bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.045: ENDOSCOPIC NEGATIVE INTRACAVITARY PRESSURE (ENDO-NIP) TO MANAGE ESOPHAGEAL LEAK AND MEDIASTINAL ABSCESS COMPLICATED BY STROKE TREATED WITH TPA
Authors: Singh Prabh , Bhangoo Harangad , Meyer Alyssa , Rizvi Zaheer , Buttar Navtej , Wang Kenneth 
Published: September 2018

Abstract

Background
Post-surgical complications such as leaks are the source of considerable morbidity and mortality. Success of conservative interventions is highly variable. Recurrence after surgical repair is also not uncommon. Our aim was to develop novel endoscopic strategies to maximize negative intracavitary pressure to manage leaks in cases where conventional management either failed or were not feasible.

Methods
We have used transluminal locking loop drains with low intermittent suction in the management of non-healing leaks in various areas. An example presented here illustrates this concept where a 68-year-old male patient underwent paraesophageal hernia repair with Nissen fundoplication. Patient presented 3 weeks later with fistula leading to a 13 cm meditational abscess. Patient developed right hemiparesis requiring tissue plasminogen activator (tPA). Post-tPA patient developed hemoptysis and hematemesis requiring emergency intubation. The defect in the esophagus was 6–8 mm. Endoscopic repair with stitching or clipping would have left a large undrained cavity with a potential to expand. Endoscopic repair with transcutaneous drain placement was challenging due to recent tPA and a difficult location. Moreover there was potential to develop esophago- pleural- broncho- cutaneous fistula. Endoscopic vacuum therapy was felt to be a suboptimal choice. Patient was high-risk surgical candidate as it would have required radical surgery in the setting of tPA.Upper endoscopy was performed and the cavity was debrided. No direct communication with bronchopulmonary tree noted. A transnasal guidewire assisted 16 Fr, 60 cm locking loop drain was placed and connected to low intermittent suction that was switched to bulb based suction.

Results
The output from naso-cavity drain decreased nearly 100 cc per day in the first 5 days and the size reduced by 30, 50 and 80% by day 5, 9 and 12 respectively. Near complete elimination of the cavity was observed on day 15. Esophagogram showed complete resolution of the leak and computerized tomography revealed no residual cavity

Conclusion
Developing transluminal endoscopic strategies to maximize negative intracavitary pressure helps expedite the healing of resistant postsurgical leaks. This technique avoids the need for frequent drain changes that remains a challenge for vacuum therapy.

Disclosure
All authors have declared no conflicts of interest.
PS01.046: ENDOSCOPIC THERAPY FOR ESOPHAGEAL VARICES IN THE ELDERLY CAN BE PERFORMED IN SAFETY
Authors: Sasaki Ryo , Iwamoto Takuya , Nishimura Tatsuro , Sakaida Isao 
Published: September 2018

Abstract

Background
In this study, we evaluated the risk of complications and the effects of the treatment of esophageal varices in elderly patients with cirrhosis, by comparing the data of elderly and non-elderly patients.

Methods
We included 284 patients who received endoscopic therapy for esophageal and gastric varices at our hospital between February 2004 and December 2016 in the study.The subjects were divided into two groups.An elderly group comprising patients who were 65 years of or order.A Non-elderly group comprising patients who were under 65 yearsWe compared various parameters such as blood data before and after the endoscopic therapy, as well as the complications associated with the treatment, and then performed statistical analyses on the results.

Results
Of the 284 subjects, 168 patients were elderly group 65 years or older and 116 patients were non-elderly groupaged less than 65 years. Complications were observed in 30 of 168 subjects (17.8%) in the elderly groupwho were aged 65 years or greater and in 25 of 116 subjects (21.6%) under 65 yearsin the non-elderly group, which did not indicate a significant difference between the two groups. The Child-Pugh score was 6.6 ± 0.1 in the elderly group and 7.1 ± 0.2 in the non-elderly group, indicating that the score was significantly lower in the elderly group (P < 0.05). Our investigation of the patients’ medical history pertaining to liver complications indicated that 32.3% of the subjects in the non-elderly group were alcoholics, as compared to 14.8% in the elderly group, indicating a significantly higher percentage of alcoholics in the non-elderly group (P < 0.01). Our investigation of the efficacy of the treatment of varices indicated that the recurrence rate within 1 year was 29.2% in the elderly group and 28.0% in the non-elderly group, indicating that there was no significant difference between the two groups.

Conclusion
Our study comparing the endoscopic treatment of esophageal varices in the elderly and the non-elderly revealed that there were no significant differences in the increase in the risk of complications or the efficacy of treatment. Therefore, we believe aggressive treatment shouldmay be considered even for elderly patients to avoid the risk of variceal rupture and bleeding.

Disclosure
All authors have declared no conflicts of interest.
PS01.048: LAPAROSCOPIC ANTIREFLUX SURGERY IN MORBIDLY OBESE PATIENTS
Authors: Migaczewski Marcin , Rubinkiewicz Mateusz , Pędziwiatr Michał , Major Piotr , Dworak Jadwiga , Natkaniec Michał , Budzyński Andrzej 
Published: September 2018

Abstract

Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proved to be effective bariatric procedure for the treatment of morbidly obese patients with gastroesophageal reflux disease (GERD). In contrast, the indication for laparoscopic sleeve gastrectomy (LSG) in these group of patients is still not clear. LSG with simultaneous crural repair it can be a new, safe and effective therapautic approach.

Methods
A total of 60 obese patients with GERD operated on in 2016–2018 were included in the study. 20 patients were qualified for LRYBG. In the rest LSG was performed, of which half with simultaneous crural repair.

Results
GERD symptoms complete control was observed in 18/20 (90%) patients after LRYGB and 17/20 (85%) after LSG with simultaneous crural repair. The same effect occurred only in 8/20 patients direct after simple LSG. ‘De novo’ GERD symptoms developed in 10% of the patients undergoing alone LSG during 12 months follow up.

Conclusion
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is still effective bariatric procedure for the treatment of morbidly obese patients with gastroesophageal reflux disease (GERD). Doubts remain in the situation of young patients without diabetes. If we additionally deal with a large hiatal hernia, the qualification for LRYGB remains debatable. In this situation, it is worth considering LSG. Simple sleeve gastrectomy not only does not guarantee a good anti-reflux effect, but it can also produce de-novo GERD. Laparoscopic simultanous crurolasty in the time of LSG, represents a valuable option for the treatment of morbid obesity with gastroesophageal reflux disease

Disclosure
All authors have declared no conflicts of interest.
PS01.051: EFFICACY OF 20-MG VONOPRAZAN ON-DEMAND THERAPY AS A MAINTENANCE THERAPY FOR PATIENTS WITH MILD REFLUX ESOPHAGITIS
Authors: Tanabe Tomohide , Kawami Noriyuki , Hoshino Shintaro , Hoshikawa Yoshimasa , Nana Takenouchi , Umezawa Mariko , Kaise Mitsuru , Iwakiri Kastuhiko 
Published: September 2018

Abstract

Background
The aim of this study is to investigate the efficacy of on-demand therapy with 20-mg Vonoprazan (VPZ) as a maintenance therapy for patients with mild RE.

Methods
On-demand therapy of orally taking one 20-mg tablet of VPZ only when reflux symptoms occurred was carried out in 30 patients with mild RE who were in a state of endoscopic remission on maintenance therapy using PPI and answered ‘very satisfied’ or ‘satisfied’ to an overall satisfaction survey. Patients who were remission on 24 weeks after the initiation of on-demand therapy continued the on-demand therapy for a total of 48 weeks. RE symptoms were assessed at 24 and 48 weeks after the initiation of on-demand therapy. Patient satisfaction, symptoms (F-scale), and gastrin level before breakfast were compared before and after the on-demand therapy. In addition, the number of VPZ tablets taken and the frequency (regular, temporary, rare) of its administration were examined.

Results
One of the 30 patients dropped out of on-demand therapy 1 week after its initiation. At the 24-week follow-up, recurrence of RE was found in 13.8% of the patients. There were no significant differences in the level of the F-scale score, overall level of satisfaction, and gastrin level before and after the on-demand therapy. During the 24-week on-demand therapy, patients took 33 (median) VPZ tablets. 31.0% of the patients took VPZ on a regular basis (at least 2 tablets a week); the remaining patients took VPZ on a temporary or rare basis. After additional 24 weeks, 21 of 25 patients who maintained remission completed the 48-week study. 15.4% had recurrent disease (grade A and B). There were no significant differences in the F-scale score, overall level of satisfaction, and gastrin level before and 48 weeks after the on-demand therapy. At the end of the 48-week on-demand therapy, patients had taken 69 VPZ tablets, and 42.9% of the patients took VPZ on a regular basis.

Conclusion
Discussion: On-demand therapy with 20-mg VPZ is an effective alternative for PPI maintenance therapy for mild RE.

Disclosure
All authors have declared no conflicts of interest.
PS01.057: THYROIDECTOMY AND LARYNGO-PHARYNGEAL REFLUX: WHAT’S NEW
Authors: Macaione Ina , Cusimano Alessia , Cipolla Calogero , Graceffa Giuseppa , Pantuso Gianni , Fiorentino Eugenio 
Published: September 2018

Abstract

Background
‘Local neck symptoms’ may be related to goiter; a persistence of those symptoms after an uncomplicated total thyroidectomy (TT) might be referred to the laryngo-pharyngeal reflux (LPR). Our previous study found a correlation between goiter and LPR in selected patients with local neck symptoms; the purpose of our current study is to investigate the presence of a laringopharyngitis in patients with goiter, before and after TT, even in the absence of local neck symptoms, assessing whether the presence of LPR may play a role at the outset of the symptomatology.

Methods
Two groups of patients were considered and they differred for the presence or absence of local neck symptoms: group A (25 patients) and group B (40 patients). The clinical evaluation was standardized using the reflux symptom index. The patients were subjected to videolaringoscopy (VLS) and to esophageal videoflurography (VFGE) before and three months after surgery.

Results
Before surgery all the patients in group A showed a normal vocal chord motility and laryngitis findings at the VLS. The VFGE was positive to abnormal swallowing in 86% of patients. The laryngitis findings at VLS, were found in 38% of cases in group B. At VFGE 96% of the patients were positive to the test. The symptoms reported in the pre-operative were unchanged after surgery in group A. In group B 63% of patients remained positive; at VFGE 73% had a clear pathological condition.

Conclusion
In 2010 ‘Amelita’ study concluded that LPR should be taken into account as a possible movens of post-thyroidectomy clinical picture, both in the diagnosis and in the therapeutic management of those patients who complained about local neck symptoms, since the only TT hadn’t been effective. The collected data of the current study are consistent with those of the previous study: symptoms persisted or increased in laryngopharingeal reflux-positive patients, while in the control group the symptoms were absent or the new appearance symptomatic pictures were moderate. It is a shared view that we shouldn’t wait for the overt clinical picture, but prevent it. It is essential to identify, through a careful pre-operative evaluation, patients positive to LPR.

Disclosure
All authors have declared no conflicts of interest.
PS01.061: LAPAROSCOPIC ENDOSTIM PLACEMENT: CASE REPORT
Authors: Morales Morales Carlos , Aguirre Mar David , Ballí Jorge , Serrano Berta 
Published: September 2018

Abstract

Background
GERD is a mechanical disorder that is caused by a dysfunction of the LES, dysfunction of the gastric emptying or an anomalous esophageal peristalsis.

Methods
We present the case of a 36-year-old male patient with intermittent heartburn, regurgitation, retrosternal pain and dysphagia. UE reports grade D esophagitis, manometry and pHmetry reporting DeMeester 21.1, acid percentage of 5.8%. Normal Motility and LES in 9 mmHg. Nissen-type fundoplication was performed without complications and with resolution of symptoms. 4 years later the patient begins with recurrent symptoms. Esophagitis in UE. DeMeester 20. EEI 7.7 mmHg. 80% Useful Motility. Nissen type fundoplication is redo. Nine years later the patient starts again with symptoms. Progressive deterioration of esophageal motility in manometry is documented. UE with grade D esophagitis, DeMeester 10, manometry reporting LES with normal resting pressure and coordinated relaxation with pharyngeal contraction. Peristalsis wave failure of 100% of swallows, in relation to absent peristalsis;

Results
Placement of Endostim was performed and patient was discharged without complications, Patient 1 month later without GERD symptoms.

Conclusion
Approximately 10 to 40% of patients with GERD fail to respond in their symptomatology despite medical treatment. Surgical indications for GERD consist of failure to medical treatment, poor adherence to the patient's treatment, high volume reflux, severe esophagitis, benign stenosis and Barret's esophagus. Treatment consists of fundoplication in its different variants. However 10% to 20% of patients present with persistent symptoms and 3% to 5% require surgical reoperation. Endostim is a minimally invasive therapy which normalizes the function of the LES through neurostimulation.

Disclosure
All authors have declared no conflicts of interest.
PS01.064: LAPAROSCOPIC FUNDOPLICATION: NEW ASPECTS IN NEURAL ANATOMY OF THE ESOPHAGOGASTRIC JUNCTION
Authors: Gehwolf Philipp , Renz Olver , Brenner Erich , Fritsch Helga , Wykypiel Heinz 
Published: September 2018

Abstract

Background
In laparoscopic fundoplication the mobilisation of the distal esophagus and the proximal stomach are mandatory in order to obtain enough intraabdominal esophageal length and to enable a posterior fundoplication. In surgical literature and in most anatomic illustrations there are no nerves described between diaphragm and stomach. Moreover the mechanism of the so-called postfundoplication complaints is not fully understood yet. We intraoperatively observed small nerve branches penetrating the left crus of the diaphragm lateral of the hiatus, presumably going into the stomach. Their course (from lateral to medial) suggested that they could be branches of the splanchnic nerves or phrenic nerves rather than branches of the vagus. It was the aim of the study to find these nerves in cadavers and to describe their origin and their target organ.

Methods
53 cadavers (23 male 30 female, age range: 35–103 years) were dissected with special attention to the course of the nerves penetrating the left crus of the diaphragm. The whole course of the nerves was documented with drawings and photos.

Results
In 17 out of 53 cadavers, one or two splanchnic nerves were found. Seen from below, they penetrated the left crus of the diaphragm in mean at the 4 o`clock (range: 2–5) position, in mean at a distance of 2cm (range: 0–5) from the hiatus, all of them going into the stomach (cardia or fundus). Ten out of them had an additional branch going into the coeliac ganglion.
In 14 cadavers, a branch of the phrenic nerve was found, penetrating the left crus at a 4 o`clock position, in mean at a distance of 7,3cm (range: 3–10). These phrenic nerves mostly went into the stomach (fundus), but in two cases, additional branches going to the coeliac ganglion were found.

Conclusion
Branches of the splanchnic nerves and of the phrenic nerve, penetrating the left crus of the diaphragm at the 3–5 o`clock position are regularily found. Most of them go to the stomach, and some also have branches to the coeliac ganglion.
The role of these nerves is not clear yet, but they all are cut regularily during a laparoscopic (posterior) fundoplication.

Disclosure
All authors have declared no conflicts of interest.
PS01.066: LAPAROSCOPIC PARA-HIATAL HERNIA REPAIR
Authors: Hui Benedict , Hughes Timothy , Chow Geoffrey 
Published: September 2018

Abstract

Description
This is a video submission showing laparoscopic repair of a parahiatal hernia. The patient is a 44 year old female who presented with heartburn, regurgitation and chest pain. EGD and CT showed a type 3 paraesophageal hernia. Intra-operatively, we discovered instead a diaphragmatic defect adjact to the hiatus through which the stomach had herniated. Although this has been reported in some case reports it is uncommon. We approached the repair laparoscopically with dissection of the right and left crus followed by dissection of the parahiatal hernia and reduction of the stomach. We then repaired the hernia defect and reinforced the repair with mesh. We concluded with a Nissen fundoplication.

Disclosure
All authors have declared no conflicts of interest.
PS01.070: EVALUATION OF THE EFFECTIVENESS OF ROBOTIC FUNDOPLICATIONS IN THE TREATMENT OF GERD
Authors: Koshkin Mikhail , Vasnev Oleg , Belousov Alexandr , Mikhnevich Mikhail , Baychorov Magomet , Domrachev Sergey 
Published: September 2018

Abstract

Background
Surgical treatment is one of the most effective options for treatment of gastroesofageal reflux disease. Laparoscopic approach became is a ‘gold standard’ over the time demonstrating all advantages of minimally invasive techniques over the open procedures. However the utility of robotic antireflux operations still remains controversial.

Methods
Since the January till the December of 2017 thirty operations were operated on. Mean age was 57,2 (35–76), among them 21 (70%) were female and 9 (30%) were males. Mean BMI was 29,4 (24,1–41,0). Laparoscopic procedures were performed in15 patients (1st group), robotic procedures with DaVinci system were performed in 15 patients of the second group. Chernousov modified Nissen fundoplication was performed in 25 patients, Toupet fundoplication was used for 4 patients, Nissen type was performed in 4 cases.

Results
The median operative time in laparoscopic group was 125 min (80–200 min), in robotic group - 124 min (90–210 min). There were no statistical differences between two groups (P = 0,93).Blood loss was minimal in both groups. Mean postoperative hospital stay was 4 days (2–7 days) in the 1st group and 4 days (2–6 days) in the second. There were no statistical differences between two groups (P = 0,19). Postoperative course was uneventful in all patients of both groups.

Conclusion
Robotic antireflux operations are safe and effective in treatment of patients with reflux-esophagitis. There were no statistically significant differences in short-term results of laparoscopic and robotic operations.

Disclosure
All authors have declared no conflicts of interest.
PS01.073: HIATAL HERNIA—DIAGNOSIS AND RELEVANCE—THE CONUNDRUM CONTINUES….
Authors: Balaji Nagammapudur , Bradbury Carl , Evans Stephanie , Rao Vittal 
Published: September 2018

Abstract

Background
Upper GI endoscopy and barium swallow are the commonly used diagnostic modalities and Oesophageal manometry of late has contributed to the diagnosis of hiatal hernias. It is known that there exist considerable limitations within each modality in the diagnosis of this seemingly common condition. Aims To assess the correlation between the commonly used investigations of Upper GI Endoscopy and Barium studies and selective use of Esophageal physiology studies in the diagnosis of hiatal hernias.

Methods
92 patients who had both an Upper GI endoscopy and Barium swallow in a University hospital formed the study population. There was a subgroup of 29 patients who also underwent a manometry and pH study as a part of their workup. A mix of endoscopists (Physicians, GPs, Surgeons, Supervised trainees and Nurses) performed the upper GI endoscopies. The barium studies were performed by specialist radiographers based on a standard protocol. GI physiology studies were performed by a single GI physiologist with over 25 years of experience. Correlation was performed in varied combinations based on the presence/absence and the size of hernias on different investigations.

Results
74% (68) of patients were diagnosed to have a hiatal hernia on endoscopy whereas only 55% of the same group had a hiatal hernia on Barium studies. Of the 29 patients who had all the 3 investigations a hiatal hernia was diagnosed in 82% on endoscopy, 34% on Barium swallow and 48% on High resolution manometry. Only 21% of patients had correlation between all 3 studies. 62 percent had correlation between any 2 modalities and 17% did not have any correlation between any of the diagnostic modalities. The correlation in-between studies was greater for the moderate to large hernias and least for the small/absent hernias.

Conclusion
There exists considerable variation between the commonly performed procedures for this relatively presumed common condition. There is a greater observed tendency to diagnose a hiatal hernias on endoscopies and less on barium swallows based on the above study. The gold standard for the diagnosis is debatable, considering known limitations based on criteria for diagnosis, dynamic of the Oesophagogastric junction and operator variability.

Disclosure
All authors have declared no conflicts of interest.