bluuebunny/crossref_metadata_2025 huggingface dataset:
Aktuelle Entwicklungen in der Konsiliar- und Liaisonpsychiatrie
Authors: Eikelmann B. , Hewer W.
Published: September 2018

Eine große Zahl epidemiologischer und klinischer Studien hat aufgezeigt, dass körperliche und psychische Symptome und Erkrankungen sowohl in der somatischen Medizin als auch in Psychiatrie und Psychotherapie überzufällig häufig gemeinsam auftreten. Die zunehmenden Erkenntnisse zu diagnostisch und therapeutisch relevanten somato-psychischen und psycho-somatischen Interaktionen haben die Konsiliar- und Liaisonpsychiatrie (CL-Psychiatrie) in den letzten zwei Jahrzehnten auch in Deutschland an Bedeutung wachsen lassen. In dieser Übersicht werden aktuelle Entwicklungen in ausgewählten Arbeitsfeldern besprochen. Diese betreffen die wachsende Zahl psychisch Alterskranker in Allgemeinkrankenhäusern, die Potenziale hinsichtlich Früherkennung und -intervention substanzbezogener Störungen in der CL-Psychiatrie, sowie die Integration psychiatrischer und somatischer Angebote für Patienten mit schweren psychischen Störungen. Angesichts der in der gesamten Medizin an Bedeutung gewinnenden Interdisziplinarität stellt die CL-Arbeit einen wichtigen Schwerpunkt in Psychiatrie und Psychotherapie dar, der eine Brückenfunktion zur Somatik wahrnimmt und in Aus-, Fort- und Weiterbildung angemessen repräsentiert sein muss.
Schizoaffektive Psychosen: eine herausfordernde klinische Realität
Authors: Angst J. , Marneros A.
Published: September 2018

Schizoaffektive Erkrankungen stellen leider immer noch ein nosologisches Ärgernis dar, obwohl sie eine sehr präsente und nicht seltene klinische Realität sind. Manche noch stattfindende Diskussionen darüber, ob es sie gibt oder nicht, sind nicht nur anachronistisch, sondern auch völlig sinnlos. Man kann klinische Realitäten nicht durch theoretische Konstrukte ersetzen. Zweck der Forschung muss gerade das Studium und die Erklärung dieser klinischen Realitäten sein. Schizoaffektive Psychosen müssen als eine Herausforderung für Klinik und Forschung betrachtet werden. Die Fragen, die sie durch ihre Position zwischen den beiden Prototypen (Schizophrenie und affektive Störungen) aufwerfen, geben auch die Chance, die prototypischen Störungen besser zu verstehen. Zukünftige Forschung und zukünftige Klassifikationssysteme sollten eine longitudinale Achse als eine Voraussetzung für die Definition von schizoaffektiven Erkrankungen betrachten. Die genetische Forschung könnte einige der wichtigsten Fragen zum Wesen der schizoaffektiven Psychosen in der Zukunft besser beantworten.
Phase-III- und -IV-Studien in der Psychopharmakotherapie
Authors: Möller H.-J.
Published: September 2018

Die Evaluation der Wirksamkeit und Verträglichkeit von Psychopharmaka ist durch eine lange Tradition der klinischen Psychopharmakologie sowie durch Vorgaben der Zulassungsbehörden streng geregelt. Für die Zulassung eines neuen Psychopharmakons sind randomisierte doppelblinde Kontrollgruppenstudien, für die meisten psychiatrischen Indikationen mit Placebovergleich, erforderlich. Diese Phase-III-Studien folgen einem hohen methodischen Standard und werden an streng selektierten Stichproben durchgeführt, um konfundierende Faktoren so weit wie möglich auszuschalten. Der Vorteil hoher interner Validität wird mit dem Nachteil schlechter Generalisierbarkeit (mangelnde externe Validität) erkauft. Deshalb sind nach der Zulassung eines neuen Psychopharmakons weitere Studien durchzuführen, deren Ergebnisse bessere Generalisierbarkeit haben. Diese Studien der Phase IV können verschiedenen Designs folgen: von offenen Studien (nicht interventive Studien) bis zu randomisierten Kontrollgruppenstudien an möglichst unselektiven Patientenstichproben. Für Studien der Phase IV, insbesondere randomisierte Phase-IV-Studien, sind in den letzten Jahren verschiedene Bezeichnungen wie „effectiveness studies“ oder „real word studies“ eingeführt worden. Phase-IV-Studien sind wegen ihrer methodischen Einschränkung im Vergleich zu Phase-III-Studien fehleranfälliger und die Ergebnisse müssen deshalb besonders vorsichtig interpretiert werden.
The threats to Australia’s imperilled species and implications for a national conservation response
Authors: Kearney Stephen G. , Carwardine Josie , Reside April E. , Fisher Diana O. , Maron Martine , Doherty Tim S. , Legge Sarah , Silcock Jennifer , Woinarski John C. Z. , Garnett Stephen T. , Wintle Brendan A. , Watson James E. M.
Published: September 2018

Since European occupation of Australia, human activities have caused the dramatic decline and sometimes extinction of many of the continent’s unique species. Here we provide a comprehensive review of threats to species listed as threatened under Australia’s Environment Protection and Biodiversity Conservation Act 1999. Following accepted global categories of threat, we find that invasive species affect the largest number of listed species (1257 species, or 82% of all threatened species); ecosystem modifications (e.g. fire) (74% of listed species) and agricultural activity (57%) are also important. The ranking of threats was largely consistent across taxonomic groups and the degree of species’ endangerment. These results were significantly different (P<0.01) from recent analyses of threats to threatened species globally, which highlighted overexploitation, agriculture and urban development as major causes of decline. Australia is distinct not only in the biodiversity it contains but also in the extent and mixture of processes that threaten the survival of these species. Notably, the IUCN threat classification scheme separates the numerous threats (e.g. urban development, agriculture, mining) that cause habitat loss, fragmentation and degradation, hence further research is required to quantify the net impact of these types of habitat change. We provide feasible suggestions for a more coordinated national approach to threatened species conservation, which could provide decision makers and managers at all levels with improved resources and information on threats and management. Adequate policy, legislative support and funding are critical for ensuring that on-ground management is successful in halting the decline of Australia’s threatened species.
Ecological science fieldwork and secondary school biology in England: does a more secure future lie in Geography?
Authors: Tilling Stephen
Published: September 2018

Fieldwork has always been an important component in the teaching of ecology in England's secondary schools where it has been delivered almost exclusively as part of the biology curriculum for nearly 70 years. However, historical evidence shows that both the quantity and quality of ecology fieldwork has been declining in recent decades at a time when the scope, complexity and interdisciplinarity of ecological science has been growing. This paper presents evidence of a continuing decline in ecology fieldwork over the past 15 years, discusses some possible causes and reviews solutions to reverse the trend. In particular, it argues that teaching scientific ecology through geography fieldwork could overcome several of the fundamental obstacles encountered in biology education. Trends in biology and geography fieldwork are compared. These show that the risks to ecology in forging a strong relationship, and increased dependency, with geography teaching are likely to be outweighed by reciprocal benefits.
Precision in 3-Dimensional Surface Imaging of the Face: A Handheld Scanner Comparison Performed in a Cadaveric Model
Authors: Koban Konstantin C , Cotofana Sebastian , Frank Konstantin , Green Jeremy B , Etzel Lucas , Li Zhouxiao , Giunta Riccardo E , Schenck Thilo L
Published: September 2018

Background

Handheld 3-dimensional surface imaging (3DSI) devices of various precision are becoming more versatile in their applications and more widely accepted by clinicians for documentation.

Objectives

The authors sought to compare the precision of facial volumetric change measurements of 3 3DSI devices in the cadaveric model: Eva (Artec 3D Inc., Luxembourg), Sense (3D Systems, Rock Hill, SC), and iSense (3D Systems, Rock Hill, SC).

Methods

A total of 336 scanning and analysis procedures were carried out in 4 cephalic specimens (mean age, 77.25 ± 24.3 years; mean BMI, 21.76 ± 6.6 kg/m2). Two superficial and 2 supraperiosteal regions of interest were injected with 0.5-cc aliquots and subsequently scanned using the 3 different scanners. Correlation coefficients between the injected and measured volume were computed.

Results

The correlation coefficient for the Eva scanner was for subcutaneous regions of interest rp = 0.935 and for the supraperiosteal regions of interest rp = 0.966, compared with rp = 0.760 and rp = 0.364 (superficial vs supraperiosteal) for the Sense and rp = 0.694 and rp = 0.382 (superficial vs supraperiosteal) for the iSense scanner.

Conclusions

3DSI devices are capable of measuring surface volume changes of the face at a level of 0.5-cc surface volume change and can thus be regarded as useful tools in the preinterventional, intrainterventional, and postinterventional phases of a treatment. One of the 3 evaluated scanners provided very high correlation coefficients between the injected and the measured volume (Eva), whereas the other evaluated 3DSI devices provided moderate (Sense) and low (iSense) coefficients.
FA04.02: JAPANESE MULTICENTER PROSPECTIVE STUDY FOR ESOPHAGOGASTRIC JUNCTION CANCER
Authors: Mine Shinji , Kurokawa Yukinori , Takeuchi Hiroya , Sano Takeshi , Terashima Masanori , Yoshida Kazuhiro , Yasuda Takushi , Daiko Hiroyuki , Sakuramoto Sinich , Kunisaki Chikara , Yoshikawa Takaki , Tamura Shigeyuki , Seto Yasuyuki , Kitagawa Yuko , Doki Yuichiro
Published: September 2018

Background

Lymph node metastasis from esophagogastric junction (EGJ) cancer is multi-directional, and the previously reported incidences in each nodal station are heavily biased by different operative approaches. We conducted a multicenter prospective study using a standardized surgical protocol of lymphadenectomy.

Methods

This study is a single-arm, multi-institutional, prospective study. Patients with resectable cT2–4 EGJ cancer were eligible, regardless of neoadjuvant therapy. The primary endpoint was the metastasis rate of each lymph nodal station. The planned sample size was 360, and the entry period was 4 years. Protocol of surgical procedure: Patients diagnosed as having EGJ adenocarcinoma with esophageal invasion > 3 cm or with upper/middle mediastinal lymph node involvement, or those having EGJ squamous cell carcinoma, underwent an esophagectomy via right thoracotomy or thoracoscopy. The lymphadenectomy included the upper/middle/lower mediastinum, paracardiac region, around the celiac axis, and the left renal vein area (16a2lat). Patients with EGJ adenocarcinoma with esophageal invasion ≤ 3 cm underwent transhiatal lower esophagectomy and gastrectomy with lymphadenectomy of the lower mediastinum, paracardiac region, around the celiac axis, and 16a2lat.

Results

From April 2014 to September 2017, 371 patients were enrolled in this study from 42 institutions. As 8 patients were excluded due to protocol violations and later refusals, 363 patients were analyzed finally. Of 363 patients, 332 (91.4%) had adenocarcinoma and 31 (8.5%) had SCC. 86 patients (23.7%) had cT2 tumors and the other 277 (76.3%) had cT3–4 tumors. 134 patients (36.9%) had cN0 and the other 229 (63.1%) had cN + disease. Neo-adjuvant treatments (mostly chemotherapy) were given to only 121 patients (33.3%). Esophagectomies were performed in 121 patients (33.3%) and extended gastrectomies were performed in 236 (65.0%). Resection with R0 was achieved in 339 (93.4%). Based on histological examinations, the incidences of nodal involvements in each area were as follows: upper mediastinum (9/118, 7.6%); middle mediastinum (14/128, 10.9%); lower mediastinum (47/353, 13.3%); abdominal (240/358, 67.0%); the left renal vein area (16A2lat) (18/344, 5.2%).

Conclusion

For patients with EGJ cancers, the incidences of nodal involvements in the upper mediastinum and the left renal vein area (16A2lat) were lower than our expectations.

Disclosure

All authors have declared no conflicts of interest.
FA04.04: IMPORTANT STEPS AND FIRST RESULTS OF FULLY ROBOTIC IVOR-LEWIS ESOPHAGEAL RESECTION (RAMIE4) FOR ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCER
Authors: Grimminger Peter , Hadzijusufovic Edin , Babic Benjamin , Matthias Corvinus Florian , Lang Hauke
Published: September 2018

Background

Robotic-assisted surgery is increasing, especially in general tumor surgery. Minimal-invasive esophagectomy (MIE) is commonly the standard operation procedure in high-volume centers. Also the fully robotic minimally invasive esophagectomy using 4 robotic arms in the abdomen and thorax (RAMIE4) is performed more frequent. The advantages of RAMIE4 as well as advantages and disadvantages of special steps in the procedure and reconstruction are not clear so far and are under comparison with other MIE techniques.

Methods

Form January 2017 until March 2018 we prospectively collect the first 50 fully robotic RAMIE4 cases performed by one specialized surgeon and additionally the 50 MIE cases performed by the same surgeon between 2016 and 2017.

Results

At the meeting we will present our RAMIE4 results of the first 50 cases operated by one specialized surgeon and compare those results with the 50 MIE cases of the same surgeon. Additionally essential steps of the RAMIE4 procedure will be presented.

Conclusion

In our opinion RAMIE4 is feasible and offers great potential, especially for lymph node dissection, surgical precision, future potential, teaching and advanced ergonomics. The overall advantages have to be proven in randomized trials by specialized surgeons in MIE and RAMIE.

Disclosure

All authors have declared no conflicts of interest.
FA05.04: CLINICAL SIGNIFICANCE OF ESOPHAGEAL INVASION LENGTH FOR THE PREDICTION OF MEDIASTINAL LYMPH NODE METASTASIS IN SIEWERT TYPE II ADENOCARCINOMA
Authors: Koyanagi Kazuo , Kato Fumihiko , Kanamori Jun , Daiko Hiroyuki , Tachimori Yuji , Ozawa Soji
Published: September 2018

Background

We focused on the esophageal invasion length (EIL), defined as the distance from the EGJ to the proximal edge, of Siewert type II adenocarcinomas. This study investigated whether the EIL could be a possible indicator of mediastinal lymph node metastasis and survival in the Siewert type II patients.

Methods

The 168 consecutive patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and survival.

Results

The ROC curve for EIL was generated to predict the rates of upper and middle mediastinal lymph node metastasis or recurrence, and the cut-off EIL value was determined to be 25 mm with an area under the curve of 0.83 (sensitivity, 80.8%; specificity, 72.3%). Siewert type II patients with an EIL of more than 25 mm (> 25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤ 25 mm EIL group) (P = 0.001 and P < 0.001). Disease free and overall survival in the > 25 mm EIL group were significantly lower than those of the ≤ 25 mm EIL group (P < 0.001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than five years. On the other hand, the efficacy index of the lower mediastinal lymph node and the abdominal lymph node were 5.6 and 21.7, respectively. Only EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zone (odds ratio, 8.85; 95% CI, 2.31−33.3; P = 0.001).

Conclusion

An EIL of more than 25 mm might be a preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones. A multimodal-therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded to the esophageal wall more than 25 mm.

Disclosure

All authors have declared no conflicts of interest.
FA06.06: CLINICAL UTILITY OF YPTNM STAGE GROUPING IN AJCC 8TH EDITION FOR JAPANESE PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Ichikawa Hiroshi , Sudo Natsuru , Kosugi Shin-Ichi , Hanyu Takaaki , Ishikawa Takashi , Kano Yosuke , Muneoka Yusuke , Otani Takahiro , Nemoto Mariko , Bamba Takeo , Nakagawa Satoru , Kameyama Hitoshi , Wakai Toshifumi
Published: September 2018

Background

The 8th edition of the American Joint Committee on Cancer staging (AJCC-8th) of esophageal cancer presents independent stage grouping for patients who underwent neoadjuvant therapy followed by esophagectomy (ypTNM). The aim of this study is to elucidate the clinical utility of ypTNM stage grouping in Japanese patients with esophageal squamous cell carcinoma (ESCC).

Methods

A total of 146 patients (121 men and 25 women, with a median age of 65 years) who underwent curative esophagectomy following neoadjuvant chemotherapy with cisplatin and 5-fluorouracil (CF) for ESCC between 2005 and 2011 were enrolled in this retrospective study. We compared the distribution of patients and disease-specific survival after esophagectomy (DSS) stratified by ypStage between AJCC-7th and 8th. Additionally, we evaluated the association between clinicopathological features including ypStage in AJCC-8th and DSS.

Results

The number of patients classified into ypStage 0/IA/IB/IIA/IIB/IIIA/IIIB/IIIC/IV was 5/1/14/11/35/40/18/18/4 in AJCC-7th, and that classified into ypStage I/II/IIIA/IIIB/IVA/IVB was 27/18/21/58/18/4 in AJCC-8th. According to the revision from AJCC-7th to 8th, ypStage of 85 and 7 patients was up- and down-graded, respectively. Up-grading of ypStage was observed in 83% of patients with ypT4 tumor and in 78% of patients with ypN1–3. The 5-year DSS of ypStage 0/IA/IB/IIA/IIB/IIIA/IIIB/IIIC/IV was 100/100/93/91/75/62/50/28/50% in AJCC-7th, and that of ypStage I/II/IIIA/IIIB/IVA/IVB was 96/83/68/58/28/50% in AJCC-8th. The 5-year DSS of ypStage III was 61% in AJCC-8th comparing to 51% in AJCC-7th, and that of ypStage IV was 31% in AJCC-8th comparing to 50% in AJCC-7th. Univariate analyses identified ypT-8th (P = 0.028), ypN-8th (P < 0.001), cStage-8th (P = 0.006) and ypStage-8th (P < 0.001) in addition to surgical procedure (P = 0.027) and histological response (P = 0.019) as significant prognostic factors for DSS. Among these, multivariate analysis showed that ypStage-8th was a significant independent prognostic factor for DSS (P < 0.001).

Conclusion

ypTNM stage grouping in AJCC-8th can more accurately stratify the prognosis of patients who underwent neoadjuvant CF therapy for ESCC, by classifying patients with residual tumor invasion to adjacent structures and regional lymph node metastasis into more unfavorable prognostic group than that in AJCC-7th. ypStage according to AJCC-8th is the most reliable prognosticator for this disease.

Disclosure

All authors have declared no conflicts of interest.
PS01.001: CARCINOMA IN ESOPHAGEAL ACHALASIA: WHO, WHEN AND HOW
Authors: Vinicius  , Mazzini Guilherme , Felipe Juchem José , Gurski Richard
Published: September 2018

Background

Esophageal achalasia is a precancerous condition for epidermoid carcinoma; prevalence and risk factors for cancer development are not defined. Aim of the study was to determine these parameters.

Methods

Achalasia patients observed in the period 1955-2016, since 1973 were periodically submitted to clinical assessment, barium swallow (esophageal diameter and residual barium column were measured), endoscopy, according to a prospective protocol. In this study we included patients with a minimum 12 months follow-up, endoscopy or radiology at the last control. Follow up was discontinued for decision or death of patients.

Results

Five hundred and eighty-three of 681 cases were considered. The median follow-up was 147.13 months (IQR 70.42-257.82 months); 17 epidermoid, 1 carcinosarcoma were diagnosed (30.8/1000 cases). At multivariate analysis esophageal diameter (p < 0.001), residual barium column (p < 0.05) and duration of dysphagia (p < 0.001) were independent risk factors. Conversely, the risk of epidermoid carcinoma development decreased after residual barium swallow decrease (p < 0.05), consequent to efficacious therapy. According to classification tree (Figure), patients with severe dysphagia at the last clinical-radiological control and sigmoid esophagus experienced a risk of epidermoid carcinoma development equal to 48.6%. classification tree for squamous cell carcinoma. o outcome; se sigmoid esophagus.jpg

Conclusion

End-stage achalasia and dysphagia lasting longer than 22 years are risk factors for development of epidermoid cancer. Effective Heller myotomy can interrupt the carcinogenetic process in the presence of end-stage achalasia. Patients who overcome the risk parameters, should be offered esophagectomy or conservative surgery followed by strict endoscopic surveillance.

Disclosure

All authors have declared no conflicts of interest.
PS01.010: CLINICAL AND FUNCTIONAL RESULTS OF PULL-DOWN HELLER-DOR AND ESOPHAGECTOMY FOR END-STAGE ACHALASIA: A PROSPECTIVE STUDY
Authors: Tassi Valentina , Lugaresi Marialuisa , Mattioli Benedetta , Daddi Niccolò , Mattioli Sandro
Published: September 2018

Background

The Heller-Dor associated with the verticalization of distal esophagus (pull-down technique PD-HD) or esophagectomy (E) may be indicated for therapy of dysphagia in end-stage achalasia the latter also prevents development of carcinoma. We compared results achieved after PD-HD and E.

Methods

Twenty-nine patients (median age 57 years IQR 49–69 years) were submitted to PD-HD and 20 patients (median age 64 years IQR 56–69 years) (P = 0.321) were submitted to E for end stage achalasia or for cancer (patients recurrence free). We adopted semi quantitative scales to investigate dysphagia, reflux symptoms and esophagitis. With SF-36 quality of life was assessed.

Results

Median follow-up was 134.13 months (IQR 92.36 - 167.03 months) for PD-HD and 42.77 months (IQR 23.57 - 65.17 months) for E (P = 0.001). No statistically significant differences were observed with regards to the objective evaluation of dysphagia, reflux symptoms and esophagitis (P = 0.515). No statistically significant differences were calculated between the two groups as it concerns the domains general health (P = 0.302), physical functioning (P = 0.275), role physical (P = 0.107) and bodily pain (P = 0.057). Significant differences with regards to the domains role emotional (PD-HD 100, E 75, P = 0.012), vitality (PD-HD 90, E 60, P < 0.001), mental health (PD-HD 92, E 69, P = 0.001) and social functioning (PD-HD 100, E 75, P = 0.014) were observed in favour of PD-HD (Figure).

Conclusion

With respect to E, PD-HD achieved similar dysphagia, GER control, better quality of life. PD-HD is the procedure of choice for patients with low or null risk for cancer.

Disclosure

All authors have declared no conflicts of interest.
PS01.011: PATHOPHYSIOLOGY OF LARYNGOPHARYNGEAL REFLUX DISEASE: ASSOCIATION WITH PULMONARY ASPIRATION ON SCINTIGRAPHY AND INEFFECTIVE OESOPHAGEAL MOTILITY
Authors: Khoma Oleksandr , Falk Michael , Van Der Wall Hans , Burton Leticia , Falk Gregory
Published: September 2018

Background

Gastro-oesophageal reflux disease (GORD) can present with typical symptoms or atypical or laryngopharyngeal reflux (LPR) symptoms. The role of impaired oesophageal motility in these two clinically distinct groups has not been previously examined.

Methods

This study is a retrospective analysis of 361 consecutive patient records that was extracted from a prospectively populated research database. Patients were categorised by symptom profile as predominantly LPR or GORD (98 GOR and 263 LPR). Presenting symptom profile, pH studies, oesophageal manometry and scintigraphy and the relationship between the above were analysed.

Results

Severe oesophageal dysmotility was more prevalent in LPR group (P = 0.037). Severe oesophageal dysmotility was strongly associated with isotope aspiration in both groups (P = 0.001). 24 per cent of patients showed evidence of pulmonary aspiration on scintigraphy. Significant correlation was established between total proximal acid on 24-hour pH monitoring and isotope aspiration in both groups (P = 0.00). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (P = 0.00).

Conclusion

Early research on oesophageal dysmotility has suggested reduced oesophageal clearance in individuals with IOM. This selected group of patients showed a high degree of impaired oesophageal motility, which was associated with rising time-activity curves in both the upper oesophagus and pharynx. The presence of refluxate in the upper oesophagus can stimulate cough via ‘reflex’ afferent pathways and the presence of gastric contents in the pharynx can cause direct irritation to upper airways, both resulting in cough. Reduced pressures in the lower oesophageal sphincter were equally prevalent in LPR and GORD groups and therefore were not discriminatory between the clinical groups. The impairment of oesophageal clearance secondary to diminished oesophageal motility, may offer a plausible explanation for the development of symptoms via combined ‘reflux’ and ‘reflex’ pathways, allowing continued oesophageal exposure or proximal exposure to refluxate. The ROC and cluster analysis demonstrated strong predictive values and linkages between ineffective oesophageal motility and rising pharyngeal time-activity curves for the prediction of lung aspiration. This may form the basis of a new approach to the definitive diagnosis of LPR and lung aspiration. Oesophageal dysmotility is a key factor in pathophysiology of LPR. Severe impaired oesophageal motility is strongly associated with pulmonary aspiration in both LPR and GORD.

Disclosure

All authors have declared no conflicts of interest.
PS01.014: DESCRIPTION OF ACHALASIA PATIENTS IN CUBA: NINE-YEAR EXPERIENCE
Authors: Anido Vivianne , Roque González Rosalba , Brizuela Raul , Amable Tatiana , Pérez Luis , Díaz Zunilda , Luis Garcia-Menocal Jorge , Morera Maricela
Published: September 2018

Background

Achalasia is a primary neurodegenerative disease of the esophagus characterized by loss of function of the lower esophageal sphincter (LES) and aperistalsis of the body of the esophagus. Among the diagnostic elements, conventional or high-resolution esophageal manometry is the ‘gold standard’ for diagnosis. In this study, our objective was to investigate the epidemiology and characteristics of patients with Achalasia, seen at the CNCMA, Cuba.

Methods

A retrospective, descriptive and observational study was performed on patients with Achalasia, diagnosed through conventional esophageal manometry, from January 2006 to December 2015. The database of patients diagnosed with the disease is analyzed at the center's Motility Laboratory. Esophageal manometries were performed by the perfusion method, with Medtronic equipment, 4 register channel catheters, at 5 cm from each other, with Polygram software, from 2005 to 2008 and from then on with catheters Zynetic, Alpine, and Polygram.Net software version 4.1.1322. The consent was asked to performance the test and the scientific use of the results.

Results

332 patients were diagnosed with achalasia through manometry. More than half of patients with achalasia in this study were female, over 40 years. Patients had no proved associations with other diseases. By conventional esophageal manometry, the typical features were poor relaxation, normal basal pressure of the lower esophageal sphincter and absence of esophageal peristalsis.

Conclusion

Conventional esophageal manometry was useful to stablish the diagnostic of Achalasia, showing the typical features of the disease.

Disclosure

All authors have declared no conflicts of interest.
PS01.019: BARIUM FLUOROSCOPY AS A GOOD DIAGNOSTIC MODALITY FOR THE PATIENTS WITH LATE DIAGNOSIS OF ESOPHAGEAL ACHALASIA
Authors: Nakano Toru , Koseki Ken , Shibata Chikashi , Kamei Takashi , Ishii Tadashi
Published: September 2018

Background

Achalasia is a relatively rare disorder and the diagnosis would be delayed or mistaken as eating disorders like as anorexia nervosa. This study aimed to assess the diagnostic modalities to find the potential achalasia with delayed diagnosis.

Methods

Thirty-eight patients of achalasia presented to Tohoku University Hospital during 2006 to 2015 were retrospectively analyzed based on the medical records. Twenty-three patients that took less than 6 months to diagnosis (group A); 15 patients that took more than 6 months (group B) were evaluated in the duration for diagnosis, modalities and their clinical findings.

Results

No patients of group B and 16 of 21 patients of group A underwent barium study in the first 6 months after visiting to their physician (P = 0.0001). During the subsequent clinical coarse after 6 months from first visit to physician, 13 cases and 8 cases of group B were diagnosed by barium study and by endoscopic examination, respectively.

Conclusion

No obstructive finding of gastrointestinal endoscopy is insufficient to deny the possibility of achalasia. It is useful for patients with eating disorders due to unknown origin should be considered to perform the barium study to make potential achalasia apparent.

Disclosure

All authors have declared no conflicts of interest.
PS01.023: EXTENDING MYOTOMY BOTH DOWNWARDS AND UPWARDS FOR MANOMETRIC PATTERN III ACHALASIA PATIENTS IMPROVES THE FINAL OUTCOME
Authors: Salvador Renato , Capovilla Giovanni , Provenzano Luca , Briscolini Dario , Perazzolo Anna , Nicoletti Loredana , Valmasoni Michele , Merigliano Stefano , Costantini Mario
Published: September 2018

Background

Achalasia is at present classified in 3 manometric patterns. Pattern III is the most unfrequent pattern and is correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome after classic laparoscopic myotomy (length ≤ 8cm, CLM) as compared with a longer laparoscopic myotomy both downwards and upwards with (length > 8cm, LLM) in patients with pattern III achalasia.

Methods

The study population consisted of 50 consecutive patients with pattern III achalasia who underwent laparoscopic myotomy between 1997–2017. Patients who had already been treated with surgical or endoscopic procedures were ruled out. Patients before 2010 had a traditional CLM procedure while patients after 2010 had a LLM. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry (conventional or HRM) were performed, before and after surgical treatment.

Results

Of the 50 patients representing the study population, 23 had CLM and 27 had LLM. In addition, all the patients add an anterior, partial fundoplication (Dor). The patients’ demographic and clinical parameters (sex, symptom-score, duration of symptoms, esophageal-diameter) were similar in both groups. No intraoperative mucosal lesions were detected. The median length of the myotomy was 7 cm (IQR:7–8) in the CLM and 10 cm (IQR:10–11) in the LLM (P < 0.001). The median of follow-up was 61 months (IQR:35–93) in the CLM and 24 months (IQR:16–36) in the LLM. As a whole, the two groups had a different drop in their symptom score: 21 (17–26) versus 6 (0–8), and 21 (18–27) versus 3 (0–6) for the CLM and LLM respectively (P < 0.05). Moreover, failures were 7/23 (30%) in the CLM and 3/27 (11.1%) in the LLM (P < 0.001). An abnormal acid exposure was detected after the treatment in 4 patients of CLM and in 3 of LLM (P = n.s.).

Conclusion

In spite of intrinsic limitations of the study (retrospective, different time window of the two procedures and different follow-up), the extension of the length of the myotomy both downwards and upwards improves the final outcome of the laparoscopic Heller-Dor procedure in patients with pattern III achalasia. On the other hand, a longer myotomy does not influence the development of postoperative gastroesophageal reflux.

Disclosure

All authors have declared no conflicts of interest.
PS01.027: HYBRID PERORAL—LAPAROSCOPIC ESOPHAGECTOMY: A NOVEL MINIMALLY INVASIVE APPROACH FOR CHRONIC ESOPHAGEAL FISTULA
Authors: Vetter Diana , Bauerfeind Peter , Schmidt Henner , Lachat Mario , Gutschow Christian
Published: September 2018

Background

Chronic esophageal fistula represents a challenging clinical scenario. Surgical therapy is associated with extreme morbidity and high mortality. Our aim was to minimize surgical trauma, introducing a combined peroral and laparoscopic approach for esophagectomy.

Methods

Case presentation of a 51-year-old patient with graft infection due to an esophago-periprosthetic fistula 2.5 years after aortic root replacement. Surgical revision of the aortic root with simultaneous esophagectomy was deemed too invasive in this case. Therefore, a minimally invasive peroral and laparoscopic approach for esophagectomy and exclusion of the infected graft was chosen. Technically, a vagus-sparing transhiatal esophageal dissection was performed laparoscopically, followed by an upper mediastinal esophageal dissection via a left cervical approach. A short esophageal segment 5cm above and below the fistula was not dissected, but here a peroral endoscopic mucosectomy was performed. After insertion of a gastric feeding tube, the stomach was transsected laparoscopically and the mobilized distal esophagus was removed. Then, the proximal portion of the esophagus was divided just above the fistula and diverted via a left cervical esophagostomy.

Results

After an uneventful postoperative course, the patient was discharged under antibiotic coverage with amoxicillin, clavulanic acid and minocyclin. At follow-up, the patient remained stable without clinical signs of infection. Seven months later, he underwent minimally invasive retrosternal reconstruction with a gastric pullup and cervical end-to-side esophago-gastrostomy.

Conclusion

To our best knowledge, this is the first clinical report of a successful hybrid peroral endoscopic and laparoscopic approach for esophagectomy. This procedure may be a viable and less invasive alternative for patients with chronic esophageal fistula.

Disclosure

All authors have declared no conflicts of interest.
PS01.030: ROBOTIC LAPAROSCOPIC HELLER-DOR FOR ACHALASIA: SINGLE INSTITUTION’S EXPERIENCE ON 89 FIRST PATIENTS
Authors: Rasanen Jari
Published: September 2018

Background

Robotics allows precise dissection during the Heller-Dor. We wanted clarify whether this has produced good results in achalasia treatment of our patients in our institution.

Methods

We reviewed eighty-nine patients who were treated with robot-assisted laparoscopic Heller-Dor between October 2010 and January 2018 at Helsinki University Hospital. They all underwent laparoscopic myotomy for achalasia extending 8 cm onto esophagus and 3 cm onto proximal stomach with partial Dor fundoplication by two surgeons. Diagnosis of achalasia was confirmed by radiography, endoscopy, and manometry. Success of the myotomy was verified by intraoperative EGD, postoperative contrast radiography, and subjective postoperative symptom recording.

Results

There were 44 men and 45 women, with a mean age 43 + /- 15 years. Thirty-three percent of patients reported weight loss and 95% of patients experienced dysphagia at least once every week preoperatively. Mean operative time was 124 + /- 34 minutes. There were no conversions. Intraoperatively there were 6 patients with minor tears in mucosa of esophagus and 1 patient with minor tear in the mucosa of stomach. They were all recognized and repaired intraoperatively without any significant consequences to the patients (no deaths or ICU admissions). Median hospitalization was 4 days (2 - 17). Postoperatively 93% of patients reported significant improvement in dysphagia. All 6 patients with intra-operative mucosal tear experienced good or excellent symptom relief. Three of patients experienced significant pain in their esophagus even after surgery. All patients but 3 rated their overall symptom control either excellent or good after median follow-up of 31 months.

Conclusion

Robotic-assisted laparoscopic Heller-Dor is feasible with good median term results although some patients may experience intraoperative mucosal tears during the learning curve

Disclosure

All authors have declared no conflicts of interest.
PS01.047: PROPHYLACTIC ANTI-REFLUX SURGERY AFTER LAPAROSCOPIC GASTRIC WEDGE RESECTIONS FOR GASTRIC SUBMUCOSAL TUMORS OF GASTROESOPHAGEAL JUNCTION
Authors: Hyun Kim Chang , Kim Jin-Jo
Published: September 2018

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.
PS01.054: GASTROESOPHAGEAL REFLUX DISEASE PHENOTYPES IN THE MODERN ERA: CLINICAL, ENDOSCOPIC, MANOMETRIC AND PH TESTING PROPERTIES
Authors: Hoversten Patrick , Katzka David , Halland Magnus
Published: September 2018

Background

Reflux phenotypes have classically been divided into supine, upright, and bipositional predominant reflux. Recent data on clinical, endoscopic, and manometric features in these patient groups are scant and most prior reports occurred prior to the advent of high resolution impedance manometry and prolonged wireless pH monitoring. We aimed to evaluate the distribution, demographic, manometric, and endoscopic characteristics of the reflux phenotypes in this modern era of testing.

Methods

Patients who had esophageal physiology testing at a single tertiary care center over a one year period were retrospectively reviewed for demographic, clinical, endoscopic, manometric and pH impedance data. We included consecutive patients who had undergone pH-impedance or wireless pH testing with an EGD within 6 months.

Results

139 patients were included and 91 (65.5%) patients were women was mean age of 51.9 + /- 15.2 years and mean BMI of 29.1 + /- 6.4. The most common reflux pattern was bipositional (46% of patients), followed by supine (25%). Baseline characteristics, endoscopic and manometric data across groups are included in Table 1. Barrett's esophagus was most common in the non-acid group. Endoscopically, esophagitis was most common in the supine and bipositional groups. Manometric findings were similar across groups.

Conclusion

The epidemiology of GERD patients appears to be changing as evidenced by a higher mean BMI than in the largest prior study from 1999. Despite demographic changes in GERD and more widespread use of advanced esophageal physiology testing, the manometric and endoscopic characteristics of GERD phenotypes remains fairly similar.

Disclosure

All authors have declared no conflicts of interest.
PS01.058: OLDER AGE AND DEMENTIA MIGHT BE CONSIDERED BACKGROUND FACTORS OF BLEEDING FROM EROSIVE REFLUX ESOPHAGITIS WITH ESOPHAGEAL ULCER
Authors: Kato Tomohiro , Uno Yukari , Ichikawa Hironao , Iwasa Yuhei , Nakayama Chiemi , Ogiso Hideyuki , Okuno Mitsuru , Suzuki Yusuke , Ogiso Tomio , Mukai Tsuyoshi , Hayashi Hideki , Sugiyama Akihiko , Nishigaki Yoichi , Tomita Eiichi
Published: September 2018

Background

Hematemesis is one of the most eventful complications in patients with reflux esophagitis (RE). But bleeding is not observed in all patients who have RE with esophageal ulcer. We retrospectively studied the association of bleeding with background factors in patients with RE with esophageal ulcer.

Methods

Between January 2013 and January 2018, 30 patients were endoscopically diagnosed as RE with Los Angeles classification D (LA-D). These 30 patients were enrolled in our study. Fifteen of them were suddenly admitted to our hospital because the RE exhibited bleeding (B-group). Patients with Mallory-Weiss syndrome, peptic ulcers, and any malignancies were excluded as possible sources of the bleeding. Bleeding was not observed in the remaining 15 RE patients (NB-group). In these 30 patients, we retrospectively studied the relations between the bleeding and the following background factors: age, gender, body mass index (BMI), esophageal hiatal hernia, endoscopical atrophy of the gastric mucosa which is related to the secretion of gastric juice, cognitive decline (so called dementia), diabetes mellitus, and drugs (NSAIDs, PPI).

Results

The B-group included 5 males and 10 females. The NB-group also included 5 males and 10 females. The mean age of the B-group was 81.7 ± 8.2 (M ± SD) yrs, which was statistically (P < 0.05) greater than that of the NB-group, which was 71.5 ± 11.0 yrs. Older age, larger esophageal hiatal hernia, and cognitive decline (so-called dementia) were significantly (P < 0.05) associated with bleeding on logistic regression analysis. Multiple logistic regression analysis showed that older age and dementia were significantly (P < 0.05) associated with bleeding.

Conclusion

It is well known that esophageal hiatal hernia is a major factor in erosive RE, such as RE with LA-D. On the other hand, it was speculated that older RE patients and those with cognitive decline could not easily explain their RE complaints, and their condition might be left unattended for long periods. This lack of attention may result in sudden bleeding in patients with non-treated RE. Further studies are needed.

Disclosure

All authors have declared no conflicts of interest.
PS01.068: LAPAROSCOPIC MANAGEMENT OF LARGE HIATAL HERNIA WITH SIMPLY SUTURE CLOSURE
Authors: Zhang Xiaobin , Sun Yifeng , Li Zhigang
Published: September 2018

Background

Laparoscopic approach has been demonstrated as safe and effective surgical access in approaching gastroesophageal reflux disease (GERD) and hiatal hernia repair. Several studies have proposed for repairing that hiatal hernia, especially large hiatus with mesh reinforcement. The objective of our study was to evaluate the effect of simple suture closure in management of large hiatus hernia (> 5 cm).

Methods

Between September 2012 to February 2018, 32 patients who underwent laparoscopic large hiatal hernia (> 5 cms hernia defect) repair by simply suture closure were included in our study. Different anti-reflux surgery was performed according to esophageal function examination. Peri-operative data and complications were retrospectively reviewed. 30-months complications and symptom control at 1 year were assessed by GERD-HRQL score and PPI use.

Results

29 cases were performed completely with laparoscopy, with 3 cases with da Vinci Surgical System and 1 case through left thoracotomy. Hiatal hernia of all patients was repaired by simply suture closure, 24 cases were successfully operated with Nissen, 5 cases with, 2 cases with Dor and 1 case with Belsey Mark IV Fundoplication. At 3 months postoperatively follow-up, 94% of patients were off anti-reflux medications, abdominal pain occurred in 8.8(3 cases) of patients, mild dysphagia occurred in 1 patient, and 2 patients with severe dysphagia required dilator therapy. Two patients (5.9%) developed recurrence on routine follow up.

Conclusion

Our study showed simply suture closure was a feasible technique for repair large hiatus hernia. The advantages between laparoscopic mesh cruroplasty and simply suture closure for large hiatal hernia repair, randomised controlled trials are needed.

Disclosure

All authors have declared no conflicts of interest.
PS01.069: PARAESOPHAGEAL HERNIA REPAIR IN A KOREAN SINGLE CENTER
Authors: Kim Sungsoo , Kim Hogoon , Pil Kang Kyung
Published: September 2018

Background

Although paraesophageal hernias (PEH) occur frequently in the elderly, in Korea, a fundoplication for PEH was performed infrequently. The aim of this study is to analyze our experience with fundoplication for PEH.

Methods

Between April 2008 and December 2017, 29 patients who underwent paraesophageal hernia repair at a tertiary referral center were analyzed retrospectively. Demographic data, ASA classification, characteristics of PEH, onset of symptom, dysphagia severity score, characteristics of fundoplication (partial vs. total; laparotomy vs. laparoscopy; emergency vs. elective) and surgical outcome (length of stay, complication and 30-day mortality) were recorded and reviewed.

Results

29 patients were included; 89.7% (26/29) were female (Mean age of 77.2 years old and mean body mass index of 21.8). Mean onset of symptom was 2.1 weeks. Type 3 PEH was the most common (type 2 vs. 3 vs. 4; 27.6% vs. 41.4% vs. 31.0%). Mean size of hernia orifice was 5.2 cm (2 ∼ 12 cm). ASA classification was 1.9 (51.7% of patients had an ASA 2). 93.1% (27/29) patients underwent laparoscopic fundoplication (partial vs. total; 17 vs. 12). The mean length of stay and Follow-up were 8.9 (4 ∼ 28) days and 13.0 (0 ∼ 38) months respectively. Postoperative complications were 24.1% (7/29).One mortality happened after fundoplication (due to myocardiac infarction). After PEH repair, dysphagia severity scores were changed 1.8 from 3.5.

Conclusion

In our series, the dysphagia severity scores reduced after surgery. Although PEH occurred in the elderly, a fundoplication was feasible and acceptable.

Disclosure

All authors have declared no conflicts of interest.
PS01.071: DIAGNOSIS OF A HIATAL HERNIA: SURGEON’S PERSPECTIVE—AUGIS SURVEY
Authors: Balaji Nagammapudur , Rao Vittal , Sharples Alistair , Eltayeb Omar
Published: September 2018

Background

The diagnosis and relevance of a hiatal hernia on different investigative modalities and the impact on treatment is important to outcomes after Antireflux surgery.

Methods

Aim

To obtain perceptions from a surgeon's view on the diagnosis and importance of a Hiatal hernia.

Methods

A survey from the surgical community—AUGIS—Association of Upper GI Surgeons of Great Britain and Ireland.

Results

Results

55 surgeons participated in a 12 questionnaire survey performed through the AUGIS national portal. > 85% were consultant surgeons with > 60% performing over 100 OGD scopes per year. Greater than 50% of surgeons identified the OG junction by the Z line and < 50% identified the same by the upper border of the rugal folds. Only 12% of surgeons measured the hernia based purely on the rugal folds and the diaphragmatic impression. Over 70% of the surgeons felt that the diagnosis of a hiatal hernia was an indirect evidence of Gastro Oesophageal reflux disease (GERD). Over 90% felt that the presence of a hiatal hernia selectively altered the management thereafter.

Conclusion

There exists significant variation in the endosocpist surgeon's perspective on the landmarks of the OG junction, diagnosis and measurement of a hiatal hernia, which is a common entity in the diagnosis and management of GERD. This may selectively impact the treatment due to lack of uniform practice of this common condition.

Disclosure

All authors have declared no conflicts of interest.