Angelchik antireflux prosthesis.
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Gastroesophageal Reflux↗
Biomedical subjects
M W Gear
Publications and source records attributed to M W Gear.
Duodenal diversion with vagotomy and antrectomy for severe or recurrent reflux oesophagitis and stricture: an alternative to operation at the hiatus.
In cases of mild symptomatic gastro-oesophageal reflux, standard antireflux surgery, such as fundoplication or the Angelchik prosthesis, produces satisfactory results. Duodenal diversion is recommended for use only in patients with severe oesophageal damage. This situation commonly arises where the gastro-oesophageal junction cannot be reduced into the abdomen, or where previous surgery has made reoperation at the hiatus difficult and hazardous. Fifty-seven patients with severe reflux oesophagitis have been treated by Roux-en-Y duodenal diversion and antrectomy. Thirty three patients had vagotomy in addition. Median follow-up after operation is 6.1 years. In 35 patients (61%), the technique was used as primary surgical treatment. These included 22 patients in a randomized trial of the method. Thirteen (23%) had previously had unsuccessful antireflux surgery. Nine (16%) had undergone previous operations for peptic ulcer or achalasia. There was no operative mortality. No patient in the series required stricture resection. Good or excellent overall results were achieved in 86% of patients. Eighteen of twenty seven patients with severe strictures required an average of three dilatations after operation before dysphagia was completely relieved. Heartburn was dramatically relieved and oesophagitis settled within an average period of 6 months. Poor or unsatisfactory overall results were observed in 8 (14%) patients. These included one tight fibrous stricture which required endoscopic intubation despite resolution of oesophagitis, and four patients who developed a stomal ulcer. No patients suffered from the dumping syndrome. Malignancy must be carefully excluded by biopsy in all cases of stricture.
Adult↗
Complications of the Angelchik antireflux prosthesis.
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Gastric Fundus↗
Enteroliths in Meckels diverticulum misinterpreted as teeth.
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Adult↗
Randomized prospective trial of Roux-en-Y duodenal diversion versus fundoplication for severe reflux oesophagitis.
It is not widely recognized that duodenal contents are implicated in the causation of severe reflux oesophagitis and stricture formation in patients with hiatus hernia. In a randomized prospective trial, including only patients with severe oesophageal changes, standard Nissen fundoplication has been compared with antrectomy and Roux-en-Y reconstruction. Twenty-two patients were randomized to each group. The 42 surviving trial patients have been followed for an average period of over 5 years. Good results (Visick I or II) have been achieved in 91 per cent of 22 patients having antrectomy and Roux-en-Y anastomosis (Group B), compared with 65 per cent of 20 patients surviving after Nissen fundoplication (Group A). Poor results (Visick III or IV) seen in seven patients (35 per cent) in group A were almost all associated with failure of fundoplication to stop reflux. Two of these patients have subsequently had antrectomy and Roux-en-Y reconstruction with excellent results. Antrectomy with Roux-en-Y gastrojejunostomy appears to be superior to a standard anti-reflux procedure as primary surgical treatment in these patients. The technique is recommended: where the patient has a fixed irreducible hiatus hernia; where previous surgery at the hiatus has failed and rendered reoperation hazardous.
Adult↗
Randomized prospective trial of the Angelchik anti-reflux prosthesis.
Fifty-two patients with reflux oesophagitis resistant to medical treatment were randomized at operation to receive either the Angelchik prosthesis or a fundoplication. All patients were assessed postoperatively by a physician unaware of the nature of the operation. Forty-two patients have been followed up for 1-2 years; ten patients for 3-9 months. Ninety-six per cent of the Angelchik patients had satisfactory or excellent results compared with 81 per cent with a fundoplication. There were no failures to control reflux with the Angelchik prosthesis whereas 6 patients (23 per cent) of the fundoplication group have persisting reflux. Operating times for insertion of the prosthesis averaged a little over half that recorded for fundoplication. Complication rates were similar. The results of the trial encourage the use of the prosthesis in patients with gastro-oesophageal reflux, where medical treatment has failed. The prosthesis should not be used if the gut is opened during operation either inadvertently or deliberately, as in making a suture line or anastomosis, because of the risk of sepsis.
Clinical Trials as Topic↗
The results of Ramstedt's operation: room for complacency?
The results of 101 pyloromyotomies performed from 1972 to 1980 have been analysed; 34 operations were performed using local anaesthesia and 67 using general anaesthesia. The use of local anaesthesia was not associated with any advantage related to postoperative or other complications. A high postoperative complication rate of 20% was found (excluding postoperative vomiting), and there were 2 deaths; 11 patients suffered wound infection, with Staphylococcus aureus isolated from 5 of these wounds. The use of prophylactic antibiotics active against Staphylococcus aureus is suggested.
Adolescent↗
Proximal gastric vagotomy versus long-term maintenance treatment with cimetidine for chronic duodenal ulcer: a prospective randomised trial.
Forty-four patients with chronic duodenal ulceration were allocated randomly to either long-term maintenance treatment with cimetidine or proximal gastric vagotomy. All were followed up both clinically and endoscopically for periods of one to four years. The rate of recurrence of ulcer during and after medical treatment was 54% while after surgery it was 10%. One patient developed severe allergic hepatitis while receiving maintenance treatment with cimetidine, and two others had to stop treatment because of possible drug reactions. Patients whose ulceration recurs while they are receiving treatment with cimetidine should be offered the possibility of operation.
Cimetidine↗
Stapling instruments in upper gastrointestinal surgery: a retrospective study of 362 cases.
A retrospective review of 362 upper gastrointestinal operations performed over a 6-year period was undertaken. The incidences of complications following the use of stapling instruments (Autosuture) or the use of conventional anastomotic techniques were compared. Complications considered to be related to anastomotic techniques were: leak or bleeding from the suture line or the development of intra-abdominal or wound sepsis. The complication rates were 21 per cent for operations using conventional suturing techniques and 16 per cent for operations in which the stapling instruments were employed.
Digestive System Surgical Procedures↗
Five year follow-up study of gastritis.
This paper describes a five year follow-up study of the incidence and course of gastritis affecting the antrum and body of the stomach of 50 patients, most of whom presented with non-ulcer dyspepsia and a few with peptic ulceration. We have shown that antral gastritis, like gastritis affecting the fundus, becomes more severe in a proportion of patients as time goes by. Perhaps more important is the increased severity and progression of atrophic and metaplastic change in the antrum compared with the fundus. The significance of these changes with regard to the development of peptic ulceration and malignancy is discussed.
Adult↗
Endoscopic studies of dyspepsia in the community: an "open-access" service.
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Community Health Services↗
Endoscopic studies of dyspepsia in a general practice.
In an urban general practice serving 7800 patients, all patients presenting over five and a half years with dyspepsia lasting more than two weeks were investigated by fibreoptic endoscopy and cholecystography, and many by barium meal. Of the 393 patients with dyspepsia, 346 completed the investigation: 180 had specific disease of the oesophagus, stomach, duodenum, or gall bladder, including six with carcinoma. Al further 67 had mucosal disease, and only 99 patients had no abnormality. After the first year the number of patients presenting annually and the percentage of patients with specific lesions remained constant. The annual incidence for patients with dyspepsia was about 1% and for patients with specific lesions 0.4%, suggesting that each year those who became symptom free (either spontaneously or because of treatment) were balanced by a similar number who developed symptoms. In contrast to the conclusions of other workers that an "open-access" endoscopy service could not be justified because the number of patients with specific lesins fell during their survey, we suggest that such endoscopy services are indeed worth while for providing an accurate diagnosis of dyspepsia.
Cholecystography↗
Vagotomy and pyloroplasty for gastric ulcers.
Eighty patients with benign gastric ulcer treated by vagotomy and pyloroplasty in a district general hospital are reviewed. There were no postoperative deaths in the patients undergoing elective surgery but 8 deaths in those undergoing emergency surgery for massive bleeding (38 per cent). Eighty-three per cent of patients had a result that was classed as good or satisfactory. Recurrent gastric ulceration was found in 8 per cent and a tendency to late asymptomatic ulcer recurrence is identified. Careful long term follow-up, including endoscopic re-examination, is advocated for patients undergoing conservative operations for benign gastric ulcer.
Adult↗
An assessment of the accuracy of modern endoscopic diagnosis of oesophageal stricture.
The results of 135 fibreoptic endoscopic examinations of oesophageal strictures carried out in a district general hospital are reported. The endoscopic diagnosis was correct in 90 per cent, uncertain in 3 per cent and incorrect in 7 per cent of these cases. This study indicates that endoscopic examination should include tissue sampling; this not only allows a precise tissue diagnosis to be made but also is shown to increase the accuracy of diagnosis. Tissue sampling should include cytological as well as histological material. Analysis of cases of stricture correctly diagnosed has shown that target biopsy and brush cytology each makes a significant contribution to diagnosis. The routine collection of cytological specimens in addition to the more commonly obtained histological specimens in addition to the more commonly obtained histological speciments is strongly advocated. The natural history of malignant oesophageal strictures in this study is reviewd. The mean survival in 58 cases was 6.9 months.
Adult↗
A follow-up survey of patients with dyspepsia in one general practice.
Eighty-three patients who had been investigated by cholecystogram, barium meal and fibreoptic endoscopy more than two years previously were interviewed to enquire into their reactions to the investigations carried out, their present symptoms, and their present smoking and alcohol consumption. Comparisons were made with previously recorded observations. Those who still complained of severe dyspepsia were asked to attend for a repeat endoscopy. Sixty-three per cent of patients were asymptomatic; 13 per cent had recurrent dyspepsia, and 24 per cent had persistent dyspepsia. Thirty-nine per cent of smokers were found to have stopped altogether following medical advice.Both radiological and endoscopic methods of investigation proved acceptable. A majority of patients preferred endoscopy to barium meal.
Dyspepsia↗
Severe pseudomembranous colitis after lincomycin and clindamycin.
Four cases of severe pseudomembranous colitis following the use of lincomycin and clindamycin are described; 2 required emergency total colectomy and 2 died. Cases of such gravity after the use of these drugs have not been previously reported. On hundred and fifty-six orthopaedic cases where clindamycin and lincomycin were used postoperatively are reviewed; 34 had diarrhoea (22 per cent), and 3 of the severe cases occurred in this group. The diagnosis of pseudomembranous colitis may be difficult as the latent period from initiation of drug therapy to commencement of diarrhoea may be as much as 18 days, and that from cessation of drug therapy may be as much as 11 days. The value of early sigmoidoscopy in cases of diarrhoea of obscure aetiology is emphasized, and the characteristic sigmoidoscopic and histological appearances of pseudomembranous colitis are described. As these drugs may produce a lethal condition it is suggested that they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk.
Aged↗
Esophageal dilatation using the Eder Puestow dilators.
We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using intravenous diazepam, the majority on an outpatient basis. The only complication has been a single case of aspiration pneumonia. We have found this method of esophageal dilatation particularly useful in the preoperative dilatation of benign strictures, and in those elderly frail patients who are unsuitable for surgery. Transthoracic resection of the stricture is avoided and thus transabdominal repair of the hiatus hernia may be undertaken.
Aged↗
Study of dyspepsia in a general practice as assessed by endoscopy and radiology.
Fifty consecutive patients presenting in a general practice with dyspepsia were studied. Each patient was referred for a combined barium-meal examination and cholecystogram, followed by fibreoptic endoscopy of the oesophagus, stomach, and duodenum. Thirty patients had a specific lesion of the upper digestive tract and a further four had gall-bladder disease; of these, 16 required surgical treatment. Endoscopy in the remaining 16 patients showed nine with mucosal abnormalities, leaving only seven patients to be classified as normal.The advantage of having an endoscopy service to supplement radiological investigation of dyspepsia is shown.
Duodenal Ulcer↗