Cascade Stomach Research Articles

Cascade (cup and spill) stomach.

Cascade (cup and spill) stomach.

Effect of Preoperative Gastric Shape on Loss of Lean Body Mass After Distal Gastrectomy.

Based on gastric shape, patients with gastric cancer can be divided into storage (hook-shaped and ptotic stomach) and reverse outflow (steer-horn and cascade stomach) groups. In patients with gastric cancer, postoperative loss of lean body mass (LBM) is associated with a poor prognosis. This study investigated the influence of preoperative gastric shape on LBM loss 1 month after curative distal gastrectomy. Between May 2011 and May 2019, we enrolled 487 patients with pathological stage IA/IB/IIA gastric cancer who underwent curative distal gastrectomy and did not receive adjuvant chemotherapy. Patients were divided into storage (n=370) and outflow (n=117) groups according to whether barium was stored in the stomach during the preoperative fluoroscopic examination. Clinicopathological features, LBM 1 month after gastrectomy, and predictors of postoperative LBM loss were compared between the groups using multivariable logistic regression. The incidence of >5% LBM loss and >7.5% body weight loss 1 month postoperatively were significantly higher in the storage group than in the outflow group (p=0.003 and p=0.009, respectively). Multivariable analysis revealed that gastric shape [odds ratio (OR)=3.30, 95% confidence interval (CI)=1.95-5.59, p<0.001], male sex (OR=3.20, 95% CI=2.07-4.96, p<0.001), and Roux-en-Y reconstruction (OR=1.69, 95% CI=1.08-2.64, p=0.02) were independent predictors of LBM loss. Postoperative dietary problems, especially dumping syndrome, diarrhea, and reflux were more common in the storage group (p<0.001). Gastric shape may be a useful independent predictor of postoperative LBM loss in patients with gastric cancer undergoing distal gastrectomy.

Case of the Successful using the Gastro-Jejunal with Jejuno-Jejunal Anastomoses (and Gastropexy) for Treatment of the Cascade Stomach

Case of the Successful using the Gastro-Jejunal with Jejuno-Jejunal Anastomoses (and Gastropexy) for Treatment of the Cascade Stomach

Gastro-jejunal with jejuno-jejunal anastomoses for treatment of the case of cascade stomach

The cascade stomach (CS) is characterized as a changing of the gastric cavity to the “hour glass" two chambers formation. The disease is well presented in the gastroenterological and radiological literature. In the case of failure of conservative treatment, the surgery is indicated. Unfortunately, the information of operative treatment of this condition is limited. We present the case of the CS successfully treated by creation of the gastro-jejunal and jejuno-jejunal anastomoses.

Side-viewing scope insertion using a large-diameter overtube designed for colonoscopy in a patient with a cascade stomach.

Side-viewing scope insertion using a large-diameter overtube designed for colonoscopy in a patient with a cascade stomach.

The Evaluation of Gastric Emptying Using the 13 C-Acetate Breath Test in Neurologically Impaired Patients - A Focus on the Stomach Function and Morphology.

We explored factors affecting gastric emptying in neurologically impaired (NI) patients using the 13C-acetate breath test. Twenty-four NI patients were classified by the presence of gastroesophageal reflux disease (GERD), which was treated by fundoplication plus gastrostomy, or the absence of GERD, which was treated by gastrostomy alone, along with gastric malposition involving cascade stomach and organoaxial gastric volvulus (OGV). Gastric emptying parameters (GEPs), which were the emptying half time (T 1/2 , minute), the lag phase time (T lag , minute), and the gastric emptying coefficient (GEC), were measured before and after surgery. We evaluated the relationship between GEPs and GERD, gastric malposition, and surgical intervention. All data were expressed as the median (interquartile range). The T1/2 and GEC of patients with OGV were significantly worse than in those without OGV before surgery (T1/2 with OGV: 241.3 [154.9, 314.3] vs. T1/2 without OGV: 113.7 [105.2, 151.4], p = 0.01, GEC with OGV: 3.19 [2.46, 3.28] vs. GEC without OGV: 3.65 [3.24, 3.90], p = 0.02). GERD and cascade stomach were not associ ated with GEPs. The GEPs of all NI patients showed no significant difference between before and after surgery. The surgical change in T1/2 (ΔT 1/2 ) in the patients with OGV was significantly lower than in those without OGV (ΔT1/2 with OGV: -47.1 [-142.7, -22.1] vs. ΔT1/2 without OGV: -3.78 [-26.6, 12.0], p = 0.03). Stomach malposition, such as OGV, seems to affect gastric emptying and may be improved by surgi cal intervention.

Mass-like Appearance on 18F-FDG PET/CT: Cascade Stomach.

A 56-year-old female patient who had involuntary weight loss underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for detection of malignancy. The scan revealed non-metabolic soft tissue density in the posterior wall of the stomach requiring endoscopy. Endoscopical examination was performed 9 days after PET/CT and cascade stomach was detected. Cascade stomach is a rare entity that can be diagnosed by radiographic barium evaluations and endoscopy, the appearance on CT is largely incidental and CT has rarely been relied on for the diagnosis. We present this incidental case of cascade stomach on PET/CT to be familiar with the appearance.

Influence of gastric morphology on gastroesophageal reflux in adults: An observational study.

The study's aim was to determine if there was an association between gastric morphology and gastroesophageal reflux (GER). Few published studies have investigated the relationship between gastric morphology and the risk of GER.A total of 777 patients were randomly selected from 3000 to 3300 patients who presented at a medical center in Taipei for annual health checkups from early 2008 through to late 2010 and underwent a series of radiographs of the upper gastrointestinal tract (UGI). GER was recorded during the real-time fluoroscopic study. Thirty-nine participants had a follow-up endoscopy, and another 164 participants were followed up by a second UGI series 12 +/ −1.5 months later, from late 2008 through to early 2022. All participants completed a lifestyle and symptom questionnaire. The variables included current smoking and alcohol consumption. Participants who had heartburn and dysphagia were included in the study. Additionally, all participants underwent a limited physical examination which recorded age, sex, body mass index, and total cholesterol and triglyceride levels.All participants were classified into types 1 to 6 based on the gastric morphology determined from the first UGI. Cascade stomach is recognized by characteristic findings on UGI. Gastric types 2 and 3 tend to appear as cascade stomachs and were significantly associated with GER (P < .05) compared with the other groups. Morphologic type 5 appeared as an elongated sac extending downward into the pelvic cavity and was less likely to develop GER (P < .001). The results of follow-up studies by UGI and endoscopy were similar to those of the first UGI. Gastric morphologic type 2 was significantly associated, and type 5 was usually not associated, with GER and erosive esophagitis (P < .05) compared with the other groups, by both UGI and endoscopy.Gastric morphologic types 2 and 3, with cascade stomach, might provide a relatively easy method for the development of the GER phenomenon. Gastric morphologic type 5 appeared as an elongated sac that might reduce the incidence of the GER phenomenon. The study suggested that gastric morphologic type could influence the occurrence of GER.

Increase of transient lower esophageal sphincter relaxation associated with cascade stomach.

We previously reported that cascade stomach was associated with reflux symptoms and esophagitis. Delayed gastric emptying has been believed to initiate transient lower esophageal sphincter relaxation (TLESR). We hypothesized that cascade stomach may be associated with frequent TLESR with delayed gastric emptying. Eleven subjects with cascade stomach and 11 subjects without cascade stomach were enrolled. Postprandial gastroesophageal manometry and gastric emptying using a continuous 13C breath system were measured simultaneously after a liquid test meal. TLESR events were counted in early period (0–60 min), late period (60–120 min), and total monitoring period. Three parameters of gastric emptying were calculated: the half emptying time, lag time, and gastric emptying coefficient. The median frequency of TLESR events in the cascade stomach and non-cascade stomach groups was 6.0 (median), 4.6 (interquartile range) vs 5.0, 3.0 in the early period, 5.0, 3.2 vs 3.0, 1.8 in the late period, and 10.0, 6.2 vs 8.0, 5.0 in the total monitoring period. TLESR events were significantly more frequent in the cascade stomach group during the late and total monitoring periods. In contrast, gastric emptying parameters showed no significant differences between the two groups. We concluded that TLESR events were significantly more frequent in persons with cascade stomach without delayed gastric emptying.

The cascade stomach in girl 11 years old

The article presents observation of case of cascade stomach being accompanied with number of dyspeptic phenomena and abdominal pain in girl of 11 years old.

New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis

We recently demonstrated that cascade stomach detected by barium studies was correlated with upper gastrointestinal symptoms. We developed a new endoscopic classification of cascade stomach and examined its relationship with reflux esophagitis. Study 1: the classification (grades 0-3) was based on detecting a ridge that runs from the cardia toward the anterior wall crossing the greater curvature. Inter-observer variation was evaluated by kappa statistics when ten experienced endoscopists used this classification three times each. Study 2: in 710 consecutive subjects (500 men and 210 women) undergoing endoscopic screening, the grade of cascade stomach and incidence of reflux esophagitis were compared. In study 1, the kappa values at the third assessment were 0.85, 0.58, 0.50, and 0.78 for each grade, respectively, while overall agreement was 0.68. In study 2, the incidence of reflux esophagitis in men was 20% in grade 0, 17% in grade 1, 25% in grade 2, and 30% in grade 3, showing significant differences. Among women, the incidence of reflux esophagitis in each grade was 9, 3, 6, and 35%, respectively, also showing significant differences. Multivariate analysis showed that independent risk factors for reflux esophagitis were cascade stomach (odds ratio=2.20), body mass index, and hiatus hernia in men, as well as cascade stomach (odds ratio=9.01) and smoking tobacco in women. This endoscopic classification of cascade stomach showed acceptable inter-observer variation. Cascade stomach is a risk factor for reflux esophagitis.

Cascade stomach: a case report

Cascade stomach is an entity wherein there is biloculation of gastric cavity. The upper loculus is spherical in shape and the lower loculus is a narrow and tubular structure. Due to its morphological features, it is also known as “cup and spill stomach” or “champagne cup deformity”. Cascade stomach is well known to radiologists but its clinical spectrum is not well researched and there is much speculation about its pathological basis. There is limited data on the treatment of this condition in the literature. Treatment varying from psychiatric management and conservative measures to surgical intervention has been reported in individual case reports. We present a case of cascade stomach successfully treated with laparoscopic Nissen’s fundoplication along with the review of literature available on the subject .

Endoscopic Cascade Stomach Is a Risk Factor for Reflux Esophagitis

Introduction: We recently demonstrated (Kusano M, et al. Neurogastroent Motil, 2012) that both Japanese men and women with cascade stomach (CS) on barium studies have a markedly elevated incidence of upper gastrointestinal symptoms, especially reflux symptoms. We hypothesized that CS might not only be associated with symptoms, but also with esophageal mucosal injury. Methods: Study 1: We developed a new endoscopic classification of CS based on the fundal incisura angularis (ridge), which is observed immediately after the endoscope passes through the cardia. The classification comprised four grades: grade 0, no ridge between fundus and corpus; grade 1, a ridge between fundus and corpus at endoscope insertion; grade 2, the ridge is also seen by retroflexed observation; and grade 3, the ridge is still observed after full gastric inflation. To assess inter-observer variation of this classification by calculating kappa statistics, 60 endoscopic photos were selected, and grading of CS was done three times at intervals > 1 week by 10 experienced endoscopists. Study 2: In 500 consecutive men and 189 women undergoing endoscopy for health screening, the incidence of reflux esophagitis (RE) and the grade of CS were compared. RE was defined as changes exceeding grade A of the LA classification, while hiatus hernia (HH) was protrusion > 2 cm. Assessment was performed by the three endoscopists with the highest kappa values (kv) in Study 1. Multivariate analysis was also performed to identify factors (age, BMI, cigarette smoking, and alcohol intake) related to CS. Results: In study 1, the kv for inter-observer agreement at the 3rd assessment were 0.85, 0.58, 0.50, and 0.78 for CS grades 0, 1, 2, and 3, respectively, while the kv for overall agreement was 0.68. Kv increased significantly after repeated assessment. In study 2, CS was classified as grade 0, 1, 2, and 3 in 40%, 28%, 17%, and 13% of men, respectively. The incidence of RE was 20% in men with grade 0 CS, 17% in grade 1, 25% in grade 2, and 30% in grade 3, showing significant differences. In addition, the incidence of RE was 10% in women with grade 0 CS, 3% in grade 1, 9% in grade 2, and 29% in grade 3 (P=0.09). Multivariate analysis showed that CS, BMI, and HH were independent risk factors for RE. Conclusion: Our new endoscopic classification of CS was shown to be both usable and meaningful. CS was identified as an independent risk factor for RE, suggesting that it could have a potential role in various functional gastrointestinal disorders.

Tu1994 Increased Frequency of Transient Lower Esophageal Sphincter (LES) Relaxation in Cascade Stomach

Background: In the Chicago Classification (CC) peristaltic integrity is determined by the size of the largest break in the isobaric contour. However, bolus clearance might be affected by the occurrence of non-continuous breaks. The aim of the study was to assess the effect of peristaltic integrity on bolus clearance by using pressure-flow analysis. Methods: 22 solidstate high-resolution impedance manometry (HRIM) tracings of 10 liquid swallows of healthy asymptomatic adults (6M; mean age 36.1 SD 11.7 years) were retrospectively analysed using MMS analysis software (version 9.1). Measures of peristaltic integrity (largest break and total break size in cm of the 20mmHg isobar) were derived. Pressure-flow analysis was performed using purpose designed MATLAB-based software (AIMplot, T. Omari) which derived peak pressure (PeakP), intra-bolus pressure (IBP), bolus flow relative to peak pressure (PNadImp) and its timing to peak pressure (TNadImp-PeakP). In addition the pressure-flow index (PFI), a composite measure of bolus pressurisation relative to flow and the impedance ratio (IR) a measure of the extent of bolus clearance failure were calculated. Results: Out of 220 swallows, 214 were suitable for analysis. A strong correlation between total break size and the largest break in the isobaric contour was found (r=0.846,p=0.000). There was a trend towards larger break size and higher IR, with a stronger correlation for the largest break (table 1). Both largest break and total break size correlated with lower PeakP, lower PNadImp, lower IBP and longer TNadImp-PeakP. However, no correlation was found between larger break size and PFI. Conclusion: Largest break and total break size seem to characterize peristaltic integrity equally. Larger break size is associated with lower peristaltic pressurization and impaired bolus movement. There seems to be little quantifiable difference between the largest break and total breaksize in relation to bolus pressurization. Esophageal break size and AIM-derived pressure-flow metrics

A Case of Cascade Stomach

Purpose: We present a 47-year-old female with history of Grave's disease, history of longstanding dysphagia in the setting upper esophageal Killian Jaimeson diverticulum that later underwent open neck surgical procedure (diverticulopexy), who developed new persistent symptoms of severe dysphagia. Upon further investigation of dysphagia, via upper gastrointestinal series, patient was incidentally found to have findings consistent with cascade stomach. Upper gastrointestinal series under fluoroscopy showed aerophagia with significant swallowed air in the esophagus, stomach, and duodenum, with slight delay in barium transit but no obstruction or stricture. The stomach was found to be rotated in its long axis with initial pooling of barium in the retroflexed gastric fundus followed by slight delayed emptying in to the body. Findings were consistent with cascade stomach. Cascade stomach is diagnosed from the characteristic appearance of the stomach on barium studies. The cascade stomach consists of a biloculation of the gastric cavity into a ventral and dorsal recess and is a rare cause of upper abdominal symptoms. The causes of gastric cascade described in the literature are manifold, some of which include reflux symptoms, dyspepsia symptoms, or epigastralgia symptoms. This disorder is often difficult to diagnose or is not recognized, therefore, its true incidence is currently not known. We summarize and highlight a case of cascade stomach incidentally found in a patient who was being evaluated for dysphagia.Figure

Tu1149 Increased Inspiratory LES Pressure in Systemic Scleroderma: A Positive Add-on to LES Function?

society for the study of obesity (JASSO) (waist circumference ≥85 cm in men, ≥90 cm in women plus at least two of following, TGs ≥150 mg/dl and/or HDL cholesterol <40 mmHg, systolic BP ≥140 mmHg and/or diastolic BP ≥85 mmHg, FPG ≥110 mg/dl). Symptoms were classified as reflux-like, dysmotility-like, or ulcer-like. Statistical calculation was performed using Student's t and Weltch's t test ,chi-square test, and logistic regression analysis. Results: The incidence of MetS was significantly higher in the CS group than the control group: in males (55.4% vs. 36.7%, p<0.001), females (36.6% vs. 1.6%, p<0.001), and total (50.4% vs. 29.7%, p<0.001). Males with CS, compared to controls, had significantly higher BMI (25.8±3.2 vs. 24.0±2.7 kg/m2, p<0.0001), waist circumference (89.0±8.6 vs. 84.7±7.6 cm, p<0.001), LDL cholesterol (133.14±76.7 vs. 122.0±31.0 mg/dl, p<0.05), TGs (154.9±110.8 vs. 134.7±83.0 mg/dl, p<0.05), and lower HDL cholesterol (50.7±11.8 vs. 55.1±16.7 mg/dl, p<0.001). Females with CS, compared to controls, had significantly higher BMI (27.3±4.8 vs. 22.1±3.7 kg/m2, p<0.0001), waist circumference (87.7±13.0 vs. 79.4±10.2 cm, p<0.0001), systolic BP (121.3±16.4 vs. 112.6±18.4 mmHg, p=0.0017), diastolic BP (74.5±12.2 vs. 69.0±10.9 mmHg, p=0.0034),and FPG <110 mg/dl. (97.6±10.5 vs. 93.4±9.1 mmHg, p<,0.01) According to multivariate analysis, CS was an independent risk factor for reflux symptoms (odds ratio: 3.98, 95%; CI: 1.80-8.83, p<0.001). Additionally, BMI (odds ratio: 3.55, 95%; CI: 2.45-5.17, p<0.0001) was an independent risk factor for CS. Conclusion: CS correlates with MetS, and CS is a risk factor for reflux symptoms. This study suggests MetS-related visceral obesity causes upper GI symptoms via cascade stomach.

Tu1148 Cascade Stomach Correlates With Metabolic Syndrome, and Closely Relates to Upper GI Symptoms in Japanese People

Tu1148 Cascade Stomach Correlates With Metabolic Syndrome, and Closely Relates to Upper GI Symptoms in Japanese People

Cascade stomach is associated with upper gastrointestinal symptoms: a population‐based study

Cascade stomach (CS) is recognized by characteristic findings on barium studies. We prospectively investigated the relationship between CS and upper gastrointestinal (GI) symptoms. In subjects undergoing health screening, CS was diagnosed by barium studies. Consecutive persons (500 men and 127 women) with CS were identified and the same number of age-matched subjects without CS were selected as controls. Upper GI symptoms were classified as reflux symptoms, dyspepsia symptoms, or epigastralgia symptoms. Then, we prospectively analyzed barium studies to classify the gastric morphology and also assessed upper GI symptoms in consecutive 5008 men and 2736 women. BMI was significantly higher in men with CS than in controls, and also in women with CS than in controls. Upper GI symptoms were significantly more frequent in the CS group than the controls among both men and women, especially reflux symptoms. In men, logistic regression analysis identified CS as an independent risk factor for upper GI symptoms (odds ratio = 1.771, P = 0.005) and for reflux symptoms (odds ratio = 2.07, P = 0.009). In women, CS was also significantly related to upper GI symptoms (odds ratio = 2.544, P = 0.020). The prevalence of CS was significantly higher (P < 0.0001) among symptomatic men than among those with no symptoms. Gastric morphology is related to upper GI symptoms in both men and women. Cascade stomach should be reconsidered as a pathophysiological factor associated with upper GI symptoms.

Cascade Stomach Promotes, While Gastroptosis Ameliorates, Upper GI Symptoms

Cascade Stomach Promotes, While Gastroptosis Ameliorates, Upper GI Symptoms

Diagnostic accuracy of cascade stomach by upper gastrointestinal endoscopy in patients with obscure symptoms: A multi-center prospective trial

Cascade stomach (CS) is a deformity of stomach, capable of leading dyspepsia, and its actual incidence is unknown. We investigated its frequency and performed a preliminary study to determine endoscopic diagnostic criteria. One thousand four hundred and seventy-five consecutive patients were enrolled to this study. A criteria for CS in endoscopy was defined as follow: A fundal pouch after cardia, difficulty in passage from fundus to corpus and/or requiring a manoeuvre, an angulation separating fundus-corpus. Cases having all three criteria were considered as complete CS (CCS) only the third one as borderline CS (BCS). CS was diagnosed endoscopically in 33 (2.5%) and radiologically in 32 (2.4%) of patients with dyspepsia. Among endoscopically diagnosed CS patients, CCS was found to be present in 17 and BCS was found to be in 16 patients. Patients in whom CS was diagnosed endoscopically, radiological examination revealed CCS in 18 patients, BCS in 14 patients, and 1 patient with normal findings were detected. There were no significant differences between these two groups (P=0.559). CS can be presented with various upper abdominal symptoms, and it can easily be diagnosed when endoscopic criteria are considered.