bluuebunny/crossref_metadata_2025 huggingface dataset:
PS01.034: GENDER AND BODY MASS INDEX HAVE AN INFLUENCE ON DELAYED GASTRIC EMPTYING FOLLOWING ESOPHAGECTOMY AND GASTRIC PULL-UP
Authors: Lindenmann Jörg , Maier Alfred , Anegg Udo , Fink-Neuboeck Nicole , Porubsky Christian , Fediuk Melanie , Gschwandtner Elisabeth , Swatek Paul , Smolle Josef , Smolle-Jüttner Freyja-Maria
Published: September 2018

Background

Delayed gastric emptying is a common feature after gastric pull-up for reconstruction following esophagectomy. Symptoms range from mild discomfort to life-threatening recurrent aspiration. Apart from the well-known and technically inevitable truncal vagotomy neither causative factors nor effective preventive measures have been clearly identified.

Methods

We did a retrospective study in 381 patients (317 males, 64 females; age: 22 -88 years; mean: 62,4 years), who underwent esophagectomy and gastric pull-up with cervical esophagogastrostomy between 1/2008 and 12/2017. During this period the surgical technique had been the same except that in the first phase no intervention at the pylorus had been done (N = 207), whereas in the second pyloromytomy (N = 97) and in the third (N = 110) intrapyloric injection of Botulinum-toxin was performed. Delayed gastric emptying was diagnosed by distension of the conduit with an air-fluid level on chest roentgenogram, and by symptoms and signs of regurgitation or vomiting in absence of other bowel obstruction. 122 patients had retrosternal pull-up due to transmural tumour growth or lymph-nodes, in 259 the orthotopic route was chosen. All patients were followed-up for at least three months after the operation.

Results

56 patients (14,7%) developed delayed gastric emptying. Neither pyloromytomy nor injection of Botox had any effect as compared with the patients in the no-intervention period. The route of gastric pull-up had no influence either. In women (N = 15; 23,4%), however, delayed gastric emptying was significantly more frequent than in men (N = 41; 12,9%; P = 0.03). Moreover, the Body Mass Index (BMI) of patients with delayed gastric emptying (BMI = 26.6) was significantly higher than in those who had not (BMI = 24,7; P = 0.03). By multivariate analysis the influence of gender and BMI on the development of delayed gastric emptying remained significant.

Conclusion

The results of our single center retrospective analysis may show that both, gender and BMI might significantly influence the development of postoperative delayed gastric emptying after esophagectomy and reconstruction by gastric pull-up. For a better understanding and management of delayed gastric emptying prospective trials with larger numbers of patients are definitely needed.

Disclosure

All authors have declared no conflicts of interest.
PS01.036: THORACOSCOPIC ENUCLEATION OF BENIGN LESIONS OF THE ESOPHAGUS WITH PATIENT IN PRONE POSITION
Authors: Vecchiato Massimo , Ziccarelli Antonio , Petri Roberto , Martino Antonio
Published: September 2018

Background

Benign lesions of the esophagus are rare, leiomyoma is the most common. Minimally invasive thoracoscopic enucleation is the currently best approache. We present our experience of thoracoscopic enucleation with patient in the prone position

Methods

Between June 2010 and December 2017 all patients referred to our Institute for symptomatic benign lesions of the esophagus underwent thoracoscopic enucleation in prone position. After single-lumen endotracheal intubation patients were placed in prone position. A right pneumothorax at 8 mmHg was created with a port at the apex of the scapula; two or three operative trocars were inserted in the right 5th and 9th intercostal spaces. The mediastinal pleura and the muscular layer over the lesion were incised and split using a coagulating hook. The lesions were carefully enucleated. The myotomy was closed with interrupted stitches. An intercostal drain was left in the right chest.

Results

5 patients (3 males and 3 females) underwent thoracoscopic enucleation in prone position, without any conversion. Median operative time was 90 minutes (60–170), blood loss was minimal, there were no intraoperative or postoperative complications. 1 lesion was in the upper esophagus, 2 in the middle and 2 in the lower esophagus. The median post operative hospital stay was 9 days (9–11). Histopathology reveal 4 leiomyomas and 1 esophageal bronchogenic cyst. The median size of the lesions was 7.25 cm (3–9). In the follow up there weren’t recurrence or other symptoms.

Conclusion

Prone thoracoscopic enucleation of benign lesions of the esophagus is safe and feasible also for lesions > 5 cm; it permits an ergonomic position and a wide, clean operative field. Double lung ventilation and less post operative pain can reduce pulmonary complications

Disclosure

All authors have declared no conflicts of interest.
PS01.040: TRANSORAL SEPTUM DIVISION WITH THE ENDOSCOPIC NEEDLE-KNIFE FOR SYMPTOMATIC ZENKER DIVERTICULUM
Authors: Zacherl Johannes , Albinni Said , Radlspöck Wolfgang , Schima Wolfgang
Published: September 2018

Background

Flexible endoscopic septum division (FESD) is an established natural orifice endoscopic technique for the treatment of symptomatic Zenker's diverticulum (ZD). We report about the experience with FESD at our center.

Methods

Consecutive patients undergoing FESD were included in the study. Inclusion criteria were craniocaudad length of the septum of at least 20mm. FESD was done with high frequency cautery in an ERCP cut modus. Postoperative fluid intake was allowed for the first 3 days followed by semisolid food for 7 days. Data were collected prospectively. Swallowing symptoms were assessed preoperatively and at follow-up by using the Eckardt score.

Results

Since 2014 52 patients were treated for ZD. Among them 47 patients consecutively undergoing FESD were included. Five minute arterial bleedings were managed intraoperatively by cautery forceps. 2 suspected perforations were clipped and oral nutrition was delayed for 2 days. All patients but one reported immediate success after FESD (97,8%), 8 patients temporarily had mild swallowing discomfort. Postoperative adverse events were fever (n = 3), pneumonia (n = 3), neck abscess (n = 2) requiring transcervical opening and drainage. Median follow up period was 20 months. Until follow up 30 patients (until abstract deadline) were evaluated: one patient underwent redo FESD for recurrent dysphagia 12 mo after FESD. A second patient with symptomatic mild recurrence did not need redo FESD so far, resulting in a recurrence rate of 6,7% (2/30). Both patients with recurrence initially had a septum shorter than 25mm.

Conclusion

FESD is an effective minimally invasive natural orifice treatment for symptomatic ZD with immediate symptomatic relief. No recurrence has been observed after intermediate follow-up, if length of myotomy was longer than 2cm. Long term results are awaited.

Disclosure

All authors have declared no conflicts of interest.
PS01.042: THE PRESENCE OF HCC AFFECT LONG-TERM PROGNOSIS AFTER ENDOSCOPIC TREATMENT FOR ESOPHAGEAL VARICES
Authors: Nishimura Tatsuro , Iwamoto Takuya , Ishikawa Tsuyoshi , Sakaida Isao , Takami Taro
Published: September 2018

Background

Gastroesophageal varices are present in approximately 50% of patients with cirrhosis, and their rupture is a life-threatening complication. However, mortality rates have declined due to the progress in the management of these patients. Especially advances in endoscopic treatment have contributed to the improved survival rates. In this study, we investigated the prognostic factors associated with long-term survival after endoscopic treatment for esophageal varices.

Methods

The subjects were 256 patients who underwent initial endoscopic treatment for esophageal varices in our hospital between January 1997 and January 2017. Among them, 143 successfully followed up. The patients’ characteristics were: mean age, 63.8 years (29–85); 97 men and 46 women; and median survival period, 53 months. For analysis, subjects were divided into long-term survival and non-long-term survival groups (n = 59 for each) with a 53-month survival period as a cut-off value.

Results

The mean age in the long-term/non-long-term survival group was 62.4 ± 9.4 years/67.2 ± 10.5 years, indicating a significantly higher age in the non-long-term group (P < 0.01). Preoperative Child-Pugh score was 6.3 ± 1.2/7.5 ± 2.2 (P < 0.01) and hepatocellular carcinoma (HCC) presence rate was 25.7%/56.2% (P < 0.01), significantly higher in the non-long-term group. Additionally, regarding the treatment method, endoscopic injection sclerotherapy (EIS): endoscopic variceal ligation (EVL) alone in the groups was 50:9/41:18, suggesting a significantly higher EVL rate in the non-long-term group (P < 0.05). Recurrence of esophageal varices occurred in 33 and 22 patients in the long-term and non-long-term groups, respectively, with no significant difference between groups. Analysis of the factors affecting survival period using Cox proportional hazards model showed that Child-Pugh score B or C [hazard ratio(HR):2.0143, P < 0.05], total bilirubin value≧ 2 [HR:2.5573, P < 0.05], and presence of HCC [HR:2.2450, P < 0.01] were noted as significant factors, but the recurrence of esophageal varices was not noted as significant. Only presence of HCC was found to be a significant factor affecting the long-term survival using multiple logistic regression analysis [odds ratio(OR) 0.3463, P < 0.05].

Conclusion

Our study revealed that liver function and the presence of HCC affect long-term prognosis after endoscopic treatment for esophageal varices.

Disclosure

All authors have declared no conflicts of interest.
PS01.043: FACTORS EFFECT THE RESULT OF ESOPHAGEAL DILATION WITH INTRALESIONAL STEROID INJECTION IN SEVERE CORROSIVE STRICTURE PATIENTS
Authors: Chanana Supansa , Limpakan (Yamada) Sirikan
Published: September 2018

Background

Endoscopic esophageal dilation has been the primary therapy in severe corrosive stricture. There is a few study on effectiveness of intralesional steroid injection combined with esophageal dilation. The author studied factors that may give positive or negative effect results of dilation, and may extend the indication of dilation before definite surgery.

Methods

The authors reviewed the complete medical records as the retrospective study of patients those underwent intralesional steroid injection combined with esophageal dilation due to severe corrosive stricture. Primary outcome is the success rate of treatment by intralesion steroid injection combined with endoscopic esophageal stricture dilation. Secondary outcome is the risk that effect result of treatment. Statistical analysis was performed using STATA version 12 for Fisher's exact, students t-test, and relative risk regression, p-value of < 0.05 isconsidered as statistical significant.

Results

There are 55 patients was enrolled and presented with at least grade 4 of dysphagia, Marchand's grade III and IV from imaging stress review, and received intralesional steroid injection combined with endoscopic esophageal dilation. We divided patients into two groups, (1) a success esophageal dilation group (76.36%; mean number of dilation is 6 sessions/year), and (2) a failure esophageal dilation group whounderwent reconstruction surgery (23.64%). Patient characteristics including gender, age, time from transfer to the first dilation, type of corrosive agent, grading of dysphagia, number, length of lesion(s), and site of lesion(s). This study showed that gender, age, type of substance, number or length of stricture(s) had no significant difference about the result of treatment. Significant success factors are timing from first swallowing to first dilation (within 8 weeks, 78.57% success), no gastric deformity combined with esophageal stricture (90.48% success), and failure factor is the occurrence of complication during the period of treatment (69.23%) that mainly related to long segment of stricture more than 5 centimeters.

Conclusion

We gained high success rate in Marchand's grade III and IV by steroid injection combined with esophageal dilation. Predictors indicate that specific factor caused failure of treatment. The author extends the indication for endoscopic intervention in severe esophageal stricture before decision to do reconstructive surgery.

Disclosure

All authors have declared no conflicts of interest.
PS01.049: ENDOSTIM™ NON-RESPONDERS: AN ANALYSIS
Authors: Matthias Corvinus Florian , Hadzijusufovic Edin , Babic Benjamin , Lang Hauke , Grimminger Peter
Published: September 2018

Background

Electronic stimulation oft the lower esophageal sphincter (LES) is a new promising anti-reflux procedure that is established in Germany since 2014. Basically two leads are inserted laparoscopicaly into the LES and connected to an implantable pulse generator (IPG) which is placed in a subcutaneous pocket. This stimulation is supposed to build up the muscular anti-reflux barrier. It is limited to patients with a small hiatal hernia < 3 cm and reflux esophagitis LA Classification Type A-C. Although long-term results up to 4 years with a good postoperative reflux control and an increased quality of life have been published, no data about Endostim™ non-responders, difficult postoperative situations and procedure failure has been reported yet.

Methods

Between 12/2015 and 11/2017 12 patients underwent laparoscopy for an Endostim™ implantation. All patients had an upper endoscopy, a barium swallow, high-resolution esophageal impedance manomentry (HRIM), 24-hour multi-channel impedance and pH monitoring (MII-pH) prior to the procedure and after 6 months. The quality of life was assessed with the GERD health related quality of life (GERD-HRQL) questionnaire preoperatively and during further follow-up.

Results

6 of 12 patients (50%), 2 female 4 male, reported new GERD symptoms after an initial postoperative symptom relief. 1 patient had a prolonged period (15 months) of reprogramming until complete symptom control was achieved. 1 patient had a recurrent 3 cm hiatal hernia after 3 months, so that only a partial responds was reported. In 2 patients reprogramming could not reach a proper responds. Two patients showed a complete technical failure due to a broken lead close to the IPG.

Conclusion

Reasons for Endostim™ failure can be heterogeneous. Because it is a young and new procedure non-responders should be investigated closely so that there can be a critical discussion about indications, contraindications and negative predictive factors.

Disclosure

All authors have declared no conflicts of interest.
PS01.050: IMPACT OF FUNDOPLICATION IN THE OUTCOME OF TRACHEAL STENOSIS PATIENTS WITH GASTROESOPHAGEAL ACID REFLUX: A RETROSPECTIVE PROPENSITY SCORE-MATCHED STUDY
Authors: Bianchi Edno , Cardoso Paulo , Minamoto Helio , Salati Michele , Bibas Benoit , Trindade Juliana , Nasi Ary , Szachnowicz Sergio , Sallum Rubens , Pego-Fernandes Paulo , Cecconello Ivan
Published: September 2018

Background

Abnormal gastroesophageal acid reflux (GEaR) is often found in laryngeal diseases and tracheal stenosis. The study focuses on the prevalence of GEaR and the impact of anti-reflux surgery in the outcome of post-intubation tracheal stenosis

Methods

Prospective non-randomized study of patients with post-intubation tracheal stenosis. Inclusion criteria: adult with subglottic or recurrent tracheal stenosis. Exclusion criteria: previous gastroesophageal surgery. Patients were submitted to esophageal manometry and pH study. Patients were divided in 3 groups: one with pH study negative, one with pH study positive receiving treatment with proton pump inhibitor and one with pH study positive submitted to Nissen fundoplication. Follow-up was 24 months. Outcome was considered satisfactory when airway stenosis could be successfully managed by resection, no need for dilatation or definitive decannulation. In order to match the 3 groups, it was used a propensity score match (PSM) and them they were compared. Statistical significance was assumed for P < 0.05

Results

Prevalence of GEaR was assessed in 175 patients. Abnormal pH study was found in 74 (42%) with a predominance of supine reflux. Typical GEaR symptoms were found in only 21%. Abnormal manometry was found in 37%, and hypotonic lower sphincter was the most frequent finding. Of the 124 patients who met the inclusion criteria, pH study was normal in 72 and abnormal in 52 (32 underwent clinical treatment and 20 nissen fundoplication). There were no peri-operative complications. After PSM, patients with abnormal pH study submitted to fundoplication had a higher chance of a satisfactory outcome of the stenosis compared to those treated with Omeprazole (OR 5.31; CI 2.41–11.07; P = 0.03) which was similar to those without GEaR (OR 1; CI 0.47–2.11; P = 0.99). Patients without GeAR had a higher chance of resolution of the tracheal stenosis compared to the patients treated with Omeprazole (OR 3.54; CI 2.02–6.19; P = 0.02).

Conclusion

Asymptomatic GEaR is a frequent finding in tracheal stenosis. Nissen fundoplication was safe and effective in selected patients with tracheal stenosis and GEaR. Control of the airway stenosis was superior after fundoplication if compared to medical treatment of GEaR. A larger prospective randomized multicenter trial is needed to confirm these findings

Disclosure

All authors have declared no conflicts of interest.
PS01.055: LAPAROSCOPIC NISSEN FUNDOPLICATION IN GERD: SINGLE INSTITUTIONAL EXPERIENCE IN KOREA
Authors: Hyun Kim Chang , Kim Jin-Jo
Published: September 2018

Background

The aim of this study is to analyze our experience with laparoscopic Nissen fundoplication.

Methods

We retrospectively collected data from 42 patients who diagnosed with GERD underwent laparoscopic Nissen fundoplication between January 2010 and December 2017

Results

There were 23 male and 19 female with an average age of 41.1 ± 15.9. Typical symptoms were present in 39 (85.7%) and atypical symptoms in 36 (%). Both typical and atypical symptoms were present in 34 of patients (81.0%). Fourteen patients (33.3%) had poor PPI responses. Preoperative studies showed hiatal hernias in 19 patients (45.2%), Barrett's esophagus in 6 (14.2%), and reflux esophagitis in 21 (50.0%). Mean DeMeester score was 9.1 ± 14.2, mean operation time 78.8 ± 28.1 minutes. There was no perioperative complication. However there was only one redo-operation case due to severe tightness of fundal wrap formation. At 3 months after surgery, typical symptoms were completely controlled in 23 patients (59.0%), partially improved in 12 patients (30.8%), and not controlled in 4 patients (10.1%) and atypical symptoms were completely controlled in 22 patients (61.1%), partially improved in 12 patients (33.3%), and not controlled in 2 patients (5.6%)

Conclusion

In our study, complete remission rates of typical and atypical symptoms were 59.0% and 61.1%, respectively after laparoscopic Nissen fundoplication. Laparoscopic Nissen fundoplication is an effective treatment method of controlling the symptoms of GERD.

Disclosure

All authors have declared no conflicts of interest.
PS01.059: REFLUX RELATED SYMPTOMS ARE LESS COMMON IN SOUTH-EAST HUNGARIAN SUBJECTS, THAN EXPECTED ON THE BASIS OF EPIDEMIOLOGIC STUDIES OF THE WESTERN COUNTRIES
Authors: Helle Krisztina , Bálint Lenke , Ollé Georgina , Vadászi Klára , Inczefi Orsolya , Róka Richárd , Szekeres Veronika , Wittmann Tibor , Rosztoczy Andras
Published: September 2018

Background

Most population based epidemiologic studies indicate approximately 20% prevalence of Gastroesophageal Reflux (GER) related typical symptoms appearing at least monthly. Since most of these works were carried out in the western countries, a little is known about Central-Europe, where substantial part of the population still lives outside of the larger cities.

The aim of the study was to obtain population-based data on the prevalence of GER related symptoms in South-East Hungary.

Methods

Two thousand and two consecutive blood donor volunteers (M/F: 1156/846, mean age: 39 (17–66) years) were enrolled. Data collection was carried out by means of a questionnaire. Typical (heartburn, regurgitation) and atypical (esophageal, extraesophageal) symptoms were assessed.

Results

Typical symptoms of GER such as heartburn and acidic regurgitation were reported by 22% (450/2002) and 17% (333/2002) of the studied healthy subjects. The 63% and 51% of them had such symptoms less than once per month. Monthly heartburn episodes were reported by 14, and weekly by 6 percent of the cases, while acidic regurgitation occurred in 8 and 3 percent respectively. Of the atypical (esophageal and extraesophageal) symptoms upper airway symptoms were the most prevalent (19%), although only 13% had such symptom at least monthly. Globus occurred in 6%, while other atypical symptoms were reported by less than 5% of the subjects. Typical GER symptoms occurred more frequently in females, coffee drinkers and subjects with moderate obesity. Current and former smoking and alcohol-use were associated with increased GER symptom prevalence.

Conclusion

In contrast to the studies carried out in the western countries South-East Hungarian subjects seem to have less GER related symptoms.

Disclosure

All authors have declared no conflicts of interest.
PS01.065: MAGNETIC SPHINCTER AUGMENTATION AS AN EFFECTIVE ALTERNATIVE TO ROUX-EN-Y CONVERSION AFTER BILLROTH II GASTRECTOMY
Authors: Lazzari Veronica , Asti Emanuele , Sironi Andrea , Melloni Matteo , Bonavina Luigi
Published: September 2018

Background

Background and hypothesis Conversion into a 60 cm Roux-en-Y jejunal loop is the most common remedial procedure in patients with gastroesophageal reflux after Billroth II gastrectomy. While this allows diversion of bilio-pancreatic secretions, symptomatic acid reflux may persist in the presence of a mechanically incompetent lower esophageal sphincter. We hypothesized that magnetic sphincter augmentation (MSA) may relieve symptoms and control esophagitis by reducing both acid and biliary reflux.

Methods

Methods A 70 year-old male patient presented with intractable reflux symptoms and grade B esophagitis 46 years after partial gastrectomy and Billroth II reconstruction for perforated gastric ulcer. The patient underwent extensive diagnostic evaluation. There was a 3 cm hiatus hernia, grade B esophagitis, and hyperemia of the gastrojejunal anastomosis. Biopsies were negative for malignancy and Helicobacter Pylori. pH-impedance testing showed combined acid and non-acid reflux; esophageal peristalsis was normal on high-resolution manometry. After informed consent, the patient preferred the option of laparoscopic MSA versus open laparotomy and Roux-en-Y conversion. Pneumoperitoneum was established with a Hasson trocar. After adhesiolysis, a hiatus hernia with retroesophageal lipoma was identified. The gastroesophageal junction was completely reduced in the abdominal cavity and a posterior crural repair was performed. A tunnel was made between the esophageal wall and the posterior vagus nerve and a no. 16 MSA (Linx®) device was applied.

Results

Results The postoperative course was uneventful and the patient was discharged home on postoperative day one. At 1- and 6-month follow-up visit the patient was off-medication, tolerated a free diet, and did not complain of any reflux symptom. The mean GERD-HRQL score decreased from 26 to 2 compared to baseline. A barium swallow confirmed the complete reduction of the hiatal hernia and the absence of reflux in the Trendelenburg position. Esophagitis was completely healed.

Conclusion

Conclusions To the best of our knowledge, this is the first case of MSA implant for refractory gastroesophageal reflux disease after Billroth II gastrectomy. This simple laparoscopic procedure allowed correction of both acid and biliary reflux.

Disclosure

All authors have declared no conflicts of interest.
PS01.072: IT IS NOT ALWAYS RISKY USING MESH IN THE TREATMENT OF HIATAL HERNIA
Authors: Loviscek Maximiliano , Acosta Mauro , Crespin Oscar , Orbe Guido , Villamil Cesar , Loviscek Luis
Published: September 2018

Background

Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA).

Methods

Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD.

Results

38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence.

Conclusion

The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications.

Disclosure

All authors have declared no conflicts of interest.
PS01.075: EUS-GUIDED TRANS-ESOPHAGEAL DRAINAGE OF A MEDIASTINAL ABSCESS DURING PREOPERATIVE CHEMOTHERAPY FOR THORACIC ESOPHAGEAL CANCER
Authors: Sakon Ryota , Tachimori Yuji
Published: September 2018

Background

A Mediastinal abscess can cause sepsis and make a patient sever condition. Early drainage treatment is required. We report a case which EUS-guided drainage was effective for a mediastinal abscess.

Methods

A 75-year-old man with T3 upper thoracic esophageal squamous cell carcinoma received preoperative chemotherapy. On day 9 the patient had fever and nuchal swelling. CT scan revealed a mediastinal abscess adjacent to the upper esophagus and the right paratracheal region extending to a retropharyngeal abscess. There was no clinical improvement with antibiotic therapy. On day 12 EUS-guided trans-esophageal drainage for the mediastinal abscess was performed.

Results

The echoendoscope was positioned within the upper esophagus, and the mediastinal collection was well visualized endosonographically. The mediastinal abscess was punctured and a pigtail catheter was placed. The retropharyngeal abscess was drainaged by pharyngeal incision. A repeated CT scan confirmed resolution of the abscess. On day 25 upper endoscopy was performed to remove the pigtail catheter. A small perforated hall was identified in the center of the esophageal tumor decreased after chemotherapy. The patients underwent esophagectomy after recovery.

Conclusion

EUS-guided trans-esophageal drainage was useful for a mediastinal abscess.

Disclosure

All authors have declared no conflicts of interest.
PS01.079: OF BARRIERS AND BALLOONS- SURGICAL MANAGEMENT OF ESOPHAGEAL IATROGENIC INJURIES USING PRIMARY REPAIR WITH A ROTATION DIAPHRAGMATIC FLAP: A SERIES FROM OMAN
Authors: Almehdi Raad , Al Riyami Salim , Rabie Reda
Published: September 2018

Background

Background Iatrogenic injuries of the Esophagus remain a challenging turf to dwell upon. Although the timing of surgical intervention, when indicated, may be controlled and hence is more favourable than other types of uncontrolled traumas, however the patient's pre-morbid state as well as the Esophagus’ presenting condition at the time of injury may confound the desired outcome. The Royal Hospital of Muscat is the biggest tertiary centre in Oman. The Upper GI surgical unit was established in 2010. In this small series, we highlight the valuable role of rotational diaphragmatic flaps in perforations of the lower Esophagus.

Methods

A case series of 4 patients presenting with iatrogenic esophageal injuries, who underwent primary repair with a rotation flap between 2012 and 2016.

Results

All patients had iatrogenic lower esophageal tears. The first was from an over inflated balloon of a calibrating tube, misplaced in the esophagus during a standard Sleeve Gastrectomy for Obesity. The second was an intraoperative perforation during a Thoracic surgical procedure for a duplication cyst. The third was a complication of an endovascular stent for a dissecting thoracic aorta aneurysm. The fourth was due to covered stent placed to seal a small perforation following variceal injection in a patient with Child's B liver cirrhosis. The average tear length was 3cms. All were operated within 48hours, before full sepsis had set in. The extent of contamination was localised and its degree minimal to moderate. All underwent a primary repair with a diaphragmatic rotation flap used as a second cover layer. Postoperative fluoroscopy showed intact surgical repair with good flow of contrast. The first three patients were discharged after an average of 12 days. The fourth succumbed to his liver failure and expired after two months in hospital.

Conclusion

Primary repair of iatrogenic lower esophageal injuries, when done early, could be consolidated with reasonable success using a diaphragmatic rotation flap. The flap's length is fashioned as required on a well vascularised pedicle. In comparison to other supportive techniques this flap is more flexible and its tissue more enduring as a good repair harness.

Disclosure

All authors have declared no conflicts of interest.
PS01.080: A CASE REPORT OF JEJUNAL VARICEAL BLEEDING SUCCESSFULLY TREATED WITH PERCUTANEOUS TRANSHEPATIC OBLITERATION AFTER SURGERY OF ESOPHAGOGASTRIC JUNCTIONAL CARCINOMA
Authors: Kawabata Ryohei , Shinno Naoki , Furukawa Haruna , Goda Seiichi , Noura Shingo , Shimizu Junzo , Hasegawa Junichi
Published: September 2018

Background

Varicose veins in the esophagogastric junction rarely occur after surgery of esophagogastric junctional carcinoma, because the collateral pathway of the left gastric vein and short gastric vein was sacrificed. We presented a case of jejunal variceal bleeding successfully treated with percutaneous transhepatic obliteration after surgery of esophagogastric junctional carcinoma.

Methods

Case report.

Results

A 50-year-old man with alcoholic liver cirrhosis (Child-B) was admitted for abdominal pain, three months after proximal gastrectomy for esophagogastric junctional carcinoma. After diagnosed with peritonitis due to jejunal perforation, emergency surgery was performed. The next day after surgery, he had developed a lot of black stool. Gastroduodenoscopy revealed the variceal bleeding at the anal side of the esophagojejunal anastomois. Although endoscopic clipping was performed, intermittent bleeding was observed for several days. Since the contrast-enhanced computed tomography scanning revealed jejunal vein dilation at the anal side of the esophagojejunal anastomois, we planned to perform percutaneous transhepatic obliteration. Percutaneous transhepatic portography revealed jejunal varices and drained to the inferior vena cava, and continuously obliterated by 5% EOI (Ethanolamine oleate iopamidol). He was discharged without re-bleeding on the 14th day after the obliteration.

Conclusion

Percutaneous transhepatic obliteration might be a useful treatment option for jejunal variceal bleeding after surgery of esophagogastric junctional carcinoma.

Disclosure

All authors have declared no conflicts of interest.
PS01.081: ENDOVAC IS A SAFE AND RELIABLE METHOD FOR INTRACTABLE ESOPHAGEAL PERFORATION
Authors: Kim Dohun , Nam Seunghyuk
Published: September 2018

Background

Esophageal rupture or sometimes, leak is a fatal disease. However management of esophageal perforation is not simple and invasive procedures are required especially in the case of delayed diagnosis. EndoVAC (endo-luminal vacuum assisted closure) is known as an effective method for esophageal leak or ruptures but it was not clear enough. We report cases of esophageal perforation which are treated with endoVAC to prove its utility.

Methods

All patients with esophageal perforation whether causes of them are traumatic or iatrogenic were included in the study from 2012 to 2018. EndoVAC was applied in all cases. Electrical medical records were analyzed including surgical information and special procedures for perforation. Primary results were length of stay and duration of endoVAC.

Results

During the study period, 9 patients were managed for esophageal perforation. 3 patients were cured with primary closure and 1 patient with stent alone. At last 5 patients were included in the study. Esophageal ruptures were in 2 patients. Primary closure was applied first, but it ruptured again and endoVAC was applied within 20 days in average. Esophageal leaks were in 3 patients. EndoVAC was applied within 15 days in average, especially endoscopic stent was applied first in one patient, but it changed into endoVAC for aggravation of mediastinitis. Overall mean duration of endoVAC was 20 days with 2.5 times of replacement and length of hospital stay was 33 days. All of them were discharged without problems. Additionally, the size of perforation was large and intractable in 2 patients, but all lesions were healed with endoVAC.

Conclusion

EndoVAC can be an alternative and effective treatment for esophageal rupture. Esophagectomy or esophageal stent can be options for those cases but they are too invasive or ineffective sometimes. However endoVAC is not only safe and reliable but also less invasive and easy to apply.

Disclosure

All authors have declared no conflicts of interest.
PS01.086: TRANSGASTRIC VACUUM DRAINAGE FOR OESOPHAGEAL PERFORATIONS: A SIMPLE TECHNIQUE FOR A COMPLEX PROBLEM
Authors: Ariyarathenam Arun , Sanders Grant , Wheatley Tim , Humphreys Lee , Berrisford Richard
Published: September 2018

Background

We present an updated case series of patients treated with a novel Transgastric (TG) drainage technique, previously published by the senior author in 2008 [Ref], which has now been used in 6 hospitals across United Kingdom and Ireland. The technique establishes vacuum drainage of the lumen of the injured oesophagus whilst maintaining its patency, effectively exteriorizing complex oesophageal perforations to allow healing.

Methods

Patients presenting with Boerhaave or iatrogenic rupture, undergo an initial decontamination of the chest with drainage as required. A 32–36 Fr Chest drain is inserted in a PEG guided technique, where the proximal end of the drain is positioned 5 cm above the perforation site within the oesophagus, whilst the distal end is pulled out through the stomach and abdominal wall. Continuous low-pressure suction at -10 cm water is applied. Patients continue to drink water. Further intervention is not required until the leak has healed and the drain removed.

Results

We have used this technique in 20 patients in our institution (3 iatrogenic perforations, 17 Boerhaave), with a median age of 72 (range; 55–85). Perforation length ranged from 1–15 cms. Three cases were performed after stenting failed to control the leak. Pleural decontamination required thoracotomy (n = 12), VATS (n = 2); in 6 cases, no pleural decontamination was required. There were four in-hospital deaths. Median duration from surgery to removal of TG drain was 31 days (range; 10 - 71). Two patients required post discharge dilatation for stricture and are currently asymptomatic.

Conclusion

TG drainage in effect exteriorizes the oesophageal lumen at the site of oesophageal perforation, encouraging the perforated edges to appose and allow healing by secondary intention. Mediastinal sepsis drains through the transgastric drain (on suction) and intercostal drains placed at decontamination (off suction). Patients tolerate it well, drinking while their perforation heals, avoiding nasogastric intubation. [Ref] Berrisford RG, Krishnadas R, Froeschle P, Wajed S. European Journal of Cardiothoracic Surgery 33(2008):742–744.

Disclosure

All authors have declared no conflicts of interest.
PS01.099: RETROSPECTIVE ANALYSIS OF CLINICAL FEATURES OF 202 CASES WITH ESOPHAGEAL FOREIGN BODIES
Authors: Feng Jinteng , Fan Kun , Gao Rui , Fu Junke , Zhang Guangjian
Published: September 2018

Background

Esophageal foreign bodies refer to objects that are accidentally or intentionally swallowed, or that are naturally swallowed during medication or eating, temporarily staying in or resting in the esophagus. Esophageal foreign body is one of the common emergency of esophageal surgery, more common in the elderly and children. This paper study clinical features of esophageal foreign body in northwestern China in order to improve the abilities of diagnosis and treatment for the disease.

Methods

Clinical data of 202 patients admitted in for esophageal foreign body was analyzed retrospectively. The general information of the patients were collected, and the types of foreign bodies, the location, diagnostic methods, methods of taking out and related complications, hospitalization days, et al were analyzed statistically.

Results

The types of esophageal foreign body included jujube pit (61.8%), animal bones (12.9%) and non-food foreign bodies (24.3%). It mainly occurred in the upper orifice of the esophagus (65.8%). Diagnostic methods were mainly consisted of esophageal angiography (57.9%), chest X-ray (19.8%) and endoscopy (16.4%). Most of the patients (189, 93.6%) were treated with esophagoscopy. Altogether 26 cases presented with complications, and 18 of them were admitted in for jujube pit.

Conclusion

The main cause of esophageal foreign body is jujube pit. Early diagnose and timely management is essential for the disease. How to guide the population as far as possible to avoid ingesting jujube pit wrongly and reduce the incidence of esophageal foreign body is of practical significance.

Disclosure

All authors have declared no conflicts of interest.
PS01.100: THORACOSCOPIC MANAGEMENT OF ESOPHAGEAL LEIOMYOMA: 11 CASE REPORTS
Authors: Aydin Yener , Eroglu Atila , Ulas Ali , Kuran Emre , Ozmen Sevilay
Published: September 2018

Background

The vast majority of esophageal tumors are cancer. Benign esophageal tumors constitute less than 1% of all esophageal tumors. Approximately 80% of benign esophagus tumors are leiomyomas. This study aims to evaluate outcomes of thoracoscopic management of esophageal leiomyomas.

Methods

Between January 2010 and December 2017, eleven cases (5 females, 6 males; mean age 45 years; range 30 to 59 years) who were operated with thoracoscopic resection due to esophageal leiomyoma were retrospectively analyzed. Age and sex of the patients, symptoms, localization of lesions, diagnosis, surgical modality, length of hospital stay and morbidity and mortality rates were reviewed. All cases were preoperatively examined using direct chest radiography, computed tomography (CT), and esophagoscopies, with endoscopic ultrasonography (EUS) also being employed in seven cases.

Results

Five patients had dysphagia and four patients were asymptomatic. Leiomyoma was located in 1/3 of the middle esophagus in all cases. All patients underwent right thoracoscopic enucleation (Single port incision in three cases). Leiomyoma was a solitary lesion in all cases. After the enucleation, 0.9% NaCl was inserted into the posterior mediastinal region. Nasogastric tube was inflated to check for leakage. Except for two cases, in all cases, the esophageal muscle layer was closed as an absorbable suture. The mean diameter of leiomyoma was 5.1 cm (range, 2 to 9 cm). Postoperative mortality was not observed in any of the cases. Postoperative pseudodiverticulum occurred in one of the cases. The mean length of hospital stay was 5.8 days (range, 4 to 11 days).

Conclusion

In esophageal leiomyomas, surgery provides both definitive diagnosis and treatment. Thoracoscopic enucleation in esophageal leiomyomas is an effective and safe treatment method.

Disclosure

All authors have declared no conflicts of interest.
PS01.104: INVESTIGATION OF FACTORS AFFECTING ENDOSCOPIC OBSERVATION FOR ESOPHAGOGASTRIC JUNCTION
Authors: Matsuo Yasumasa , Yasuda Hiroshi , Itoh Fumio
Published: September 2018

Background

Evaluation of the esophagogastric junction (EGJ) area is essential for detecting EGJ cancer including Barrett's adenocarcinoma. The aim of this study is to analyze the factors of difficulty in endoscopic EGJ evaluation.

Methods

Data were collected retrospectively from consecutive subjects who underwent esophagogastroduodenoscopy (EGD) for medical examination/health checkup in our institution between April 2013 and March 2014. The EGJ observed was assessed during both insertion and withdrawal of the EGD. The difficulty level of endoscopic EGJ evaluation was classified into two groups: an easy-evaluation (100% of the EGJ) and a difficult-evaluation (Not 100% of the EGJ) group. Midazolam was used as a sedative. We compared ages, genders, heights, weights, BMIs, coexisting heart and pulmonary diseases, gastric ulcers, sedations with midazolam and hiatal hernias between the two groups.

Results

The study included 692 patients (mean age 65.4 ± 12.4 years, 327 females). The easy-evaluation group comprised 575 cases (83.1%) and the difficult-evaluation group comprised 117 cases (16.9%). In the easy- and difficult-evaluation groups, the numbers of sedated cases were 348 (60.5%) and 96 (82.1%), the numbers of cases without esophageal hiatal hernia were 299 (52.0%) and 83 (70.9%), respectively. The cases that was sedated with midazolam and without esophageal hiatal hernia were identified as independent risk factors associated with difficulty in observation of the EGJ (for both factors, P < 0.001), and their odds ratios were 3.16 and 2.30, respectively. There were no other factors associated with difficulty in observation of the EGJ.

Conclusion

Sedation with midazolam and without esophageal hiatal hernia causes difficulty in endoscopic observation of the EGJ.

Disclosure

All authors have declared no conflicts of interest.
PS01.119: TO INVESTIGATE WHETHER BILATERAL MEDIASTINAL PLEURA SHOULD BE REMOVED IN I-IIA ESOPHAGEAL CANCER SURGERY
Authors: Yu Zhang
Published: September 2018

Background

For thoracic segment esophageal range, Some think resect double side mediastinal pleura. other think never resection has no difference, increased complications.

Methods

This study used a prospective, randomized controlled study method. 213 patients with I-IIIA esophageal cancer were randomly divided into two groups. one group of 106 patients were completely removed with bilateral mediastinal pleura. Another group of 107 patients had the mediastinal pleura in the implementation; Both groups performed a thoracic lymph node dissection. we observed the incidence of pleural effusion, pulmonary infection rate, chest infection rate, OS, thoracic metastatic tumor incidence, and the postoperative review PET- CT.

Results

Among the 106 patients, there were 11 cases of pleural metastasis, 8 cases of chest infection and 33 cases of pulmonary infection, thoracic drainage tube pulling time averaged 3.8 days. After surgery three months, six months, one year, two years, 47 cases PET-CT are positive. an average 5-year survival rate of 47.3%. In other group, 15 patients with pleural metastases, 5 patients with chest infection, 19 in the lungs, thoracic drainage tube pulling time averaged 3.4 days. After surgery three months, six months, one year, two years, 43 cases PET-CT are positive and an average 5-year survival rate of 46,8%..

Conclusion

This study is a prospective study on mediastinal pleural resection of esophageal cancer. Experimental conclusion found two groups of patients with pleural and pleural metastasis rate was not significant difference, and the chest cavity infection and pulmonary infection rate, less resection in patients with bilateral mediastinal pleura resection group is more, chest tube pull out two groups of almost the same time, there was no significant difference. Postoperative three months, six months, one year, two years PET-CT results, no significant difference in chest positive results. Patients with bilateral mediastinal pleural resection had a higher chest discomfort. In conclusion, it was concluded that there was no significant advantage in the surgical excision of bilateral mediastinal pleura in patients with esophageal cancer, and there were many complications. The sample size of this experiment is small, which is a single center study, and more large samples are needed.

Disclosure

All authors have declared no conflicts of interest.
PS01.120: INVESTIGATION OF NUTRITIONAL INDICATORS COMPARING RECONSTRUCTION ROUTE AFTER ESOPHAGECTOMY
Authors: Tokuhisa Akihiro , Kanekiyo Shinsuke , Takeda Shigeru , Nagano Hiroaki
Published: September 2018

Background

The gastric tube reconstruction route after esophagectomy is generally adopted posterior mediastinal or retrosternal route. Currently it is selected for each hospital or case. Preoperative and postoperative nutritional assessment, surgical complications and rate of survival are retrospectively compared between Posterior mediastinal routec(Group P) and Retrosternal route (Group R).

Methods

From January 2006 to December 2015, 198 patients with gastric tube reconstruction after esophagectomy (112 patients in Group P and 86 patients in Group R) were included. Propensity score was calculated and adjusted by multiple logistic regression analysis because bias of background factors occurs. 1) Surgical complications and survival rate, 2) CONUT score as a nutritional evaluation index before, 6 months and 12 months after surgery, 3) Endoscopic findings at 12 months after surgery were examined.

Results

In Group R, there were more advanced cases with thoracotomy than Group P. As a result of matching these factors as covariates using Propensity score, 27 groups were extracted in each group. 1) Surgical complications and survival rate: There was no difference in the incidence of complications such as arrhythmia, suture failure, pulmonary complications between the two groups. There was no difference between PFS and OS in the two groups. 2) Nutritional Evaluation Indicator: The patients who recognized malnutrition (CONUT score 3 or more) before surgery (group P 9.3% vs. group R 7.4%, P = 0.715), 6 months after surgery (18.0% vs 15.4%, P = 1.000), 12 months after surgery (8.6% vs 22.9%, P = 0.049), group P had good nutritional status for 12 months postoperatively. 3) Endoscopic findings: Anastomotic stenosis (group P 22.5% vs. group R 10.2%, P = 0.052) tended to be few in group R. The occurrence of reflux esophagitis and food residue stagnation was not different between both groups.

Conclusion

Although short-term benefits such as ease of response to postoperative recurrence and postoperative complications are considered to be in retrosternal reconstruction, as the results of esophageal cancer treatment outcome improve, longer term of nutrition etc is taken from the viewpoint. The posterior mediastinal route is the first choice in our department.

Disclosure

All authors have declared no conflicts of interest.