Biomedical subjects

Vic Velanovich

Publications and source records attributed to Vic Velanovich.

21 records · Page 2Linked to original sources

PubMed2002

Case-control comparison of endoscopic gastroplication with laparoscopic fundoplication in the management of gastroesophageal reflux disease: early symptomatic outcomes.

Endoscopic gastroplication is a new technique in the management of gastroesophageal reflux disease. No comparisons of this technique with laparoscopic fundoplication have been done. Twenty-seven patients with symptoms of reflux disease were evaluated with upper endoscopy, esophageal manometry, and 24-hour esophageal pH monitoring, as well as a symptom severity questionnaire. Patients then underwent endoscopic gastroplication with use of the Bard Interventional Endoscopic Suturing System. Patients completed the symptom severity questionnaire 6 weeks after the procedure. These 27 patients were matched for age, gender, and pre-procedure symptom score with patients in a prospectively gathered database of laparoscopic antireflux operations. Twenty-one patients (78%) in the endoscopic gastroplication group were satisfied with their symptomatic outcome, 2 (7%) were neutral, and 4 (15%) were dissatisfied. In comparison, there were 26 satisfied patients (96%) in the laparoscopic group ( < 0.01). Median symptom scores improved similarly in both groups, with no statistically significant difference. The patients who were dissatisfied had a mean improvement in symptom score of 10, compared with 27 for the satisfied patients ( < 0.01). Endoscopic gastroplication is a viable alternative to laparoscopic fundoplication in selected patients. Nevertheless, approximately one quarter of patients will have no improvement, which is much more than those undergoing laparoscopic fundoplication.

Adult↗

PubMed2002

Relationship of gastroesophageal reflux disease with adenocarcinoma of the distal esophagus and cardia.

BACKGROUND: Recent studies have suggested that gastroesophageal reflux disease (GERD) increases the risk of developing adenocarcinoma of the distal esophagus and cardia. In order to further define this risk, we studied the relationship of GERD in patients with or without gastroesophageal junction adenocarcinomas. METHODS: The records of all patients with adenocarcinoma of the distal esophagus and cardia treated between 1991 and 1999 were reviewed for the following data: gender, age of diagnosis, presence of GERD, presence of GERD for >4 years, and GERD treatment. A control group of patients without gastroesophageal junction adenocarcinoma were matched for age and gender. Data obtained from the control group included presence of GERD and treatment for GERD. RESULTS: 60 patients with adenocarcinoma of the distal esophagus and cardia were identified. 40% of cancer patients had GERD at the time of diagnosis, (odds ratio 39, p < 0.0001). 27% of cancer patients had GERD for >4 years (odds ratio 21, p < 0.0001). 50% of cancer patients with GERD were being treated with either H(2)-blockers or proton pump inhibitors at the time of cancer diagnosis, with an average duration of treatment of 17 months, compared to none of the patients without GERD (p = 0.006). CONCLUSIONS: Patients with gastroesophageal junction adenocarcinoma had a higher prevalence of GERD-like symptoms compared to age- and gender-matched controls. This supports an association between GERD and gastroesophageal junction cancers. In addition, cancer patients with GERD may be treated for prolonged periods of time with acid-suppression medication prior to the diagnosis of cancer, masking the symptoms of cancer. Patients with long-standing GERD or older patients with new onset GERD may need endoscopy or imaging studies to evaluate for cancer of the distal esophagus or cardia.

Adenocarcinoma↗

PubMedDate not supplied

Effects of manometrically discovered nonspecific motility disorders of the esophagus on the outcomes of antireflux surgery.

Nonspecific motility disorders (NMDs) of the esophagus are common manometric findings in patients evaluated for gastroesophageal reflux disease (GERD). However, it is unclear how these disorders affect the outcomes of antireflux surgery. The purpose of this study was to assess symptomatic outcomes of patients with and without NMDs undergoing surgical treatment for GERD. A prospectively gathered database of all patients undergoing antireflux surgery was retrospectively reviewed for preoperative symptoms, symptom severity using the GERD-HRQL (best score 0, worst score 50), esophageal manometry measurements, presence of NMD, type of operation, any transient or permanent postoperative dysphagia, severity of postoperative dysphagia (best score 0, worst score 5), and postoperative symptom severity. A total of 239 patients were studied; 24% had a NMD identified by preoperative esophageal manometry, and 17% of this +NMD group had preoperative dysphagia or atypical chest/epigastric pain compared to 28% of those without a NMD (-NMD group) (P=NS). Preoperative symptom scores were +NMD 33 vs. -NMD 27 (P=0.01). Postoperative symptom scores were +NMD 5 vs. -NMD 3 (P=NS). There were no differences in preoperative or postoperative dysphagia scores. Transient postoperative dysphagia was 15.8% in the +NMD group vs. 16.4% in the -NMD group (P=NS). Postoperative dilation was 0% in the +NMD group vs. 2% in the -NMD group (P=NS). Manometrically discovered NMDs do not appear to affect preoperative symptoms or symptomatic outcomes of patients surgically treated for GERD. These findings my reflect the severity of GERD and may improve with antireflux surgery.

Case-Control Studies↗