Re: Refractory cervical esophagogastric anastomotic strictures

January 19, 2011

you know, years ago I met a Phys Asst. who had A and she talked about self

dilating and all I can say is - ugh!! Not a chance!!

'self dilate'?!? Seriously?!?

without drugs??

I'm still shuddering just thinking about it

>

> http://jtcs.ctsnetjournals.org/cgi/content/abstract/141/2/444?ct=ct

>

> J Thorac Cardiovasc Surg 2011;141:444-448

>

> General Thoracic Surgery

>

> Refractory cervical esophagogastric anastomotic strictures: Management and

outcomes

>

> J. , BSa,*,

> Lili Zhao, PhDb,

> C. Chang, MDc,

> Mark B. Orringer, MDc

>

> a University of Michigan Medical School, Section of Thoracic Surgery, Ann

Arbor, Mich

>

> b University of Michigan Comprehensive Cancer Center, Section of Thoracic

Surgery, Ann Arbor, Mich

>

> c University of Michigan Medical Center, Section of Thoracic Surgery, Ann

Arbor, Mich

>

> Read at the 36th Annual Meeting of The Western Thoracic Surgical Association,

Ojai, California, June 23â€ " 26, 2010.

>

> Received for publication June 13, 2010; revisions received September 23, 2010;

accepted for publication October 10, 2010.

> * Address for reprints:

> J. , BS, University of Michigan Medical Center, Department of

> Surgery, Section of Thoracic Surgery, 2120 Taubman Center, Box 0344,

> 1500 East Medical Center Drive, Ann Arbor, MI 48109-5344. (Email: sjdmed@...).

>

> Objective: For recalcitrant cervical esophagogastric anastomotic strictures

after transhiatal esophagectomy, a protocol of self-dilatation was developed at

the University of Michigan Medical Center, as previously described. This study

was undertaken to determine the outcomes of this treatment.

>

> Methods: Self-dilatation was required in 158 (7.6%) of 2075 patients with

cervical esophagogastric anastomotic strictures after transhiatal esophagectomy.

An esophageal-specific survey evaluated the frequency and duration of

dilatation, swallowing function, and satisfaction with treatment. The

relationship among anastomotic leak, subsequent stricture, and the need for

self-dilatation was assessed. A validated survey tool, the Short Form 36-item,

version 2, was used to assess quality of life.

>

> Results: At the time of this study, 78 of 158 patients were alive; 34 (43%)

participated in the esophageal-specific survey. Median duration of

self-dilatation was 10 years. The majority were satisfied with their ability to

eat. No adverse events were reported. All patients said they would use

self-dilatation therapy again under similar circumstances. Of these patients, 20

(59%) responded to the Short Form 36-item, version 2. Compared with the general

population, 55% and 70% of participants scored at or above the norm for physical

health and mental health status, respectively. Patients who required

self-dilatation were twice as likely to have a history of cervical

esophagogastric anastomotic leak as those who did not require this therapy

(PÂ =Â .0002).

>

> Conclusions: Refractory cervical esophagogastric anastomotic strictures are

best managed initially with frequent outpatient dilatations, then transitioning

to self-dilatation. Home use of Maloney dilators is a safe, well-tolerated,

convenient, and cost-effective way to maintain comfortable swallowing. The

effectiveness ofÂ self-dilatation therapy is reflected in this cohortâ€™s good

quality of life and level of functioning.

>

> Abbreviations and Acronyms CEGA = cervical esophagogastric anastomosis; ESS =

Esophageal-Specific Survey; QOL = quality of life; SF-36v2 = Short Form 36-item,

version 2; THE = transhiatal esophagectomy

> Â California Collegiate Shooting Sports 4-H All-Star Advisor to the

most awesome Â kids of Amador County!

>

January 19, 2011

I was thinking the same thing? How do you get past the gag reflex? I would die

trying. Seriously.

> >

> > http://jtcs.ctsnetjournals.org/cgi/content/abstract/141/2/444?ct=ct

> >

> > J Thorac Cardiovasc Surg 2011;141:444-448

> >

> > General Thoracic Surgery

> >

> > Refractory cervical esophagogastric anastomotic strictures: Management and

outcomes

> >

> > J. , BSa,*,

> > Lili Zhao, PhDb,

> > C. Chang, MDc,

> > Mark B. Orringer, MDc

> >

> > a University of Michigan Medical School, Section of Thoracic Surgery, Ann

Arbor, Mich

> >

> > b University of Michigan Comprehensive Cancer Center, Section of Thoracic

Surgery, Ann Arbor, Mich

> >

> > c University of Michigan Medical Center, Section of Thoracic Surgery, Ann

Arbor, Mich

> >

> > Read at the 36th Annual Meeting of The Western Thoracic Surgical

Association, Ojai, California, June 23â€ " 26, 2010.

> >

> > Received for publication June 13, 2010; revisions received September 23,

2010; accepted for publication October 10, 2010.

> > * Address for reprints:

> > J. , BS, University of Michigan Medical Center, Department of

> > Surgery, Section of Thoracic Surgery, 2120 Taubman Center, Box 0344,

> > 1500 East Medical Center Drive, Ann Arbor, MI 48109-5344. (Email: sjdmed@).

> >

> > Objective: For recalcitrant cervical esophagogastric anastomotic strictures

after transhiatal esophagectomy, a protocol of self-dilatation was developed at

the University of Michigan Medical Center, as previously described. This study

was undertaken to determine the outcomes of this treatment.

> >

> > Methods: Self-dilatation was required in 158 (7.6%) of 2075 patients with

cervical esophagogastric anastomotic strictures after transhiatal esophagectomy.

An esophageal-specific survey evaluated the frequency and duration of

dilatation, swallowing function, and satisfaction with treatment. The

relationship among anastomotic leak, subsequent stricture, and the need for

self-dilatation was assessed. A validated survey tool, the Short Form 36-item,

version 2, was used to assess quality of life.

> >

> > Results: At the time of this study, 78 of 158 patients were alive; 34 (43%)