Endoscopic therapy through dilatation of benign esophageal stenosis

Introduction: Endoscopic dilatation is the first therapeutic option to eliminate benign esophageal stenosis and improve the symptoms and the quality of life of those patients who suffer from it. Objective: To describe the results of endoscopic dilatation in patients with benign esophageal stenosis treated in the National Center for Endoscopic Surgery from January 2015 to December 2016.  Material and Methods:A case series longitudinal observational study was conducted in 59 patients with benign esophageal stenosis. Dilatations were done with Savary-Gilliard bougie and balloons. Results: The mean age was 52,5 years, and the condition predominated in 37 male patients (62,7%). Post-surgical, peptic, and caustic were the most frequent etiologies with 25, 14, and 6 cases, respectively.  Short stenosis predominated in 51 cases. Bougies were used in 48 patients for a total of 149 dilatations, corresponding to a mean of 3,1 dilatations/ patients. Correction of the stenosis was made in 1-3 sessions in 47 % of patients; 11 cases were dilated with balloon, corresponding to a mean of 1- 3 dilatations/ patients. Four patients from the group that were dilated with Savary-Gilliard bougies showed refractoriness. A perforation, and two bleedings occurred.  After the dilatations, dysphagia improved or disappeared in 93,2 % of patients. Conclusions: Endoscopic therapy through dilatation of benign esophageal stenosis indicated to be a good alternative method in achieving corrections in a few dilatation sessions, with a low number of complications, and an improvement of the dysphagia.  Keywords: esophageal stenosis, benign esophageal stenosis, endoscopic therapy, balloon dilatation, dilatation with Savary-Gilliard bougies.</p

Efficacy of endoscopic ultrasound in the evaluation of post-radiotherapy rectal tumor

Introduction: Local restaging of rectal tumor to assess the degree of rectal wall invasion determines the extent of surgical intervention. Endoscopic ultrasound is an accurate technique in initial staging, but has limitations in post-radiation therapy evaluation. Objective: To determine the diagnostic efficacy of endoscopic ultrasound in the evaluation of post-radiotherapy rectal tumor. Methods: Observational, descriptive, cross-sectional, case series study of 54 patients with irradiated rectal tumor re-evaluated by endoscopic ultrasound at the National Center for Minimal Access Surgery between September 2018 and December 2022. To determine the efficacy of endoscopic ultrasound, the following were calculated: sensitivity, specificity, positive and negative predictive value, likelihood ratios, Youden index and diagnostic agreement according to kappa index. The histological study of the surgical specimen was the reference standard. Results: The overall concordance of the endoscopic ultrasound was 79.6%, the kappa index was weak (k= 0.1951; p= 0.05). It showed good sensitivity (97.62%), however, specificity, negative predictive value and positive likelihood ratio were low. Of the patients, 48.1% were overstaged. The validity index was good (79.63%) and the test performance showed a Youden index of 0.14. Conclusions: The efficacy of endoscopic ultrasound in the evaluation of post-radiotherapy rectal tumor, has limitations due to its low specificity; it fails to discriminate between fibrosis and residual malignant lesion

Terapéutica endoscópica mediante dilataciones en estenosis esofágicas benignas

Introduction: Endoscopic dilatation is the first therapeutic option to eliminate benign esophageal stenosis and improve the symptoms and the quality of life of those patients who suffer from it. Objective: To describe the results of endoscopic dilatation in patients with benign esophageal stenosis treated in the National Center for Endoscopic Surgery from January 2015 to December 2016.  Material and Methods:A case series longitudinal observational study was conducted in 59 patients with benign esophageal stenosis. Dilatations were done with Savary-Gilliard bougie and balloons. Results: The mean age was 52,5 years, and the condition predominated in 37 male patients (62,7%). Post-surgical, peptic, and caustic were the most frequent etiologies with 25, 14, and 6 cases, respectively.  Short stenosis predominated in 51 cases. Bougies were used in 48 patients for a total of 149 dilatations, corresponding to a mean of 3,1 dilatations/ patients. Correction of the stenosis was made in 1-3 sessions in 47 % of patients; 11 cases were dilated with balloon, corresponding to a mean of 1- 3 dilatations/ patients. Four patients from the group that were dilated with Savary-Gilliard bougies showed refractoriness. A perforation, and two bleedings occurred.  After the dilatations, dysphagia improved or disappeared in 93,2 % of patients. Conclusions: Endoscopic therapy through dilatation of benign esophageal stenosis indicated to be a good alternative method in achieving corrections in a few dilatation sessions, with a low number of complications, and an improvement of the dysphagia.  Keywords: esophageal stenosis, benign esophageal stenosis, endoscopic therapy, balloon dilatation, dilatation with Savary-Gilliard bougies.Introducción: Las dilataciones endoscópicas constituyen la primera opción terapéutica para eliminar las estenosis esofágicas benignas y mejorar los síntomas y la calidad de vida de los pacientes que las presentan. Objetivo: Describir los resultados de las dilataciones endoscópicas en pacientes con estenosis esofágicas benignas, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso, durante enero de 2015 a diciembre de 2016. Material y Métodos: Se realizó un estudio observacional longitudinal de serie de casos, en 59 pacientes con estenosis esofágicas benignas. Las dilataciones se efectuaron con Bujías de Savary-Gilliard y balones. Resultados: La edad media fue de 52,5 años, predominaron los hombres con 37 (62,7%) pacientes. Las etiologías más frecuentes fueron la postquirúrgicas, pépticas y caústicas con 25, 14 y 6 casos respectivamente. Predominaron las estenosis cortas en 51 casos. En 48 pacientes se utilizaron bujías, con un total de 149dilataciones, con una media de 3,1 dilataciones/pacientes, 47,5%corrigió la estenosis con 1-3 sesiones; 11 casos se dilataron con balón, con una media de 1,3 dilataciones/pacientes. En el grupo de los dilatados con Bujías de Savary-Guilliard, 4 pacientes mostraron refractariedad y ocurrieron una perforación y 2 sangrados. Posterior a las dilataciones, en 93,2% de los pacientes, mejoró o desapareció la disfagia. Conclusiones: La terapéutica endoscópica mediante dilataciones en las estenosis esofágicas benignas demostró ser una buena alternativa, al lograr su corrección con pocas sesiones de dilataciones, bajo número de complicaciones y mejoría de la disfagia.   Palabras claves: Estenosis de esófago, estenosis benigna de esófago, terapéutica endoscópica, dilatación con balón, dilatación con Bujías de Savary Giliard