bluuebunny/crossref_metadata_2025_split huggingface dataset:
FA07.04: THE ROLE OF ENDOSCOPIC DILATION AND STENTS IN THE REFRACTORY BENIGN ESOPHAGEAL STRICTURES: A RETROSPECTIVE ANALYSIS
Authors: Lu Qing , Lei Tiantian , Yan Hailin , Yang Jinlin , Ma Hongsheng 
Published: September 2018

Abstract

Background
The outcomes of patients with refractory benign esophageal strictures (RBES) was unclear and lacking in relative researches on the clinical efficacy of dilation compared with stent placement. Our objective was to explore the role of endoscopic dilation and stents in the management of RBES.

Methods
This study including patients with RBES (recurrence of dysphagia despite endoscopic therapy more than 3 sessions) by dilation and stents between January 2009 and December 2017. Endoscopic therapy success was defined as: before the end of the follow-up, no need for endoscopic interventions for at least 6 months. The primary outcome was to assess clinical effectiveness and adverse events. Secondary outcome was to identify factors that predicted the dysphagia-free period (the time interval of two subsequent endoscopic interventions). Multivariate analysis was used to estimate the risk factors influencing the treatment success. To explore the trend of dysphagia-free period along with times used hierarchical linear models.

Results
75 patients (54 male; median age, 59 years) with RBES, 39 (52%), 20 (26.7%), 3 (4%), 10(13.3%), and 3(4%) were post-surgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median times of endoscopic therapy was 5 times (range 3, 21). Self-expandable metal stents (SEMSs) were placed in 20 patients (26.7%), and the success rate of patients treated with dilation (70.9%, 39/55) was higher than with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The dysphagia-free period of patients treated with dilation was 3.7months (95% CI, 2.7–5), and with stents was 2.3 months (95% CI, 1.5–3). The dysphagia-free period has linear growth trend with times, increased by 12 days per endoscopic therapy.

Conclusion
The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic dilation and stents tended to be effective in patients with RBES. Before the end of follow-up, nearly half of patients required continuing endoscopic dilation and stents, therefore, the patients with RBES may have negative long-term results. Stents therapy tended to not reduce the times and frequency of dilation.

Disclosure
All authors have declared no conflicts of interest.
PS01.004: UTILIZATION OF HIGH RESOLUTION IMPEDANCE MANOMETRY FOR LIVER TRANSPLANTATION PATIENTS WITH CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY AND DYSPHAGIA
Authors: Huang Hsu-Kai 
Published: September 2018

Abstract

Background
Chronic inflammatory demyelinating polyneuropathy(CIDP) is a rare problem in liver transplantation recipients. We observed three patients with slowly progressive muscle weakness and dysphagia with body weight loss.

Methods
We describe the clinical features and high resolution impedance manometry(HRiM) results of 3 patients with liver transplantation who developed CIDP. Two patients had orthotopic liver transplantation and the other had living-donor liver transplantation.

Results
All 3 patients developed muscle weakness, dysphagia and body weight loss in the period of tapering immune suppressants. Diagnosis of CIDP were checked by neurologist consultation. All patients had immunosuppressive therapy with tacrolimus. Prednisolone in two cases and everolimus in one case were noted. Telbivudine treatment for chronic hepatitis B were given in all 3 patients. After HRiM evaluation, decreased functional oral intake scale(FOIS), distal contractile integral(DCI) and complete bolus rate were discovered. Plasma exchange were done and the follow up HRiM result showed obvious improved FOIS and DCI.

Conclusion
HRiM is a feasible and effective tool for evaluation of dysphagia in CIDP patients. This exam can be utilized before and after proper treatment.

Disclosure
All authors have declared no conflicts of interest.
PS01.005: HIGH-RESOLUTION MANOMETRY GUIDING SURGICAL PROCEDURE FOR TREATMENT OF ACHALASIA OF THE ESOPHAGUS. LONG-TERM RESULTS OF A PROSPECTIVE STUDY
Authors: Triantafyllou Tania , Doulami Georgia , Theodoropoulos Charalampos , Zografos Georgios , Theodorou Dimitrios 
Published: September 2018

Abstract

Background
Laparoscopic myotomy and fundoplication for the treatment of achalasia presents with 90% success rate. The intraoperative use of manometry during surgery has been previously introduced to improve the outcome. Recently, we presented our pilot study proposing the use of the HRM during surgery. The aim of this study is to evaluate the long-term outcome of the intraoperative use of High-Resolution Manometry (HRM) in achalasia patients.

Methods
In this prospective study, consecutive achalasia patients underwent laparoscopic myotomy and fundoplication along with real-time use of HRM. Eckardt scores (ES) and HRM results were collected before and after surgery.

Results
Twenty-three achalasia patients (22% Type I, 57% Type II, 22% Type III, according to Chicago Classification v3.0) with a mean age 48 years underwent calibrated and uneventful myotomy and fundoplication. Eleven myotomies were further extended, while sixteen fundoplications were intraoperatively modified, according to manometric findings. During postoperative follow-up, mean resting and residual pressures of the LES were significantly decreased after surgery (16,1 vs. 41,9, P = 0 and 9 vs. 28,7, P = 0, respectively). The ES was also diminished (1 vs. 7, P = 0).

Conclusion
The intraoperative use of HRM during laparoscopic myotomy and fundoplication for the treatment of achalasia of the esophagus is a safe, promising and efficient approach aiming to individualize both myotomy and fundoplication for each achalasia patient.

Disclosure
All authors have declared no conflicts of interest.
PS01.006: ROLE OF HIGH RESOLUSION MANOMETRY FOR DIAGNOSIS OF ESOPHAGEAL SPASTIC DISORDERS
Authors: Kameyama Hisako , Masaoka Tatsuhiro , Yamane Tsuyoshi , Takeuchi Hiroya , Kawakubo Hirofumi , Suzuki Hidekazu , Kitagawa Yuko , Kanai Takanori 
Published: September 2018

Abstract

Background
Esophageal spastic disorders such as spastic (Type III) achalasia, distal esophageal spasm, and Jackhammer esophagus are rare clinical condition. Moreover, symptoms associated with esophageal spastic disorders such as dysphagia, chest pain, regurgitation, and heartburn is not specific to esophageal spastic disorders (Gastroenterol Clin North Am. 42:27–43, 2013.). Therefore, it is difficult to diagnose esophageal spastic disorders from symptoms. The aim of this study is to clarify diagnostic strategy for esophageal spastic disorders.

Methods
Patients who underwent all of esophagogastroduodenoscopy (EGD), High resolution manometry (HRM: Starlet®)) and esophagography in our Hospital for evaluation of symptoms such as dysphagia, chest pain, regurgitation, and heartburn from November 2013 to November 2017 were involved in the study. After approval by the research ethical committee (No.20150081), we retrospectively reviewed the clinical findings of these patients. Based on the Chicago classification (CC) v3.0 (Neurogastroenterol Motil. 27:160–174, 2015), findings obtained by HRM were classified. Patients who had past history of upper-gastrointestinal surgery were excluded from analysis.

Results
174 patients (Mean age of 58.6 ± 15.4; 70male) were finally analyzed. Based on findings obtained by HRM, patients were classified as 25 achalasia, 15 Jackhammer esophagus, 0 distal esophageal spasm, 25 Esophagogastric junction outflow obstruction, 25 weak peristalsis, 6 failed peristalsis, 78 normal. Moreover, 23 patients with achalasia were classified as 8 Type I, 13 Type II, 4 Type III. In each subtype of achalasia, prevalence of esophageal dilation in EGD was 100%, 85%, 0%, respectively. In each subtype of achalasia, prevalence of liquid pool in esophagus in EGD was 100%, 69%, 0%, respectively. In esophagography, Compared with no findings group (15.5 ± 4.3cm), diameter of esophagus in patients with Type III achalasia(12.3 ± 4.8cm) were comparable, however that in patients with Type I(38.9 ± 18.6cm, P < 0.05) or Type II(32.0 ± 10.4cm, P < 0.01) achalasia were significantly wider. In patients with Jackhammer esophagus, prevalence of ring contractions in EGD and prevalence of corkscrew esophagus in esophagography were 33% and 13%, respectively.

Conclusion
With only EGD and esophagography, it was difficult to find visible findings which suggest esophageal spastic disorders. This suggests efficacy of HRM for diagnosis of this disorder and possibility of hidden esophageal spastic disorders in patients presumed as refractory GERD.

Disclosure
All authors have declared no conflicts of interest.
PS01.007: THE ROLE OF HIGH RESOLUTION MANOMETRY AFTER TOUPET-FUNDOPLICATION: COMPARING THE RESULTS WITH THE SYMPTOMS REMAINED 6 MONTHS AFTER SURGERY
Authors: Csucska Máté , Kovács Balázs , Ozorai Lilla , Patai Árpád , Lóderer Zoltán , Juhász Árpád 
Published: September 2018

Abstract

Background
Fundoplication is a well accepted method in treatment of gastro-esophageal reflux disease. High Resolution Manometry (HRM) is essential in diagnosis of functional esophageal diseases. The aim of our study was to find the place and value of HRM after 6 months of Toupet-fundoplication, and find correlation in symptoms remained, if any.

Methods
In 2016–2017 98 Toupet-fundoplications were performed by single surgeon. Surgeries were after HRM, EGD and pre-operative reflux symptom questionnaire performed in our Esophageal Center. Six months after surgery EGD, HRM and post-operative symptom questionnaire was planned to manage in each patients.

Results
Until Feb/01/2018 74/98 patients were more than 6 months after their operation. 72/74 patients completed the questionnaire and the EGD as well. 28/72 patients absolved HRM also. 25/28 patients had no complains and pre-operative symptoms relieved completely requiring neither PPI nor H2 blockers. 2/28 patients had gastric emptying problems, and 1/28 had moderate reflux associated symptom. Compared to that 22/28 patients HRM verified abnormal values mostly in DCI, however these 22 patients were asymptomatic. It has to be mentioned that DCI was better pre-operatively than post-operatively in 12 out of 22 cases.

Conclusion
Post-operative HRM can qualify and describe the wrap objectively (its location and basic pressure) however the latest Chicago-criteria was not developed for after-surgery states. We can conclude that post-operative routine HRM can mislead the physician, has importance only in patients with significant complains.

Disclosure
All authors have declared no conflicts of interest.
PS01.008: LOWER ESOPHAGEAL SPHINCTER PRESSURE (LESP) AS A MEASURE OF ANTI-REFLUX BARRIER IN PATIENTS WITH HIATUS HERNIA
Authors: Kovacs Balazs , Masuda Takahiro , Bremner Ross , Mittal Sumeet 
Published: September 2018

Abstract

Background
Hiatus Hernia (HH), with its anatomical/physiological derangement of esophagogastric junction (EGJ) barrier function is a risk factor for pathological gastro-esophageal reflux (GER). However, a subset of patients with HH do not have reflux. The aim of this study is to explore Lower Esophageal sphincter parameters and GER across the EGJ in patients with manometeric type C hiatal hernia (LES-Crural Diaphragm separation > 1cm, and Pressure Inversion Point below LES).

Methods
An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients who underwent High Resolution Manometry and 24h pH study (within 1 week) between 11/01/2016 and 11/01/2017. HRM characteristics of the EGJ (LES-CD separation, overall length, LESP, LESPI), 24 hour pH score, and pH < 4 holding time were extracted. Spearman's Rho correlation was calculated for all parameters and Receiver operating characteristic (ROC) curve was applied for parameters with significant correlation.

Results
A total of 1139 patients underwent HRM during the study period, of these 416 also had 24 hour pH study. 76 Patients met criteria for EGJ morphology Type C. After excluding patients with major disorders of peristalsis (16) the remaining 60 patients form the cohort of this study. Hiatal hernia size, overall length of LES, and LESPI did not correlate with 24 hour pH score or pH < 4 holding time. LESP had a significant negative correlation both with 24 hour pH score (R: -0.322; P = 0.011), and total acid holding time (R: -0.348; P = 0.006). A LESP cut-off value of 24.4 mmHg had a sensitivity of 53.8% and a Specificity of 91.2% for predicting pathological reflux.

Conclusion
A higher LESP (> 24.4 mmHg) appears to provide an effective barrier to pathological GER even when normal EGJ function is compromised by a hiatal hernia.

Disclosure
All authors have declared no conflicts of interest.
PS01.012: LAPAROSCOPIC REMEDIAL MYOTOMY FOR RECURRENT ESOPHAGEAL ACHALASIA
Authors: Capovilla Giovanni , Salvador Renato , Briscolini Dario , Nicoletti Loredana , Perazzolo Anna , Valmasoni Michele , Merigliano Stefano , Costantini Mario 
Published: September 2018

Abstract

Background
Revisional surgery is sometimes necessary after failed laparoscopic Heller myotomy for esophageal achalasia. We evaluated the feasibility complications and final outcome of laparoscopic revisional myotomy (LRM) for recurrent esophageal achalasia.

Methods
Post-operative outcome after LRM at our Institution between 2000 and 2017 was assessed by a symptom questionnaire, endoscopy, barium swallow and pH-monitoring.

Results
Forty-one patients underwent LRM: 7 from our series, 34 from elsewhere. Primary treatments included laparoscopic (20 pts) or open (5) Heller-Dor; laparoscopic (6) or open (7) Heller-Nissen; 3 pts had open myotomy only. Thirty-four pts (83%) underwent a median of 3 (1–6) pneumatic dilations (PD) between primary operation and LRM. All the operations were performed laparoscopically. The median operating time was 180 minutes (65–260). One patient was converted to open for a mucosal lesion. The fundoplication was dismounted, when present. A new myotomy, longer than the previous one (especially on the gastric side), was performed in a healthy tissue, on a different quadrant of the esophageal wall. A fundoplication was reconstructed in 29 patients (70.7%) by performing a Dor (24 pts) or a Toupet (5) procedure. Two patients needed laparoscopic revision on 2nd post-operative day (POD) for radiological evidence of an obstructive fundoplication. One patient required revision on 2nd POD for a leakage, treated by suture and conversion from a Toupet to a Dor. Median follow-up time was 76 months (2–179). After revisional surgery, 27 pts had a resolution of their symptoms (66%), whereas other 6 (14.6%) needed further PD to achieve a satisfactory outcome. Other 4 patients (9.8%) still need periodic PD and 3 patients (7.3%) required esophageal resection. Endoscopic gastrostomy was necessary in one patient (2.4%) who wasn’t suitable for resection. Reflux was detected in 11 patients (26.8%).

Conclusion
LRM is feasible when primary surgery has failed. One-third of the patients still require repeat dilations or esophagectomy, especially in case of megaesophagus. Albeit this is a more difficult operation and carries significant morbidity, LRM may provide the resolution of symptoms to an overall 80% of this group of patients, highly refractory to standard treatments.

Disclosure
All authors have declared no conflicts of interest.
PS01.015: TIMED BARIUM ESOPHAGRAM (TBE) IS RELIABLE IN DEFINING RESPONSE TO TREATMENT AFTER HELLER-DOR FOR ACHALASIA: INITIAL SINGLE CENTER EXPERIENCE
Authors: Zanoni Andrea , Verlato Giuseppe , Ventura Luisa , Armelao Franco , Lauro Enrico , Bonadies Enzo , Scudo Giovanni , Zanella Simone , Mazzetti Cristian , Preciso Elisabetta , De Pretis Giovanni , Della Sala Sabino , Ricci Francesco 
Published: September 2018

Abstract

Background
Routine timed barium esophagram (TBE), before and after Heller myotomy and Dor funduplication for achalasia, could offer the unique opportunity to objectively measure the outcome of the surgical procedure. In an initial single center experience we aimed at comparing pre-operative and post-operative TBE to objectively measure esophageal emptying and dilation, and to look for possible factors related to surgery results.

Methods
From 2016 to 2017, 11 patients underwent Heller myotomy and Dor funduplication for achalasia at a single center; all had a pre-operative and post-operative TBE after one month of surgery. TBE measured height and width of barium column at 1 and 5 minutes. All patients were staged according to radiological achalasia staging system: 1 patient was stage 1 (pre-operative esophageal width between 2 and 3 cm), 4 stage 2 (4–6 cm) and 6 stage 3 (> 6 cm). TBE height and width at 1 and 5 minutes were compared between pre-operative and post-operative TBE by the Wilcoxon signed-rank test. Moreover the association between surgery results and possible risk factors was evaluated by Spearman's rho.

Results
TBE height and width at 1 minute decreased in median by 79% (range 17–100%) and 57% (37–100%), respectively, from pre-operative to post-operative TBE. The decrease was more pronounced at 5 minutes, where it was 85% (40–100%) and 71% (40–100%), respectively. Although all patients reported a significant subjective improvement in symptoms, radiological stage was associated to esophageal emptying: the 4 subjects in stage 2 and the subject in stage 1 had complete or near complete emptying at 5 minutes, while the 6 patients in stage 3 had a median percent decrease at 5 min in height of 75% (40–86%) and in width of 50% (40–71%) (Spearman's rho for height = -0.87, P < 0.001; Spearman's rho for width = -0.88, P < 0.001).

Conclusion
TBE is essential post myotomy, particularly if a substantial esophageal dilatation occurs pre-operatively (stage 3). Initial stage is associated with surgical outcomes, advanced stages being related to poorer emptying and more dilated esophagus after surgery. TBE is a reliable system to objectively define surgical outcomes and preserved esophageal function after Heller-Dor procedure.

Disclosure
All authors have declared no conflicts of interest.
PS01.016: ESOPHAGEAL DYSMOTILITY CAUSED BY ESOPHAGEAL EOSINOPHILIA REGULATES PATIENTS’ SYMPTOMS AND TREATMENT REQUIREMENTS
Authors: Hosaka Hiroko , Kuribayashi Shiko , Shimoyama Yasuyuki , Kawamura Osamu , Kusano Motoyasu , Uraoka Toshio 
Published: September 2018

Abstract

Background
Only a few studies –none from Asia– have been reported on high-resolution manometry (HRM) assessment of esophageal motor function in eosinophilic esophagitis (EoE). This study aimed to evaluate esophageal motility in Japanese patients with esophageal eosinophil infiltration and to clarify the association between esophageal dysmotility and symptoms, endoscopic findings, severity of eosinophilic infiltration, blood eosinophil count, and response to treatment.

Methods
Ninety-two patients underwent both esophageal manometry and endoscopic biopsy to determine eosinophil infiltration in esophageal mucosa, looking for esophageal motility disorders, between 2009 and 2016. Of these 92 patients, 18 patients (9 males, mean age, 52.5 years) who had esophageal eosinophilia (≥ 15 eosinophils per high power field)w ere enrolled in this study. Characteristic endoscopic findings included circular rings, linear furrowing, and white exudates. HRM [ManoScan; Given Imaging] was performed and evaluated by Chicago classification ver. 3.

Results
HRM revealed that 15 patients (83%) had esophageal motility disorders (7 achalasia, 2 esophagogastric junction outflow obstruction (EGJOO), 2 jackhammer esophagus, 1 diffuse esophageal spasm (DES), 3 Ineffective esophageal motility (IEM). Dysphagia was observed in all the patients with achalasia or EGJOO. GERD symptoms like regurgitation or heartburn occurred in most of the patients with EGJOO or IEM. Endoscopic findings of EoE did not differ among types of dysmotility. Severity of esophageal eosinophilia did not correlate with hypercontractile motility disorders. Four patients had blood eosinophilia; none of the achalasia patients or those with normal motility had blood eosinophilia. All the patients, except those with achalasia, were treated with a proton pump inhibitor (PPI). None of the patients with jackhammer esophagus or DES responded to PPI, but one (1/2, 50%) with EGJOO, one (1/3, 33%) with IEM, and two patients (2/3, 66%) with normal motility had their symptom relieved after PPI therapy. Seven patients, including 2 with achalasia, needed steroid therapy either by prednisolone or topical steroid orally. The patients with achalasia showed good temporary response to steroid, though they underwent ordinal myotomy afterwards. One with jackhammer esophagus did not respond to steroid therapy and needed repeated myotomy.

Conclusion
Symptom was a possible factor to predict a type of esophageal dysmotility. Presence of esophageal dysmotility may affect treatment strategy.

Disclosure
All authors have declared no conflicts of interest.
PS01.017: CLINICAL SPECTRUM AND PRESENTATION OF PATIENTS WITH APERISTALSIS
Authors: Kovacs Balazs , Masuda Takahiro , Bremner Ross , Mittal Sumeet 
Published: September 2018

Abstract

Background
Primary aperistalsis is an uncommon finding on high resolution manometry (HRM), and has been linked to autoimmune disorders. The goal of the study is to describe and explore clinical spectrum and presentation of this group of patients.

Methods
An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients with aperistalsis between 08/01/2016 and the 11/10/2017. HRM studies were reevaluated. Patients with poor studies, or insufficient clinical information were excluded. Patients with history of previous foregut surgery or esophagram consistent with achalasia were also excluded.

Results
A total of 1225 patients underwent HRM during the study period of which 36 (2.9%) met inclusion criteria and form the cohort of this study. In this group 30 patients also had UGI contrast study and endoscopy, while foregut symptom questionnaire was available for 24 patients. There were 16 (44%) females. The mean age was 57.6(± 13.58) Yrs. and mean BMI 26.28 (± 5.4) kg/m2. More than half (21/36) of the patients were undergoing lung transplant evaluation. 26 patients (72.2%) had history of autoimmune or immune mediated diseases (including 6 with Scleroderma and 11 interstitial lung disease). On symptom questionnaire, 75% (18/24) of patients reported heartburn, and 50% (12/24) reported dysphagia while 9 (37.5%) patients reported both. 9 of 36 patients had hiatal hernia on HRM, median IRP 4s was 4.8mmHg, average LESP was 21mmHg. On ambulatory pH-monitoring, 9/19 had pathological DeMeester scores. Endoscopic biopsy results showed columnar intestinal metaplasia in 16.7% (5/30) of patients. Esophageal candidiasis was confirmed in 2 (6.7%) cases. On esophagogram two (6.7%) were additionally diagnosed with Zenker's diverticula.

Conclusion
Aperistalsis on HRM is rare and covers a wide array of diseases; the usual clinical presentation is reflux and/or dysphagia. Interestingly only half these patients with absent motility have dysphagia. In our study a large number of patients were undergoing pre-lung transplant evaluation, this could either be due to causative underlying disease process or a result of deranged pulmonary dynamics affecting esophageal motility.

Disclosure
All authors have declared no conflicts of interest.