Treatment of esophageal stricture under the guidance of digital erasure

This is an automatically translated article.

The article is professionally consulted by MSc, BS. Dang Manh Cuong - Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.
Esophageal stricture is a condition in which a section of the esophagus is damaged, causing narrowing of the lumen, leading to obstruction of circulation and transport of food to the stomach. Depending on the cause and severity, the treatment of esophageal stricture will be different, including digital imaging techniques to erase the background.

1. Overview

Esophageal stricture has many causes and is divided into several types such as benign or malignant, intraesophageal or extraesophageal stricture. Specifically:
Benign esophageal stenosis due to the formation of scar tissue in the esophagus; Gastroesophageal reflux disease recurs many times, causing irreversible damage to the esophagus and gradually forming scar tissue; Congenital esophageal stricture in the 4th week of pregnancy, possibly genetic; Malignant esophageal stricture due to cancer or malignancy that compresses and narrows the lumen of the esophagus; Esophageal stricture can also be a complication of: Radiation therapy to the chest or neck, esophageal burns, long-term gastric tube retention causing esophageal ulceration, endoscopic trauma, after treatment of esophageal varices, or due to esophageal stricture. Cardiac spasm, ... Currently, the technique of using flexible endoscopic tubes to re-establish esophageal circulation is widely used in the treatment of esophageal strictures. However, it is still a deeply invasive technique, especially in cases where the patient is exhausted or uncooperative, or under general anesthesia. There are even a few cases where the bronchoscope does not pass through the narrow site, so it cannot be performed successfully.
Treatment of re-circulation for the gastrointestinal tract with electroluminescence has been applied in many countries around the world. By definition, the digital background angiography (DSA) system is a diagnostic method that combines X-ray and digital image processing to take angiograms of the body. The outstanding advantages of this method under the guidance of digitizing background removal are:
Minimal intrusiveness; No need for general anesthesia; The necessary tools are very small in size, so it is easy to succeed when going through a narrow place; Few complications; Good support for those who are no longer indicated for surgery or have had surgery.

2. When is it necessary to take digitized photos to remove the background?

2.1. Indications Condition of esophageal stricture after surgery; Tumor from esophagus or mediastinum causing esophageal stricture but no longer operable; The patient is waiting for surgery or is not eligible for surgery (called preoperative intervention). 2.2. Contraindications Systemic infections; Esophageal perforation; Esophageal burns causing progressive damage; Severe esophageal varices, high risk of bleeding.

3. Prepare

3.1. The person performing the interventional radiology specialist; Electro-optical technician; Physician support; Nursing; Medical staff specializing in anesthesiology (in case the patient cannot cooperate). 3.2. Media Digital Background Eraser (DSA); Film, printers and image storage systems; Lead vest and protective apron for X-ray shielding 3.3. Medicines Local anesthetic; General anesthesia (if indicated); Iodine enantiomers dissolve in water; Reducing spasms of the digestive tract; Antiseptic solution for skin and mucous membranes.

3.4. General medical supplies

5 - 10 - 20ml syringes; Distilled water or physiological saline; Gloves, gowns, caps and surgical masks; Aseptic intervention kit: Knife, scissors, tongs, metal bowl, pea tray and tool tray; Cotton, gauze and surgical tape; Medicine box and first aid kit for contrast drug accidents. 3.5. Special medical supplies Chiba soft tissue needle aspiration; Catheter catheter set; Standard conductor size 0.035 inch; Hard conductor 0.035 inch long (260 - 300cm); Cobra 4-5F angiography catheter; Balloon angioplasty; Pressure pump; Bracket (stent). 3.6. Patient The doctor explains the procedure carefully to coordinate well during the implementation; Need to fast and drink before 6 hours. Can drink but not more than 50ml of water; In the intervention room: The patient is lying on his back, fitted with a monitor to monitor breathing, pulse, blood pressure, electrocardiogram and SpO2 oxygen saturation. Disinfect the skin then cover with a sterile towel; If the patient is too excited, cannot lie still, sedation should be given. 3.7. Test slips Include:
Inpatient medical records; Indication sheet for performing the procedure; X-ray film, computed tomography (CT) scan, or magnetic resonance imaging (MRI) (if available).

4. Steps to take

4.1. Evaluation of the site of the stricture Insert the catheter and guide through the mouth - esophagus into the stomach to reach the narrowing site; Withdraw the lead wire; Inject a water-soluble contrast agent to assess the location and extent of the stenosis. 4.2. Narrow approach Approach Continue to guide wire through the narrow site under the guidance of the enhanced X-ray screen; Insert the tube through the narrow position under the guide wire guide; Inject contrast agent through the catheter to determine the extent, location, and length of the stricture. 4.3. Dilatation and stenting at the site of stricture Insertion of rigid wire into the tube through the site of esophageal stricture; Use a narrow position balloon through a rigid conductor; Place and release the stent holder through the rigid lead. 4.4. End of procedure Use contrast agent to check the esophageal circulation down to the stomach; Withdraw all leads and catheters.

5. Complications and treatment

The procedure is considered successful when re-establishing gastrointestinal circulation from the esophagus to the stomach, the degree of narrowing is less than 30%. At the same time, it is also necessary to ensure that the drug does not escape into the esophagus. However, rare complications can also occur such as:
Stent slip: Due to the selection of the size of the bracket is not suitable for the degree of narrowing; Intestinal obstruction: Due to the rack sliding downstream or fibrous or undercooked food caught in the stent; Esophageal perforation; Gastrointestinal bleeding: Need to monitor and treat medically. If the bleeding does not stop on its own, endoscopic intervention can be used. In summary, this technique of digital erasure of the background (DSA) will intervene treatment from within the blood vessel, with the advantage of minimally invasive without the need for open surgery. One of the common applications of this method is to guide dilation and stenting of the esophagus, helping to treat esophageal strictures without drugs.
Vinmec International General Hospital is one of the general hospitals that guarantees the quality of medical examination and treatment expertise, and is famous for its comprehensive medical examination and consulting services, including specialties. Digest. With a team of highly qualified doctors and nurses with many years of experience in the profession, they will provide the best treatment plan as well as advice on the best health for the patient.
Before taking a job at Vinmec Central Park International Hospital from December 2017, Doctor Dang Manh Cuong has over 18 years of experience in the field of ultrasound - diagnostic imaging in Transport Hospitals. Hai Phong, MRI Department of Nguyen Tri Phuong Hospital and Diagnostic Imaging Department of Becamex International Hospital.
Customers can directly go to Vinmec Health system nationwide to visit or contact the hotline here for support.