TP6.2.14 Outcome of POEM (Per-oral endoscopic myotomy) for achalasia

Aims Laparoscopic Heller’s myotomy (LHM) has been the surgical gold standard for treatment of oesophageal achalasia. Peroral endoscopic myotomy (POEM) has been proposed as an alternative technique. The aim of this study was to assess the safety and efficacy of POEM for achalasia in our unit. Methods We have operated on 202 patients for oesophageal achalasia since 2005: 107 had LHM, 86 had POEM, and 9 had an oesophagectomy. We assessed the clinical outcome of POEM comparing pre- and postoperative endoscopic, radiologic and manometric findings, as well as Eckardt-, GERD- and DsQoL score for achalasia. All follow-up patients were offered endoscopy. Results Data were completed for the first 45 POEM patients. The average age was 45 years. 18 patients (40%) had prior achalasia treatment. The median hospital stay was 2 days (2-5). There was no mortality, but 4 patients (9%) had post-operative complications. The median follow-up was 24 months (12-49). Clinical success (Eckardt score ≤ 3) was achieved in 39 patients (87%). Thirteen patients (29%) were taking PPIs for chest symptoms. Eleven of these underwent pH studies of whom only 1 had a DeMeester score > 14.5. Of the 24 patients who had post-operative endoscopy, 40% was diagnosed with oesophagitis grade A, yet only 5 of them were symptomatic. Conclusions POEM appears to be safe and effective and warrants consideration as first-line therapy in expert achalasia centres. Longer term randomized studies comparing the outcomes of POEM with LHM and pneumatic dilatation will determine its place in the treatment of achalasia.

A Study on the Correlation Between Endoscopic Findings and Symptoms of Gastro-Esophageal Reflux Disease

Background and Aim: Gastroesophageal reflux disease (GERD) is a physiological passage of stomach contents into the esophagus. It is basically the pathological complications and symptoms. Endoscopy is a gold standard investigation tool that eliminates the gastroesophageal reflux disease co-morbidities such as malignancy and Barret’s esophagus. The present study was carried out to evaluate the correlation between endoscopic findings and symptoms of gastroesophageal reflux disease. Materials and Methods: This intervention cross-sectional study was carried out on 109 gastro esophageal reflux disease patients in Gastroenterology department of Isra University Hospital, Hyderabad for six months duration from January 2021 to June 2021. Suspected gastroesophageal reflux disease patients were assessed thoroughly by physical examination, history, and endoscopy for gastrointestinal symptoms. Severity, symptom type, duration, and frequency were assessed as clinical symptoms. The upper gastrointestinal endoscopy findings were evaluated in terms of esophageal erosions, and their grades such as Grade A, Grade B, Grade C, and Grade D. The endoscopy abnormal findings such as hernia, esophagus, malignancy, and Barret’s esophagus were correlated with gastroesophageal reflux disease. Result: Out of 109 patients, 78 (71.5%) were females while 31 (28.5%) were male. The mean age of the patients was 43.54 ± 7.3 years with an age range between 25 and 67 years and the mean BMI was 43.34 ± 5.76 kg/m2. Gastro esophageal reflux disease symptoms such as malignancy and Barrett’s esophagus shown no evidence on pre-operative endoscopy. About 29 (26.6%) patients had normal endoscopy. The symptomatic patients were 80 (73.4%) which were categorized based on LA classifications into Grade A 62 (77.5%), Grade B 13 (16.3%), Grade C 3 (3.8%) and Grade D 2 (2.5%). Based on the reflux score system, patients were distributed as mild 43 (53.8%), moderate 11 (13.8%), severe 5 (6.3%), and very severe 21 (26.3%). Conclusion: Our study found a significant correlation between gastro esophageal reflux disease and endoscopy esophagitis findings. Pre-operative endoscopy should be carried for abnormal endoscopy in both symptomatic and asymptomatic patients. Keywords: Gastro-oesophageal reflux disease, Endoscopy, Esophagitis

Surgery with Post-Operative Endoscopy Improves Recurrence Detection in Sinonasal Malignancies

Objective: The mainstay of treatment in sinonasal malignancy (SNM) is surgery, and when combined with chemoradiation therapy, often leads to the best overall prognosis. Nasal endoscopy is essential for post-treatment surveillance along with physical exam and radiologic evaluation. The ability to directly visualize the sinus cavities after surgery may also improve early detection of tumor recurrence and is another reason to potentially advocate for surgery in these patients. Methods: A retrospective chart review of medical records of patients with pathologically proven SNM was conducted from 2005 to 2019. Results: The nasal cavity and maxillary sinus were the most common primary tumor sub-sites. The most common pathology was squamous cell carcinoma (42%). The median time to recurrence was 9.8 months. Recurrence was initially detected endoscopically in 34.3% patients, by imaging in 62.7% patients, and by physical exam in 3.0% patients. 67 (29%) total recurrences were detected on follow-up, of which 46 (68.7%) were local. Twenty-three of the local recurrences were identified via nasal endoscopy. Thirteen recurrences were identified via endoscopic surveillance within the surgically patent paranasal sinuses while 13 were identified within the nasal cavity; 5 patients had multiple sites of recurrence. Conclusion: Local recurrence of SNM is the most common site for recurrent disease and nasal endoscopy identified half of these cases. 50% of these recurrences were within the paranasal sinuses and would not have been easily identified if the sinuses were not open for inspection. Thus, open sinus cavities aid in the detection of tumor recurrence and is another advantage of surgery in the management of SNM.

A COMPARATIVE STUDY OF LUND-MACKAY SCORING AND POSE SCORING IN CHRONIC RHINO-SINUSITIS PATIENTS.

INTRODUCTION: To compare preoperative Computed Tomography scan ndings of Para nasal sinuses using Lund-Mackay scoring and intra operative Functional endoscopic sinus surgery ndings in patients with Chronic Rhino-sinusitis using the POSE scoring and to correlate maximum scores obtained in Perioperative sinus endoscopy (POSE) scoring system and Lund-Mackay scoring system. MATERIALS AND METHODS:AProspective study was done for 1 year on 48 patients attending outpatient department of ENT, Sri Siddhartha Medical College aged between 18-60 years, who were clinically diagnosed to have Chronic Rhino-sinusitis, underwent pre-operative CT scan of nose and paranasal sinuses and thereafter FESS were enrolled for the study after obtaining the due consent. RESULTS: From our study group of 48 patients who underwent endoscopic sinus surgery for CRS, the minimum value of Lund-MacKay Scoring was 3 whereas the maximum was 18 (maximum obtainable is 24) with a mean value of 12.02 and standard deviation of 3.987. The minimum POSE Score obtained was 7 and the maximum POSE Score obtained was 37 (maximum obtainable being 40), with a mean value of 16.31 and standard deviation of 5.095. CONCLUSION: Pre operative CT scan combined with per operative endoscopy ndings has made the approach to Chronic rhinosinusitis more specic, rational and accurate. The results of our study highlights that CT scan is an important investigation tool to detect Chronic rhinosinusitis . CT scan has very much emerged as the gold standard in preoperative diagnosis and allows for accurate patient selection for FESS. In our study, POSE Scoring has shown a good correlation with Lund MacKay scoring system

Acute paraoesophageal hiatal hernia following laparoscopic sleeve gastrectomy

Anti-obesity surgery is the most effective therapy available for significant weight loss in patients with morbid obesity. Obesity in consider a major independent risk factor for Hiatal hernia (HH) and it is present in about 37%-50% of morbidly obese patients undergoing bariatric surgery.1,2,3 It might be overlooked or under looked especially if the patient was asymptomatic and no pre-operative endoscopy or radiological workup. Denovo closure of the hiatal defect in case of an intraoperative finding of HH strongly recommended preventing such acute postoperative complications. Herein we report a rare and acute post laparoscopic sleeve gastrectomy with gastric herniation were uneventfully diagnosed and interfered early to prevent a catastrophic outcome.

Hysteroscopy - history and development

Hysteroscopy is the gold standard for diagnosing and managing endocervical and endometrial pathology. The development of today?s hysteroscopy begins in the early 19th century. Initially, hysteroscopy was used solely for diagnostics. Operative hysteroscopy surfaced with the development of distension media, the hysteroscope, and its associated instruments. Operative hysteroscopy underwent the most significant development in the early 1970s, when new hysteroscopes were introduced, and the distension media became more widely used. A multitude of hysteroscopic procedures are performed with the common goal of removing pathological changes in the endometrial cavity. In the 1980s, small cameras, also known as ?chip? cameras, were developed, leading to the transition of endoscopy into videoendoscopy. Bettocchi revolutionized modern hysteroscopy in 1996 when he used the first operative office hysteroscope. Operative resectoscopes, containing monopolar and bipolar energy, were also constructed. Hysteroscopic morcellators have been in use since the beginning of the 21st century. Today?s modern hysteroscopy represents a safe diagnostic and operative endoscopy.