Esophageal adenocarcinoma developing above an Angelchik prosthesis

Abstract

The Angelchik device is a horseshoe-shaped prosthesis made of silicone elastomer; it was inserted by the trans-abdominal route to encircle the lower esophagus and was used in the treatment of gastro-esophageal reflux disease. Over 25 000 were inserted worldwide, with acceptable symptom control in between 54% and 95% of patients. However, they were associated with a wide variety of complications, including intractable dysphagia, prosthesis migration and erosion into the stomach, and a significant proportion had to be removed. This article details the cases of three patients in our institution who underwent the insertion of an Angelchik prosthesis and who subsequently developed adenocarcinoma of the esophagus. It is suggested that the Angelchik prosthesis does not effectively prevent acid reflux and thus has no effect in preventing the dysplasia-metaplasia-adenocarcinoma sequence in the lower esophagus.