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OBSTRUCTIONS-STENOSIS / STRICTURE OF ESOPHAGUS

UNDERSTANDING THE PROBLEM

The oesophagus is the tube that conveys food from the throat down to the stomach. Obstruction or Stenosis (narrowing of the esophagus) is a condition where the esophagus is narrowed or completely obstructed.

Most esophageal obstruction develops slowly and is incomplete when patients first seek care, typically for difficulty swallowing solids. However, sometimes complete esophageal obstruction develops suddenly because of an impacted esophageal foreign body or food bolus. Obstruction may have intrinsic or extrinsic causes.

Intrinsic obstruction may be caused by:

  • Esophageal tumors (benign or malignant)
  • Esophageal rings
  • Esophageal webs
  • Strictures caused by gastroesophageal reflux or, rarely, caustic ingestion

Extrinsic obstruction may be caused by compression resulting from:

  • An enlarged left atrium of the heart
  • An aortic aneurysm
  • Dysphagia lusoria
  • A substernal thyroid gland
  • Cervical bony outgrowth
  • A thoracic tumor

An oesophageal stricture is a gradual narrowing of the oesophagus, which can lead to swallowing difficulties. The strictures are caused by scar tissue that builds up in the oesophagus

UNDERSTANDING WHO SUFFERS

Oesophageal obstruction is directly associated with episodes of food ingestion regardless of underlying cause and it occurs more frequently in adults, although it is occasionally observed in children too.

Food impaction usually occurs as a result of two factors: the state of the esophagus, and the nature of the food that has been swallowed. Research shows that food bolus impactions have underlying esophageal pathology in 88% to 97% of adult patients evaluated. Benign esophageal stenoses caused by Schatzki rings (type of narrowing) or by peptic strictures are the most common causes, followed by webs, extrinsic compression, surgical anastomosis, esophagitis and motor disorders such as achalasia.

Gastroesophageal reflux affects approximately 40% of adults at some time in their life. Esophageal strictures are estimated to occur in 7-23% of untreated patients with reflux disease.

Gastroesophageal reflux disease accounts for approximately 70-80% of all cases of esophageal stricture.

POTENTIAL SIGNS AND SYMPTOMS

The most often encounter symptoms include:

  • Difficulty Swallowing
  • Choking or dysphagia
  • Drooling
  • Chest Pain
  • Neck Pain
  • Abdominal Pain
  • Heartburn
  • Gastroesophageal Reflux
  • Painful Swallowing or odinophagia
  • Asthma.

The symptoms of Oesophageal Obstruction include:

  • Difficulty Swallowing/Choking (dysphagia)
  • Drooling
  • Chest Pain
  • Neck Pain
  • Abdominal Pain
  • Heartburn
  • Gastroesophageal Reflux
  • Painful Swallowing (odinophagia)
  • Asthma

The symptoms of oesophageal stricture are:

  • chest pain after swallowing
  • difficulty swallowing
  • discomfort with swallowing
  • a feeling that food gets stuck in the oesophagus
  • regurgitation of food
  • weight loss
  • upper back pain after swallowing
  • hiccups
EXAMINATIONS USUALLY REQUIRED

Oesophageal obstruction is normally diagnosed through

  • Endoscopy: where a narrow tube is inserted into the oesophagus which can show any narrowing of the oesophagus.
  • Barium swallow x-ray: Patient will swallow barium and x-rays can be taken to show any narrowing of the oesophagus.
  • C T Scan
  • MRI

Diagnosis for oesophageal stricture is usually done by:

  • Barium swallow x-ray
  • Endoscopy exam
PROPOSING TREATMENT AND WHY AIMIS

The recommended treatment or surgery for Esophageal Obstruction and Stricture will largely depend on the severity and what the underlying cause of the condition is.

Esophageal dilation, also called stretching, can be an option of choice for some patients.

Another method used is the insertion of esophageal stents, a thin tube made from plastic, flexible mesh material or expandable metal, to provide relief from esophageal stricture. This is also used to keep a blocked esophagus open allowing the patient to swallow both food and liquids.

If Surgery is recommended the surgical procedure will allow repairs to the LES and prevent GERD symptoms. In cases, rare, where the patient has a non-functioning esophagus that is causing the stricture, surgery can be very difficult to perform and the only effective option open to the surgical team is to replace the esophagus.

AIMIS is an expert in Da Vinci Minimal invasive esophageal surgery (Esophageal Stent Placement, Surgical Repair, Esophagealectomy and Esophagus Replacement) and provides advanced techniques offering many advantages over standard laparoscopy such as:

  • 3D visualization through a stereo endoscope.
  • Tremor reduction.
  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • Less trauma to the body
  • Shorter hospital stay
  • Return to normal activities in a shorter period of time.

This equipment allows our surgeons to work in the narrow space of the mediastinum and overcome all the spatial limitations experienced using thoracoscopic or laparoscopic techniques. The Da Vinci Robotic system is of tremendous assistance accessing remote areas through a very small esophageal hiatus.

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

An esophageal stricture is a narrowing of the esophagus. Stomach acid, accidentally swallowed harsh chemicals and other irritants may injure the esophageal lining, causing inflammation and the formation of scar tissue. This may gradually lead to obstruction of the esophagus, preventing food and fluids from reaching the stomach.

Disease processes that can produce esophageal strictures can be grouped into 3 general categories:

  • a) Intrinsic disease (outlined above) that narrow the esophageal lumen through inflammation, fibrosis, or neoplasia;
  • b) Extrinsic diseases (outlined above) that compromise the esophageal lumen by direct invasion or lymph node enlargement; and
  • c) Diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function by their effects on esophageal smooth muscle and its innervation. Many diseases can cause esophageal stricture formation, these include acid peptic, autoimmune, infectious, caustic, congenital, iatrogenic, medication-induced, radiation-induced, malignant, and idiopathic disease processes. The etiology of esophageal stricture can usually be identified using radiologic and endoscopic modalities and can be confirmed by endoscopic visualization and tissue biopsy.
FURTHER INFORMATION ON INCREASED RISK GROUPS

The incidence of esophageal stricture is approximately 1.1 per 10,000 person-years and increased markedly with age. Incidence of stricture has decreased however this is concomitant with a substantial increase in proton pump inhibitor (PPI) use.

The majority of stricture cases (68%) were peptic. Prior dysphagia, gastroesophageal reflux disease (GERD), hiatus hernia, peptic ulcer disease, and heavy alcohol use were associated with an increased risk of stricture.

The rate of stricture recurrence was 11.1 per 100 person-years.

Surgery was proposed in those with reoccurrence.

FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Imaging tests - Imaging tests dependent on suspected diagnosis may include x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.

Bronchoscopy- This exam may be done for cancer in the upper part of the esophagus to see if it has spread to the windpipe (trachea) or the tubes leading from the windpipe into the lungs (bronchi).

Thoracoscopy and laparoscopy - These exams let the doctor see lymph nodes and other organs near the esophagus inside the chest or the abdomen through a hollow lighted tube.

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Upper Gastrointestinal Problems including:
Fundoplication Surgery, Minimally Invasive Heller Myotomy Surgery, Subtotal Gastrectomy Esophageal Stent Placement, Esophageal Surgical Repair, Esophagectomy, Esophagus Replacement and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Upper Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • High patient satisfaction
  • Minimal pain
OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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