bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT
Authors: Chandramohan Servarayan , Varadharajan Visvarath , Chinnathambi Madeshwaran , Manickavasagam Kanagavel , Jebaraj Abishai , Chandramohan Apsara 
Published: September 2018

Abstract

Background
Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement.

Methods
58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone.

Results
The patient is free of dysphagia and is on regular follow up.

Conclusion
In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure.

Disclosure
All authors have declared no conflicts of interest.
PS01.021: SHORT POEM GUIDED BY ENDOFLIP RESULTS IN LESS REFLUX RATE IN PATIENTS SUFFERING FROM ACHALASIA
Authors: Barbieri Lavinia , Ilczysyn Andrei , Jafari Jafar , Botha Abraham , Smyth Edel 
Published: September 2018

Abstract

Background
Peroral Endoscopic Myotomy (POEM) has gained ground for achalasia tratment. Although laparoscopic Heller's-Dor (LHD) is a proven intervention, the cut of the inner muscular layer during POEM offers a goal-directed procedure. However, concerns regarding post-procedure reflux had been raised. As during POEM long myotomy is generally adviced, we decreased the length to reduce reflux after treatment.

Methods
19 patients with type 1 or 2 achalasia underwent POEM guided intraoperatively by Endoflip® (Crospon Ltd., Galway, Ireland) to target the myotomy where the major point of tightness was. We aimed for an increase of compliance and distensibility of three times of the lower esophageal sphincter (LOS) via a short myotomy. We compared these patients with a historic control LHD group of 15 patients in terms of Eckardt's score, GERD-HRQL questionnaire, high-resolution manometry to check pressure of the LOS 24h pH-impedence to measure acid exposure with minimum follow-up of 9 months.

Results
Length of myotomy was 7 cm (6–10) for POEM and 9 cm for LHD. Median Eckard's score after POEM was 0.5 versus 2 for LHD group. Median Eckardt's score and GERD-HRQL were 0.5 vs 2 and 13 vs 15, respectively after POEM or LHD. 24h pH-monitoring revealed pathologic reflux in one patient after POEM and in 3 after LHD, with median acid % time of 0,1 vs 1,2. Data are summarized in table.

Conclusion
POEM is effective in achieving symptom relief in patient with achalasia. Although randomized data are not available, reflux rate after POEM with short myotomy guided by Endoflip is comparable with LHD and lower than the data of literature.

Disclosure
All authors have declared no conflicts of interest.
PS01.031: REVISITING THE ESOPHAGOGASTRIC JUNCTION ANATOMY: WHERE IS THE INFRACARDIAC BURSA?
Authors: Nakamura Tatsuro , Shinohara Hisashi , Okada Tomoaki , Hisamori Shigeo , Tsunoda Shigeru , Obama Kazutaka , Kurahashi Yasunori , Takai Akihiro , Takakuwa Tetsuya , Yamada Shigehito , Sakai Yoshiharu 
Published: September 2018

Abstract

Background
The infracardiac bursa (ICB), the closed space encountered in the esophagogastric junction (EGJ) surgery, is rarely described in anatomical atlases. The purpose of the study is to link surgery to embryology and propose the new anatomical chart including the ICB.

Methods
Histological serial sections of Carnegie stages (CS) 13–23 embryos and magnetic resonance (MR) images of the fetus with 43.5 mm crown-rump length from the Kyoto Collection of Human Embryos were examined for embryological changes in the ICB. Seventy-four surgery videos of laparoscopic and thoracoscopic esophagectomy were reviewed to investigate the appearance of the ICB and frequency of the recognition in surgery.

Results
The right pneumato-enteric recess appeared in CS13 embryos and the ICB was separated from the recess by the development of the diaphragm between CS17 and CS18 embryos and established as a closed space up until CS23. The three-dimensional reconstruction of fetus MR images showed the ICB was located adjacent nearly one third around the esophagus above the right crus. The ICB was clinically encountered in 12 of 14 (86%) transhiatal surgeries and 23 of 60 (38%) thoracic surgeries. Via the transhiatal approach, the caudal edge of the ICB appeared as a thick whitish membrane after the dissection of the phrenico-esophageal ligament and a closed space enveloped with a serosa was opened by the incision of the membrane. Via the right thoracic approach, the ICB appeared on the right crus after the dissection of the pulmonary ligament.

Conclusion
We described a new chart around EGJ including the ICB based on embryology. This anatomical chart can contribute to promote accuracy and safety of operating procedures around the EGJ.

Disclosure
All authors have declared no conflicts of interest.
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.