Gastric Stenosis Research Articles

Bypass gastrique après sleeve gastrectomie pour sténose gastrique compliquant la mise en place d’une prothèse endoscopique pour fistule

Surgery and digestive endoscopy require a multidisciplinary medical approach. Digestive endoscopy plays an utmost role in all the phases of the management of pathological obesity in order to optimize the outcome, the management strategy entails a step-by-step management of some of the complications. Priority should be given to less invasive methods, if they fail, then a more invasive step should be taken. Thus, a strong collaboration between the endoscopic and the surgical teams is compulsory.We report a case of conversion from sleeve gastrectomy to gastric bypass for gastric stenosis after setting up an endoscopic prosthesis positioned for gastric sleeve fistula.

Comparison of short-term outcomes between laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy

Laparoscopic greater curvature plication (LGCP) is an emerging restrictive bariatric procedure that successfully reduces the gastric volume by plication of the gastric greater curvature. The aim of this prospective nonrandomized study was to compare short-term outcomes and associated complications between LGCP and laparoscopic sleeve gastrectomy (LSG). From January 2011 to November 2011, a total of 39 patients were allocated to undergo either LGCP (n = 19) or LSG (n = 20). Data on the operative time, complications, hospital stay, overall cost of LSG and LGCP, body mass index loss (BMIL), percentage of excess weight loss (%EWL), loss of appetite and improvement of comorbidities were collected during the follow-up examinations. All procedures were completed laparoscopically. The mean operative time was 95.0 ± 17.4 minutes for the LGCP group and 85.5 ± 18.4 minutes for the LSG group (P = 0.107). No patient required reoperation due to an early complication. One patient in the LSG group was readmitted because of gastric stenosis. The mean hospital stay was 4.2 ± 1.9 days in the LGCP group and 3.9 ± 1.7 days in the LSG group (P = 0.595). The total cost of LSG was $7,826 ± 537 compared to LGCP ($3,358 ± 264) (P < 0.001). One year after surgery, the mean %EWL was 58.8 ± 16.7 % (n = 11) in the LGCP group and 80.0 ± 26.8 % (n = 11) in the LSG group (P = 0.038). Loss of feeling of hunger was reported in 27.3 % LGCP patients and 72.7 % LSG patients (P = 0.033) at 1 year after surgery. The comorbidities, including diabetes, sleep apnea and hypertension, were markedly improved in both groups 6 months after surgery. The short-term outcomes of our study demonstrate that compared with LSG, LGCP is inferior as a restrictive procedure for weight loss, despite its significantly smaller cost. Longer follow-up and prospective comparative trials are needed to confirm the long-term outcomes of this novel procedure and make definitive conclusions.

バイパス手術を要した強酸性洗剤服用後の胃腐食性瘢痕狭窄の1例

バイパス手術を要した強酸性洗剤服用後の胃腐食性瘢痕狭窄の1例

Minimally invasive repair of a late stricture in a reversed gastric tube

Ingestion of caustic agents may result in severe scarring and stricture formation of the esophagus. Reversed gastric tube esophagoplasty is an option for definitive surgical management of severe esophageal stricture refractory to medical treatment. Delayed complications from this procedure have rarely been reported. We present a case involving a patient who developed a delayed gastric stricture three decades after receiving a reversed gastric tube esophagoplasty. A historical review of the reversed gastroplasty is presented as well.

PMO-198 Post-operative endoscopy in bariatric surgery patients

IntroductionBariatric surgical patients may require endoscopy in the post-operative phase. The current study analyses the indications and findings of upper GI endoscopy (OGD) in post-operative bariatric surgery patients.MethodsA retrospective analysis...

An Analysis of 1–3-Year Follow-up Results of Laparoscopic Sleeve Gastrectomy: an Indian Perspective

Laparoscopic sleeve gastrectomy (LSG) has become very popular nowadays among bariatric surgeons because of its surgical simplicity and good postoperative results. We present our experience on LSG as a single stage primary bariatric procedure for morbid obesity and its 1-3-year follow-up results. Between March 2008 and March 2011, a total of 110 patients underwent laparoscopic sleeve gastrectomy. Two patients were excluded from the study and thus the prospectively maintained data of 108 patients were retrospectively reviewed and outcomes were recorded. The mean patient age was 39.3 ± 11.1years, mean body mass index was 44.5 ± 6.8, mean excess body weight was 54.1 ± 16.3kg, and the mean American Society of Anesthesiologists score was 3.1 ± 0.57. The mean operative time for the LSG procedure was 64.8 ± 10.6min. The minimum follow-up duration was 6months and maximum of 36months. The mean postoperative percent excess body weight loss achieved was 67.5 ± 13.0 at 1year, 71.1 ± 13.8 at 2years, and 66.09 ± 14.3 at 3years. At the end of 3years, there was 83.3% resolution in diabetes, 85.7% resolution in hypertension, and 85.71% resolution in dyslipidemia. There were no reports of postoperative hemorrhage, gastric leak, deep venous thrombosis, pulmonary embolism, delayed gastric tube stricture, and operative mortality. LSG is a safe and effective bariatric procedure with low perioperative complications. Before it is considered as a single stage primary procedure, a long-term prospective comparative study with other bariatric procedures is required.

Evaluation of salvage surgery for type 4 gastric cancer

Patients with type 4 gastric cancer and peritoneal metastasis respond better to chemotherapy than surgery. In particular, patients without gastric stenosis who can consume a meal usually experience better quality of life (QOL). However, some patients with unsuccessful chemotherapy are unable to consume a meal because of gastric stenosis and obstruction. These patients ultimately require salvage surgery to enable them to consume food normally. We evaluated the outcomes of salvage total gastrectomy after chemotherapy in four patients with gastric stenosis. We determined clinical outcomes of four patients who underwent total gastrectomy as salvage surgery. Outcomes were time from chemotherapy to death and QOL, which was assessed using the Support Team Assessment Schedule-Japanese version (STAS-J). Three of the patients received combination chemotherapy [tegafur, gimestat and otastat potassium (TS-1); cisplatin]. Two of these patients underwent salvage chemotherapy after 12 and 4 mo of chemotherapy. Following surgery, they could consume food adequately and their STAS-J scores improved, so their treatments were continued. The third patient underwent salvage surgery after 7 mo of chemotherapy. This patient was unable to consume food adequately after surgery and developed surgical complications. His clinical outcomes at 3 mo were very poor. The fourth patient received combination chemotherapy (TS-1 and irinotecan hydrochloride) for 6 mo and then underwent received salvage surgery. After surgery, he could consume food adequately and his STAS-J score improved, so his treatment was continued. After the surgery, he enjoyed his life for 16 mo. Of four patients who received salvage total gastrectomy after unsuccessful chemotherapy, the QOL improved in three patients, but not in the other patient. Salvage surgery improves QOL in most patients, but some patients develop surgical complications that prevent improvements in QOL. If salvage surgery is indicated, the surgeon and/or oncologist must provide the patient with a clear explanation of the purpose of surgery, as well as the possible risks and benefits to allow the patient to reach an informed decision on whether to consent to the procedure.

Corrosive poisonings in adults.

Ingestion of corrosive substances may cause severe to serious injuries of the upper gastrointestinal tract and the poisoning can even result in death. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. The golden standard for determination of the grade and extent of the lesion is esophagogastroduodenoscopy performed in the first 12-24 hours following corrosive ingestion. The most common late complications are esophageal stenosis, gastric stenosis of the antrum and pyloris, and rarely carcinoma of the upper gastrointestinal tract. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery.

P-22 Incidence and management of strictures after laparoscopic sleeve gastrectomy for morbid obesity

Background: Sleeve gastrectomy (SG) is the first part of duodenal switch. Two stage procedures were designed for high-risk cases. Initial good results moved some surgeons to use this operation as a stand-alone procedure. Here we evaluate the mid-term results of our experience. Methods: Retrospective review of the prospective database of morbid obesity from our institution was done. We studied all patients who underwent SG from December 2004 to September 2010. Variables were morbidity, mortality, weight loss and resolution of comorbidities. Results: 127 out of the 169 patients operated were analyzed. Mean BMI at the time of surgery was 52.05 kg/m (range 35-75). 89 patients were included as a 2-stage procedure, mean BMI at the time of surgery was 57.88 kg/m (range 45-75). Patients who had a stand-alone procedure had an initial mean BMI of 38.4 kg/m (35-43). After 3 years of follow-up mean BMI was 33kg/m and 31.9kg/m respectively. We performed 15 second stages (14 duodenal switch and 1 Roux-en-Y gastric bypass). Global morbidity was 4.7% (6 cases), the most frequent was gastric stenosis, all of them were treated by endoscopy. We also had 1 leak (0.6%). We had no mortality in our series. 89% of the patients improved their diabetes mellitus after 1 year of follow-up, and 91% after 2 years. Conclusion: The SG showed good results in terms of weight loss and resolution of comorbidities, with a low morbidity in our series. Proper patient selection is probably, along with proper surgical technique, the most important factor in achieving good results.

Gastric Antral Stenosis: Late Complication of Acid Ingestion

Gastric Antral Stenosis: Late Complication of Acid Ingestion

Isolated gastric outlet obstruction due to corrosive ingestion

To analyze the diagnostic and therapeutic aspects of isolated gastric outlet obstruction secondary to corrosive ingestion. Retrospective chart review of eight patients who developed gastric stricture following corrosive ingestion and were treated in the Digestive and General Surgery Service of Yopougon Teaching Hospital in Abidjan from 1991 to 2009. Six men and two women (mean age of 34.3 [range 21 to 48 years]) had isolated gastric outlet obstruction following accidental (n=2) or suicidal (n=6) acid ingestion. Two patients sought hospital medical attention two days after ingestion, whereas six patients came to hospital with a mean delay of 60.8 days (range 12 and 96 days). Patients sought medical attention for poor general status (n=6), postprandial vomiting (n=4), early satiety (n=2) and retrosternal pain (n=2). Two patients, who presented early to hospital, underwent upper gastrointestinal tract endoscopy the day after admission and then received a feeding jejunostomy whereas the esogastroduodenal barium swallow and feeding jejunostomy were performed after a mean delay of 2 days (range 1 and 3 days) and 3 days (range 1 and 5 days), respectively. The findings at upper endoscopy and barium swallow were: microgastria (n=2), midgastric stricture (n=1), antropyloric stricture (n=4) and gastric body stricture (n=1). One patient died preoperatively as the result of severe nutritional depletion. A follow-up endoscopy and barium swallow were performed respectively 21 and 35 days later. Definitive surgery was performed after a mean delay of 85 days (range 74 to 123 days) in the remaining seven patients. Gastric lesions were managed by total gastrectomy with Roux-en-Y esophagojejunostomy (n=2), partial gastrectomy with gastrojejunostomy (n=2) or simple gastrojejunostomy (n=3). During the mean follow-up period of 4 years (range 1 to 7 years), all patients were free of symptoms. Isolated corrosive gastric stricture is relatively rare. Surgery tailored according to the extent of gastric stricture provides excellent results.

S-1 and the treatment of gastric cancer with peritoneal dissemination

Peritoneal dissemination is the most common metastatic pattern of gastric cancer. We frequently face the necessity for gastrectomy in the event of gastric stenosis or gastric bleeding. However, the indication for palliative gastrectomy and the effectiveness of palliative chemotherapy are not clear. We retrospectively evaluated the prognostic factors after palliative gastrectomy in 121 gastric cancer patients with peritoneal dissemination. The expression of orotate phosphoribosyl transferase (OPRT) was examined immunohistochemically. The median survival time of all patients after palliative gastrectomy was 8.8 months. In the multivariate analyses, we adjusted the data of 82 patients without liver metastases for the background of 5-fluouracil (5-FU)-based chemotherapy regimen. The analysis revealed that the degree of peritoneal dissemination (multiple vs. a few metastases or cytology-positive; P= 0.01) and chemotherapy (S-1 vs. other 5-FU; P=0.01) were independent predictors of survival. Particularly, S-1 treatment was associated with a more favorable prognosis of the patients with high levels of OPRT expression compared to that of the patients with low expression. Patients with peritoneal dissemination are considered as terminal and inoperable. However, S-1 treatment may improve the survival after palliative gastrectomy in patients selected according to the degree of peritoneal dissemination and high OPRT expression.

Traitement par dilatation instrumentale des sténoses caustiques de l’œsophage de l’adulte : étude prospective de 132 cas

IntroductionIngestion of caustic is common, and it causes serious injury. Occurrence of esophageal stricture is a terrible sequel.AimTo evaluate efficiency and security of dilatation with Savary-Gilliard dilator in esophageal caustic stenosis in adults.Patients and methodsThis prospective study included 132 patients during a period of four years. The mean age was 26.7 ± 11 years (16/78). The sex ratio was 0.32. The substance drunken was a strong alkali in 78% and a strong acid in 20%. All the patients underwent an upper gastrointestinal endoscopy and a barium swallow. A severe esophageal stricture was noticed in 74% of the cases, and a gastric stricture was associated in 23%. Dilatation was realized with Savary-Gilliard dilator. The therapeutic results were judged after 12 months.ResultsThe average number of dilatation was 11 ± 8.5 (2/46). Success was observed in 80% and failure in 20% of the cases. Four perforations were recorded.ConclusionThe dilatation with Savary-Gilliard dilator is an efficient, sure, and simple method of treatment in esophageal caustic stenosis. It must be used at first; surgery should be planned in case of failure of dilatation.

STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCERS AND ADENOMAS

Stricture is a complication that may occur after endoscopic submucosal dissection (ESD) of gastric neoplasms. The goal of the present study was to investigate the incidence, risk factors and management of gastric stricture after ESD. The medical records of 308 patients who underwent ESD for gastric neoplasms were reviewed. Stricture is defined as having symptoms caused by an obstruction through which a 1-cm diameter endoscopic fiber cannot be passed. Stricture was identified in six of 308 patients (1.9%). Three of the six lesions were located in the prepylorus, two cases in the antrum and one in the cardia. The mean longitudinal distance and the mean area of the resected specimens in the six cases with stricture (7.8 ± 2.0 cm, 34.0 ± 15.8cm(2) , respectively) was significantly larger than in those without stricture (4.5 ± 1.4cm, 12.7 ± 8.3cm(2) , respectively, P<0.01). The ratio of the resected circumference/whole circumference was 83.3±7.5% in those with stricture in comparison to 25.4 ± 16.3% in those without stricture (P<0.01). All six patients underwent endoscopic balloon dilations, and obtained relief from stricture. However, one patient experienced a gastric perforation and recovered following conservative therapy. Sub-circumferential resection over 75% of the circumference by ESD in the prepylorus, antrum and cardia is a risk factor for the occurrence of stricture. Early intervention might be considered for this high-risk group to avoid a perforation during balloon dilation.

Gastric stricture after endoscopic submucosal dissection for early gastric cancers

Gastric stricture after endoscopic submucosal dissection for early gastric cancers

Gastric stricture following zinc chloride ingestion

Aim. We present the case of an adult who ingested soldering fluid containing zinc chloride (ZC) in a suicide attempt. He developed a gastric stricture that was managed successfully by laparoscopic Roux-en-Y gastrojejunostomy. An extensive literature review shows that there are few reports of ZC ingestion. Furthermore, management of corrosive gastrointestinal tract injury is debatable. The evidence is summarized in this case report. Results. ZC is a strong corrosive agent, which, following ingestion, is capable of producing widespread damage locally and systematically with long-lasting morbidity and significant mortality. The mainstay of treatment is supportive. Esophago-gastro-duodenoscopy is the diagnostic procedure of choice in the absence of perforation. Strictures that cannot be dilated endoscopically may require surgery. Emergency surgery is required for patients with evidence of perforation. Early and aggressive surgical resection in patients with high-grade burns may improve mortality and morbidity. Conclusion. Because of the lack of data, it remains debatable as to the optimal management strategies following ZC ingestion. Our patient was managed conservatively throughout the acute phase. However following recognition of the gastric stricture, surgical intervention ensued and he underwent successful laparoscopic Roux-en-Y gastrojejunostomy and was subsequently discharged having made an excellent recovery.

Comparative evaluation of nasoenteral feeding and jejunostomy feeding in acute corrosive injury: a retrospective analysis

Nutritional support in corrosive injury patients is traditionally achieved through total parenteral nutrition (TPN) or jejunostomy feeding (JF). There are no reports of nasoenteral tube feeding in patients with corrosive ingestion. We report our experience with nasoenteral tube feeding (NETF) and compare the outcome of these patients with those undergoing JF. Tertiary medical center in North India. The records of 53 and 43 patients with severe acute corrosive injury who underwent NETF and JF, respectively, were reviewed. All had received a 50-kcal/kg, 2-g/kg protein homogenized liquid diet for 8 weeks. A contrast study was performed at 8 weeks, and body weight and serum albumin levels were recorded at hospitalization and at 8 weeks. Change in weight and serum albumin at 8 weeks and stricture development rate. Strictures developed in 41 (80.39%) and 36 (83.72%) patients in the NETF and JF groups, respectively. Development of esophageal stricture (P = .71) and gastric stenosis (P = .89) was comparable in the 2 groups. No significant changes in serum albumin and weight were noted at 8 weeks in either group. The complication rate was lower in the NETF group compared with the JF group. Although all of the patients in the NETF group had a patent lumen, 5 in the JF group had total obstruction precluding endoscopic intervention. Retrospective study design. NETF is as effective as JF in maintaining nutrition in patients with severe corrosive injury. The stricture development rate is similar, but nasoenteral tube placement provides a lumen for dilatation should a tight stricture develop.

Surgical management of gastric cicatrisation resulting from corrosive ingestion

Background Caustic injury to the stomach can be complicated by gastric stenosis. We review our experience with surgical management of symptomatic gastric stenosis. Methods This is a retrospective chart review of patients who underwent surgery for gastric stenosis within 6 weeks to 26 months following corrosive ingestion. The data analyzed included the extent of cicatrisation, surgical procedure performed and outcome. Preoperative evaluation in these patients included a barium contrast study and upper gastrointestinal endoscopy. Results Main presenting symptoms were nonbilious vomiting, early satiety, dysphagia and significant weight loss. Antropyloric strictures were present in 28 (64%) patients, total gastric involvement was seen in 16 (36%) patients, associated esophageal stenosis was present in 18 (40.91%) patients. Surgical procedures performed included distal gastrectomy with Billroth1 reconstruction in 31.82%, distal gastrectomy with Roux-en-Y reconstruction in 20.45%, stricturoplasty in 11.36%, subtotal gastrectomy in 18.18% and total gastrectomy with pouch reconstruction in another 18.18% patients. Complications encountered were pneumonitis in 18.18%, wound infection in 11.36%, intra-abdominal infection, anastomotic breakdown, reactivation of pulmonary tuberculosis and dumping syndrome, each in 2.27% patients. One patient (2.27%) died. Conclusion Surgical procedure should be tailored according to the extent of gastric involvement. Surgical resection is feasible and safe. Our results suggest that satisfactory outcome could be expected with different therapeutic modalities based on degree of cicatrisation.

Superior mesenteric artery syndrome resulting from acute massive gastric dilatation caused by Helicobacter pylori-induced acute antral gastritis.

A previously well, slender 14-year-old boy developed right epigastric pain with vomiting. His vomiting gradually changed to bile-stained fluid for 8h. He was diagnosed with superior mesenteric artery syndrome with acute massive gastric dilatation by contrast-enhanced computed tomography, which also showed markedly thickened prepyloric gastric wall that may have caused gastric outlet stenosis. Acute gastric mucosal lesions of the antrum were confirmed by endoscopic and histological studies. Endoscopic biopsy specimens using rapid urease test and histopathology detected Helicobacter pylori. Serum anti-H.pylori antibody was negative. He did well after conservative treatment. We conclude that an acute form of superior mesenteric artery syndrome resulted from compression of the artery by acute massive gastric dilatation associated with transient gastric outlet stenosis caused by acute antral gastritis, which resulted from the initial H.pylori infection.

Reconstruction of the gastric passage by a side-to-side gastrogastrostomy after failed vertical-banded gastroplasty: a case report

IntroductionVertical-banded gastroplasty, a technique that is commonly performed in the treatment of morbid obesity, represents a nonadjustable restrictive procedure which reduces the volume of the upper stomach by a vertical stapler line. In addition, a textile or silicone band restricts food passage through the stomach.Case presentationA 71-year-old woman presented with a severe gastric stenosis 11 years after vertical gastroplasty. We describe a side-to-side gastrogastrostomy as a safe surgical procedure to restore the physiological gastric passage after failed vertical-banded gastroplasty.ConclusionOccasionally, restrictive procedures for morbid obesity cannot be converted into an alternative bariatric procedure to maintain weight control. This report demonstrates that a side-to-side gastrogastrostomy is a feasible and safe procedure.