362 SUPERIOR POLAR GASTRECTOMY ASSOCIATED WITH ANTI-REFLUX TECHNIQUE: CASE REPORT

Superior polar gastrectomy remains an accepted surgical alternative for proximal gastric tumors, although this approach has higher rates of gastroesophageal reflux since the valvular mechanism of cardias disappears. Thus, an additional technique is needed to avoid its presence. Methods This is a description of surgical technique and short term results of superior polar gastrectomy associated to Kamikawa’s anti-reflux technique in a female patient with proximal gastric cancer. Results A 55 year-old female diagnosed with gastric adenocarcinoma. Tumor was 3 cm long, from esophago-gastric junction to subcardial region (cT3N1M0). Patient underwent perioperative chemotherapy and surgical intervention 6 weeks later. A laparoscopic superior polar gastrectomy was performed and D1+ lymphadenectomy. A laparotomy was made to externalize the surgical specimen. Saline solution was injected into submucosa of gastric pouch and two seromuscular flaps were dissected. Gastric mucous membrane was opened in the inferior part of the flaps, constructing an esophagogastric end-to-side anastomosis. Seromuscular flaps were sewn overlapping the esophago-gastric anastomosis. Patient presented an optimal postoperative evolution, without heartburn, dysphagia neither vomiting. Conclusion The procedure described here is feasible and performable, and achieves correct oncological results avoiding performing a total gastrectomy and improving the gastroesophageal reflux problems derived from a superior polar gastrectomy.

Gastroprotective effect of fluvoxamine and ondansetron on stress-induced gastric ulcers in mice

Objectives The association between stress and gastric ulcers has been well reported. This study is divided into two parts: the first part of this study is consisted of analyzing the effect of fluvoxamine administration by intracerebroventricular (ICV) and intraperitoneal (IP) injections on stress-induced gastric ulcers. The second part investigates the effect of ondansetron in influencing the protection of the gastric mucous by giving fluvoxamine to the mice before being induced with stress. Methods Water immersion restraint stress (WIRS) was used to induce stress. Fluvoxamine 50 and 100 mg/kg by IP injection, fluvoxamine 9.3 µg, and 18.6 µg by ICV injection 30 min before the induction of stress. Meanwhile, single drug and in combination administered to the mice, ondansetron 3 mg/kg was given by IP at 60 min, and fluvoxamine 50, 100 mg/kg orally at 30 min before stress induction. Results The obtained results show fluvoxamine 50 and 100 mg/kg by IP, and fluvoxamine 18.6 µg by ICV had significantly reduced ulcer index with p<0.005, p<0.001, and p<0.005 while fluvoxamine 9.3 µg showed the insignificant result. Fluvoxamine 50 mg/kg, fluvoxamine 100 mg/kg, and ondansetron 3 mg/kg monotherapy have a significant reduction in ulcers with p<0.005, p<0.001, and p<0.05, while the combination drugs showed an insignificant reduction in ulcers. Conclusions Fluvoxamine with different administration routes and ondansetron monotherapy before stress reduce the occurrence of gastric ulcers, while the combination drugs did not increase the protective effect of the gastric mucosa.

Disruption of gastric mucous granule exocytosis by Helicobacter pylori virulence factor CagA

Helicobacter pylori infection is the strongest known risk factor of stomach cancer. Strains harboring the virulence factor CagA (cytotoxin-associated gene A) significantly stimulate host inflammatory response, which increases the risk of ulceration and cancer. However, the mechanisms by which CagA triggers prolonged inflammation with mucosal damage remain elusive. Based on a large-scale genetic screen using Drosophila, we identified a novel CagA target Synaptotagmin-like protein 2-a, Slp2-a, an effector of small GTPase Rab27. Using gastric organoid-derived monolayers of polarized mucous cells, we demonstrated that CagA inhibited Slp2-a-mediated docking of mucous granules to the plasma membrane by direct binding to Slp2-a. We further observed aberrant cytoplasmic retention of mucus in human gastric mucosa infected with CagA-expressing strains. These results suggest that CagA could be disrupting the protective mucous barrier by inhibiting Slp2-a-mediated mucous granule exocytosis, which may lead to mucosal damage from luminal acid and pepsin to promote inflammation leading to cancer.

Pediatric Erosive Gastritis: A Case Report

Dyspepsia is a common gastrointestinal disorder which needs diagnostic examination test using endoscopy. Pediatric erosive gastritis, the case presented, is one of the diagnosis confirmed after endoscopy examination test which is mostly associated with Helicobacter pylori infection. A 10-year-old boy was presented to emergency department complaining cyclic vomiting, heartburn and constipation. Further inquiry revealed that similar progressive condition was also complained one year ago prompting endoscopy examination test to find out the underlying etiology. Erosive gastritis and Gastroesophageal Reflux Disease (GERD) were confirmed after examination. Investigation of Helicobacter pylori infection with fecal examination test was impossible due to constipation. Erosive gastritis is a gastric mucous inflammation commonly caused by Helicobacter pylori infection. The clinical manifestation of gastritis tends to be asymptomatic until a pathological component is found. Any pathology suspicion of the gastric lining may require further endoscopy examination test. The therapy of paediatric erosive gastritis includes Proton Pump Inhibitor (PPI), sucralfate sucralfate as also lifestyle modification could improve children’s condition. In conclusion, paediatric erosive gastritis is an organic disorder of gastric lining treated by Proton Pump Inhibitor (PPI), sucralfate and symptomatic agents for associated symptoms. Helicobacter pylori is often associated with erosive gastritis so that further examination is needed.

Subcellular Localization of the TFF Peptides xP1 and xP4 in the Xenopus laevis Gastric/Esophageal Mucosa: Different Secretion Modes Reflecting Diverse Protective Functions

The TFF peptides xP1 and xP4 from Xenopus laevis are orthologs of TFF1 and TFF2, respectively. xP1 is secreted as a monomer from gastric surface mucous cells and is generally not associated with mucins, whereas xP4 is a typical secretory peptide from esophageal goblet cells, and gastric mucous neck and antral gland cells tightly associated as a lectin with the ortholog of mucin MUC6. Both TFF peptides have diverse protective functions, xP1 as a scavenger for reactive oxygen species preventing oxidative damage and xP4 as a constituent of the water-insoluble adherent inner mucus barrier. Here, we present localization studies using immunofluorescence and immunoelectron microscopy. xP1 is concentrated in dense cores of secretory granules of surface mucous cells, whereas xP4 mixes with MUC6 in esophageal goblet cells. Of note, we observe two different types of goblet cells, which differ in their xP4 synthesis, and this is even visible morphologically at the electron microscopic level. xP4-negative granules are recognized by their halo, which is probably the result of shrinkage during the processing of samples for electron microscopy. Probably, the tight lectin binding of xP4 and MUC6 creates a crosslinked mucous network forming a stabile granule matrix, which prevents shrinkage.

P198 SUPERIOR POLAR GASTRECTOMY ASSOCIATED WITH ANTI-REFLUX TECHNIQUE: CASE REPORT

Aim To present a case report where Kamikawa’s technique1 was used, as well as the patient’s postoperative evolution and results. Background and Methods Superior polar gastrectomy remains an accepted surgical alternative for proximal gastric tumors, although this approach has higher rates of gastroesophageal reflux since the valvular mechanism of cardias disappears. Thus, an additional technique is needed to avoid its presence. This is a description of surgical technique and short term results of superior polar gastrectomy associated to Kamikawa’s anti-reflux technique in a female patient with proximal gastric cancer. Results A 55 year-old female with no relevant medical history, diagnosed with diffuse signet ring cell gastric adenocarcinoma. The tumor was 3 cm long, extending from the esophago-gastric junction to the subcardial region (cT3 N1 M0). After presentation in a Multidisciplinary Group, the patient underwent perioperative chemotherapy according to the FLOT-4 protocol, presenting partial clinical response. The surgical intervention took place 6 weeks after finishing chemotherapy, and a laparoscopic superior polar gastrectomy was performed, associating extended resection including 3-4 cm of distal esophagus and D1+ lymphadenectomy with periesophageal lymph node regions 110 and 111. Once the resection was finalized, an assistance laparotomy was made to externalize the surgical specimen. Saline solution was injected into submucosa of the cranial part of the gastric pouch and afterwards, two seromuscular flaps were dissected. Then, the gastric mucous membrane was opened in the inferior part of the flaps, constructing an esophagogastric end-to-side anastomosis made with 2 running sutures of V-lock 3/0. Finally, the previously prepared seromuscular flaps were sewn overlapping the esophagus and the esophago-gastric anastomosis in order to prevent reflux. The patient presented a benign postoperative course, reintroducing oral intake and developing no heartburn, no dysphagia, nor vomiting and was discharged on the 9th postoperative day. The postoperative barium swallow radiography showed no leak of contrast nor any regurgitation. The pathology report showed pT3N1 (2/17) and confirmed tumor free resection margins. Conclusion The procedure described here is feasible and performable, and achieves correct oncological results avoiding performing a total gastrectomy and improving the gastroesophageal reflux problems derived from a superior polar gastrectomy.

Clinical and functional features of the upper gastrointestinal tract in children with chronic gastroduodenitis in 3 and 6 months after eradication therapy

We studied the morphological and functional features of the stomach and duodenum in children with chronic gastroduodenitis (CGD) associated with Helicobacter pylori infection in 3 and 6 months after successful eradication therapy. Initially we carried out examination of 155 children with CGD associated with Helicobacter pylori (HP)-infection in the acute phase of the disease. In the following we examined 100 children in 3 and 6 months after the proven eradication of HP. We found that manifestations of abdominal pain syndrome was significantly decreased (100% in the acute stage versus 7% and 5% at 3 and 6 months after eradication, p < 0.01). At the same time, almost 30% of children still had symptoms of intestinal dyspepsia (31% and 36% of children after 3 and 6 months) in the form of rumbling along the colon and changes in stool. The morphological changes in the stomach and duodenum preserved in 37% of cases: was present lymphoplasmocytic infiltration of gastric mucous and atrophy in 9%. These changes were positively correlated with the identification of CagA factor. Changes in the motor-evacuation function of the stomach were characterized by disturbances in the anthro-duodenal regulation in 25% of children and positively correlated with disorders of acid-neutralizing function.