PS01.061: LAPAROSCOPIC ENDOSTIM PLACEMENT: CASE REPORT

Abstract Background GERD is a mechanical disorder that is caused by a dysfunction of the LES, dysfunction of the gastric emptying or an anomalous esophageal peristalsis. Methods We present the case of a 36-year-old male patient with intermittent heartburn, regurgitation, retrosternal pain and dysphagia. UE reports grade D esophagitis, manometry and pHmetry reporting DeMeester 21.1, acid percentage of 5.8%. Normal Motility and LES in 9 mmHg. Nissen-type fundoplication was performed without complications and with resolution of symptoms. 4 years later the patient begins with recurrent symptoms. Esophagitis in UE. DeMeester 20. EEI 7.7 mmHg. 80% Useful Motility. Nissen type fundoplication is redo. Nine years later the patient starts again with symptoms. Progressive deterioration of esophageal motility in manometry is documented. UE with grade D esophagitis, DeMeester 10, manometry reporting LES with normal resting pressure and coordinated relaxation with pharyngeal contraction. Peristalsis wave failure of 100% of swallows, in relation to absent peristalsis; Results Placement of Endostim was performed and patient was discharged without complications, Patient 1 month later without GERD symptoms. Conclusion Approximately 10 to 40% of patients with GERD fail to respond in their symptomatology despite medical treatment. Surgical indications for GERD consist of failure to medical treatment, poor adherence to the patient's treatment, high volume reflux, severe esophagitis, benign stenosis and Barret's esophagus. Treatment consists of fundoplication in its different variants. However 10% to 20% of patients present with persistent symptoms and 3% to 5% require surgical reoperation. Endostim is a minimally invasive therapy which normalizes the function of the LES through neurostimulation. Disclosure All authors have declared no conflicts of interest.

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PS01.211: IMPLEMENTATION OF A TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY PROGRAMME IN A UK SPECIALIST CENTRE: INITIAL EXPERIENCE AND OUTCOMES

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.211 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 109-110

Author(s):

Temisanren Akitikori ◽

Bruno Lorenzi ◽

Kanatheepan Shanmuganathan ◽

Oluwasunmisola Soile ◽

Aadil Hussain ◽

...

Keyword(s):

Lymph Node ◽

Minimally Invasive ◽

Conflicts Of Interest ◽

High Volume ◽

Pulmonary Complications ◽

Cardiac Complications ◽

Initial Experience ◽

Chyle Leak ◽

Anastomotic Strictures ◽

Minimally Invasive Oesophagectomy

Abstract Background Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer. Methods From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM). Results Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%. Conclusion Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes. Disclosure All authors have declared no conflicts of interest.

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PS02.138: SALVAGE ESOPHAGECTOMY: SINGLE ONCOLOGICAL CENTER EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.138 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 159-160

Author(s):

Flávio Sabino ◽

Marco Guimaraes ◽

Carlos Eduardo Pinto ◽

Daniel Fernandes ◽

Luis Felipe Pinto ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Conflicts Of Interest ◽

High Volume ◽

Published Data ◽

Surgical Morbidity ◽

Salvage Esophagectomy ◽

Thoracic Approach ◽

Clinical Conditions ◽

Local Advanced

Abstract Background Surgical resection is considering the gold standard in esophageal cancer treatment, with 15–40% cure global rates. Radical exclusive chemoradiotherapy (CRT) is used in patients with local advanced esophageal cancer or without clinical conditions for esophagectomy, with a 5-year overall survival up to 30%. However, locoregional control is poor with a 40–60% recurrence rate and salvage esophagectomy maybe an option for these patients. Methods Our objective is to report the experience of a single high volume oncological institution with salvage esophagectomy. Retrospective analysis of 28 patients medical records, with esophageal cancer, submitted to Salvage Esophagectomy in Brazilian NCI after radical exclusive CRT or RT between January 1990 and December 2015. Results Median age was 56 years and most are male (78,5%). Esophageal middle third was the tumor principal location (50%) and histological type was squamous cell carcinoma (82%). Thoracic approach for esophagectomy was the principal surgical technique, and gastric tube the most used conduit for reconstruction (78,5%). Surgery was R0 in 83% of the cases, with a surgical morbidity of 64%. Median hospital time was 15 days (8–58) and surgical mortality 14% (4 patients), with 7% in the first 30 days. Median overall survival was 22,3 months. Conclusion Our results are in line with published data in the literature. Besides surgical morbidity and mortality, Salvage Esophagectomy remains de only chance of cure for patients with locoregional recurrence after radical exclusive CRT. Disclosure All authors have declared no conflicts of interest.

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PS01.167: MUMELE STUDY: MULTICENTER STUDY ON INCIDENCE OF MEDIASTINAL LEAKS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.167 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 96-97

Author(s):

Uberto Fumagalli Romario ◽

Andrea Celotti ◽

Stefano De Pascale ◽

Riccardo Rosati ◽

Andrea Cossu ◽

...

Keyword(s):

Mortality Rate ◽

Conflicts Of Interest ◽

High Volume ◽

Esophageal Resection ◽

Esophageal Surgery ◽

Leakage Rate ◽

First Line ◽

Stoma Formation ◽

Standard Strategy ◽

First Line Treatment

Abstract Background Mediastinal anastomotic leak (ML) represent one of the most feared complication of esophageal resection. The incidence of ML, and of the associated mortality rate and the treatment strategy are variously reported. A standard strategy for diagnosis and treatment is difficult to establish Methods In order to evaluate the incidence, predictive factors, treatment and mortality of ML in 7 Italian surgical centers with interest in esophageal surgery (5 high volume centers) a retrospective study including all esophagectomies (E) with intrathoracic esophagogastric anastomosis performed in a 3 year period (2014–2017), was planned. ML were defined according to the classification proposed by the Esophagectomy Complications Consensus Group. Results The data of 501 E were collected. Overall incidence of ML was 11.8%. Surgical approach significantly influenced the rate of ML: leakage rate was highest for totally minimally invasive (TMIE) and lowest for hybrid esophagectomy (HE) (respectively 20 and 9%). No other predictive factor was found. Overall 30 and 90 day (d) mortality rate (M) were respectively 1,4% and 3,2%; 30 and 90 d M for leaks were respectively 5% and 15,3%; 90 d M for TMIE and HE were 5,9% and 1,8% respectively. Endoscopy was the first line treatment in 49% of leaks, with a need for retreatment in 17,2% of cases. Surgery was needed globally in 44,1% of ML. Endoscopic treatment appeared to have the lowest M (6,9%). Removal of the gastric tube with stoma formation was necessary in 8 cases (13.6%). Conclusion The incidence of mediastinal leaks after esophagectomy in the MUMELE study is high mainly in TMIE group. General and specific (leak) mortality rate is however low. Early ‘aggressive’ treatment of severe leaks is mandatory, with no hesitation to redo surgery if first attempt of conservative management fails. Disclosure All authors have declared no conflicts of interest.

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Radiofrequency ablation for Barrett’s esophagus high-volume center initial results

Acta chirurgica iugoslavica ◽

10.2298/aci1201019s ◽

2012 ◽

Vol 59 (1) ◽

pp. 19-24

Author(s):

Aleksandar Simic ◽

Ognjan Skrobic ◽

Marijan Micev ◽

Mirko Gligorijevic ◽

Dejan Velickovic ◽

...

Keyword(s):

Radiofrequency Ablation ◽

High Volume ◽

Lower Esophageal Sphincter Pressure ◽

Sphincter Pressure ◽

Esophageal Function ◽

Mean Values ◽

Retrosternal Pain ◽

The Mean ◽

One Year ◽

Initial Results

Introduction: Barrett?s esophagus (BE) is a well established precursor of esophageal adenocarcinoma. Both, surveillance and therapeutic strategies have been proposed over the years. Recent development of endoscopic radiofrequency ablation (RFA) brought new perspectives in the treatment of BE, with excellent initial results. Methods: The study of 40 pts with macroscopically visible BE on endoscopy and biopsy proven goblet cells presence, was conducted from January 2010 until March 2012. In all pts a complete symptomatic, endoscopic and manometric evaluation was performed. Initially RFA HALO 90 and 360 were performed in 28 and 12pts respectively. Repeated treatments were conducted in 7 pts. The overall number was 50, while the mean number of RFA procedures per patient was 1.25. Results: The mean circumferential length and maximal extent of BE were 1.61 and 3.29 cm respectively. We did not encounter esophageal perforation or hemorrhage during the procedure. Complications were transient short-term retrosternal pain (23 pts) and dysphagia (11 pts). Three months after the RFA mean values of cumulative symptom and heartburn score dropped significantly (p<0.05). Functional diagnostics did not disclose any statistically significant decrease of lower esophageal sphincter pressure or esophageal body contraction amplitudes. One year follow-up was obtained in 26 pts and revealed a complete macroscopically visible BE eradication. So far, in 19 pts a laparoscopic Nissen fundoplication was performed up to 3 months after complete RFA BE eradication. Conclusion: HALO RFA procedure is safe and very effective in the treatment of pts with BE, does not lead to esophageal function impairment, and produces no long term and serious side effects.

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Medical Treatment and Surgical Indications for Functioning Pituitary Adenomas

Japanese Journal of Neurosurgery ◽

10.7887/jcns.30.19 ◽

2021 ◽

Vol 30 (1) ◽

pp. 19-28

Author(s):

Satoru Oshino ◽

Youichi Saitoh ◽

Manabu Kinoshita ◽

Haruhiko Kishima

Keyword(s):

Medical Treatment ◽

Pituitary Adenomas ◽

Surgical Indications

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PS01.047: PROPHYLACTIC ANTI-REFLUX SURGERY AFTER LAPAROSCOPIC GASTRIC WEDGE RESECTIONS FOR GASTRIC SUBMUCOSAL TUMORS OF GASTROESOPHAGEAL JUNCTION

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.047 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 63-63

Author(s):

Chang Hyun Kim ◽

Jin-Jo Kim

Keyword(s):

Conflicts Of Interest ◽

Submucosal Tumor ◽

Wedge Resection ◽

Gastroesophageal Junction ◽

Submucosal Tumors ◽

Gastric Submucosal Tumors ◽

Increased Risk ◽

Group A ◽

Group B ◽

Gerd Symptoms

Abstract Background A laparoscopic wedge resection (LWR) for a gastric submucosal tumor (SMT) close to gastroesophageal junction (GEJ) is technically challenging due to increased risk of damage to the lower esophageal sphincter. We hypothesized that GERD would be less prevalent if a prophylactic anti-reflux surgery (ARS) was added after this surgery. The aim of this study is to analyze our experience of prophylactic ARS after LWR for a gastric SMT close to GEJ Methods We retrospectively collected data from 51 patients who diagnosed with SMT of near the GEJ and who underwent LWR between January 2000 and December 2017. The patients were divided into 2 groups, the patient with prophylactic ARS (group A) or not (group B). Results There was no difference in the frequency of the preoperative GERD symptoms between the 2 groups, whereas postoperative GERD symptoms and postoperative use of acid suppressive medications were more frequent in the group B (P = 0.032, P = 0.036). However, there were no differences in the follow-up endoscopic findings in terms of reflux esophagitis and Hill's grade between the 2 groups. Conclusion The prophylactic ARS after LWR for SMT close to GEJ is an effective method of prevent gastroesophageal reflux symptoms after surgery. Disclosure All authors have declared no conflicts of interest.

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Severe Adverse Skin Reaction Used For Sclerodermatous Chronic Graft Versus Host Disease Of The Skin

Blood ◽

10.1182/blood.v122.21.5417.5417 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5417-5417 ◽

Cited By ~ 1

Author(s):

Caroline Hamm ◽

Sindu M. Kanjeekal ◽

David Shum ◽

Tarek Elfiki ◽

John Mathews

Keyword(s):

Graft Versus Host Disease ◽

Conflicts Of Interest ◽

Chronic Gvhd ◽

Myelogenous Leukemia ◽

High Dose ◽

Cell Transplant ◽

Diffuse Infiltration ◽

Host Disease ◽

Graft Versus Host ◽

Persistent Symptoms

Abstract Treatment of sclerodermatous chronic graft versus host disease remains a daunting challenge. Supportive care measures remain the primary mode of therapy with little evidence of treatments that reverse the process. Photopheresis has been used with varying success in this disorder. Recently, case reports and case series have reported on the successful use of imatinib in this disorder(1, 2) Drug intolerance was reported in four of the patients treated. We report a case of a 40 year old man with extensive scelerodermatous chronic graft versus host disease (GVHD) of the skin ( Skin : score of 3 using the NIH Criteria). Four years earlier, he underwent a matched unrelated stem cell transplant for chronic myelogenous leukemia. His transplant course was complicated with TTP associated with all standard immune suppressive agents (cyclosporine, tacrolimus, sirolimus). This gentleman developed progressive sclerodermatous skin GVHD. Photopheresis was carried out for two years with stabilization, but no improvement in his symptoms. Imatinib was started due to persistent symptoms (joint restriction Score of 2 in NIH criteria, > 50% of skin involvement, joint Ð score of 3 NIH). 3 Imatinib was started for progressive symptoms and within five days, he was hospitalized with a generalized erythroderma with associated skin sloughing. The Imatinib was stopped and he received high dose steroids with slow improvement of his symptoms. Skin biopsy at that time revealed subcorneal pustular dermatosis; there was no herpes viral effects and special stains were negative for bacterial or fungal organisms. There was a diffuse infiltration of neutrophils. Histological differential diagnosis included pustular psoariasis and Sneedon-Wilkinson syndrome. In view of the history, the concluding diagnosis was exanthematous pustulosis secondary to imatinib. We recommend that close attention be paid to patients with chronic GVHD treated with imatinib and early intervention with stopping the Imatinib. Steroid worked in this case and should be considered.Blood 2009 Mar. Magro et alArch Dermatol 2008 Sept; 144(9): 1106-9 National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Repor Alexandra H. Filipovich,1 Daniel Weisdorf,2 Steven Pavletic, et al Biology of Blood and Marrow Transplantation 11:945-955 (2005). Disclosures: No relevant conflicts of interest to declare.

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RA06.07: PSYLLIUM SUPPLEMENTATION EFFECT ON ESOPHAGEAL FUNCTION TESTING AND SYMPTOMS IN PATIENTS WITH NON-EROSIVE GERD

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra06.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 32-32

Author(s):

Sergey Morozov ◽

Vasily Isakov ◽

Mariya Konovalova

Keyword(s):

Dietary Fiber ◽

Conflicts Of Interest ◽

Final Analysis ◽

Epidemiological Data ◽

Lower Esophageal Sphincter Pressure ◽

Sphincter Pressure ◽

Esophageal Function ◽

Resting Pressure ◽

Esophageal Function Testing ◽

Function Testing

Abstract Background Epidemiological data showed negative correlation between heartburn frequency and amount of dietary fiber consumed. However no interventional study was performed to prove clinically beneficial effect of dietary fibers in gastroesophageal reflux disease (GERD) patients. The aim of the study was to investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive GERD patients (NCT01882088) Methods Thirty six NERD patients were examined using food frequency questionnaire and in case of less than 20 g/day dietary fibre intake underwent high-resolution esophageal manometry and 24-hours esophageal pH-impedance. Language-specific GERD-Q questionnaire was used to assess symptoms. Repeated examinations were performed after 10 days of usual diet supplemented by psyllium 15.0 gram a day. Complete data of 30 NERD patients were available for the final analysis. Study design is shown in a figure 1. Wilcoxon matched pairs test was used to assess changes in the studied parameters Results The decrease in proportion of patients experiencing heartburn as well as GERD-Q score decrease were found. Minimal resting lower esophageal sphincter pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4, P = 0.023. No change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes decreased from 67.9 ± 17.7 to 42.4 ± 13.5, P < 0.001 (Table 1). Conclusion Supplementation of diet with psyllium 5.0 gram TID in NERD patients led to significant increase of minimal esophageal resting pressure, decrease of number of gastroesophageal refluxes and frequency of heartburn per week. The work was supported by Federal Agency of Scientific Organizations of Russia (0529–2017-0057) Disclosure All authors have declared no conflicts of interest.

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Radical pericardiectomy for pericardial diseases

10.1510/mmcts.2021.069 ◽

2021 ◽

Keyword(s):

New York ◽

Medical Treatment ◽

Constrictive Pericarditis ◽

Heart Association ◽

Complete Removal ◽

Functional Class ◽

Class Iii ◽

Pericardial Disease ◽

Persistent Symptoms ◽

Pericardial Diseases

Pericarditis is the most common form of pericardial disease. Its exact incidence remains unknown, probably because many cases resolve without diagnosis. Indications for pericardiectomy from the standpoint of the cardiac surgeon are based mainly on the physiopathology of 2 different entities that can overlap: inflammatory or relapsing pericarditis and constrictive pericarditis. Surgical indications are not always straightforward. Patients with inflammatory or relapsing pericarditis may undergo radical pericardiectomy because they experience severe symptoms despite maximal medical treatment or have sequelae from the medical treatment. Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis and persistent symptoms who are in New York Heart Association functional class III or IV and a class I recommendation in the European Society of Cardiology/European Association of Cardio-Vascular Surgery guidelines. The goal of surgery is always complete removal of any site of inflammation through a radical pericardiectomy.

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Nanofiber-Based Expansion and Differentiation Technology for High-Volume Ex Vivo Production of Reticulocytes for P. Vivax Malaria Research

Blood ◽

10.1182/blood.v118.21.2357.2357 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2357-2357

Author(s):

Hong Wang ◽

Adam M Sorkin ◽

Ramasamy Sakthivel

Keyword(s):

Cord Blood ◽

Large Scale ◽

Conflicts Of Interest ◽

Ex Vivo ◽

Rapid Development ◽

High Volume ◽

In Vitro Models ◽

Scale Production ◽

Hematopoietic Stem

Abstract Abstract 2357 Infection by Plasmodium Vivax (P. Vivax) is the most common cause of Sleeping Malaria. P. Vivax and other plasmodia have grown increasingly resistant to antimalarial drugs. Introduced by mosquito bite, P. vivax sporozoites enter circulation and preferentially penetrate reticulocytes by attaching to the Fya and Fyb Duffy antigen/chemokine receptor (DARC) via PvRBP-1 and PvRBP-2 proteins located at their apical poles. Once in a reticulocyte, the parasite begins to reproduce asexually, releasing of thousands of merozoites into circulation. At this point, merozoites can also enter the liver and triggering relapses months or years later. The emergence of drug-resistant strains of p. vivax has stimulated development of new vaccines and treatments, but progress has been slowed by the dearth of reliable screening platforms. Many vaccine candidates have been developed to act upon vivax merozoites by preventing binding of PvRBP-1 and 2 to DARC, thereby arresting reproduction. However, there is a distinct lack of in vitro models to evaluate candidates that employ this mechanism. We are addressing this issue with a novel ex vivo expansion and differentiation technology for large-scale production of DARC expressing reticulocytes for in vitro P. vivax infection studies. This technology comprises an expansion system that can produce high yields of hematopoietic precursors (CD133+/CD34+ cells) from a variety of sources (marrow, peripheral blood, and cord blood), and a differentiation system to produce a relatively pure population of enucleated erythrocytes. In this study, we have refined the polyethersulfone (PES) nanofiber-based culturing system containing growth factors and cytokines in a serum-free media, to expand hematopoietic stem and progenitor cells (HSPC) ex vivo. This expansion technology allows rapid 200-fold ex vivo proliferation within 7 days of umbilical cord blood derived CD133+/CD34+ HSPCs from a DARC+ donor. Following expansion, over 50% of these cells retained HSPC phenotype (expression of CD34+). We have subsequently demonstrated that feeder layer free three-step differentiation of nanofiber-expanded cells using cytokines results in a population containing predominately enucleated reticulocyte-like cells. At 21 days of differentiation, cells had expanded 50-fold. Around 41% of cells were enucleated reticulocytes. These cells expressed glycophorin-A, a major sialoglycoprotein present on the human erythrocyte membrane. ∼28% of cells were CD36+, and ∼70% were CD71+ indicating an erythroid lineage. These results suggest that this technology can produce a population of DARC+ reticulocytes that is ∼5,000-fold greater than the starting population of HSPCs. We are partnering with leading malaria vaccine researchers to demonstrate that these reticulocytes can be parasitized by p. vivax. We believe that this will provide a unique platform to jumpstart research of malaria parasites and enable rapid development of effective vaccines. Further development of this technology may also have significant implications for large-scale ex vivo production of erythrocytes for general use. Reticulocyte-like cells and expelled nuclei during differentiation of nanofiber-expanded HSPC. Disclosures: No relevant conflicts of interest to declare.

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