• Journal of Chest Surgery
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• v.23 no.1
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• pp.90-94
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• 1990

Between Dec. 1958 and Oct. 1989, we had been experienced 14 cases of the esophageal corrosion carcinoma among 562 cases of corrosive esophageal stricture, which incidence was revealed 5.6 % of total esophageal carcinoma cases and 2.5 9o of total benign esophageal stricture cases. The age distribution was from 15 to 64 years, and the mean age was 45.6 years. Ten of the patients were women. The caustic agents were lye in 12 patients and hydrochloric acid in 2 patients. The latent time from injury to the development of carcinoma was from 12 years to 45 years, and the mean latent time was 29 years. In majority of cases, the developing site of carcinoma was just or just above the benign stricture portion of the esophagus. Corrective surgery were made in seven cases; three cases were made esophagectomy and esophagogastrostomy, and the other four cases were made esophagectomy and colon interposition. Palliative surgery including feeding gastrostomy were made in seven cases. All cases had a longstanding history of difficult oral swallowing especially at the site of stricture. We think chronic food irritations of stricture portion of the esophagus induced the development of corrosion carcinoma. In conclusion, we had to suspect possibility of carcinoma in patient with long standing history of benign esophageal stricture. So we recommended preoperative esophagoscopic biopsy in such cases.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.107-114
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• 1990

During a ten-year period from August, 1978 to September, 1989 45 patients with benign esophageal stricture were surgically evaluated. The results are as follows; l. Out of 45 patients, there were 26 males and 19 females ranging from 2 to 70 years of age with a mean of 31.9 years. 2. The most common cause of benign esophageal stricture was corrosive burn due to caustic agents[40 cases, 88.9 %]. Corrosive agents were 15 cases of lye, 22 cases of acid and 3 cases of other agents. Other causes were two cases of esophageal web and each one case of previous surgical result, inflammation and idiopathic mediastinal fibrosis respectively. 3. The most frequent stricture site was whole esophagus as 21 cases[46.7 %] and the next was lower a third thoracic esophagus[10 cases, 25.0%]. 4. In 33 of total 45 cases, colon interposition with right colon was performed without resection of the strictured esophagus except one case which was complicated esophageal cancer. Other procedures were 4 cases esophagogastrostomy with segmental resection, 2 cases of plastic repair and so on. 5. Major postoperative complications which were needed for secondary operation were 5 cases[11.1 %]. [2 cases of stenosis, ileus and ulcer bleeding respectively] Overall mortality rate was 4.4 %.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.62-71
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• 2000

Background: For the purpose of reducing operating time and rate of anastomotic leakage, we have performed esophagovisceral anastomosis with an EEA stapler using the largest size possible. If any difficulty in the approach of the EEA stapler was encountered one-layer interrupted hand-sewn anastomosis. Because the rate of postoperative benign anastomotic stricture was higher than expected, a retrospective study was done on all patients who underwent esophageal reconstruction. Material and Method: Over a period of 3 years from January 1996 to December 1998, we performed esophageal reconstructions on 30 patients. Patients were divided into two groups ; EEA stapler group(Group Ⅰ) comprised of 21 patients and hand-sewn group(Group Ⅱ) comprised of 9 patients.Result:The hospital mortality was 6.67 %(2/30) and the anastomotic leakage rate was 3.33 %(1/30). Among the discharged patients, the rate of recurrent anastomotic tumor was 3.57 %(1/28) and the rate of benign anastomotic stricture stricture rate was 35 %(7/20) in Group Ⅰ and 12.5 %(1/8) in Group Ⅱ, which was not significant. Conclusion: Although nontumor benign stricture was significantly higher in Group Ⅱ than in Group Ⅰ(p=0.0492), the incidence of anastomotic complications did not differ between the two groups. The one-layer interrupted hand-sewn esophagovisceral anastomosis by maintaining a wide lumen and close approximation of mucosa to mucosal layers with evenly spaced sutures could be one of the preferred surgical method to reduce benign anastomotic strictures.

• Clinical Endoscopy
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• v.57 no.1
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• pp.122-127
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• 2024

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

• Clinical Endoscopy
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• v.57 no.2
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• pp.253-262
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• 2024

Background/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS. Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020. Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01-7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85-6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively. Conclusions: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1032-1037
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• 1995

Between September 1988 and December 1993, 32 cases of benign esophageal stricture, of which 12 males and 20 females, were managed in Seoul National University Hospital hospital. Their age ranged from 2 to 61 years, and the mean age was 33.9 years. The ingestion of caustic agent was the most common cause, and the caustic material was acid in 16 patients [58% and alkali in 11patients [39% . Nearly all of the patients complained of dysphagia, and some of chest pain, epigastric pain, weight loss, vomiting, general malaise, and dyspnea. The most frequent site of stricture was found in the upper thoracic esophagus with 34% incidence followed by the lower thoracic esophagus[28% , whole esophagus[19% , and the mid esophagus[16% . The operations performed were 17[53% ECG[esophagocologastrostomy , 5[16% PCG[pharyngocologastrostomy , 5[16% EG[esophagogastrostomy , 2 EJG [esophagojejunogastrostormy by free jejunal graft , and 1 case each of EJ [esophagojejunostomy , esophageal end to end anastomosis, jejunostomy only, and gastrostomy only. In 23 patients [72% , diseased esophaguses were resected, using transhiatal total esophagectomy in 15 [47% and transthoracic partial esophagectomy in 8 [25% . Of those 23 patients, 3 patients [9.4% were diagnosed as esophageal carsinoma on microscopic examination. The postoperative most common complications were unilateral vocal cord palsy in 6 patients [19% , followed by cervical anastomosis leakage in 4 patients [12.5% , wound infection in 2 patients [6% , and pneumothorax in 2 patients [6% . Late death occurred 8 months after the operation in one patient, which was associated with infection due to anastomotic leakage. Our experience shows that the rate of mortality and the morbidity were low in patients receiving surgical management for esophageal stricture and that the cancer transformation rate was high. We recommend esophageal reconstruction surgery with esophagectomy [transhiatal or transthoracic for the esophageal stricture because it can avoid a chance of prevent cancer transformation.

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.246-251
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• 2005

Purpose: Benign anastomotic stricture after an esophagojejunostomy using EEA stapler following a radical total gastrectomy is one of the most serious complications. The purpose of this study is to evaluate the incidence risk factors, and treatment associated with benign stricture. Materials and Methods: From March 1998 to February 2001, 436 patients underwent an esophagojejunostomy with Roux-en-Y anastomosis using an EEA stapler followed by an endoscopy. Thirty three of the 436 patients(5.5%) developed an anastomotic stricture; included 24 of the 33 patients had a benign stricture. Nine patients with a malignant stricture were excluded. Results: The median age of the 436 patients was 57 years $(23{\sim}85\;years)$. Two hundred ninety two patients were male, and 144 patients were female. The median time to diagnosing the stricture was 1.5 months $(0.5{\sim}6months)$. There was no statistical significance in any of the risk factors, including the diameter of the stapling device, the status of adjuvant treatment, the status of reflux esophagitis, and a clinical history of diabetes and hypertension. The strictured patients were treated with balloon dilatation, one to three times, with symptom relief. Conclusion: There were no statistically significant risk factors. However, further study of the vascularity of anastomoses and benign strictures needs to be considered. In the anastomotic strictured patients endoscopic balloon dilatation appeared to be the first line of treatment.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.617-621
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• 2004

End-to-end anastomosis for benign esophageal stricture (BES) is technically easier and relatively lower in morbidity than esophago-enterostomy. We performed segmental resection and end-to-end anastomosis in 2 cases of short segmental BES who were failed repeated endoscopic dilatation. A 13-month-old female with postoperative stricture was treated successfully. However, a 27-year-old female with corrosive stricture required second operative management of esophago-colo-gastrostomy following end-to-end anastomosis. Our experiences suggested that end-to-end anastomosis for BES could be used as a valid procedure for well selected patients. However, further studty is needed to compare with esophago-enterostomy.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1217-1221
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• 1998

Background: The advent of EEA stapler has lowered the leakage rate of esophagogastric anastomoses and thereby contributed to a decrease in the operative mortality of the easophageal resection. Recent surgical reports, however, have documented 10% to 20% prevalence of benign anastomotic stricture formation after the use of EEA stapler to construct an esophagogastric anastomosis. We analyzed the cases of anastomotic strictures to reduce the incidence of anastomotic strictures with EEA stapled esophagogastrostomy. Material and Method: EEA stapled esophagogastrostomy was performed in 195 parients during the period of over 11 years from Jan. 1986 to Dec. 1996 in Kosin Medical Center. Ten patients of them died in the early postoperative days. In the remaining 185 patients, we studied the incidence and the onset time of anastomotic strictures, relationship between the patients' ages, the anastomotic sites, and the size of the cartridges with incidence of anastomotic stricture. We also studied the method of treatment and its effect in the anastomotic strictures. Result: Benign anastomotic strictures occurred in 39 cases among 185 patients(21%), 25 cases(64.1%) of the 39 cases developed in one to three months postoperatively. The patients' ages and the anastomotic sites did not effect with the incidence of anastomotic stricture, but high incidence of anastomotic stricture in EEA stapled esophagogastrostomy(p=0.04)was observed in small cartridge sizes. One or two balloon dilatation(89%) relieved the anastomotic strictures. Conclusion: We conclude that a larger size cartridge is recommended in EEA stapled esophagogastrostomy to reduce the incidence of anastomotic stricture if possible, and one or two balloon dilatation would seem to be a safe and reliable method in treating anastomotic stricture when the anastomotic stricture was occurrs.

• The Korean Journal of Cytopathology
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• v.11 no.1
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• pp.11-18
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• 2000

Pancreaticobiliary tract strictures are frequent Indications for endoscopic retrograde cholangiopancreatography(ERCP). We have investigated the brushing cytology in order to determine its efficacy for diagnosis of pancreaticobiliary malisnancies. Brushing cytology during ERCP was evaluated in 56 patients with biliary tract stricture presenting to the Catholic Hospital of Taegu-Hyosung from April 1997 to August 1999. A comparison was made between the cytologic and histologic diagnoses on 32 cases from 30 patients. A diagnosis of malignancy was establishied in 78.1%, benign in 15.6%, and inadequate in 6.3% of the cases. Statistical data on cytologic diagnoses in strictures of the bile duct were as follows; specificity and sensitivity of blushing procedure was 100% & 83.3%, respectively: sensitivity of interpretation was 89.3%: with no false positive cases and 3 false negative cases: predictive value for malignancy was 100% & 100%, respectively: predictive value for benign was 28.6% & 40%,, respectively: overall diagnostic efficiency was 84.4%. It is concluded that brush cytology is a diagnostically reliable, highly specific technique for malignant lesions encounted at ERCP, although a negative result does not rule out the diagnosis of malignancy.