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PubMed1979

Pneumatic dilation under general anesthesia after unsuccessful cardiomyotomy for achalasia.

A 12-year-old girl with achalasia was treated successfully under general anesthesia with pneumatic dilation after she had experienced two unsuccessful surgical procedures. The Mosher dilator was passed into the stomach by threading it over a guide wire. Our experience suggests that pneumatic dilation can be performed in children or adults after surgical failure and that general anesthesia may be employed.

Anesthesia, General↗
PubMed1997

Nissen and Toupet fundoplications effectively inhibit gastroesophageal reflux irrespective of natural anatomy and function.

BACKGROUND: The physiology of Nissen fundoplication (NF) and Toupet fundoplication (TF) is controversial. The aim of this study was to determine the contribution of elevated intragastric pressure to the antireflux mechanism after surgically created fundoplication in explanted porcine stomachs. METHODS: The stomachs and 6-8 cm of distal esophagus were removed from 15 pigs and placed in anatomic position. Five NF, 2 cm in length with three interrupted sutures, were performed, taking full-thickness bites of stomach and partial-thickness bites of esophagus around a 60 French dilator. Five 270 degree TF 2 cm in length with six interrupted sutures were performed taking full-thickness bites of stomach and partial-thickness bites of esophagus around a 60 French dilator. Each stomach served as its own control. The pylorus was tied off and the stomach was inflated with Ringer's lactate while the pressure was monitored. RESULTS: Before NF, reflux could be easily induced with a mean intragastric pressure of 5.5 +/- 3.7 mmHg. After NF reflux could not be induced but the sutures pulled out of the stomach at a mean pressure of 36.8 +/- 11.7 mmHg (p<0.01 vs control). Before TF, reflux could easily be induced with a mean intragastric pressure of 3.0 +/- 3.0 mmHg. After TF, reflux could not be induced and the sutures pulled out of the esophagus or stomach with a mean pressure of 30.8 +/- 9.0 mmHg (p<0.01 vs control). Porcine stomachs in vivo are resistant to reflux, but when explanted they reflux easily. NF and TF are so effective at interrupting reflux that the sutures tear out instead of allowing reflux. CONCLUSIONS: While not yet statistically significant, it appears that sutures tear out of the esophagus (TF) more readily than they tear out of the stomach (NF). TF and NF prevent reflux in the absence of anatomic or functional components of the lower esophageal sphincter.

Animals↗
PubMed1994

Vascular bed-dependent roles of the peptide CGRP and nitric oxide in acid-evoked hyperaemia of the rat stomach.

1. Acid back-diffusion through a disrupted gastric mucosal barrier is known to increase gastric mucosal blood flow via a neural mechanism. The present study examined how the acid-evoked change in the gastric microcirculation compares with blood flow changes in the left gastric artery, one of the major arteries supplying the stomach, and whether the dilator mediators in the left gastric artery are identical to those in the gastric mucosa. 2. The experiments were performed on rats anaesthetized with urethane. Blood flow in the left gastric artery was measured by the ultrasonic transit time shift technique, and blood flow in the gastric mucosa was assessed by the hydrogen gas clearance method. 3. Gastric acid back-diffusion evoked by perfusion of the stomach with 15% ethanol in 0.15 M HCl increased blood flow in the left gastric artery by a factor of 4.7, which was significantly larger than the 2.9-fold increase in blood flow through the gastric mucosa. Blood pressure and heart rate were not altered appreciably. 4. The acid-evoked hyperaemia in the left gastric artery was left unaltered by atropine and the substance P receptor antagonist RP-67580. 5. The calcitonin gene-related peptide (CGRP) antagonist CGRP (8-37) had no effect on gastric blood flow but prevented the dilator action of CGRP and inhibited the acid-evoked hyperaemia in the gastric mucosa to a larger degree than the hyperaemia in the left gastric artery. 6. Blockade of nitric oxide synthesis by N omega-nitro-L-arginine methyl ester (L-NAME) caused constriction of the left gastric artery and the gastric mucosal microvessels. The acid-evoked vasodilatation in the gastric mucosa was blocked by L-NAME, whereas the dilator response in the left gastric artery was not significantly depressed. 7. The data show that the gastric hyperaemic response to acid back-diffusion results from dilatation of mucosal microvessels and extramural arteries. The dilator mechanisms, however, differ between the two vascular beds. CGRP and nitric oxide are important vasodilator mediators in the gastric mucosa but are of less relevance in the left gastric artery.

Animals↗
PubMed2003

Percutaneous endoscopic gastrostomy before multimodality therapy in patients with esophageal cancer.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has not been widely used in esophageal cancer because of concerns about safety of dilatation, suitability of the stomach as an esophageal replacement, and potential for inoculation metastasis. METHODS: Experience with PEG in consecutive patients presenting with new esophageal cancer from March 1991 to March 2001 was reviewed retrospectively. PEG was planned in 119 of 179 (66%) of these patients excluding those presenting moribund and those for whom early resection was planned. The PEG was placed using an endoscopic method with wire-guided endoscopic bougienage or laser ablation or both as needed. Success of placement, requirement for dilatation and ablation, PEG-related complications, tolerance of enteral feeds, and impact on therapy were evaluated. RESULTS: PEG placement was possible in 87% of patients (103 of 119). Dilatation or laser ablation or both was required in 46% (47 of 103). There was no procedure-related mortality. Thirty-day mortality was 13.5%. Major PEG-related complications were observed in 4% (4 of 103) and minor PEG-related complications in 12% (12 of 103). PEG removal was required in 4 patients and interruption of enteral feeds required in 33 (32%). No instances of esophageal disruption or tumor inoculation metastasis were noted. PEG takedown and site closure at the time of operation was uncomplicated and use of the stomach as an esophageal substitute was possible in all 61 resected patients. Rates of anastomotic leak, stricture, and gastric emptying delay were similar to those for patients proceeding to resection without prior PEG (leak: PEG = 8% [5 of 61] versus non-PEG = 10.5% [2 of 19]), (stricture: PEG = 37% [22 of 61] versus non-PEG = 32.5% [6 of 19]), (delay: PEG = 9.8% [6 of 61] versus non-PEG = 10.5% [2 of 19]). Analysis of variables showed PEG to be significantly related to attainment of target doses of chemoradiotherapy (p = 0.034), and survival at 12 months (p = 0.02). CONCLUSIONS: PEG in esophageal cancer is safe and useful and does not compromise the stomach or esophagogastric anastomosis. Further study is required to define the efficacy of PEG as a means of nutritional support and its impact on survival.

Adult↗
PubMedDate not supplied

Surgical management of corrosive strictures of stomach.

BACKGROUND: Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. METHODS: Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. RESULTS: The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.

Adolescent↗
PubMed1993

[Clinical studies of intra-thoracic stomach function in patients after esophagectomy and reconstruction by whole stomach].

We usually use the stomach to hung up into the chest and to the neck for esophago-gastrostomy in the patients of esophageal cancer. We had studied the intrathoracic stomach function in patients after esophagectomy with isotope 99m Tc labelled 717-resin semisolid meal for scintigram. We measured the gastric emptying time (GET) and fund the GET1/2 was no difference between the preoperative group and contrast group (P > 0.05). The study indicated that GET1/2 was faster obviously in postoperative patients with pyloroplasty than without pyloroplasty (P < 0.01). It was proved that to perform pyloroplasty with esophagostomy should be used routinely for preventing the pylorospasm, dilatation of the intrathoracic stomach and gastroesophageal reflux. At the same time, we found fasting serum gastrin (FSG) was increased (P < 0.01) in patients after esophagectomy than before, but basal acid output (BAO) decreased. It indicated that vagotomy caused the BAO decreasing and PH increasing. There were some relations between high level of FSG and postoperative diarrhea.

Esophageal Neoplasms↗
PubMed1984

Pathologic findings in the stomachs of rats treated with the H2-receptor antagonist tiotidine.

The gross and histopathologic findings seen in the stomach of rats treated with an H2-antagonist, tiotidine, will be presented. The data presented is from two studies, a six month oral (gavage) and dietary study in male rats, and a 12 month oral chronic toxicity study combined with a 24 month oncogenicity feeding study in rats. Significant findings in the stomach included fundic glandular dilatation, parietal cell atrophy, metaplastic fundic cells, fundic nuclear clusters, and dysplasia/carcinoma lesions. The chronology of the borderline type dysplasia/carcinoma lesions starting from the very early to the more advanced infiltrating carcinomas will be shown. A total of 17 rats with lesions of the dysplasia/carcinoma complex out of 828 treated rats from the two studies were present. No similar type lesions were seen in any of the 432 control rats examined. The importance of the diagnostic methods used in the examination of the stomach is stressed.

Animals↗
PubMed1988

[Indications and limitations of laser treatment for early gastric cancer and palliative treatments for malignant obstruction of the esophagus and stomach].

The long-term effect of endoscopic laser treatment for early gastric cancer as a local curative procedure was reported. Forty-seven patients with endoscopically diagnosed early gastric cancer whose surgical risk was critical or who refused surgery were treated by either photocoagulative Nd: YAG laser (YAG) or photodynamic therapy (PDT) with argon dye laser and hematoporphyrin derivatives (HpD) or both and followed-up for more than 3 years. Thirty-one patients were initially treated by YAG. One patient was lost to follow-up. Sixteen of 30 cases (53%) treated by YAG were negative for cancer on biopsy for 9 to 73 months (mean 3 years and 7 months) after the initial treatment. Sixteen cases were initially treated by PDT. Eight of 14 cases (57%) treated by PDT with argon dye laser were negative for cancer on biopsy for 19 to 35 months (mean 1 year and 7 months). Ten of 13 cases treated by combined laser therapy were negative for cancer on biopsy for 12 to 77 months (mean 3 years and 2 months). Curative effect of YAG and PDT was expected in lesions of superficially elevated mucosal cancer (type) IIa less than 20mm and well demarcated superficially depressed mucosal cancer (type IIc) less than 10mm. PDT was superior to YAG in treating early gastric cancer, particularly when the margin of lesion is unclear, and depth of cancer invasion is estimated to be submucosal. Risks of lymph node metastasis in these lesions are reportedly minimal as well. Quality of life scores did not decrease when the patients were treated by lasers, but did so statistically significantly in the surgically treated group of patients. Therefore, we conclude that the endoscopic laser is the treatment of choice of treatment for early gastric cancer as a local curative procedure in the aged if they have a curable lesion as mentioned above. As a palliative treatment, 34 patients with neoplastic obstruction of the esophagus and stomach were treated by dilators with or without intubation of prosthesis tube and laser recanalization. Functional efficacy (ability to eat solid or semi-solid diet which could not be eater before treatment) was noted in 64% of 11 cases treated by dilators alone, 75% of 12 cases treated by intubation of prosthesis tube and 45% of 11 cases treated by lasers. There was a greater complication rate in the intubation group also. Patients with malignant stricture due to mediastinal lymph node metastasis were at higher risk of perforation.

Aged↗
PubMed1998

[A case of idiopathic intussusception of the stomach].

A 73-year-old man was admitted to our hospital because of vomiting. A fist-sized tumor with tenderness was palpated on his epigastric region. Fluoroscopic examination of the stomach showed narrow body and dilated antrum with intussusception. Endoscopic findings revealed fold convergence to the antrum. Intraoperatively, the body of the stomach was invaginated into the antrum with hepatoduodenal ligament. It was difficult to repair or resect, and a gastrojejunostomy was performed. On the 10th operative day, fluoroscopic examination of the stomach showed no intussusception of the stomach and no lesion in the upper gastrointestinal tract. To our knowledge, such cases of idiopathic intussusception of the stomach are rare.

Aged↗
PubMed1979

Surgical management of gastric torsion.

Considerable investigation has been devoted to the gastric dilatation-torsion complex. An adequate explanation of its cause has yet to be made, or a means of prevention described. We do know of its highly lethal nature, especially if not aggressively treated, of the high incidence of recurrence, and of the associated pathophysiology. As surgeons, we must approach the patient in an aggressive systematic manner. Decompression and patient stabilization must be achieved prior to definitive surgical management. The surgery planned must correct the obvious pathologic state and include procedures designed to prevent recurrence of this condition. The tube gastrostomy technique promotes gastric fixation by dense adhesion bands exceeding that attainable by gastropexy alone. The procedure is easy to perform, requires little surgical time, and does not appear to be discomforting to the patient. In addition, the tube gastrostomy acts as a convenient decompressive pathway during the postoperative period, circumventing gastric intubation or pharyngostomy tube placement should distention occur.

Animals↗
PubMedDate not supplied

Gastric myoelectric activity after experimental gastric dilatation-volvulus and tube gastrostomy in dogs.

Gastric myoelectric activity was measured after experimental gastric dilatation-volvulus (GDV), GDV and tube gastrostomy, or tube gastrostomy in 12 dogs. Gastric myoelectric activity was recorded for 1 hour before (hour 0) and at hours 5, 24, 48, 72, and 96 after surgically induced GDV in six dogs. Three dogs with induced GDV and tube gastrostomy, and three dogs with tube gastrostomy only were also studied at hours 120, 144, and 168. The only significant change in the slow wave appearance or frequency from hours 0 to 48 was bradygastria at hour 5 in all three groups. A relative increase in the mean percentages of dysrhythmia from hours 72 to 168 in the dogs with a tube gastrostomy was caused by increases in tachygastria and arrhythmias. Dogs with GDV and tube gastrostomy had the greatest mean percentages of dysrhythmia, which were significantly more than those in dogs with GDV alone at hours 48, 72 and 96. The mean percentage of spike activity was less than or equal to 31 and varied widely. In general, there was less spike activity when the frequency of dysrhythmias was high. Thus, gastric myoelectric activity was disrupted from hours 48 to 168 after GDV with tube gastrostomy and after tube gastrostomy alone. Surgically induced GDV alone did not produce any significant or sustained dysrhythmias.

Animals↗
PubMed2003

Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is the preferred operation for the treatment of morbid obesity by many surgeons. Hereby we present the process by which laparoscopic RYGBP (LRYGBP) developed at our institution. METHODS: Perioperative morbidity was recorded from 150 consecutive morbidly obese patients operated upon by RYGBP from August 1994 to March 2002. The first 76 consecutive patients have been followed up to 5 years postoperatively. A subgroup of 40 patients was recruited to evaluate the postoperative lung function in a randomized study between receiving and not receiving prophylactic chest physiotherapy. RESULTS: In the whole series, there were 4 conversions to open surgery, 5 leaks, 12 postoperative bleedings and 1 intestinal obstruction. 1 patient succumbed after developing acute dilatation of the bypassed stomach. Respiratory function deteriorated significantly in all patients in the early postoperative period, irrespective if given physiotherapy. During the follow-up period, 3 patients developed mechanical obstruction of the Roux limb. Another patient had a perforated ulcer at the proximal pouch. Weight reduction averaged 70% of excess body weight at 2 years after surgery. CONCLUSIONS: LRYGBP is an effective treatment for morbid obesity. During the initial development, we experienced a number of serious complications. The complication rate decreased over time. Postoperative lung function was markedly impaired, but there were no beneficial effects of chest physiotherapy. Long-term weight loss after LRYGBP seems to be comparable to what has been reported after open RYGBP.

Adult↗