PS01.076: LAPAROSCOPIC REMOVAL OF A SLIPPED ANGELCHIK ANTIREFLUX PROSTHESIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 70-71
Author(s):  
Takahiro Masuda ◽  
Sumeet Mittal
Keyword(s):  
Gastric Bypass ◽  
Conflicts Of Interest ◽  
Gastroesophageal Junction ◽  
Gastric Pouch ◽  
Acid Reflux ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Proximal Stomach ◽  
Distal Stomach ◽  
Laparoscopic Removal

Abstract Background The Angelchik prosthesis is c-shaped silicone ring designed to prevent acid reflux. The device, which is fitted around the gastroesophageal junction, was popular in 1980s and over 25,000 devices were placed in patients worldwide. However, follow-up showed a high frequency of undesirable results, including device migration and esophageal erosion. The use of this device was therefore abandoned in the early 1990s. Methods A 70-year-old man with a body mass index of 36 kg/m2 presented to us with persistent dysphagia and progressively increasing heartburn. He had undergone placement of an Angelchik prosthesis 37 years earlier. He said that he had experienced dysphagia since it was implanted, but had accepted it. His past medical history included hypertension, hyperlipidemia, sleep apnea, atrial fibrillation, cerebrovascular accident, and benign prostatic hypertrophy. Upper gastrointestinal endoscopy, contrast esophagram, and high-resolution manometry showed a slipped Angelchik device on the stomach with moderately impaired esophageal body motility. Results The patient underwent laparoscopic removal of the Angelchik prosthesis, followed by a Roux-en-Y gastric bypass for antireflux. After laparoscopic access, adhesions from previous laparotomy were taken down and standard laparoscopic foregut surgery ports were placed. A fibrous calcified capsule encircling the Angelchik prosthesis was noted around the proximal stomach. The anterior wall of the capsule was peeled off using a Harmonic scalpel, and the Angelchik prosthesis was removed in one piece. Given the patient's esophageal dysmotility and scarring around the fundus, we proceeded with Roux-en-Y gastric bypass. The alimentary and biliary limbs were tailored to 80 cm and 30 cm in length, respectively. Using linear staplers, the gastric pouch was created by dividing the proximal stomach just below the level of the scarred tissue created by the Angelchik device. The distal stomach was left in situ. The operation lasted 160 minutes, and the intraoperative blood loss was 150 mL. Barium swallow on postoperative day 1 showed no leakage, and a liquid diet was initiated. The patient was discharged on postoperative day 2. The patient now reports resolved dysphagia and reflux. Conclusion Laparoscopic removal of the Angelchik prosthesis and Roux-en-Y gastric bypass was performed safely with good outcomes. Disclosure All authors have declared no conflicts of interest.

scholarly journals Endoscopic Insufflation–Induced Gastric Barotrauma during Percutaneous Endoscopic Gastrostomy: A Report of Three Patients and Review of Literature

2021 ◽  
Vol 12 (02) ◽  
pp. 103-106
Author(s):  
Avnish Kumar Seth ◽  
Rinkesh Kumar Bansal
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Gastrointestinal Endoscopy ◽  
Gastroesophageal Junction ◽  
Upper Gastrointestinal Endoscopy ◽  
Proximal Stomach ◽  
Endoscopic Gastrostomy ◽  
Lesser Curvature ◽  
Upper Gastrointestinal ◽  
New Onset

Abstract Background We report three patients with endoscopic insufflation–induced gastric barotrauma (EIGB) during upper gastrointestinal endoscopy (UGIE) for percutaneous endoscopic gastrostomy (PEG). A definition and classification of EIGB is proposed. Materials and Methods Records of patients undergoing UGIE over 7 years (April 2013–March 2020) were reviewed. Patients who developed new onset of bleeding or petechial spots in proximal stomach, in an area previously documented to be normal during the same endoscopic procedure, were studied. Results New onset of bleeding or petechial spots in proximal stomach occurred in 3/286 (0.1%) patients undergoing PEG and in none of the 19,323 other UGIE procedures during the study period. All patients were men with median age 76 years (range 68–80 years), with no coagulopathy. Aspirin and apixaban were discontinued 1 week and 3 days prior to the procedure. Fresh blood was noted in the stomach at a median of 275 seconds (range 130–340) seconds after commencement of endoscopy. At retroflexion, multiple linear mucosal breaks of up to 3 cm, with oozing of blood, were noted in the proximal stomach along the lesser curvature, close to the gastroesophageal junction in two patients. In the third patient, multiple petechial spots were noticed in the fundus. The plan for PEG was abandoned and the stomach deflated by endoscopic suction. There was no subsequent hematemesis, melena, or drop in hemoglobin. One week later, repeat UGIE in the first two patients revealed multiple healing linear ulcers of 1 to 3 cm in the lesser curvature and PEG was performed. Conclusion Overinsufflation over a short duration during UGIE may lead to EIGB. Early detection is key and in the absence gastric perforation, patients can be managed conservatively.

scholarly journals Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass

2019 ◽  
Vol 30 (3) ◽  
pp. 875-881 ◽  
Author(s):  
Tuure Saarinen ◽  
Kirsi H. Pietiläinen ◽  
Antti Loimaala ◽  
Toni Ihalainen ◽  
Henna Sammalkorpi ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
De Novo ◽  
Bile Reflux ◽  
Gastric Pouch ◽  
Total Activity ◽  
One Anastomosis Gastric Bypass ◽  
Common Finding ◽  
Upper Gastrointestinal Endoscopy ◽  
Long Term Effects

Abstract Introduction Data on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial). Methods Forty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%). Results Twenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1–21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively). Conclusion Postoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up. Trial registration Clinical Trials Identifier NCT02882685

P36 DE NOVO GORD AFTER ROUX Y GASTRIC BYPASS: UNCOMMON BUT POSSIBLE – A LOOK AT THE WHY FACTORS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Al Saadi Hatem ◽  
Sharples Alistair ◽  
Cornes Bridie ◽  
Rao Vittal ◽  
Nagammapudur Balaji
Keyword(s):  
Gastric Bypass ◽  
De Novo ◽  
Gastric Pouch ◽  
Barium Swallow ◽  
Gastric Fistula ◽  
Ulcer Disease ◽  
The Past ◽  
Diagnostic Work ◽  
Work Up ◽  
New Onset

Abstract Background Roux Y gastric bypass (RYGB) is the preferred bariatric surgical option in patients with Gastro oesophageal reflux disease (GORD). However, de novo GORD after RYGB although uncommon is possible and present challenges in further management. Proposed mechanisms have been a large gastric pouch or a short alimentary limb. Objective Analyse anatomical causes of De Novo GORD post RYGB Methods Data of patients who presented with new onset GORD after RYGB were collected and analysed. Results Specific and remediable anatomical factors contributing to de novo GORD was found in 8 patients post RYGB (3 Males and 5 Females). Onset of symptoms ranged from 1.16-15 years. Mean age was 53.14 and mean BMI 37.39. One patient had R-Y gastric bypass for peptic ulcer disease in the past. Diagnostic work up included; Barium swallow (85.7%), CT Abdomen (42.9%), OGD (57.1%). Diagnosis of candy cane (CC) syndrome was seen in 50 % of cases (n=4) followed by Gastro-gastric fistula (n=1), gastric pouch herniation (n=1) and pouch herniation with CC syndrome (n=2). Excision of excess CC limb achieved resolution in symptoms of reflux. 4 patients are awaiting surgical anatomical correction. Conclusion De novo GORD after RYGB can be challenging. These patients need thorough anatomic and physiologic assessment to identify potentially correctable anatomical causes. A long CC, herniated gastric pouch, gastro-gastric fistula are anatomical causes identified in our study. Identification and evaluation of this sub group of patients has not been reported in the past but are likely to be increasingly encountered.

P140 LAPAROSCOPIC MODIFIED BELSEY TYPE FUNDOPLICATION FOR REFLUX AFTER ROUX Y GASTRIC BYPASS – A POTENTIAL SAVIOR WHEN THE SAVIOR IS IN TROUBLE!

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Al Saadi Hatem ◽  
Raza Syed ◽  
Sharples Alistair ◽  
Rao Vittal ◽  
Nagammapudur Balaji
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Hiatal Hernia ◽  
Gastric Pouch ◽  
Revisional Bariatric Surgery ◽  
Barium Swallow ◽  
Hiatal Hernia Repair ◽  
Co Morbidity ◽  
Patient Reported

Abstract Background Roux Y Gastric Bypass (RYGB) is the preferred primary bariatric surgical option in patients with preoperative gastro oesophageal reflux disease (GERD). It is also the preferred revisional bariatric surgery after when GERD develops after an alternate primary bariatric surgery. However reflux after RYGB although uncommon can present due to a variety of factors. Management can be challenging. Aim/Hypothesis A modified version of the Belsey IV fundoplication can be done laparoscopically to reconstitute the antireflux barrier in the absence of a Fundal remnant in the gastric pouch after RYGB. Methods We present a single patient experience/case study where there was evidence of recurrent GERD in spite of a successful RYGB in terms of weight loss and comorbidity resolution. A 42 year old female with a BMI > 40 and metabolic co-morbidities and GERD was deemed fit for RYGB. After a technically uneventful RYGB with standard limb lengths ( Roux 120cms and BP limb 70 cms) there was significant weight loss ( > 70% EBWL) and co-morbidity resolution. However her symptoms of GERD persisted. An gastroscopy confimed esophagitis and a barium swallow showed evidence of GERD with a small hiatal hernia and a 3-4 cms Candy cane limb. There was no evidence of a gastrogastric fistula. Revisonal surgery was done which revealed no significant candy cane limb. A small (<2cms) hiatal hernia was found. Complete esophageal mobilization and a hiatal hernia repair was done in a standard fashion. Furthermore the anterior wall of the long gastric pouch was invaginated to obtain an approximate coverage of 200 degrees in a single layer Belsey technique. The procedure was completed laparoscopically. Results The post-operative period was uneventful. Patient reported complete absence of reflux after surgery and remains off PPI in the short term. Temporary dysphagia was noticed in the first few weeks after surgery which improved with expectant treatment. Conclusion A Laparoscopic modified Belsey type fundoplication serves as an effective method to treat GERD after a RYGB if other potential causes of GERD are excluded.

scholarly journals Mixed adenoneuroendocrine carcinoma of proximal stomach; a rare but sinister pathology

2020 ◽  
Vol 10 (2) ◽  
pp. 1772-1775
Author(s):  
Deepshikha Gaire ◽  
Daisy Maharjan ◽  
Nisha Sharma
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Histopathological Examination ◽  
Gastroesophageal Junction ◽  
Upper Gastrointestinal Endoscopy ◽  
Radiological Findings ◽  
Proximal Stomach ◽  
History Of ◽  
Adenocarcinoma Component ◽  
Physical Findings ◽  
Upper Gastrointestinal

Mixed adeno-neuroendocrine carcinoma is a rare tumor of the gastrointestinal tract comprising of both epithelial and neuroendocrine components, each representing at least 30% of the tumor. Diagnosis is based on clinical evaluation, radiological findings, histopathological features in conjunction with immunostaining with specific neuroendocrine markers such as chromogranin, synaptophysin, CD56, and markers of epithelial differentiation such as cytokeratin, CDX2, and carcinoembryonic antigen. A 50-year-old female presented with a history of dysphagia, chest pain, anorexia, and significant weight loss with normal physical findings and baseline investigations. Upper Gastrointestinal endoscopy showed growth at the gastroesophageal junction involving cardia of the stomach. Histopathological examination of the resected mass showed both adenocarcinoma and neuroendocrine carcinomatous components each involving more than 30% of total mass examined. Identifying adenocarcinoma component admixed with a high-grade neuroendocrine component is significant as the prognosis and survival of patients differ from pure adenocarcinoma.

PS01.105: PANCREATITIS IN THE ESOPHAGEAL ECTOPIC PANCREAS: A RARE CONDITION WITH DIFFERENT PRESENTATIONS! TREATMENTS AND REVIEW OF THE LITERATURE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 79-79
Author(s):  
Sergio Szachnowicz ◽  
Rubens Sallum ◽  
Hilton Libanori ◽  
Edno Bianchi ◽  
Andre Duarte ◽  
...  
Keyword(s):  
Chest Pain ◽  
Ct Scan ◽  
Acute Inflammation ◽  
Conflicts Of Interest ◽  
Gastroesophageal Junction ◽  
Elevated Serum ◽  
Pancreatic Tissue ◽  
Ectopic Pancreas ◽  
Esophageal Wall ◽  
Review Of The Literature

Abstract Background Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature. Methods We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature. Results 1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis. Conclusion The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment. Disclosure All authors have declared no conflicts of interest.

FA02.02: TWENTY-FIVE YEARS OF LAPAROSCOPIC TREATMENT FOR ESOPHAGEAL ACHALASIA: OUR EXPERIENCE ON 1000 LAPAROSCOPIC HELLER-DOR OPERATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 3-3
Author(s):  
Mario Costantini ◽  
Renato Salvador ◽  
Giovanni Capovilla ◽  
Andrea Costantini ◽  
Anna Perazzolo ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pain Score ◽  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Univariate Analysis ◽  
Esophageal Achalasia ◽  
Barium Swallow ◽  
Pneumatic Dilation ◽  
Tertiary Referral Center ◽  
Manometric Pattern

Abstract Background In the past decades, Laparoscopic Heller-Dor (LHD) progressively became the treatment of choice for esophageal achalasia. Aim of this study was to assess our 25-year experience with LHD at a single high-volume institution. Methods 1000 patients underwent LHD from 1992–2017 by 6 staff surgeons. Patients who had already been treated with surgical or endoscopic myotomy were ruled out. Symptoms were scored using a detailed questionnaire; barium swallow, endoscopy, manometry (conventional or High Resolution) were performed, before and after surgery, while 24-hour pH monitoring was performed 6 months after surgery. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. >8). Results LHD was performed on 1000 patients (M: F = 536:464); the median age was 46 (IQR 36–54), 183 (18.3%) had a history of endoscopic treatments (pneumatic dilation or botox injections, or both). The surgical procedure was completed laparoscopically in all but 7 patients (0.7%) and there was one perioperative death for heart attack. There were 25 perforations (2.5%): 22 were recognized and repaired during the operation, 3 were detected by postoperative contrast swallow. In 674 patients the manometric pattern was classified as follows: 310 (46%) pattern I, 315 (46.7%) pattern II and 49 (7.3%) pattern III. The outcome was positive in 902 patients (90.2%). In patients who had a previous treatment the failures were 25/183 (13.7%) while in the primary treatment group the failures were 73/817 (8.9%) (P = 0.055). All the 98 patients whose LHD failed underwent one or more pneumatic dilations, which ameliorated their symptoms in all but 11 patients (10 required reoperation). The overall success rate of combined LHD and dilations was 98.4%. At univariate analysis, manometric pattern (P = 0.001), absent sigmoid megaesophagus (P = 0.003) and chest pain score (P = 0.002) were the only factors predictive of the result. At multivariate analysis, these three factors were independently associated with good outcome. Postoperative 24-hour pH was abnormal in 50/590 patients (8.5%). Two patients developed an esophageal cancer during follow-up. Conclusion In a university tertiary referral center, LHD relieves achalasia symptoms durably. The preoperative manometric pattern, the absence of a sigmoid esophagus and the chest pain score represent the strongest predictors of outcome. Disclosure All authors have declared no conflicts of interest.

scholarly journals Comparison of weight loss, food consumption and frequency of vomiting among Roux-en-Y gastric bypass patients with or without constriction ring

2014 ◽  
Vol 27 (suppl 1) ◽  
pp. 43-46 ◽  
Author(s):  
Silvia Leite FARIA ◽  
Orlando Pereira FARIA ◽  
Mariane de Almeida CARDEAL
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Medical Records ◽  
Excess Weight Loss ◽  
Gastric Pouch ◽  
Excess Weight ◽  
Bariatric Patient ◽  
Constriction Ring ◽  
Ring Group ◽  
Weight Protein

BACKGROUND: After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch. AIM: To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch. METHOD: A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection. RESULTS: Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88±17.50 months, and for the No-Ring Group 51±15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%). CONCLUSION: The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors that have definite influence in the health of the bariatric patient.

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