bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.020: OPTIMISTIC PATIENTS AND ITS HIDDEN PERILS: A REVIEW OF ACID REFLUX IN INDIVIDUALS POST PER-ORAL ENDOSCOPIC MYOTOMY (POEM)
Authors: Zhi Lim Tian , Qi Leong Wei , Chin Teo Siok , Chen Elya , Wei Kim Guo , Shabbir Asim , Yan Bok , So Jimmy 
Published: September 2018

Abstract

Background
Per-Oral Endoscopic Myotomy (POEM) has been adopted as a treatment option for Achalasia, with similar efficacy and safety profile as laparoscopic Heller Myotomy. However, issues of acid reflux and reflux oesophagitis have often plagued these patients. We aim to evaluate the clinical outcomes and resolution of reflux disease among individuals post-POEM.

Methods
A prospective review was performed for all patients who have undergone POEM from January 2014 to December 2017, with individuals analysed at the 1 year mark post-POEM. Subjective assessment of reflux was performed using self-administered questionnaires, with 24h pH impedence test and high resolution manometry providing objective correlation.

Results
Forty-three individuals underwent POEM during the 4 year period. The median age was 52 years (range, 24–78), with half being males (53.5%). The individuals had a median ASA score of 2 (range, 1–3). Majority of the individuals had type II achalasia (58.1%) followed by type I (34.9%) and type III (7%). Patients presented with dysphagia (88.4%) and reflux (10%); symptomatic for a median of 36 months (range, 3–540). One-third required the use of proton pump inhibitors (PPI) for symptomatic relief, with 35% receiving prior interventions for achalasia. These patients had a median Integrated Relaxation Pressure (IRP) of 23.6 mmHg (range, 4.6–160) and a median Eckardt score of 6 (range, 1 -11). One-third developed complications such as mucosal injury (18.6%), carbon dioxide pneumoperitoneum (16.3%) and bleeding (4.7%). The median length of stay was 3 days (range, 1–6). At the 1 year mark, 86% reported improvement in dysphagia (p: 0.043) with 66% having reduction in ratings for their severity (p: 0.002) and frequency (p: 0.05) of reflux. The median IRP (23 vs 13 mmHg) was also significantly lower (p: 0.005). However, only 38.5% correlated with a normal acid exposure on the impedence test (p: 0.592).

Conclusion
POEM is a promising solution in the management of achalasia given good clinical response for dysphagia and reflux. However, excessive lower oesophageal acid exposure may still be present in almost half of these patients, which may be alleviated with the use of long term use of PPI.

Disclosure
All authors have declared no conflicts of interest.
PS01.022: EVALUATION OF THE EFFECT OF THE HORMONE STATUS ON GASTROESOPHAGEAL REFLUX DISEASE, ESOPHAGEAL MOTILITY DISORDERS AND GASTROINTESTINAL SYMPTOMS
Authors: Weitzendorfer Michael , Wahl Lisa , Emmanuel Klaus , Koch Oliver 
Published: September 2018

Abstract

Background
The aim of the study was to evaluate, if gastroesophageal reflux disease (GERD), esophageal motility disorders and gastrointestinal symptoms are influenced by the levels of hormones.

Methods
One-hundred patients with symptoms of GERD were included in the study. All patients routinely underwent 24-hours esophageal impedance pH-monitoring (MII-pH) and high-resolution esophageal manometry (HRM). Symptoms were evaluated using the Reflux-symptom index (RSI) and symptom check list (SCL) questionnaire. Blood samples were taken to analyze the levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4), gastrin, vasoactive intestinal peptide (VIP) and calcitonin. According to the results of HRM, patients were subdivided into three motility disorder groups: patients with EGJ (esophageal gastric junction) outflow obstruction or major motility disorders (group I), patients with minor motility disorders (group II) and patients with normal esophageal motility (group III). According to the results of 24h-pH-impedence-monitoring patients were divided in patients with and without objective GERD.

Results
Complete data was available from 86/100 patients (44 men, 42 women with a median age of 56 years). Motility disorders were found in 38/86 patients (22 in group I, 16 in group II). A pathological DeMeester score was found in 45/86 patients (median score 35). No correlation between different hormone levels and DeMeester score, LES-pressure and patients with motility disorders (group I, II) was found. A significant difference regarding calcitonin level was found between group I and III (P = 0043). Furthermore a strong inverse relation between calcitonin and the Integrated Relaxation Pressure (IRP) was found (r = -0492; P = 0000). Positive correlations were found between VIP and GI-Symptoms (r = 0298; P = 0011), as well as correlations between FT3 and dysphagia (r = 0283, P = 0016).

Conclusion
Calcitonin could have an effect on the function of the EGJ and esophageal motility. The hormones TSH, FT3, FT4, VIP and gastrin do not affect the motility of the esophagus and the EGJ. The levels of the evaluated hormones do not influence distal acid exposure. Thyroid hormones, as well as VIP seem to influence gastrointestinal symptoms.

Disclosure
All authors have declared no conflicts of interest.
PS01.024: ENDOSTIMTM THERAPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS
Authors: Matthias Corvinus Florian , Hadzijusufovic Edin , Babic Benjamin , Lang Hauke , Grimminger Peter 
Published: September 2018

Abstract

Background
Electric stimulation of the lower esophageal sphincter is a new surgical option for patients with gastroesophageal reflux disease (GERD) and a diaphragmatic hernia less than 3 cm. In comparison to standard anti-reflux procedures like Nissen or Toupet fundoplication the procedure`s advantage is that there had been no report on postoperative dysphagia. Esophageal motility disorders can increase the risk of dysphagia after fundoplication. Therefor EndostimÔ might be an alternative for these patients.

Methods
Between December 2015 and November 2017 twelve patients with GERD received Endostim™ therapy. All patients underwent endoscopy, high resolution impedance manometry (HRIM), 24 hour impedance pH-monitoring and a barium swallow. Quality of life was assessed by GERD-HRLQ a validated questionnaire.

Results
Seven patients with an esophageal motility disorder received an Endostim™ due to symptomatic GERD. Three patients had an esophageal hypomotility, 2 patients had a CREST syndrome and 2 patients showed a functional outflow obstruction in HRIM. There were no postsurgical complications. No dysphagia, regurgitation or retrosternal pain was reported. After a follow up of 6 months all patients are satisfied with the procedure and report an increase of their quality of life.

Conclusion
These results demonstrate the feasibility of an Endostim™ therapy in patients with esophageal motility disorders for the first time.

Disclosure
All authors have declared no conflicts of interest.
PS01.026: CHANGES IN SURGICAL PROCEDURES AND SHORT-TERM OUTCOMES FOR ACHALASIA SINCE THE INTRODUCTION OF POEM
Authors: Yano Fumiaki , Omura Nobuo , Tsuboi Kazuto , Hoshino Masato , Yamamoto Se-Ryung , Akimoto Shunsuke , Masuda Takahiro , Nishikawa Katsunori , Mitsumori Norio , Kashiwagi Hideyuki , Matsui Hiroaki , Sumiyama Kazuki , Yanaga Katsuhiko 
Published: September 2018

Abstract

Background
In our institution, laparoscopic Heller-Dor procedure (LHD) has been the first-line surgical procedure for achalasia since the introduction in August 1994, and 578 patients underwent LHD until January 2018. In January 2016, per-oral endoscopic myotomy (POEM) was started, taking into patients’ needs into consideration. Since then, treatment options have expanded to include balloon dilation, conventional LHD, LHD by reduced port surgery (RPS), LHD by needlescopic surgery (NS), and POEM. Here, we report changes we have observed in surgical procedures and short-term outcomes since the introduction of POEM.

Methods
The subjects were 82 patients (mean age 47.4 ± 14.7 years, 39 women) who underwent surgery for achalasia from January 2016 to January 2018. After explaining the advantages and disadvantages, the choice of surgical procedure was decided by the patient.

Results
The surgical procedures consisted of LHD in 57 (including 1 RPS and 33 NS) and POEM in 25 patients. A total of 7 peri-operative complications (POEM = 1) were observed in 7 patients (9%), consisting of gastroesophageal mucosal injury (7%, LHD) and injuring of esophageal longitudinal muscles (2%, POEM), while dysphagia improved in all patients. Postoperative reflux esophagitis was observed in 9 patients with POEM (36%), which was significantly higher than 6 patients (11%) in LHD (P = 0.0173).

Conclusion
While 30% of patients underwent POEM, reflux esophagitis occurred at a higher rate in POEM as compared to LHD.

Disclosure
All authors have declared no conflicts of interest.
PS01.029: QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL ACHALASIA AFTER VIDEO-LAPAROSCOPIC SURGERY
Authors: Jiménez Raul , Roque González Rosalba , Angel Martínez Miguel , Anido Vivianne , Neri Pinol Felipe 
Published: September 2018

Abstract

Background
Achalasia is the most frequent motor disorder of the esophagus associated with dysphagia, regurgitation, weight loss and a decline in the quality of live. Videolaparoscopic surgery remains the gold standard, however health related quality of live measurements still necessary to asses treatment results and the impact on their lives. Asses health related quality of live in patients with esophageal achalasia after videolaparoscopic surgery.

Methods
Observational descriptive longitudinal and prospective study, by using GIQLI questionnaire before, three months and a year after videolaparoscopic surgery in patients with achalasia from January to December 2015 in the National Center of Minimally Invasive Surgery. Percentages for qualitative variables, means ± SD of the mean for quantitative variables. To asses health related quality of live a variance analysis of repetitive measures was made (ANOVA) with level of statistical significance α = 0.05.

Results
34 patients included; 14 men (41,2%); 20 women (58,8%), with a median age of 44,8 years, preoperative median GIQLI score 85,6 (± 20,9), median GIQLI at follow-up of three months was 125,2 (± 12,4) and twelve months was 134,0 (± 9,6) P = 0000.

Conclusion
Videolaparoscopic surgery improve health related quality of live in patients with esophageal achalasia.

Disclosure
All authors have declared no conflicts of interest.
PS01.032: OUTCOMES OF MINIMALLY INVASIVE MYOTOMY FOR THE TREATMENT OF ESOPHAGEAL ACHALASIA
Authors: Roque González Rosalba , Angel Martínez Miguel , Anido Vivianne , Torres Rafael , Jiménez Raul , Neri Pinol Felipe , Bencil Samira 
Published: September 2018

Abstract

Background
Laparoscopic Heller myotomy and fundoplication is considered today the treatment of choice for achalasia. The primary objective of this study was to review our experience in minimally invasive myotomy as primary therapy for the treatment of esophageal achalasia.

Methods
A retrospective analysis of a prospective database was made in which 253 clinical histories of patients diagnosed with EA were reviewed. These patients underwent primary laparoscopic Heller´s myotomy from January 2010 to December 2016. Duration of symptoms, previous endoscopic treatments, degree of dilation of the esophagus and clinical progress were some of the variables assessed. Postoperative assessment was obtained through the attending physicians’ consultations and recorded in the clinical history at six months and one year. Vantrappen and Helleman´s classification was used.

Results
253 Heller´s myotomies were performed by laparoscopic approach. The mean age of the patients was 47 years (range, 16 to 86). Duration of the symptoms was between 7 and 360 months, with an average of 54 months. The mean operative time was 100 minutes (range 90–210). Average hospital stay was one day. There were no conversions and no mortalities. Four patients (1,1%) underwent redo surgery. The clinical progress was excellent in 98,5% of patients.

Conclusion
Laparoscopic myotomy is the first line of treatment of esophageal achalasia. In this series of patients, laparoscopic Heller´s myotomy was an effective and safe treatment for esophageal achalasia.

Disclosure
All authors have declared no conflicts of interest.
PS01.033: THE ROLE OF EARLY LAPAROSCOPY IN CORROSIVE INJURY OF ESOPHAGUS AND STOMACH
Authors: Chou Yi-Pin 
Published: September 2018

Abstract

Background
Corrosive agents usually induce chemical burn of upper gastro-intestine tract. Most patients could be managed successfully with medical treatment, but damage control surgery (DCS) with esophagectomy and gastrectomy are required when trans-mural necrosis is progressed. Making decision of timing on these radical surgeries is quite difficult in patients without initial peritoneal signs.

Methods
From Feb. 2007 to Oct. 2016, patients with corrosive injury without indication of emergent DCS were included. All these patients were divided into two groups. The Group 1 receives early laparoscopy within 24 hours after accidents. The other patients receive observations and surgical intervention once organs injuries are progressed. All basic demographic data and clinical outcomes were recorded.

Results
Total 65 patients were included. 14 patients receive emergent laparoscopy as Group 1. The other 51 patients receive close observations as Group 2. Two patients in Group 1 convert to DCS and the other patients receive gastrostomy and feeding jejunostomy. 18 patients in Group 2 receive DCS due to progressing peritoneal signs. Rates of esophageal stricture and stomach contracture are higher in Group 2 (8.3% vs. 48.5%, P = 0.014).

Conclusion
Early laparoscopy is a good diagnostic tool in corrosive injury patient without obvious peritoneal signs. This method could early detect trans-mural necrosis. In addition to diagnosis, laparoscopy could also perform gastrostomy for adequate drainage that could prevent esophageal and gastric stricture.

Disclosure
All authors have declared no conflicts of interest.
PS01.037: APPLYING THORACIC ENDOVASCULAR AORTIC REPAIR (TEVAR) AND SURGICAL RESECTION WITH RECONSTRUCTION OF ESOPHAGUS IN MANAGING OF AORTA-ESOPHAGEAL FISTULA
Authors: Chou Yi-Pin , Lin Hsing-Lin 
Published: September 2018

Abstract

Background
Aorta-esophageal fistula (AEF) is very dangerous with high mortality. Treatment is difficult because of hemorrhagic shock in acute stage and infection in sub-acute stage. We develop a method to manage both perforations from aorta and esophagus successfully.

Methods
A 56 male patient had fish bone incarcerated in thoracic esophagus. Two months after this accident, intermittent massive hematemesis occurred. The esophagoscopy displayed active bleeding and AEF was diagnosed by computed tomography angiography (CTA). TEVAR is applied immediately and stopped bleeding successfully. Fever with sepsis and mediastinitis was happened after oral intake. The perforated esophagus was removed by wire-stripper through neck and abdomen incisions and reconstructed with gastric tube via retro-sternal route.

Results
After subtotal esophagectomy with gastric tube reconstruction, the ventilator is weaned and endotracheal tube was removed. No leakage from anastomosis between cervical esophagus and gastric tube. Patient could swallow regular diet smoothly. No further post-operative complication was happened after follow up two years.

Conclusion
TEVAR is the first step in managing AEF in acute stage to prevent hemorrhagic shock. Although esophageal perforation could be managed with esophageal stent, the marginal ulcer with pain and bleeding may cause other side effects. Esophageal stent is also another contra-indication applied in benign disease. Subtotal esophagectomy with wire-stripper and reconstruction with gastric tube could provide definite treatment for this esophageal perforation.

Disclosure
All authors have declared no conflicts of interest.
PS01.039: RECURRENCE PREDICTION EQUATION OF ESOPHAGEAL VARICES
Authors: Iwamoto Takuya , Ishikawa Tsuyoshi , Sakaida Isao 
Published: September 2018

Abstract

Background
Endoscopic treatment is widely performed for esophageal varices, but prediction of post-treatment recurrence is difficult.

Methods
The subjects were 298 patients with cirrhosis who underwent initial endoscopic treatment for esophageal varices from January 1997 to December 2010 and were followed-up at our hospital. The average age was 64.5 years (29–84) and the male/female ratio was 119:89. The causes of cirrhosis were hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholism, non-alcoholic steatohepatitis (NASH), and others in 66, 14, 13, 3 and 4% of the subjects, respectively. Hepatic reserve capacity before treatment was Child-Pugh score 6.9 ± 1.5 points, albumin 3.2 ± 0.6 g/dl, total bilirubin 1.4 ± 0.7 mg/dl, and PT% 71.0 ± 13.8%. Complication of hepatocellular cancer (HCC) was present in 63 subjects (30.4%). Treatment-indicated recurrence was defined as ³F2 and ³RC2. Recurrence occurred in 102 subjects, including 65 who redeveloped varicosity within 1 year. Data were compared between patients with (n = 65) and without (n = 43) early recurrence (within 1 year).

Results
The early recurrence group had a significantly higher Child-Pugh score (7.4 ± 1.8 vs. 6.7 ± 1.3, P < 0.01), total bilirubin (1.6 ± 0.8 vs. 1.2 ± 0.6 mg/dl, P < 0.01), and HCC complication rate (44.6% vs. 23.9%, P < 0.01), and significantly lower albumin (3.0 ± 0.7 vs. 3.3 ± 0.6 g/dl, P < 0.01) and administration rate of antihypertensive drugs (10.8% vs. 41.0%, P < 0.01). In multivariate logistic regression analysis, use of antihypertensive drugs, total bilirubin, HCC, underlying disease (alcoholism), and treatment method (endoscopic injection sclerotherapy [EIS] or endoscopic variceal ligation [EVL]) emerged as factors that affected early recurrence. Based on these findings, we developed the following predictive equation: recurrence time (months) = - 12.5206 (HCC: confirmed = 1, not confirmed = 0) - 3.5029 (total bilirubin) + 6.2169 (antihypertensive drug: used = 1, not used = 0) - 7.2581 (alcoholism: yes = 1, no = 0) - 6.0764 (EVL = 1, EIS = 0) + 35.7165. Based on this formula, we examined the predicted and actual recurrence times in 68 subjects from January 2011 to December 2012 and found a significant positive correlation between these data (R = 0.583, P < 0.01).

Conclusion
An equation was developed for prediction of recurrence of esophageal varices after treatment and was shown to have utility in actual cases.

Disclosure
All authors have declared no conflicts of interest.
PS01.041: REMOVAL OF ESOPHAGEAL HEMANGIOMA USING ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT AND REVIEW
Authors: Tani Yukiko , Nakajima Masanobu , Muroi Hiroto , Fujita Junki 
Published: September 2018

Abstract

Background
Esophageal hemangiomas are rare, representing around 3% of all benign esophageal tumors. Esophagectomy or tumor enucleation has been performed to treat esophageal hemangiomas, but recently the use of endoscopic therapy, such as endoscopic mucosal resection or endoscopic injection sclerotherapy, is increasing. We describe removal of a hemangioma using endoscopic submucosal dissection.

Methods
A 59-year-old woman underwent endoscopic examination after an esophageal lesion was found during a general health examination. Endoscopy identified a broad-based, elevated, dark purple lesion located 17 cm distal from the incisor teeth. It measured approximately 25 mm and was rounded and soft.Endoscopic ultrasonography using a 20-MHz catheter probe and the water filling method identified a tumor 25 mm in diameter located in the mucosal and submucosal layers. The border was unclear, but the bottom of the tumor was demarcated from the adjacent normal muscle layer. Compared with the adjacent muscle layer, the tumor was hyperechoic. On the basis of these endoscopic findings, the lesion was diagnosed as a hemangioma. Because the tumor was broad-based and relatively large, we thought that polypectomy or EMR should be avoided to prevent incomplete resection and postoperative hemorrhage from the residual stump. We therefore decided that ESD was the best treatment modality for this lesion.

Results
Approximately 2 mL of the solution was injected into the submucosal layer at intervals, which was repeated until the mucosa became elevated. After lifting the lesion, the mucosa including the tumor was gently cut with the Flush knife using the Endocut mode. The submucosal layer was highly fibrous, so lifting the lesion was somewhat difficult. The histopathological findings showed formation of a vascular lumen with irregular dilatation just below the lamina muscularis mucosa, suggesting a cavernous hemangioma. The patient was discharged 5 days after surgery without complications.

Conclusion
Until quite recently, large or broad-based esophageal hemangiomas had been treated by esophagectomy or sclerotherapy. Esophagectomy is associated with a high mortality rate [19], and endoscopic sclerotherapy may cause hemorrhage upon puncture, side effects due to the infused agents, and other complications. Endoscopic resection is less invasive than sclerotherapy, and further advances in endoscopic treatment and instruments may reduce the risk of several complications. ESD has being established as a safer, less invasive therapy than esophagectomy, it is perhaps the best therapeutic option for treating large or broad-based submucosal esophageal hemangiomas.

Disclosure
All authors have declared no conflicts of interest.
PS01.044: PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) IN THE TREATMENT OF REFRACTORY GASTROPARESIS: MID—TERM SINGLE CENTRE EXPERIENCE
Authors: Husťak Rastislav , Vackova Zuzana , Rabekova Zuzana , Spicak Julius , Martinek Jan 
Published: September 2018

Abstract

Background
Gastroparesis is a chronic, debilitating motility disorder. Effective treatment is challenging especially in patients with severe symptoms. G-POEM is an emerging modality for refractory gastroparesis with promising preliminary results. The aim of this prospective case series was to assess the first single-center experience with G-POEM. Main outcomes were: the clinical efficacy defined by an improvement of GCSI ≥ 40% from baseline; gastric emptying study (GES) and safety.

Methods
Since Nov 2015, a total of 8 patients have undergone G-POEM. The etiology of gastroparesis was post-operative in 5, diabetic in 2 and idiopathic in 1 patient. One patient underwent G-POEM for gastroparesis following a multivisceral transplantation; one underwent G-POEM and POEM as a single procedure for coexisting refractory idiopathic gastroparesis and achalasia. All patients had abnormal GES. F-u visit at 3, 6, 12 and 24M were completed in 7/8 (87.5%), 7/8 (87.5%), 5/8 (62.5%) and 1/8 (12.5%) of patients, respectively. Upper GI endoscopy and GES were performed 3M after G-POEM.

Results
G-POEM was successfully performed in all patients. Mean procedure time was 75 minutes (range 43–106). After G-POEM, in 7 patients mean GCSI decreased from 3.26 ± 0.96 to 0.79 ± 0.76 (at 3M; P = 0.018), 0,72 ± 0.69 (6M; P = 0.018) and 1.24 ± 0.85 (12M; P = 0.028). One women finished the 24M follow maintaining excellent outcome (mean GCSI 0.77). Treatment success was reached in 6/7 (85%) of patient at 3 and 6 months. GES normalized in all patients, mean T1/2 of GES decreased from 108 ± 30 to 62 ± 23min (P = 0.018); mean residual % at 4h decreased from 17 ± 9.2% to 2.0 ± 2.0% (P = 0.018). One patient developed bleeding ulcer 10 days after G-POEM, which was successfully managed endoscopically (clips) and by a parenteral proton pump inhibitor.

Conclusion
We report our first experiences with G-POEM for refractory gastroparesis, demonstrating its feasibility and safety with promising mid-term efficacy. A clinical effectiveness of G-POEM needs to be assessed in a large clinical trial.

Disclosure
All authors have declared no conflicts of interest.