RESUMEN
Gastroesophageal reflux disease (GERD) presents a general health problem with a variety of symptoms and an impairment of life quality. Conservative therapies do not offer sufficient symptom relief in up to 30% of patients. Patients who suffer from ineffective esophageal motility (IEM) and also GERD may exhibit symptoms ranging from mild to severe. In cases where surgical intervention becomes necessary for this diverse group of patients, it is important to consider the potential occurrence of postoperative dysphagia. RefluxStop is a new alternative anti-reflux surgery potentially reducing postoperative dysphagia rates. In this bicentric tertiary hospital observational study consecutive patients diagnosed with PPI refractory GERD and IEM that received RefluxStop implantation were included. A first safety and efficacy evaluation including clinical examination and GERD-HRQL questionnaire was conducted. 40 patients (25 male and 15 female) were included. 31 patients (77.5%) were on PPI at time of surgery, with mean acid exposure time of 8.14% ± 2.53. The median hospital stay was 3 days. Postoperative QoL improved significantly measured by GERD HRQL total score from 32.83 ± 5.08 to 6.6 ± 3.71 (p < 0.001). A 84% reduction of PPI usage (p < 0.001) was noted. 36 patients (90%) showed gone or improved symptoms and were satisfied at first follow-up. Two severe adverse events need mentioning: one postoperative slipping of the RefluxStop with need of immediate revisional operation on the first postoperative day (Clavien-Dindo Score 3b) and one device migration with no necessary further intervention. RefluxStop device implantation is safe and efficient in the short term follow up in patients with GERD and IEM. Further studies and longer follow-up are necessary to prove long-lasting positive effects.
Asunto(s)
Reflujo Gastroesofágico , Calidad de Vida , Humanos , Masculino , Femenino , Reflujo Gastroesofágico/cirugía , Persona de Mediana Edad , Anciano , Adulto , Trastornos de la Motilidad Esofágica/terapia , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVES: Gastro-oesophageal reflux disease (GERD) consists in the passage of gastric acid content from the stomach to the oesophagus, causing burns and deteriorating the quality of life. Laparoscopic Sleeve Gastrectomy (LSG) could induce de novo GERD and worsen pre-existing GERD because of the higher gastric pressurisation, reduction of stomach volume and a wider His-angle. In the proposed work, various computational gastric 2D models were developed to understand the effects of variables such as the His-angle, the antral dimension, and the bolus viscosity on the reflux increase. METHODS: Fluid-Structure Interaction (FSI) computational models which couple the solid mechanics of the gastric wall, and the fluid domain of the bolus, have been developed to shed light on biomechanical aspects of GERD after LSG. A closure was imposed to the lower oesophageal sphincter (LES) mimicking what happens physiologically after food intake. RESULTS: Results showed that the configuration prone to higher reflux flow was the post-surgical 65° model with a staple line starting directly from the pylorus without antral preservation, for all considered viscosities. Increasing viscosity, reflux flow decreased. Post-surgical refluxes were higher than pre-ones and decreased with increasing antrum preservation. CONCLUSIONS: These results could be a starting point for analysis of anatomical features, bariatric surgery and GERD occurrence. Further studies based on 3D geometries need to be performed.
Asunto(s)
Reflujo Gastroesofágico , Laparoscopía , Obesidad Mórbida , Humanos , Calidad de Vida , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/cirugía , Gastrectomía/efectos adversos , Gastrectomía/métodos , Laparoscopía/métodos , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
The purpose of this study was to assess the reproducibility of functional and anatomical parameters of swallowing events as determined by real-time MRI at 40â¯ms temporal resolution (25 frames per second). Twenty-three consecutive patients with gastroesophageal reflux disease (GERD) underwent real-time MRI of the gastroesophageal junction at 3.0â¯T. Real-time MRI was based on highly undersampled radial fast low angle shot (FLASH) acquisitions with iterative image reconstruction by regularized nonlinear inversion (NLINV). MRI movies visualized the esophageal transport of a pineapple juice bolus, its passage through the gastroesophageal junction and functional responses during a Valsalva maneuver. His-angle, sphincter position, sphincter length and sphincter transit time were assessed by two radiologists. Interobserver and intraobserver intraclass correlation coefficients (ICC) were evaluated and Bland-Altman plots were constructed to assess the observer agreement. Interobserver agreement was excellent for sphincter transit time (ICCâ¯=â¯0.92), His-angle (ICCâ¯=â¯0.93), His-angle during Valsalva maneuver (ICCâ¯=â¯0.91) and sphincter-to-diaphragm distance (ICCâ¯=â¯0.98). Sphincter length and oesophageal diameter showed good interobserver agreement (ICCâ¯=â¯0.62 and ICCâ¯=â¯0.70). Intraobserver agreement was good for sphincter length (ICCâ¯=â¯0.80) and excellent for sphincter transit time, His-angle and His-angle during Valsalva maneuver, sphincter-to-diaphragm distance, and esophageal diameter (ICCâ¯=â¯0.91; ICCâ¯=â¯0.97; ICCâ¯=â¯0.97; ICCâ¯=â¯0.998; ICCâ¯=â¯0.93). All functional parameters of the gastroesophageal junction had good to excellent reproducibility. Visual assessment of Bland Altman plots did not reveal any systematic interobserver bias. In conclusion, the visualization of swallowing events by real-time MRI has a high potential for clinical application in gastroesophageal reflux disease.
Asunto(s)
Deglución/fisiología , Reflujo Gastroesofágico/diagnóstico por imagen , Imagen por Resonancia Magnética , Maniobra de Valsalva/fisiología , Adulto , Anciano , Femenino , Reflujo Gastroesofágico/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND/AIMS: The gastroesophageal junction is an important barrier against gastroesophageal ref lux. Endoscopic grading of gastroesophageal f lap valve is simple, reproducible, and may predict reflux activity. We investigated the correlation between gastroesophageal flap valve grade and the gastroesophageal junction's structural properties using abdominal computed tomography. METHODS: A total of 138 patients with early gastric cancer who underwent both pre-treatment esophagogastroduodenoscopy and water-distended stomach two-phase computed tomography were enrolled. Endoscopic gastroesophageal f lap valve grade and abdominal computed tomography findings were analyzed to assess anatomical factors including the gastroesophageal junction and related organs. RESULTS: The angle of His increased significantly with gastroesophageal flap valve grade (grade I, 65.2Ë ± 19.6Ë; grade II, 66.6Ë ± 19.8Ë; grade III, 76.7Ë ± 11.9Ë; grade IV, 120.0Ë ± 30.3Ë; p < 0.001), as did the size of the diaphragmatic hiatus (grade I, 213.0 ± 53.8 mm2 ; grade II, 232.6 ± 71.0 mm2 ; grade III, 292.3 ± 99.2 mm2 ; grade IV, 584.4 ± 268.3; p < 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, 34.6 ± 5.8 mm; grade II, 32.0 ± 6.5 mm; grade III, 24.6 ± 7.8 mm; grade IV, -22.6 ± 38.2 mm; p < 0.001). There was no significant relationship between gastroesophageal flap valve grade and visceral and subcutaneous fat areas (p = 0.877 and p = 0.508, respectively). CONCLUSIONS: Endoscopic grading of the gastroesophageal flap valve is well correlated with anatomical changes around the gastroesophageal junction on abdominal computed tomography, and it can provide useful information about the anti-reflux barrier.
Asunto(s)
Unión Esofagogástrica/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Esofagitis Péptica/diagnóstico por imagen , Esofagitis Péptica/etiología , Unión Esofagogástrica/anatomía & histología , Femenino , Reflujo Gastroesofágico/prevención & control , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND/AIMS: The gastroesophageal junction is an important barrier against gastroesophageal ref lux. Endoscopic grading of gastroesophageal f lap valve is simple, reproducible, and may predict reflux activity. We investigated the correlation between gastroesophageal flap valve grade and the gastroesophageal junction’s structural properties using abdominal computed tomography. METHODS: A total of 138 patients with early gastric cancer who underwent both pre-treatment esophagogastroduodenoscopy and water-distended stomach two-phase computed tomography were enrolled. Endoscopic gastroesophageal f lap valve grade and abdominal computed tomography findings were analyzed to assess anatomical factors including the gastroesophageal junction and related organs. RESULTS: The angle of His increased significantly with gastroesophageal flap valve grade (grade I, 65.2˚± 19.6˚; grade II, 66.6˚± 19.8˚; grade III, 76.7˚± 11.9˚; grade IV, 120.0˚± 30.3˚; p < 0.001), as did the size of the diaphragmatic hiatus (grade I, 213.0 ± 53.8 mm2 ; grade II, 232.6 ± 71.0 mm2 ; grade III, 292.3 ± 99.2 mm2 ; grade IV, 584.4 ± 268.3; p < 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, 34.6 ± 5.8 mm; grade II, 32.0 ± 6.5 mm; grade III, 24.6 ± 7.8 mm; grade IV, –22.6 ± 38.2 mm; p < 0.001). There was no significant relationship between gastroesophageal flap valve grade and visceral and subcutaneous fat areas (p = 0.877 and p = 0.508, respectively). CONCLUSIONS: Endoscopic grading of the gastroesophageal flap valve is well correlated with anatomical changes around the gastroesophageal junction on abdominal computed tomography, and it can provide useful information about the anti-reflux barrier.
Asunto(s)
Humanos , Endoscopía , Endoscopía del Sistema Digestivo , Unión Esofagogástrica , Esófago , Estómago , Neoplasias Gástricas , Grasa SubcutáneaRESUMEN
PURPOSE: This article describes the surgical techniques to prevent reflux esophagitis (RE) after proximal gastrectomy reconstructed by esophagogastrostomy (PGE) preservation of the lower esophageal sphincter (LES) and both pyloric and celiac branches of the vagal nerve (PCVN), and reconstruction of the new His angle (HA) for early proximal gastric cancer (PGC). METHODS: Twenty patients after PGE were divided into 2 groups (group A: 10 patients without preserved LES and PCVN for advanced PGC; group B: 10 patients with preserved LES and PCNV and the addition of a new HA for early PGC). A postoperative interview on gastroesophageal reflux disease (GERD) and satisfaction with this procedure and the collection of endoscopic findings for RE and stasis of the remnant stomach (SRS) were conducted 1 year after PGE in groups A and B. RESULTS: The rates of proton pump inhibitor administration and the symptoms of GERD, RE and SRS in group A were significantly higher than those in group B (p = 0.0433, p = 0.0190, p = 0.0253, p = 0.0190, respectively). Seven out of 10 patients in group A voiced dissatisfaction. Patients in group B were significantly more satisfied with this procedure than those in group A (p = 0.0010). CONCLUSION: This method is useful for preventing postoperative GERD including RE in early PGC patients.
Asunto(s)
Arteria Celíaca/inervación , Esfínter Esofágico Inferior/cirugía , Esófago/cirugía , Gastrectomía/métodos , Reflujo Gastroesofágico/prevención & control , Gastrostomía/métodos , Tratamientos Conservadores del Órgano/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/prevención & control , Píloro/inervación , Neoplasias Gástricas/cirugía , Nervio Vago/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND AND AIM: The function of the lower esophageal sphincter (LES) is evaluated using an esophageal manometric study. However, information regarding the surrounding organs is difficult to obtain with use of a sensor catheter. We investigated the utility of 320-row area detector computed tomography (CT) to evaluate morphological changes of the esophagogastric junction and surrounding organs. METHODS: The study subjects were 18 healthy volunteers and 29 patients with reflux esophagitis (RE). Immediately after swallowing a diluted contrast agent, continuous imaging of the esophagogastric junctional area was performed for 15 s. Using CT images, the presence or absence of esophageal hiatal hernia, His angle before and after swallowing, size of the diaphragmatic hiatus, morphologically identified-LES (MI-LES) length, intraluminal horizontal area of MI-LES during relaxation phase, MI-LES thickness, abdominal esophagus length, subcutaneous fat area, visceral fat area, and esophagogastric junction fat area were evaluated. RESULTS: Analysis of CT images showed more frequent occurrence of hiatal hernia, greater His angle, and a larger diaphragmatic hiatus in patients with severe RE, while the lengths of MI-LES and abdominal esophagus were shorter in those patients. Visceral and esophagogastric junction fat areas tended to be greater in patients with RE. In all subjects, the posterior wall of the MI-LES was thicker than the anterior wall. CONCLUSION: Continuous imaging with 320-row area detector CT is useful to evaluate morphological changes in the esophagogastric junction area in both normal individuals and patients with reflux esophagitis.