Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastri...Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. It was successfully treated with transposition of a pedicled pectoralis major muscle flap.展开更多
Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute...Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.展开更多
Objectives:Few studies have evaluated the long-term complications and outcomes of esophageal atresia with or without tracheoesophageal fistula(EA/TEF)beyond childhood.The aim of our study was to characterize the esoph...Objectives:Few studies have evaluated the long-term complications and outcomes of esophageal atresia with or without tracheoesophageal fistula(EA/TEF)beyond childhood.The aim of our study was to characterize the esophageal and respiratory morbidity of EA/TEF through evaluation of clinical symptoms,diagnostic testing and therapeutic intervention at a tertiary care center.Methods:Patients with congenital EA/TEF evaluated from 2011 to 2014 were included.Demographic characteristics,type and mode of repair of EA/TEF,clinical symptoms,radiographic,endoscopic,bronchoscopic and medication use data were obtained.Results:A total of 43 patients were identified.The median age of this predominantly Caucasian population was 8 years(interquartile range:3,20).Twenty(62.5%)had type C(EA with distal TEF)abnormality.Twenty-one(48.8%)patients had heartburn,19(44.1%)had acid regurgitation,and 31(72.1%)had dysphagia to solids.Barium swallow in 26 patients revealed strictures in 17(65.4%),dysmotility in 20(76.9%)and recurrent fistulas in four patients(15.4%).Thirty patients underwent upper endoscopy,of which 21(70.0%)had a stricture,and six(20.0%)had recurrent fistula requiring surgical intervention.Eight(18.6%)patients underwent fundoplication.Pulmonary evaluation showed cough and choking in 31(72.1%)patients and dyspnea and wheezing in 32(53.4%)patients.Recurrent respiratory infections were reported in 19(44.2%).patients.Other findings included tracheomalacia in 86.7% and restrictive lung disease in 54.5%of patients.Conclusion:There is a high burden of residual esophageal and pulmonary pathology in patients with EA/TEF.Ongoing follow-up is required to monitor both the clinical symptoms and treatment responses.展开更多
文摘Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. It was successfully treated with transposition of a pedicled pectoralis major muscle flap.
文摘Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.
文摘Objectives:Few studies have evaluated the long-term complications and outcomes of esophageal atresia with or without tracheoesophageal fistula(EA/TEF)beyond childhood.The aim of our study was to characterize the esophageal and respiratory morbidity of EA/TEF through evaluation of clinical symptoms,diagnostic testing and therapeutic intervention at a tertiary care center.Methods:Patients with congenital EA/TEF evaluated from 2011 to 2014 were included.Demographic characteristics,type and mode of repair of EA/TEF,clinical symptoms,radiographic,endoscopic,bronchoscopic and medication use data were obtained.Results:A total of 43 patients were identified.The median age of this predominantly Caucasian population was 8 years(interquartile range:3,20).Twenty(62.5%)had type C(EA with distal TEF)abnormality.Twenty-one(48.8%)patients had heartburn,19(44.1%)had acid regurgitation,and 31(72.1%)had dysphagia to solids.Barium swallow in 26 patients revealed strictures in 17(65.4%),dysmotility in 20(76.9%)and recurrent fistulas in four patients(15.4%).Thirty patients underwent upper endoscopy,of which 21(70.0%)had a stricture,and six(20.0%)had recurrent fistula requiring surgical intervention.Eight(18.6%)patients underwent fundoplication.Pulmonary evaluation showed cough and choking in 31(72.1%)patients and dyspnea and wheezing in 32(53.4%)patients.Recurrent respiratory infections were reported in 19(44.2%).patients.Other findings included tracheomalacia in 86.7% and restrictive lung disease in 54.5%of patients.Conclusion:There is a high burden of residual esophageal and pulmonary pathology in patients with EA/TEF.Ongoing follow-up is required to monitor both the clinical symptoms and treatment responses.
