Scholarlink

Introduction <p>Caustic oesophageal strictures are common in many low-income countries. Purpose-made endoscopes for dilatation may be unavailable, making management of long, eccentric strictures challenging.</p> Methods <p>Within a formal health system strengthening partnership, international and local resources/expertise were pooled to manage caustic strictures in two children. Dilatation equipment: flexible bronchoscopes (Vathin H-steriScope2.8mm, 2.2mm<sup>™</sup>), mobile screen (Vathin DVM-A1), flexible guidewire (Terumo<sup>™</sup> 0.035″ flexible tip), urethral dilators (Cook Medical, S ~ Curve<sup>®</sup>, G32789).</p> Results <p>Two boys (4&#xa0;years, 5&#xa0;years) with caustic oesophageal strictures, unable to feed orally, had gastrostomies formed. Each underwent per-oral and via-gastrostomy combined endoscopy to pass guidewires. Urethral-S-dilators were used for dilatation in patient 1. Patient 2, with a long, eccentric stricture, required a second anaesthetic and combined fluoroscopy/endoscopy for guidewire passage. This facilitated dilatation with urethral-S-dilators. A string left from mouth to gastrostomy facilitated further non-endoscopic Savary-Gilliard dilatations for both. Subsequent dilatations were effective: both progressed rapidly to oral solids and remain well at 6-month follow-up.</p> Discussion <p>Challenges with bronchoscopes: lack of rigidity; no continuous air insufflation; less manoeuvrability than purpose-made endoscopes. Collaborative, cross-disciplinary anaesthetic, and surgical working ensured optimal ‘frugal innovation’ equipment use and successful outcomes. Global surgery partnership and cross-disciplinary team working resulted in an innovative solution to a challenging clinical problem.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Oesophageal strictures in the austere environment: innovative, cross-disciplinary endoscopic management

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年3月25日

查看全文
  • Esther Westwood,
  • Benjamin Martin,
  • Cherno Jallow,
  • Abdouli Bah,
  • Meera Kurup,
  • Anu Paul,
  • Niyi Ade-Ajayi

摘要

Introduction

Caustic oesophageal strictures are common in many low-income countries. Purpose-made endoscopes for dilatation may be unavailable, making management of long, eccentric strictures challenging.

Methods

Within a formal health system strengthening partnership, international and local resources/expertise were pooled to manage caustic strictures in two children. Dilatation equipment: flexible bronchoscopes (Vathin H-steriScope2.8mm, 2.2mm™), mobile screen (Vathin DVM-A1), flexible guidewire (Terumo™ 0.035″ flexible tip), urethral dilators (Cook Medical, S ~ Curve®, G32789).

Results

Two boys (4 years, 5 years) with caustic oesophageal strictures, unable to feed orally, had gastrostomies formed. Each underwent per-oral and via-gastrostomy combined endoscopy to pass guidewires. Urethral-S-dilators were used for dilatation in patient 1. Patient 2, with a long, eccentric stricture, required a second anaesthetic and combined fluoroscopy/endoscopy for guidewire passage. This facilitated dilatation with urethral-S-dilators. A string left from mouth to gastrostomy facilitated further non-endoscopic Savary-Gilliard dilatations for both. Subsequent dilatations were effective: both progressed rapidly to oral solids and remain well at 6-month follow-up.

Discussion

Challenges with bronchoscopes: lack of rigidity; no continuous air insufflation; less manoeuvrability than purpose-made endoscopes. Collaborative, cross-disciplinary anaesthetic, and surgical working ensured optimal ‘frugal innovation’ equipment use and successful outcomes. Global surgery partnership and cross-disciplinary team working resulted in an innovative solution to a challenging clinical problem.