Gastric Stenosis Research Articles

The Efficacy and Safety of Endoscopic Balloon Dilatation in the Treatment of Functional Post-Sleeve-Gastrectomy Stenosis

Background and Objectives: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. Patients and Methods: Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. Results: A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients’ clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. Conclusions: Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.

Saudi Female Sexual Dysfunction After Bariatric Surgery: A Cross-Sectional Survey.

Background Obesity disrupts the equilibrium of sexual hormones, resulting in decreased sexual desire, arousal, and orgasm. The aim of this study was to investigate the effects of substantial weight loss after bariatric surgery on sexual function, psychological health, and the overall quality of sexual life in a group of Saudi females. Method The study used a cross-sectional design and was conducted at King Fahad Hospital in Medina, Saudi Arabia. The study included adult female patients who had previously undergone bariatric surgery. We used the Sexual Quality of Life for Female (SQoL-F) and the Female Sexual Function Index (FSFI) questionnaires to collect data. The study was extended from January 1, 2021, to December 30, 2022. Results A total of 100 participants were included in this study, all the samples underwent vertical sleeve gastrectomy, their mean age was 36.7±9.3, 94% (n=94) of the respondents had high school education or above, 50.0%(n=50) were unemployed, and around 13% (n=13) of the samples had a psychiatric history. Surgery complications were reported in 10% (n=10), which were reported as esophagitis (n=4), gastric ulcer (n=2), gastric stricture (n=1), infection (n=2), and leakage (n=1). The median of the FSFI and SQoL-F was 47.0 and 24.5, respectively. Approximately 66% of the respondents agreed that their sexual lives improved after surgery, 22% did not feel any difference before and after surgery, and 9% witnessed deterioration. In total, 61.0% had female sexual dysfunction (FSD) (25% had no dysfunction afterward, 45% had mild dysfunction, 27% suffered mild to moderate dysfunction, and only 2% had severe dysfunction). Regarding SQoL-F, the mean score was 5.59 for sexual repression, 6.1 for self-worthlessness, 18.56 for sexual and relationship satisfaction, and 16.4 for psychological feelings. Conclusions Bariatric surgery was associated with the improvement of female sexual function.

Laparoscopic Gastrogastrostomy – An Alternative Procedure for Stenosis after Sleeve Gastrectomy

Abstract Introduction: Reflux symptoms associated with stenosis after laparoscopic sleeve gastrectomy can occur secondary to anatomical abnormality including mechanical stenosis and axial deviation, commonly occurring mid-sleeve. Treatment options include endoscopic intervention, including dilatation, stenting, myotomy, and surgical revision, with Roux-en-Y gastric bypass (RYGB) being preferred by many. In this case series, we report six patients who have undergone laparoscopic gastrogastrostomy (GG) for gastric stenosis and propose this as a possible surgical alternative for appropriately selected patients with symptomatic angularis stenosis. Patients and Methods: Medical records for six patients who underwent laparoscopic GG for treatment of persistent reflux symptoms due to angularis stenosis were reviewed. All patients were preoperatively investigated with endoscopy and abdominal three-dimensional computed tomography. Hiatal hernia and esophageal dilation were excluded. After further consultation, patients proceeded to laparoscopic GG. Results: Complete resolution of symptoms was reported in three of six patients, with Visick score 1, while the other three reported significantly improved symptoms. Postoperative body mass index remained similar to prerevision baseline. There were no postoperative complications. Conclusion: Revision to RYGB is effective for stenosis and reflux but can be challenging with the potential for long-term nutritional deficiencies and surgical complications. For patients with angularis stenosis, laparoscopic GG is a simpler revisional procedure that has shown adequate initial outcomes with no short or anticipated long-term complications in this case series. Patients with persisting symptoms could undergo subsequent gastric bypass if needed.

Гостро кровоточивий рак шлунка, ускладнений перфорацією

покращення та оптимізація діагностики та лікування ускладнень раку шлунка.Було проліковано 56 пацієнтів із ускладненим раком шлунка. Середній вік хворих становив56 років. З них жінок було 13 (або 23,21%), а чоловіків – 43 (або 76,79%). Під час всебічногодіагностично-лікувального моніторингу було виявлено, що 15 пацієнтів (або 26,79%) страждаливід шлунково-кишкової кровотечі, 12 пацієнтів (або 21,43%) мали стеноз шлунка різного ступеняважкості, а у решти 29 пацієнтів (або 51,79%) рак шлунка ускладнився перфорацією шлунка,при цьому у 21 пацієнта перфорація виливалася в кровотечу. Досліджували також вік, стать,передопераційну діагностику, місцезнаходження перфорації, глибину інвазії стінки шлунка,наявність метастазів у лімфатичних вузлах, вид операції, рівень лімфатичної диссекції, стадіюта інші ускладнення. Відсоток ускладнення у вигляді перфорації серед раку шлунка становив51,79%. Захворювання частіше зустрічалося на III/IV стадії (70%). Проведені операції:гастректомія у 16 хворих та атипова резекція зони ураження шлунка з відновленням дефектуу 10 пацієнтів. Смерть, пов’язана з хірургічним втручанням, спостерігалася у 4 пацієнтів.Було виконано 10 субтотальних гастректомій і 6 тотальних гастректомій. У 15 пацієнтівспостерігалася клінічно виражена шлунково-кишкова кровотеча, яка проявлялася у виглядімелени, гематемезису або у вигляді мелени та гематемезису одночасно (2,5%). Середнійвік становив 68 ± 12 (діапазон 47–87). Ускладнення у вигляді стенозу шлунка було виявлено у12 пацієнтів (21,43%). Під час дослідження у 5 пацієнтів було виявлено субкомпенсованийстеноз пілоричного відділу шлунка, у решти пацієнтів – декомпенсований стеноз. Вибір методуоперативного втручання проводився індивідуально, залежно від стану хворого, ступеня стенозуі характеру патоморфологічних змін, стану секреторної та моторної функції шлунка, наявностісупупровідньої патології та стадії раку шлунка. Перевагу надавали субтотальній резекціїшлунка. У цій групі пацієнтів наявний 1 випадок летальності, який був обумовлений ІV стадієюраку шлунка та декомпенсованим стенозом з вираженими розладами водно-електролітногобалансу і кислотно-лужної рівноваги.

Re-sleeve gastrectomy is a safe and sensible intervention in selected patients: retrospective cohort study.

Sleeve gastrectomy is a good treatment intervention to control the metabolic syndrome in patients with obesity worldwide. However, weight regain is of great concern and would usually necessitate a reintervention. In recent years, re-sleeve gastrectomy (ReSG) has been proposed to treat weight regain in the context of a large residual stomach. Our objective was to analyze the long-term results and safety profile of this intervention in a large case series. From September 2010 to March 2021, a retrospective cohort study in a tertiary nonuniversity hospital was performed. Seventy-nine patients received a ReSG by laparoscopy. Preoperative radiologic imaging showed a dilation of the gastric pouch exceeding 250cc in all cases. A total of 79 patients (87% females) with a mean age of 44.8 years old and a mean BMI of 40.0kg/m 2 were enrolled in the study. The mean follow-up was 44.8 months. The ReSG indication was insufficient weight loss in 37 patients (46.8%) and weight regain in 39 patients (53.2%). The authors noticed a 10.1% complications rate: gastric stenosis (5.1%), bleeding (2.5%), and incisional site hernia in 2.5%, with no death. There was no gastric fistula detected. The mean BMI decreased to 33.1kg/m 2 after ReSG (a decrease of 6.9kg/m 2 ). After insufficient weight loss or weight regain following sleeve gastrectomy and in the presence of localized or global gastric tube dilation, ReSG seems to be a good treatment choice and a safe procedure.

Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery.

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks. A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed. The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43years and a median follow-up of 24months. The mean preoperative body mass index was 45.1kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45days after the index surgery. Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.

Complications of endoscopic resection in the upper gastrointestinal tract.

Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

Esophageal and Gastric Stricture Formation Following Corrosive Ingestion in Our Local Population

Corrosive substances are defined as chemicals which cause injury upon coming in contact with living tissues such as the skin, gastrointestinal tract, respiratory tract and eyes. These include acids, alkalis, oxidizing agents, hydrocarbons among others. Objective: To determine the frequency and difference in the frequency of upper gastrointestinal stricture formation following corrosive ingestion in the gastroenterology unit of Lady Reading Hospital, Peshawar. Methods: This cross- sectional study was held in the Gastroenterology unit of Lady Reading Hospital, Peshawar from 16th July, 2019 to 16th Jan, 2019. Detailed history was taken from the patient and the container of the chemical ingested was examined to find out the duration since ingestion, amount of chemical ingested, and the type of chemical ingested (acid or alkali). Results: Mean and SD for age was 35 ± 5.55. Mean and SDs for duration since ingestion. Mean and SDs for amount of corrosive ingestion was 24 ± 1.54. 50 (34.48%) patients were recorded in 10-25 years’ age group and 95 (65.51%) patients were recorded in 26-40 years’ age group. 97 (66.89%) patients were male, and 48 (33.10%) patients were female. 41 (28.27%) patients had acidic corrosion and 104 (71.72%) patients had alkali corrosion. As per frequencies and percentages for stricture formation, 57 (39.31%) patients had stricture formation. Conclusions: Although the mortality and morbidity of corrosive gastric injuries is high, the key to improve the survival is early identification of perforation, maintenance of nutrition and control of sepsis.

S2892 A Novel Application of Double-Pigtail Plastic Stents for Endoscopic Treatment of Stenoses and Anastomotic Leaks Following Bariatric Surgery: Endoluminal Placement to Facilitate Gastrointestinal Flow

Introduction: Transmural double pigtail plastic stents (DPPS) for treatment of anastomotic leaks have shown high success rates ( >75%), while being well-tolerated and cost-effective. For example, DPPS can be endoscopically deployed across staple-line leaks following laparoscopic sleeve gastrectomy (LSG), often combined with dilation of distal sleeve stenoses or kinks. The rationale for this combination treatment is to promote internal drainage AND intraluminal flow. However, there may also be a beneficial role for endoluminal DPPS placement in the treatment of complex anastomotic leaks and luminal stenoses. We present a series of four patients with complicated post-bariatric anatomy successfully managed with endoluminal DPPS placement. Case Description/Methods: Patient 1: 50-year-old female POD5 from LSG and duodenal switch presented with symptomatic gastric sleeve stenosis. Dilation was considered too high-risk. Two 10Fr x 12cm DPPS were endoscopically placed spanning the stenosis, pylorus, and duodenal-ileal anastomosis with instant symptom relief. DPPS were removed on POD65 with continued symptom resolution. Patients 2 and 3: 67-year-old and 70-year-old females POD12 and 14, respectively, from duodenal switch with duodeno-ileal anastomotic leak and stricture. Two 7Fr x 3cm DPPS were deployed across the leak site. A third 10Fr x 3cm DPPS was placed across the anastomosis. All stents were removed on POD45 and POD65, respectively, following leak resolution. Patient 4: 34-year-old female POD3 from complex gastric bypass reversal and duodenal switch complicated by large staple line leak proximal to stenosis. A 10Fr x 3cm DPPS was placed across the leak site. A 10Fr x 9cm DPPS was placed across the gastric stenosis and duodenal-ileal anastomosis. Serial dilation of stenosis began on POD45. All stents were removed on POD95 with resolution of leak and stenosis. Discussion: Transluminal DPPS placement across anastomotic leaks is an effective, well-tolerated, and cost-effective treatment option. This case series suggests that intraluminal DPPS placement may also be clinically beneficial by promoting GI flow and ultimately diverting away from the leak site. Intraluminal DPPS can be used singly or in combination with transluminal DPPS. Applicable scenarios include newly post-operative gastric sleeve stenoses or kinks where dilation is too high-risk and duodenal anastomotic leaks with concomitant anastomotic stricture (where metal stent placement would be challenging and dilation likewise risky). (Figure)Figure 1.: a) Endoscopic image of moderate stenosis of the mid gastric sleeve POD 5 precluding safe dilation; b) two intraluminal DPPS traversing sleeve stricture with symptom resolution ; c) improved sleeve stenosis and continued symptom resolution following DPPS removal

Early and late complication of sleeve gastrectomy

The rate of obesity is on rise worldwide and almost 13% of the global population is obese leading to development of various other diseases and complications. Lack of effective outcome from conventional approach for weight control and loss is causing a transition among people to approach for bariatric surgeries. Sleeve gastrectomy is one of the surgical techniques of bariatric surgery aimed to achieve weight loss. Like any other surgical procedure, it also has certain post-operative complications associated with it. The complications of sleeve gastrectomy are further divided into early and late phase. The purpose of this research is to review the available information about early and late complication of sleeve gastrectomy. In the surgical treatment of morbid obesity, sleeve gastrectomy is the most widely performed bariatric procedure. It is a minimally invasive and risk-free surgery with a low risk of complications and death. The complication rates for early and late complication range from 5.4% to 7.3%, with incidence of serious complications ranging from 1.2% to 2.2%. Early complications include bleeding such as intraluminal or extraluminal, a leak in the staple line, and the formation of an abscess. While gastric stenosis, nutritional shortages, mediastinal pouch migration, and the development or worsening of gastroesophageal reflux disease are all late consequences. Older age, male sex, increased body mass index, smoking, and comorbidities are considered the risk factors for the development of complications of sleeve gastrectomy. Overall, sleeve gastrectomy is considered a safe and effective surgical weight loss technique.

The utility of intraoperative endoscopy to assist novice surgeons in the detection of gastric stenosis during laparoscopic sleeve gastrectomy

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Gastric stenosis and leaks are 2 major complications associated with LSG and revision surgery might be needed. Herein, we report our experience of intraoperative endoscopy (IOE) to evaluate stenosis and leaks during LSG.MethodsLSG was performed by three surgeons. Patients who underwent LSG and IOE between January 2016 and March 2020 were enrolled and assigned to two groups: group 1 (1st–30th LSG case for each surgeon) and group 2 (> 30th LSG for each surgeon). Patients’ anthropometric and biochemical data pre- and post-LSG, as well as IOE findings and follow-up esophagogastroduodenoscopy records were reviewed.ResultsIn total, 352 patients were enrolled including 90 patients in group 1 and 262 patients in group 2. Three out of 352 patients (0.9%) were found to have stenosis by IOE, which was related to tightly gastropexy stitch or reinforcement stitch, all of which were in group 1. Stenosis was resolved after removal of the stitch during LSG. The incidence of gastric stenosis detected by IOE was 3.3% (3/90) and 0% (0/262) in group 1 and group 2, respectively (P = 0.003). No leakage was found in this study and no patient developed clinical or endoscopic stenosis after LSG.ConclusionsThe existing evidence showed that IOE can help detect gastric stenosis during LSG, especially for novice surgeons, and the stenosis could be resolved during operation.

The incremental value of multislice CT in diagnosis of late bariatric surgery complications

BackgroundBariatric surgery has become a widely accepted treatment option among the population for obesity management. Nevertheless, different complications may still be encountered during the late post-operative period. Our prospective cross-sectional study aimed to show the incremental value of multislice CT for diagnosis of such complications.ResultsWithin the included twenty patients who underwent multislice CT of upper abdomen, gastric pouch dilatation causing recurrent weight gain was the commonest complication detected in 70% of the studied patients and was found mainly after sleeve gastrectomy in whom mean gastric pouch volume was 248.4 ml. Gastric stricture, gastric herniation through plication suture, hiatus hernia and incisional hernia were less commonly encountered complications.ConclusionMultislice CT is a useful non-invasive imaging modality for detection of late bariatric surgery complications.

Learning Curve for Laparoscopic Sleeve Gastrectomy: a Cumulative Summation (CUSUM) Analysis

Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. to analyze the learning curve for LSG. We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared. According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss. According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.

Surgical management and postoperative outcome of patients with gastric pathologies in three hospitals in the city of Douala

Background: To bring out the different surgical approach and to appreciate the post-surgery outcome of patients with gastric pathologies in three Douala’s hospitals.Methods: This retrospective and analytic study has been carryout from January 1st 2010 to November 31st 2019 in three healthcare centers in Douala. Patients’ records who had presented a surgical gastric pathology were included in our study and patients with incomplete filled records were excluded. Statistical analysis was been realized by means of the SPSS 23.0.Results: We selected 158 files of gastric perforation (85.4%), 17 of gastric stenosis (9.2%), and 10 of gastric cancers (5.4%). The mean age of occurrence of gastric perforation in our sample was 42.11±16.5 years and for stenosis was 43.65±23.3 years with a male predominance for these two pathologies. For the cancerous patients the mean age was 54.70±7.5 years with a sex ratio of 1. Simple suture was the most used surgical technique in perforation, pyloromyotomy was done in gastric stenosis. Total gastrectomy and gastrojejunostomy were the most practiced in cancer cases. The death rate varied from 15.8% with perforation to 40% with cancer. The associated factors to complications were age (p=0.002) and duration of hospitalization (p=0,004) in gastric perforation.Conclusions: Gastric perforation was the most frequent pathology affecting mostly traders. The surgical approach was thus pathology dependent.

Spontaneous Gastric Perforation in a Child and Endoscopic Balloon Dilation for Postoperative Gastric Stenosis.

Spontaneous Gastric Perforation in a Child and Endoscopic Balloon Dilation for Postoperative Gastric Stenosis.

Pneumatic Balloon Dilation of Gastric Sleeve Stenosis Is Not Associated with Weight Regain.

Gastric sleeve stenosis (GSS) occurs in up to 4% of patients after laparoscopic sleeve gastrectomy (LSG). Typical symptoms include reflux, abdominal pain, dysphagia, and regurgitation. Serial pneumatic balloon dilation (PBD) is a successful treatment in many cases obviating the need for revisional surgery, but the potential for weight regain is unknown. The aim of the current study was to assess weight trends following serial pneumatic dilation for GSS. Retrospective analysis of a prospectively maintained database of patients undergoing serial PBD for GSS at one institution. Primary outcome was change in BMI before and after serial PBD. Secondary outcomes included complication rates and need for revisional surgery. Sub-group analyses were performed to determine the relationship of patient and procedural factors to BMI after PBD. Forty-four patients met inclusion criteria, 34 (84.1%) women. Mean age was 46.7 (SD 11.9). Mean pre-sleeve BMI was 47.8 (SD 9.2), and mean BMI prior to first dilation was 34.2 (SD 6.8). Median follow-up was 395days (range 48-571). Mean BMI at time of last follow up was 33.7 (SD 6.7). There was no statistical difference in BMI pre- or post-PBD (p 0.980). The lowest 10th and highest 90th BMI percentile trended toward a higher and lower BMI after PBD, respectively, though not significant. As the prevalence of sleeve gastrectomy continues to rise, an increasing number of patients will require treatment for GSS. Stenosis is effectively treated with serial PBD in most patients without any impact on weight gain, making this an effective and appealing option for many patients.

Transgastric laparoendoscopic approach to tumours of the stomach.

There is currently limited data to reassure the technical efficacy, particularly in attaining clear margins, through a transgastric laparo-endoscopic approach to resecting tumours located near the gastroesophageal junction (GOJ) or the pylorus. Single institution retrospective analysis of all cases from 1 April 2008 to 31 Dec 2019. Overall, 34 patients (38 tumours) underwent transgastric laparo-endoscopic resection. Of these, 27 (71.1%) and 5 (14.7%) cases were located close to the GOJ and pylorus respectively. Three (8.0%) cases were converted to conventional laparoscopic excision. No anatomical gastric resection was required. The mean (SD) operative time was 167.5 (64.2) minutes and reduced with increasing experience. The median (IQR) length-of-stay was 3.0 (3.0-4.5) days. Major post-operative complication (Clavian-Dindo ≥3) occurred in 1 (2.9%) patient, which required surgical control of staple line bleeding. The most common pathology was gastrointestinal stromal tumour (71.1%), followed by leiomyoma (10.5%), schwannoma (5.2%), dysplastic polyp (5.2%), and neuroendocrine tumour (2.6%). The mean (SD) tumour diameter was 3.9 (2.1) cm (largest 10.1cm, 10 cases >5cm). Resection margins were clear in all cases. We found no evidence of tumour recurrence or gastric stenosis at a median follow-up of 88 months. Transgastric laparo-endoscopic resection of junctional and pyloric tumours with low metastatic potential is technically feasible. This approach achieved clear resection margins in all our cases, with acceptable perioperative and longer-term outcomes.

Squamous gastric ulceration complicated by gastric stenosis in a foal

SummaryA 2‐month‐old Warmblood colt presented with recurrent colic and regurgitation. Gastroscopy, performed on several occasions, and barium‐contrast radiography revealed severe squamous gastric ulceration and stenosis at the level of the margo plicatus. Treatment with omeprazole reduced the extent and severity of the gastric ulcers but did not affect the stenosis. The foal was euthanised because of a poor prognosis, and post‐mortem examination confirmed the clinical diagnosis. Severe squamous gastric ulceration, granulation tissue formation and cicatrisation of deep gastric lesions were considered to have caused the stenosis. Gastroduodenal outflow obstruction is a recognised disorder in foals, but stenosis at the level of the margo plicatus has not been reported in foals or adult horses. To the authors' knowledge, this is the first case of severe squamous gastric ulceration, complicated by stenosis at the level of the margo plicatus, in a foal. Although rare, gastric stenosis should be considered in foals suffering recurrent colic and regurgitation.

Quantifying Healthcare Utilization and Delay in the Treatment of Gastric Stenosis Following Sleeve Gastrectomy.

Sleeve gastrectomy (SG) is the most common bariatric procedure performed. The incidence of gastric sleeve stenosis (GSS) is up to 4%, with a rising prevalence given increasing popularity of this surgery. GSS is best treated with pneumatic balloon dilation (PBD), but the diagnosis is not always straightforward, oftentimes leading to an extensive diagnostic workup. The aims of the current study were to quantify delay to treatment and overall healthcare utilization during this delay in patients with GSS following SG. This was a retrospective review of a prospectively collected database including patients with SG diagnosed with GSS between October 2017 and September 2020. The primary outcome was time between symptom development and treatment with PBD. Secondary outcomes included total healthcare utilization as reflected by the number and charges of imaging and emergency room (ER) visits. Forty-five patients were included in the analysis; 37 (82%) were female. The mean (± SD) time to treatment was 755 (± 713) days. The probability of receiving treatment at 1, 2, and 3 years was 37%, 62%, and 76%, respectively. The mean (± SD) abdominal CT scans, radiographs, and UGIS between symptoms and PBD were 1.3 ± 2.0, 1.2 ± 1.6, and 1.2 ± 1.0, respectively. The mean number of ER visits was 1.9 ± 2.5 (range 0-8). The average number of diagnostic non-therapeutic upper endoscopies was 1.6 ± 1.5. The mean (± SD) total charges were $16,473 ± 15,173. Patients who develop GSS following SG experience significant delay in diagnosis and management, reflected by multiple imaging studies, emergency department visits, and non-therapeutic procedures.

Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience.

The aim of this study was to analyze patients who underwent endoscopic resection (ER) for gastric subepithelial tumors (SETs) with a high probability of surgical intervention. Between January 2013 and January 2021, 83 patients underwent ER at the operation theater and 27 patients (32.5%) required backup surgery mainly due to incidental perforation or uncontrolled bleeding despite endoscopic repairing. The tumor was predominantly located in the upper-third stomach (81%) with a size ≤ 2 cm (69.9%) and deep to the muscularis propria (MP) layer (92.8%) but there were no significant differences between two groups except tumor exophytic growth as a risk factor in the surgery group (37% vs. 0%, p < 0.0001). Patients in the ER-only group had shorter durations of procedure times (60 min vs. 185 min, p < 0.0001) and lengths of stay (5 days vs. 7 days, p < 0.0001) but with a higher percentage of overall morbidity graded III (0% vs. 7.1%, p = 0.1571). After ER, five patients (6%) had delayed perforation and two (2.4%) required emergent laparoscopic surgery. Neither recurrence nor gastric stenosis was reported during long-term surveillance. Here, we provide a minimally invasive strategy of endoscopic resection with backup laparoscopic surgery for gastric SETs.