bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.
PS01.074: ENDOSCOPIC FILLING METHOD OF POLYGLYCOLIC ACID SHEETS AND FIBRIN GLUE THE LEAK FOR THE TREATMENT OF REFRACTORY ESOPHAGOGASTRIC ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY
Authors: Tashiro Kousei , Takeno Shinsuke , Kawano Fumiaki , Miyazaki Yasuyuki , Munakata Syun , Tanoue Yukinori , Wada Takashi , Hamada Rouko , Nanashima Atsushi , Nakamura Kunihide 
Published: September 2018

Abstract

Background
Treatment of anastomotic leakage in the reconstruction after esophagectomy remains a challenge. Secure treatment method has been established and there is very few clinical studies. Although internal drainage using nasogastric tube has been reported recently. In this report, the authors present endoscopic filling method (EFM) for anastomotic leakage.

Methods
Six patients (five males and one female) with anastomotic leakage whose ages ranged from 54 to 77 were includes in this study. The patients underwent EFM and the anastomotic leakage was filled with polyglycolic acid sheets and fibrin glue endoscopically. Initially, tube drainage was performed, and this treatment was performed as the secondary treatment, when the improvement was not made by tube drainerge.

Results
Every patient had a jejunostomy, with any concern for nutrition. Abscess was present in all patients, but external drainerge was not required. EFM was required once to five times until the fistulas cured. There was no motality. There are no cases of relapse after discharge from the hospital. Three of them cured in the first treatment, it takes average 26 days from esophagectomy to starting oral intake. This method allows us to repair for all fistula with regardless of inflammation or infection.

Conclusion
In conclusion, the patients with reflactly esophagogastric anastomotic leakage after esophagectomy would be better served by EFM. Further study is required larger series of patients and a longer follow-up period to examine the safety and effectiveness of EFM.

Disclosure
All authors have declared no conflicts of interest.
PS01.078: AN UNUSUAL PRESENTATION OF BOERHAAVE SYNDROME
Authors: Annalisa Ng Ya-Lyn , Lee June , Lin Jinlin , Siong Ching Siok , Yih Andrew Wong Siang 
Published: September 2018

Abstract

Background
Oesophageal perforations are rare but potentially lethal. Boerhaave syndrome classically results in a longitudinal oesophageal perforation at the left posterolateral distal oesophagus. We present an unusual case with cervical oesophageal mucosal perforation and submucosal dissection.

Methods
We review our patient—a 53 year old lady, Mdm S, who presented after 4 days of vomiting with sepsis and diabetic ketoacidosis. CT thorax scan showed extensive long segment circumferential mural thickening and oedema of the entire oesophagus, extensive pneumotosis of the proximal half, and a focal mucosal discontinuitiy of the cervical oesophagus. There were also pneumomediastinum, fat stranding in the superior mediastinum, and a right pleural effusion.

Results
Gastroscopy and surgical exploration of the right hemithorax and neck identified a 2cm linear cervical oesophageal mucosal defect. There was no muscular perforation; an air leak test did not demonstrate a transmural perforation. Copious lavage of the mediastinum and right thoracic cavity were performed and large bore drains were placed in the neck, right thoracic cavity and superior mediastinum. A venting gastrostomy and a feeding jejunostomy were also created. Mdm S’s recovery was complicated by a persistent right pneumothorax. An interval gastroscopy revealed a line of interrupted longitudinal oesphageal mucosal defects starting at 18cm to 31 cm from the incisors. The submucosal space had opened up for the same length, and the scope easily entered the submucosal plane, where a muscle wall defect was detected at 18cm from the incisors.

Conclusion
Cervical oesophagus is an unusual site of Boerhaave's perforation. While the initial perforation was not transmural, surgical lavage and drainage were essential for sepsis control. Subsequent recovery was achieved by following principles of fistula management- diversion of gastrointestinal contents, drainage of oesophageal leak to control sepsis, optimisation of nutrition via a feeding jejunostomy.

Disclosure
All authors have declared no conflicts of interest.