A. Cusumano

EARLY AND LONG-TERM RESULTS OF PNEUMATIC DILATION IN THE TREATMENT OF OESOPHAGEAL ACHALASIA.

SummaryBetween 1967 and 1989, 60 patients underwent pneumatic dilation of the cardia at our institution. Of these, 33 had not undergone any previous treatment (group 1), whereas 27 presented with recurrent dysphagia after a failure of surgical treatment (group 2). In this series there was no procedure-related mortality and a perforation occurred only in 1 patient who was treated conservatively. The mean follow-up was similar in both groups (44 and 49 months, respectively). The results of pneumatic dilation were either excellent or good in 61% of group 1 patients, and in 76% of group 2 patients. Reflux oesophagitis requiring medical therapy occurred in 1 group 2 patient. We conclude that pneumatic dilation is a safe and relatively effective procedure in patients with achalasia. Patients with a failed Heller myotomy seem to respond better than patients without previous surgery. However, the risk of gastro-oesophageal reflux after pneumatic dilation should not be underestimated.

Esophageal Prosthesis in the Treatment of Cancer of the Esophagus

During the past five years only a few more than 50% of our patients with esophageal cancer received surgical resection of the neoplasia and only one-third of patients were treated with esophageal prosthesis. Esophageal prosthesis application began here in 1969 when the prosthesis was applied exclusively by surgery. Technical progress was made in 1977 when the endoscope was used for applying the esophageal prosthesis by transoral push through [4, 5]. Some years had to pass before we could say that this method was useful for improving results and lowering the number of complications. The materials and the method are now defined and the results are good even if the indication is the palliative management of dysphagia of patients with esophageal cancer [1, 3, 6].

Evaluation critique des prélèvements cyto-histologiques perendoscopiques après coloration vitale au bleu de Toluidine dans le cancer de I’œsophage

RésuméLes auteurs apportent leur casuistique dans l’étude du cancer de l’œsophage, avec prélèvements cyto-histologiques, après coloration vitale.La chromo-œsophagoscopie permet de déterminer l’exacte extension muqueuse d’un carcinome invasif, précise l’endroit idéal des prélèvements et révèle des zones de dysplasie ou de carcinome in situ occultes.Les auteurs révèlent que la coloration vitale porte à une augmentation de la positivité des prélèvements cyto-histologiques jusqu’à 97%.SummaryThe authors report their experience with endoscopic vital staining and cytohistologic specimens in patients affected by esophageal cancer.Endoscopic vital staining permits the detection of cancer extension and consents the individualization of the exact site of brushing and biopsy. Moreover, dysplasia or carcinoma éin situé can be detected by this method.The authors conclude that vital staining permits the diagnosis of carcinoma in 97% of cyto-histologic specimens.

Endoscopic Vital Staining in the Diagnosis of Esophageal Cancer

Esophageal carcinoma is rarely diagnosed in western countries until dysphagia occurs, and since approximately two-thirds of the esophageal lumen are involved by this time, it is not surprising that unresectability rates as high as 65% have been reported [1].

Evaluation critique des résultats obtenus dans 650 cas de sténose néoplasique de ľœsophage traités par prothèse

RésuméLes auteurs présentent leur expérience du traitement de 650 cas de sténose néoplasique de ľœsophage par prothèse. De 1969 à 1977, les prothèses ont été mises en place par voie chirurgicale, de 1977 à 1984, par priorité avec la technique endoscopique.Un bon résultat palliatif a été obtenu dans la dysphagie, dans environ 90 % des cas. La fréquence des perforations a été de 2,1 % avec la technique chirurgicale et de 4,3 % avec la technique endoscopique, alors que la mortalité hospitalière a été respectivement de 7,3 % et 3,1 %. Selon les auteurs, la méthode endoscopique constitue actuellement la technique de choix dans ľapplication des prothèses œsophagiennes.SummaryThe Authors refer to their experience of 650 cases of œsophageal stenosis treated with prosthesis intubation. From 1969 to 1977 the prosthesis was applied surgically. Then the endoscopic method became the technique of choice from 1977 to 1984.A good dysphagia palliation was reached in about 90 % of the cases. (Esophageal perforation occurred in 2,1 % with surgery and in 4,3 % with the endoscopic technique. Mortality rate was 7,3 % and 3,1 % respectively. The authors maintain that the endoscopic method is today the technique of choice for esophageal prosthesis application.