Sa1909 Fatty Acid Synthase Modulates NSAID Sensitivity via 15-Hydroxyprostaglandin Dehydrogenase (15-PGDH): Implications for Personalizing Chemopreventive Strategies

Abstract

G A A b st ra ct s for intractable anastomosis stenosis resistant to repeated EBD.(Purpose)The utility of mucosal incision with steroid injection for intractable anastomotic stenosis after gastrectomy is considered.(Material and Methods)The data of a total of 520 consecutive patients who underwent gastrectomy between 2009 and 2014were analyzed retrospectively with a view to determining the incidence of anastomotic stenosis. The period after operation when symptoms of stenosis appeared, methods of gastrectomy and reconstruction of surgery, complications, methods of treatment of stenosis, times of EBD, and the period until symptoms were disappeared were analyzed. We performed EBD only for cases with severe anastomosis stenosis. Mucosal incision was performed by needle knife for thickest part of stricture scar. As steroid injection, 80mg triamcinolone was performed for lack of mucosa after mucosal incision. (Results)Seven patients (1.3%) were developed severe stenosis which needed to be treated by EBD. The median interval between the surgery and detection of stenosis was 1.5 months. The methods of operation and reconstruction after gastrectomy are proximal gastrectomy with esophagogastric anastomosis for 6 patients and with esophago-jejuno anastomosis for 1 patient. 3 patients were added mucosal incision and steroid injection. No serious complication was happened . The median time of EBD until the lumen was kept was 7 times in all patients. The median period after first EBD until the lumen was kept was 10 months in patients conducted only balloon dilatation without mucosal incision, while the median period after mucosal incision was 1 month in patients with mucosal incision(P<0.001).(Conclusion) Mucosal incision with steroid injection was shown to be safety and useful method for severe anastomotic stenosis after gastrectomy. The adaptation of this method is thought to be cases with severe stricture of anastomoses resistant to EBD dilatation, which shows thick scar and restenosis by mucosal defect by EBD. Steroid mucosal injection is thought to be very useful for maintaining the lumen without stricture. Mucosal incision with steroid injection showed to have possibility to improve stenosis for severe stricture resistant of EBD in a short period.