non-Cirrhotic Portal Hypertension- A Retrospective Analysis of a Prospectively Performed Series","authors":"J. Aluru","doi":"10.19080/ARGH.2021.16.555937","DOIUrl":"https://doi.org/10.19080/ARGH.2021.16.555937","url":null,"abstract":"In our institute, laparoscopic splenectomy was performed in 27 patients over a period of 7 years for two major indications: hypersplenism and refractory variceal bleeding. 19 patients had Extra Hepatic Portal Venous Obstruction (EHPVO) and 8 patients had Non-Cirrhotic Portal Fibrosis ( NCPF). All the patients had hypersplenism, with thrombocytopenia( < 50,000/cu.mm),leukopenia (< 4000/Cu mm)as well in 9 (33% )of the patients, and anemia ( Hb<10gm) in 8(30%) . Variceal bleeding requiring Endoscopic Variceal Ligation (EVL) were found in 23 patients,17 in the EHPVO group and 6 in the NCPF group . 4 patients were females and 23 were male. The age range was from 12 to 37 years, the mean being 24 years. The laparoscopic procedure was successful in 25, but 2 patients needed conversion to left subcostal laparotomy because of extensive and giant collaterals around the hilum of the spleen; these conversions happened in the first three years of our laparoscopic splenectomy experience, with no conversions in the subsequent 4 years. Even in the presence of a relative contraindication like portal hypertension, laparoscopic splenectomy is still a viable proposition in the vast majority of cases. Technical considerations , like deployment of powerful energy sources, vascular staplers and preliminary splenic artery ligation are discussed in this article.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47726823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-23DOI: 10.19080/ARGH.2020.16.555936
A. Palmieri
Acute alithiasic cholecystitis (AAC), also called acalculous, corresponds to the presence of an inflammation of the gallbladder in the absence of stones inside, it is a rare entity (10%), reported in diabetic patients, immunosuppressed, with pathologies infectious (viral, bacterial), major surgery, drugs, multiple trauma, mechanical ventilation, use of vasopressors, opioid analgesics, prolonged fasting, total parenteral nutrition, burns, among others. In this time of the SARS CoV-2 virus / COVID-19 coronavirus disease pandemic, surgeons have found an increase in the request for interconsultations from respiratory hospitalization services, intermediate care and intensive care units, due to ultrasound findings of incidental abdomen of acute alithiasic cholecystitis in those patients without improvement to treatment or worsening of sepsis, or the cytokine cascade, difficult to evaluate abdominal epigastric pain, right upper quadrant, induces us to explore and find little painful palpable gallbladder, reporting edema gallbladder wall greater than 3 mm, gallbladder distention, sometimes ultrasound Murphy’s sign, extending imaging studies according to the patient’s conditions with contrasted computed axial tomography and nuclear magnetic cholangioresonance, and even with reports of micro perforations with peri-vesicular extravasation of contents , free air on its walls, ruling out other causes of acalculous cholecystitis. It is a real diagnostic and therapeutic challenge in these patients with the SARS virus –COV-2 / COVID-19, already afflicted by viremia, or in some cases subjected to cytokine storms, poor general conditions, hermodynamically unstable in Intensive care units, intubated, with vasopressor support, and even some overcoming the emergency, what would be the best time to resolve Acute acalculous cholecystitis medically or surgically? This is the big question.
{"title":"Acute Acalculous Cholecystitis in a Patient with Covid - 19","authors":"A. Palmieri","doi":"10.19080/ARGH.2020.16.555936","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555936","url":null,"abstract":"Acute alithiasic cholecystitis (AAC), also called acalculous, corresponds to the presence of an inflammation of the gallbladder in the absence of stones inside, it is a rare entity (10%), reported in diabetic patients, immunosuppressed, with pathologies infectious (viral, bacterial), major surgery, drugs, multiple trauma, mechanical ventilation, use of vasopressors, opioid analgesics, prolonged fasting, total parenteral nutrition, burns, among others. In this time of the SARS CoV-2 virus / COVID-19 coronavirus disease pandemic, surgeons have found an increase in the request for interconsultations from respiratory hospitalization services, intermediate care and intensive care units, due to ultrasound findings of incidental abdomen of acute alithiasic cholecystitis in those patients without improvement to treatment or worsening of sepsis, or the cytokine cascade, difficult to evaluate abdominal epigastric pain, right upper quadrant, induces us to explore and find little painful palpable gallbladder, reporting edema gallbladder wall greater than 3 mm, gallbladder distention, sometimes ultrasound Murphy’s sign, extending imaging studies according to the patient’s conditions with contrasted computed axial tomography and nuclear magnetic cholangioresonance, and even with reports of micro perforations with peri-vesicular extravasation of contents , free air on its walls, ruling out other causes of acalculous cholecystitis. It is a real diagnostic and therapeutic challenge in these patients with the SARS virus –COV-2 / COVID-19, already afflicted by viremia, or in some cases subjected to cytokine storms, poor general conditions, hermodynamically unstable in Intensive care units, intubated, with vasopressor support, and even some overcoming the emergency, what would be the best time to resolve Acute acalculous cholecystitis medically or surgically? This is the big question.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45434849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-10DOI: 10.19080/ARGH.2020.16.555934
D. A. Ortiz
Plasmablastic lymphoma is a rare variety of diffuse large B-cell lymphoma, regularly aggressive, usually localized in the oral cavity in patients with human immunodeficiency virus infection. Uncommon extraoral locations include the gastrointestinal tract. The endoscopic view of the tumor in the stomach is presented as well as its response to chemotherapy.
{"title":"Gastric Plasmablastic Lymphoma, A Very Rare Tumor","authors":"D. A. Ortiz","doi":"10.19080/ARGH.2020.16.555934","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555934","url":null,"abstract":"Plasmablastic lymphoma is a rare variety of diffuse large B-cell lymphoma, regularly aggressive, usually localized in the oral cavity in patients with human immunodeficiency virus infection. Uncommon extraoral locations include the gastrointestinal tract. The endoscopic view of the tumor in the stomach is presented as well as its response to chemotherapy.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48841189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-10DOI: 10.19080/ARGH.2020.16.555935
A. Sinesi
Celiac disease (CD) is an immune-mediated enteropathy correlated to the gluten ingestion in genetically predisposed subjects. The current and only therapy is a Gluten Free Diet (GFD). In recent years, new therapies and complementary strategies are being studied, including the modulation of the intestinal microbiome. The gut microbiota is involved in the onset and perpetuation of intestinal inflammation of various chronic bowel diseases, including CD. Intestinal dysbiosis has been reported in not treated or treated (with the GFD) celiac individuals, compared to healthy ones. Numerous studies have identified different bacterial clusters associated with CD. However, it’s still unclear whether gut dysbiosis is the cause or effect of CD.
{"title":"Gut Microbiota and Celiac Disease: Why Eat Gluten-Free if you are not Celiac?","authors":"A. Sinesi","doi":"10.19080/ARGH.2020.16.555935","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555935","url":null,"abstract":"Celiac disease (CD) is an immune-mediated enteropathy correlated to the gluten ingestion in genetically predisposed subjects. The current and only therapy is a Gluten Free Diet (GFD). In recent years, new therapies and complementary strategies are being studied, including the modulation of the intestinal microbiome. The gut microbiota is involved in the onset and perpetuation of intestinal inflammation of various chronic bowel diseases, including CD. Intestinal dysbiosis has been reported in not treated or treated (with the GFD) celiac individuals, compared to healthy ones. Numerous studies have identified different bacterial clusters associated with CD. However, it’s still unclear whether gut dysbiosis is the cause or effect of CD.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45601144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-12DOI: 10.19080/ARGH.2020.16.555933
wenhui zhang
Background and Aims: Ectopic embolization is the most serious complication of gastric variceal Histoacryl injection for the treatment of Isolated Gastric Varices (IGV) with Gastro-Renal Shunt (GRS). To evaluate the safety and efficacy of modified balloon-occluded retrograde transvenous obliteration-assisted Endoscopic Histoacryl Injection (E-BRTO) for the treatment of IGV with GRS. Methods: Patients that had IGV with significant GRS, treated with E-BRTO, were included in this study. The GRS was temporarily occluded with an occlusion balloon and the IGV was treated by Endoscopic Histoacryl Injection using the “sandwich technique”. Intra- and postoperative complications as well as the IGV eradication, re-bleeding, and recurrence rates were recorded and analyzed. Results: 22 patients were included in this study. The mean volume of Histoacryl used was 16.57±11.76mL. No deaths or serious complications were observed, including ectopic embolism and the worsening of hepatic and renal functions. IGV were eradicated in 22 cases (100%). Abdominal pain and fever was observed in one patient (4.55%), recurrence and re-bleeding of IGV in one patient (4.55%), who was recovery by another Histoacryl injection. Conclusion: E-BRTO is technically feasible, safe, and effective for the treatment of IGV associated with GRS in cirrhotic patients and worthy of clinical application. Keywords:
{"title":"Safety and Efficacy of Modified BRTO-Assisted Endoscopic Histoacryl Injection for the Treatment of Isolated Gastric Varices with Gastro-Renal Shunt","authors":"wenhui zhang","doi":"10.19080/ARGH.2020.16.555933","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555933","url":null,"abstract":"Background and Aims: Ectopic embolization is the most serious complication of gastric variceal Histoacryl injection for the treatment of Isolated Gastric Varices (IGV) with Gastro-Renal Shunt (GRS). To evaluate the safety and efficacy of modified balloon-occluded retrograde transvenous obliteration-assisted Endoscopic Histoacryl Injection (E-BRTO) for the treatment of IGV with GRS. Methods: Patients that had IGV with significant GRS, treated with E-BRTO, were included in this study. The GRS was temporarily occluded with an occlusion balloon and the IGV was treated by Endoscopic Histoacryl Injection using the “sandwich technique”. Intra- and postoperative complications as well as the IGV eradication, re-bleeding, and recurrence rates were recorded and analyzed. Results: 22 patients were included in this study. The mean volume of Histoacryl used was 16.57±11.76mL. No deaths or serious complications were observed, including ectopic embolism and the worsening of hepatic and renal functions. IGV were eradicated in 22 cases (100%). Abdominal pain and fever was observed in one patient (4.55%), recurrence and re-bleeding of IGV in one patient (4.55%), who was recovery by another Histoacryl injection. Conclusion: E-BRTO is technically feasible, safe, and effective for the treatment of IGV associated with GRS in cirrhotic patients and worthy of clinical application. Keywords:","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46808952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-09DOI: 10.19080/ARGH.2020.16.555932
S. Keiding
The organic anion indocyanine green (ICG) is eliminated solely via hepatobiliary excretion. Consequently, ICG is used to measure the hepatic blood flow by a constant intravenous infusion of ICG, with measurements of ICG blood concentrations in an artery and a hepatic vein, and calculation by Fick’s principle according to simple mass conservation. Secondly, ICG is used to estimate various hepatic clearances, using constant intravenous infusion or bolus injection of ICG and measurements of concentrations of ICG in peripheral blood. These clearance values reflect hepatic blood flow and hepatobiliary excretory function depending on hepatic removal kinetics and systemic blood circulation at the (patho)- physiological condition studied. Third, during recent years, a simple ICG 15-minute retention test (ICG-r15) is developed, using intravenous bolus injection of ICG, measurements of ICG concentration in peripheral blood after 15 minutes, and calculation of percentage ICG of the dose injected which is retained in the body. The ICG-r15 test, which is primarily used to assess the hepatobiliary excretory function but also a wide range of other conditions, is however based on dubious physiological assumptions. In this review, we go through these various applications of ICG measures in hepatology, focusing on physiological background of the tests and their use in studies of liver hemodynamics during normal conditions and liver diseases.
{"title":"Use of Indocyanine Green (ICG) in Hepatology","authors":"S. Keiding","doi":"10.19080/ARGH.2020.16.555932","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555932","url":null,"abstract":"The organic anion indocyanine green (ICG) is eliminated solely via hepatobiliary excretion. Consequently, ICG is used to measure the hepatic blood flow by a constant intravenous infusion of ICG, with measurements of ICG blood concentrations in an artery and a hepatic vein, and calculation by Fick’s principle according to simple mass conservation. Secondly, ICG is used to estimate various hepatic clearances, using constant intravenous infusion or bolus injection of ICG and measurements of concentrations of ICG in peripheral blood. These clearance values reflect hepatic blood flow and hepatobiliary excretory function depending on hepatic removal kinetics and systemic blood circulation at the (patho)- physiological condition studied. Third, during recent years, a simple ICG 15-minute retention test (ICG-r15) is developed, using intravenous bolus injection of ICG, measurements of ICG concentration in peripheral blood after 15 minutes, and calculation of percentage ICG of the dose injected which is retained in the body. The ICG-r15 test, which is primarily used to assess the hepatobiliary excretory function but also a wide range of other conditions, is however based on dubious physiological assumptions. In this review, we go through these various applications of ICG measures in hepatology, focusing on physiological background of the tests and their use in studies of liver hemodynamics during normal conditions and liver diseases.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44879883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-05DOI: 10.19080/ARGH.2020.16.555931
I. KhalidAlhaj
Background: Spillage of gallstones during the extraction of the gallbladder through the abdominal wall incision in laparoscopic cholecystecomy may lead to considerable complications. Methods: We describe an abdominal wall abscess formation in a 50-year-old female that developed 8 months after a laparoscopic cholecystectomy. Results: Undetected spillage of gallstones at the epigastric port site followed by stones migration through subcutaneous plane has lead to abdominal wall abscess formation at hypochondrial area 8 months later. Conclusion: Retained stone should be considered in any patient with foreign body in the subcutaneous tissues after a laparoscopic cholecystectomy. The use of a retrieval device avoids stone spillage. Spilled gallstones always should be removed when possible. In delayed presentations of abdominal wall abscesses due to Spilled gallstones, open drainage of the abscess and open retrieval of the stones followed by antibiotics and daily dressing should achieve adequate results.
{"title":"Late Onset Abdominal Wall Abscess after Laparoscopic Cholecystectomy","authors":"I. KhalidAlhaj","doi":"10.19080/ARGH.2020.16.555931","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555931","url":null,"abstract":"Background: Spillage of gallstones during the extraction of the gallbladder through the abdominal wall incision in laparoscopic cholecystecomy may lead to considerable complications. Methods: We describe an abdominal wall abscess formation in a 50-year-old female that developed 8 months after a laparoscopic cholecystectomy. Results: Undetected spillage of gallstones at the epigastric port site followed by stones migration through subcutaneous plane has lead to abdominal wall abscess formation at hypochondrial area 8 months later. Conclusion: Retained stone should be considered in any patient with foreign body in the subcutaneous tissues after a laparoscopic cholecystectomy. The use of a retrieval device avoids stone spillage. Spilled gallstones always should be removed when possible. In delayed presentations of abdominal wall abscesses due to Spilled gallstones, open drainage of the abscess and open retrieval of the stones followed by antibiotics and daily dressing should achieve adequate results.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46310010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-22DOI: 10.19080/ARGH.2020.16.555930
A. Rivera
Eosinophilic enteritis is a rare disease characterized by eosinophilic infiltration in the small intestine; In the absence of non-gastrointestinal diseases that cause eosinophilia or causes known as parasites, medications, or malignancies.
{"title":"Eosinophilic Enteritis, A Rare Dissease","authors":"A. Rivera","doi":"10.19080/ARGH.2020.16.555930","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555930","url":null,"abstract":"Eosinophilic enteritis is a rare disease characterized by eosinophilic infiltration in the small intestine; In the absence of non-gastrointestinal diseases that cause eosinophilia or causes known as parasites, medications, or malignancies.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45056004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-20DOI: 10.19080/ARGH.2020.16.555929
Deganello Saccomani Marco
Background and Study Aim: Esophageal stenosis (ES) is the most common complication associated with congenital esophageal atresia (EA). There is no consensus regarding the endoscopic management of strictures in terms of timing and techniques of dilation. The aim of this study is to describe the endoscopic approach of esophageal stenosis in children with EA admitted to our tertiary care center. Patients and Methods: A retrospective descriptive single center study was conducted. Data of all patients diagnosed with EA admitted to Woman’s and Child’s University Hospital of Verona, Italy, between 2004 and 2017, were reviewed and collected. For each patient type of EA, associated malformations, age of surgical correction, number and timing of dilations, technique of dilation and side effects of the procedure were registered. Results: Thirty-seven patients with EA were admitted to our center between 2004 and 2017. Twenty of them were excluded from the analysis for insufficient data. Five of the seventeen patients enrolled were affected by VACTERL syndrome and 3 had other congenital malformations. Twelve (70 %) subjects had tracheoesophageal fistula, all of them with type C EA. Three (18%) children presented with long gap EA. All patients underwent surgical correction within 2 months of life and an endoscopic control was performed in all of them. Eleven patients (65%), 8 with Type C EA and 3 with Type A EA, underwent endoscopic dilations because of ES. Eight of them (72%) needed more than one dilation due to anastomotic re- stenosis. Median age of first dilation was 3 months (1-12 months), whereas median age of last dilation was 6 months (1-18 months). Only in one case was used balloon dilator, whereas all other procedures were performed using Savary- Gilliard semi- rigid dilators. One patient (Type C EA with long gap) underwent surgical re-treatment due to an endoscopic complication (fistula recurrence). Six of the seventeen subjects (35%) enrolled developed long-term complications (stridor; severe esophagitis; subglottic stenosis; esophageal diverticulum; dysphagia). Conclusion: Our data confirmed that anastomotic stricture is frequent in patients with EA after surgical correction. Endoscopic management of stenosis is a safe and effective procedure that lead to a limited number of complications. Regular follow-up by a multidisciplinary team is fundamental to prevent and treat short-term and long-term complications.
{"title":"Endoscopic Management of Esophageal Stenosis in Children with Congenital Esophageal Atresia","authors":"Deganello Saccomani Marco","doi":"10.19080/ARGH.2020.16.555929","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555929","url":null,"abstract":"Background and Study Aim: Esophageal stenosis (ES) is the most common complication associated with congenital esophageal atresia (EA). There is no consensus regarding the endoscopic management of strictures in terms of timing and techniques of dilation. The aim of this study is to describe the endoscopic approach of esophageal stenosis in children with EA admitted to our tertiary care center. Patients and Methods: A retrospective descriptive single center study was conducted. Data of all patients diagnosed with EA admitted to Woman’s and Child’s University Hospital of Verona, Italy, between 2004 and 2017, were reviewed and collected. For each patient type of EA, associated malformations, age of surgical correction, number and timing of dilations, technique of dilation and side effects of the procedure were registered. Results: Thirty-seven patients with EA were admitted to our center between 2004 and 2017. Twenty of them were excluded from the analysis for insufficient data. Five of the seventeen patients enrolled were affected by VACTERL syndrome and 3 had other congenital malformations. Twelve (70 %) subjects had tracheoesophageal fistula, all of them with type C EA. Three (18%) children presented with long gap EA. All patients underwent surgical correction within 2 months of life and an endoscopic control was performed in all of them. Eleven patients (65%), 8 with Type C EA and 3 with Type A EA, underwent endoscopic dilations because of ES. Eight of them (72%) needed more than one dilation due to anastomotic re- stenosis. Median age of first dilation was 3 months (1-12 months), whereas median age of last dilation was 6 months (1-18 months). Only in one case was used balloon dilator, whereas all other procedures were performed using Savary- Gilliard semi- rigid dilators. One patient (Type C EA with long gap) underwent surgical re-treatment due to an endoscopic complication (fistula recurrence). Six of the seventeen subjects (35%) enrolled developed long-term complications (stridor; severe esophagitis; subglottic stenosis; esophageal diverticulum; dysphagia). Conclusion: Our data confirmed that anastomotic stricture is frequent in patients with EA after surgical correction. Endoscopic management of stenosis is a safe and effective procedure that lead to a limited number of complications. Regular follow-up by a multidisciplinary team is fundamental to prevent and treat short-term and long-term complications.","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42860808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-05DOI: 10.19080/ARGH.2020.16.555927
I. Trubitsyna
Trubitsyna I*1, Vinokurova L1, Tarasova T2, Lesko K1, Dorofeev A1, Papysheva L1,3, Efremov1, Abdulatipova Z1, Smirnova A1,4 and Varvanina G1 1Moscow clinical research and practice center Of the Moscow Department of health, Russia 2Professor of the Department of psychology of the Historical and sociological Institute of the Federal state budgetary educational institution of higher education, Ogarev Mordovian state University, Russia
{"title":"The Process of Formation the Autoimmune Reaction in the Gastric Mucosa the Damaged Liver","authors":"I. Trubitsyna","doi":"10.19080/ARGH.2020.16.555927","DOIUrl":"https://doi.org/10.19080/ARGH.2020.16.555927","url":null,"abstract":"Trubitsyna I*1, Vinokurova L1, Tarasova T2, Lesko K1, Dorofeev A1, Papysheva L1,3, Efremov1, Abdulatipova Z1, Smirnova A1,4 and Varvanina G1 1Moscow clinical research and practice center Of the Moscow Department of health, Russia 2Professor of the Department of psychology of the Historical and sociological Institute of the Federal state budgetary educational institution of higher education, Ogarev Mordovian state University, Russia","PeriodicalId":72074,"journal":{"name":"Advanced research in gastroenterology & hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41398047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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