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Suggest Treatment For Severe Esophageal Strictures
Question: After 13 dilatation and/or needle knife proceedures, i still have a severe esophageal stricture ( 2mm opening) two years post esophageal ca surgery,radiation, and chemo. Does Mayo have any additional treatment options for me? what are they?
What additional treatment do you offer to open the stricture sufficiently that I could have a "normal" diet?
What is your success rate in extreme cases such as mine?
What additional treatment do you offer to open the stricture sufficiently that I could have a "normal" diet?
What is your success rate in extreme cases such as mine?
Brief Answer:
Stent is the option.
Detailed Answer:
Hello.
Thank you for the query.
Do you have any signs of cancer recurrence? I assume that the stricture is due radiation and/or anastomosis narrowing. If so, you may be a good candidate for a stent implantation (a kind of pipe which can permanently solve the problem).
If you are cancer free, esophageal reconstruction using large intestine is an option as well.
If the stricture is due to cancer recurrence, gastrostomy (nutrition pipe placed directly to the stomach) may be the only solution.
Hope this helps.
Regards.
Stent is the option.
Detailed Answer:
Hello.
Thank you for the query.
Do you have any signs of cancer recurrence? I assume that the stricture is due radiation and/or anastomosis narrowing. If so, you may be a good candidate for a stent implantation (a kind of pipe which can permanently solve the problem).
If you are cancer free, esophageal reconstruction using large intestine is an option as well.
If the stricture is due to cancer recurrence, gastrostomy (nutrition pipe placed directly to the stomach) may be the only solution.
Hope this helps.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I neglected to mention that I have had two stents previously. One was in place for about 4 months causing, chronic cough, back pain, and chest pain. The second one, slightly smaller, was also removed after several months due to the same symptoms and the doctor's insistence that there is no long term or permanent stent.
Has stent technology changed in the past 18 months so as to not cause these symptoms? Is there a long-term stent which has a good history and FDA approval?
Yes, anastamosis and radiation. No signs of recurrence.
My understanding from Georgetown is that reconstruction is very high risk and is usually done as part of the initial surgery. Is that not correct?
Gastrostomy is NOT an option I would consider. Liquid diet and very soft/moist mechanical is easier to live with..
Additionally, the cancer was easy to cure. I have had complications and side effects from all the treatment subsequent to surgery and I heal very slowly.
The risk/benefit analysis of a procedure is highly important to me. I do not want to lessen the quality of my life - only improve it. Mayo is my last hope before reconciling myself to living with a "blrnder" for the rest of my life.
Has stent technology changed in the past 18 months so as to not cause these symptoms? Is there a long-term stent which has a good history and FDA approval?
Yes, anastamosis and radiation. No signs of recurrence.
My understanding from Georgetown is that reconstruction is very high risk and is usually done as part of the initial surgery. Is that not correct?
Gastrostomy is NOT an option I would consider. Liquid diet and very soft/moist mechanical is easier to live with..
Additionally, the cancer was easy to cure. I have had complications and side effects from all the treatment subsequent to surgery and I heal very slowly.
The risk/benefit analysis of a procedure is highly important to me. I do not want to lessen the quality of my life - only improve it. Mayo is my last hope before reconciling myself to living with a "blrnder" for the rest of my life.
Brief Answer:
Stent is not an option.
Detailed Answer:
Well, your case is very hard indeed. From one side you are very lucky to be cancer free (it is quite rare in case of esophageal cancer). From the other side you are struggling with complication which is hard to treat. Especialy after radiation, which makes scars all over so any surgery in this area is very risky.
Stents are still the same. You need to construct them from something resistant so this is not an option for you anymore.
Question is where is the anastomosis (how far from the throat). If it is in the middle of your chest, large intestine reconstruction (with intestine placed under the skin outside the chest) seems possible option. It can be done not only during the first surgery.
If the anastomosis is high, close to tge throat, this id not an option.
Stent is not an option.
Detailed Answer:
Well, your case is very hard indeed. From one side you are very lucky to be cancer free (it is quite rare in case of esophageal cancer). From the other side you are struggling with complication which is hard to treat. Especialy after radiation, which makes scars all over so any surgery in this area is very risky.
Stents are still the same. You need to construct them from something resistant so this is not an option for you anymore.
Question is where is the anastomosis (how far from the throat). If it is in the middle of your chest, large intestine reconstruction (with intestine placed under the skin outside the chest) seems possible option. It can be done not only during the first surgery.
If the anastomosis is high, close to tge throat, this id not an option.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have an additional question regarding my needle knife and dilation proceedures. Unlike many people, zofran DOES NOT WORK FOR ME.During general anesthesia, I need compazine in order to not be nauseous for days afterwards. Twice, in two different hospitals, I was told that they did not have compazine and I ended up nauseous immediately after recovery and for days later.
In order to circumvent this problem, I would provide my own compazine. My question is what dosage should I use for an injectable? and what dosage for oral compazine?
The anesthesiologists believe that something other than compazine works but they do not end up nauseous. I cannot undergo further treatment unless I know ow much and what type of administration of compazine I need to take.
Thank you,
XXXXX
In order to circumvent this problem, I would provide my own compazine. My question is what dosage should I use for an injectable? and what dosage for oral compazine?
The anesthesiologists believe that something other than compazine works but they do not end up nauseous. I cannot undergo further treatment unless I know ow much and what type of administration of compazine I need to take.
Thank you,
XXXXX
Brief Answer:
Please see the answer below.
Detailed Answer:
There might be problem to convince anesthesiologist to use this drug. It is rarely used in anesthesiology as we have plenty of other medicines to control vomiting. I do believe those might not be effective for you and I do understand your fear.
Compazine should be given 15-30 before induction of anesthesia. The regular dosage is 5 to 10 mgs. The infusion should be given slowly (not faster than 5mgs per minute).
Total daily dosage should not exceed 40 mgs. The infusion can be repeated every 3-4 hours. Once you will be able to swallow, it can be switched to tablets. The dosage is similar, 5 mgs every 3-4 hours.
Hope this helps.
Regards.
Please see the answer below.
Detailed Answer:
There might be problem to convince anesthesiologist to use this drug. It is rarely used in anesthesiology as we have plenty of other medicines to control vomiting. I do believe those might not be effective for you and I do understand your fear.
Compazine should be given 15-30 before induction of anesthesia. The regular dosage is 5 to 10 mgs. The infusion should be given slowly (not faster than 5mgs per minute).
Total daily dosage should not exceed 40 mgs. The infusion can be repeated every 3-4 hours. Once you will be able to swallow, it can be switched to tablets. The dosage is similar, 5 mgs every 3-4 hours.
Hope this helps.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
And if I were to crush a compazine 5mg pill and swallow it with a few sips of water, then how long before the procedure should I take it? I am now in desperation mode. I do not vomit but have super severe nausea.
Brief Answer:
1 hour before the procedure.
Detailed Answer:
Welcome back,
1 hour before the procedure is the perfect time to swallow it.
Zofran is a good anti-vomiting agent in case of chemotherapy. And can be completely ineffective in the case of other reasons.
How about trying other medicines including: Tietylperazine (Torecan), prometazine (Diphergan) or the strongest one Chlorpromazine.
Regards
1 hour before the procedure.
Detailed Answer:
Welcome back,
1 hour before the procedure is the perfect time to swallow it.
Zofran is a good anti-vomiting agent in case of chemotherapy. And can be completely ineffective in the case of other reasons.
How about trying other medicines including: Tietylperazine (Torecan), prometazine (Diphergan) or the strongest one Chlorpromazine.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
If I take my compazine before treatment, when the anesthesiologist asks if I have "any problem" with anesthesia, should I tell him "No" or let him still add antinausea med to the mix?
Since I am allergic to Cipro and Macrobid makes me really gastro challenged, is there another antibiotic which is effective for UTI?
Since I am allergic to Cipro and Macrobid makes me really gastro challenged, is there another antibiotic which is effective for UTI?
Brief Answer:
Let them give antivomiting medicine.
Detailed Answer:
You should rather let him give antinausea medicine. In 99% they do give Ondansetrone (Zofran) before or during the anesthesia. This medicine affects different receptor than Compazine does. So there is no interaction between this two medicines. And antivomiting effect can be amplified.
Actually there is a lot of UTI antibiotics. As you have some pretty bad reactions to mentioned antibiotics, it would be good to determine the type of bacteria you are dealing with. Swab test of your urine can give such information. We are able to determine which antibiotic will be most effective to specific bacteria.
Cotrimoksazole, Trimetoprim, Amoxyciline are just some examples of available antibiotics.
Let them give antivomiting medicine.
Detailed Answer:
You should rather let him give antinausea medicine. In 99% they do give Ondansetrone (Zofran) before or during the anesthesia. This medicine affects different receptor than Compazine does. So there is no interaction between this two medicines. And antivomiting effect can be amplified.
Actually there is a lot of UTI antibiotics. As you have some pretty bad reactions to mentioned antibiotics, it would be good to determine the type of bacteria you are dealing with. Swab test of your urine can give such information. We are able to determine which antibiotic will be most effective to specific bacteria.
Cotrimoksazole, Trimetoprim, Amoxyciline are just some examples of available antibiotics.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
With PVCs ocurring once or twice a minute, while taking Trepanol, what is the prognosis for incidents in the future?
Brief Answer:
Try Magnesium and Potassium.
Detailed Answer:
Are you sure that you mentioned correct medicine (Trepanol?). I assume you mean some kind of beta blocker. If so, PVC can be greatly controlled with beta blockers. Add Magnesium with potassium to your supplementation and you may need no medicine at all as most PVC can be eliminated with this two ions only.
Try Magnesium and Potassium.
Detailed Answer:
Are you sure that you mentioned correct medicine (Trepanol?). I assume you mean some kind of beta blocker. If so, PVC can be greatly controlled with beta blockers. Add Magnesium with potassium to your supplementation and you may need no medicine at all as most PVC can be eliminated with this two ions only.
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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