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At least 775 records · Page 43Linked to original sources
PubMed1993

Esophageal dilation with polyvinyl bougies, using a marked guidewire without the aid of fluoroscopy: an update.

One hundred thirty-eight patients with esophageal stricture underwent polyvinyl bougie dilations whereby American Endoscopy dilators were passed over a marked guidewire that had been placed endoscopically. Fluoroscopy was not utilized during the dilations. The dilations were performed only after the guidewire was properly placed, with 60-cm markings at the incisors, which ensured that the tip of the guidewire was in the antrum. One hundred fourteen patients had benign strictures and 24 had malignant strictures. There were 197 sessions of dilations for a total of 748 individual dilations. In 97 of 138 patients, the guidewire was placed in the antrum under direct vision. The remaining 41 patients had significant esophageal stenosis which prevented passage of the endoscope into the stomach; therefore, the guidewire was placed by advancing it blindly through the stenosis. There were no procedure-related complications. During this period, eight patients were dilated without complications, using fluoroscopic placement of guidewire because endoscopic placement of the guidewire was not considered safe. We conclude that esophageal strictures can be safely dilated in most patients by means of the American Endoscopy dilator system and the marked guidewire without the aid of fluoroscopy.

Adult↗
PubMed2001

Methyl ethyl ketone peroxide ingestion: toxicity and outcome in a 6-year-old child.

A 6-year-old boy developed respiratory distress, metabolic acidosis, severe esophageal and gastric burns, and a coagulopathy after ingestion of an unknown volume of methyl ethyl ketone peroxide (MEKP) in dimethyl phthalate. He was discharged from the pediatric intensive care unit 19 days postingestion but subsequently developed a stricture of the gastroesophageal junction and complete fibrosis of the middle third of the stomach, necessitating gastric resection and reconstruction. He was discharged 93 days postingestion on a program of dilation for the residual esophageal stricture. MEKP acts by initiating lipid peroxidation via free radical production that results in cellular dysfunction and death. Acetylcysteine, a glutathione precursor and possible free radical scavenger, may be of use in severe MEKP poisoning. This case demonstrates the severe effects that some industrial chemicals can have both systemically and locally at the point of contact with the gastrointestinal tract, as well as the long-term management required to ensure good quality of life.

Accidents, Home↗
PubMed1998

Management of patients with giant paraesophageal hernia.

Paraesophageal herniation can cause massive bleeding, strangulation or perforation. This study reviews the experience with 24 patients (74.6 years, range 63-89 years, 20 males, 4 females) with a total or near-total intrathoracic stomach, managed at the Royal Lancaster Infirmary. All patients were symptomatic with 3/24 patients presenting as emergencies. Twenty-three of 24 patients underwent surgery: gastropexy alone-5, gastropexy and hiatal repair-17, gastropexy, hiatal repair and fundoplication 1. One of the emergency patients died prior to surgery. Median operative time was 50 min (range 35-65 min) and median hospital stay was 7 days (range 5 days-3 weeks). A splenectomy was necessary in 1/23 (4.4%) patients. Postoperative morbidity included: recurrent hernia requiring surgery-1, pleural effusion requiring chest tube-1, empyema-1, dysphagia requiring dilatation-1, reflux with stricturing-1. Elderly patients with a total or a near-total intrathoracic stomach can be managed by gastropexy and hiatal repair, with acceptable morbidity.

Aged↗
PubMed1984

Roles of gastrin release and neural reflexes during the gastric phase of acid secretion in dogs.

The acid secretion from the main stomachs and from denervated Heidenhain pouches in response to peptone meals infused in the stomach was determined in 4 dogs. When expressed as percent of the maximal acid response to histamine, the acid secretion from the innervated and from the denervated fundic mucosa was similar, but the response from the Heidenhain pouch was larger when expressed as percent of the maximal response to pentagastrin. These studies indicate that, under the conditions used, short (gastrogastric) and long (vagovagal) reflexes during the gastric phase, are of minor importance in inducing the acid response to the meal.

Animals↗
PubMed2003

Scintigraphic evaluation of jejunal interposition after distal esophageal resection for early Barrett's carcinoma.

Subtotal esophagectomy still is the major treatment for early Barrett's carcinoma. The inevitable loss of the gastric reservoir leaves an unresolved functional problem. Distal esophageal resection combined with a short jejunal interposition might be a safe alternative with the advantage of better functional results. In this series, 12 or more months after limited surgery for early Barrett's carcinoma 8 patients underwent functional investigation by alimentary scintigraphy. The activity of a technetium-labeled bolus passing through the esophagus and the jejunal interposition into the stomach was consecutively measured. Compared to 11 healthy controls the transit through the tubular esophagus showed no significant delay; transit time, however, increased with a bolus-induced dilation of the jejunal interposition. The length of the transit time through the jejunal interposition correlated with the length of the jejunal segment. The delay of bolus passage into the stomach did not result in substantial symptoms in jejunal segments shorter than 12 cm. Propulsive activity within the jejunal interposition resulted in a bolus transport into the stomach without any reflux to the esophagus. These data demonstrate good transport function and reflux prevention of short jejunal segments interposed between the esophagus and the stomach.

Adult↗
PubMed1986

Surgical treatment after the failed antireflux operation.

Eighty-seven adults have undergone reoperation for recurrent gastroesophageal reflux or complications of prior antireflux procedures. Operations performed included the transthoracic Collis-Nissen procedure (59), Collis-Belsey repair (14), Nissen fundoplication (one), repair of acute postoperative paraesophageal hernia (one), division of obstructing crural suture (one), and esophageal resection (23). Among the 73 patients undergoing an additional hiatal hernia repair, there were two postoperative deaths. Follow-up averages 28 months. Subjectively, results have been excellent or good (no or mild reflux symptoms or dysphagia) in 47 (67%); fair in eight (12%), who have moderate dysphagia or reflux symptoms controlled medically; and poor in 15 (21%), 12 of whom have required additional operations. Early postoperative esophageal dilations were required in 25 patients (36%) and regular dilations in seven (10%). Among the 23 patients undergoing esophageal resection, four had a distal esophagectomy and short-segment colon interposition and 19 had a transhiatal esophagectomy without thoracotomy; stomach was used for esophageal replacement in 14 and colon in five. There were no operative deaths. Follow-up averages 17 months. Thirteen patients have had esophageal dilations (nine early and four regularly), and one has clinically significant reflux. Overall, subjective results are good or excellent in 64 (76%). The results of "redo hiatal hernia operation" are far from ideal. Optimal surgical treatment after the failed antireflux operation requires careful analysis of the existing anatomy and experience to decide when esophageal resection is a safer and more reliable approach than another hiatal hernia repair.

Adult↗
PubMed2006

Selective effects of nutrients on gut sensitivity and reflexes.

BACKGROUND: Intestinal nutrients induce gut reflexes and modulate perception. AIM: To elucidate the relative potency and putative relationship of motor and sensory effects induced by different nutrients. METHODS: By paired tests carried out in sequence on healthy patients, the effect of isocaloric duodenal infusions of carbohydrates and lipids was determined on gastric compliance and on perception of gastric distension. Gastric distension at stepwise tension increments was applied using a tensostat, and perception at each tension level was measured on a 0-6 scale. In separate groups (n = 8 each), three nutrient loads were tested: (A) low (0.2 kcal/min), (B) medium (0.5 kcal/min) and (C) high (1 kcal/min). RESULTS: Values are mean (standard error). (A) Low caloric loads: both gastric perception and compliance were similar with lipids (45 (2) g, 451 (28) ml tolerated) and carbohydrates (46 (1) g, 449 (22) ml tolerated). (B) Medium caloric loads: although perception remained unchanged (46 (1) g and 46 (2) g tolerated, respectively), lipids, but not carbohydrates, partially relaxed the stomach (559 (18) v 442 (31) ml intragastric volume, respectively; p<0.05). (C) High caloric loads: lipids markedly reduced gastric tolerance and increased compliance (22 (3) g, 635 (34) ml tolerated), whereas carbohydrates did not affect perception and induced only a partial gastric relaxation (46 (1) g, 565 (46) ml tolerated; p<0.05 v lipids for both). CONCLUSION: The effects of intestinal nutrients on gastric tone are more potent than those on gastric sensation, and both depend on the caloric load and the type of nutrient.

Adult↗
PubMed1990

Balloon catheter dilatation for hypertrophic pyloric stenosis.

Balloon dilating catheters (BDC) have provided a non-operative means of managing obstructive lesions within the gastrointestinal tract. Its potential utility in infants with hypertrophic pyloric stenosis (HPS) was studied. Six patients with HPS underwent balloon catheter dilatation of the pylorus under the direct observation of the surgeon. The pylorus was exposed using a standard right upper quadrant incision. The BDC was passed transorally into the stomach and manipulated into the pyloric canal by the surgeon. The balloon was inflated with saline to a maximum pressure of 50 psi for 2 minutes. Four patients were dilated with a 10-mm diameter balloon catheter, and in two patients, a 15-mm balloon was used. Success was defined as the complete and longitudinal disruption of the seromuscular ring without violation of mucosal integrity. Using this criterion, none had successful pyloric dilatation. No disruption occurred in three patients, partial disruption in two. These patients subsequently underwent a Ramstedt pyloromyotomy. Complete disruption was observed in one; however, a breach of the mucosa was evident. This was repaired without incident. All seromuscular breaks occurred at the point of vascular entry along the lesser curve, presumably the weakest point of the ring. Pyloric dilatation using BDC does not reliably disrupt the muscular ring. This preliminary report recognizes that major refinements must occur before this method will supplant the time-honored surgical pyloromyotomy for HPS.

Catheterization↗
PubMed1979

[Problems in emergency surgery: segmental portal hypertension].

Three typical cases of segmental portal hypertension due to occlusion of the splenic vein are reported. This syndrome may be asymptomatic for a very long time and then present suddenly in the form of a serious picture of high digestive haemorrhage due to rupture of the varices of the fundus of the stomach as a result of hypertrophized submucous collateral drainage circulation. Useful for diagnosis are oesophagogastroduodenoscopy, which points to stomach varices, and splenoportography or superselective arteriography of the splenic artery with venous phase, which highlight pathognomonic dilatation and tortuosity of the gastroepiploic veins. Surgical exploration typically shows: presence of large epipolic vessels, splenomegaly, absence of changes in the liver and in the portal and mesenteric circulation. Resolutive treatment of choice is splenectomy.

Adult↗
PubMed1992

Surgical management of esophageal strictures.

Benign esophageal strictures may be caused by numerous disorders, but more than 90% of them are due to severe gastroesophageal reflux or ingestion of lye. A new classification of the severity of the stricture is proposed, based on the endoscopic and radiological evaluation of three parameters: internal diameter, length of the stricture and ease or difficulty of dilatation. In patients with strictures secondary to reflux, initial treatment includes periodic dilatation. Grade I and II strictures require esophageal resection. In grade III patients, bile diversion or esophageal resection should be performed. Caustic ingestion produces a wide spectrum of tissue damage in the upper digestive tract ranging from minimal chemical burn to an extensive and massive necrotic lesion. The basic and main treatment in patients with an established esophageal stricture is periodic dilatation avoiding, if at all possible, any kind of surgery. In patients with grade III stricture, colonic interposition between cervical esophagus and stomach or duodenum is preferred, treating the damaged esophagus by resection or leaving it "in situ". Psychiatric evaluation is mandatory in these cases.

Burns, Chemical↗
PubMed2000

Stomachs of mice lacking the gastric H,K-ATPase alpha -subunit have achlorhydria, abnormal parietal cells, and ciliated metaplasia.

The H,K-ATPase of the gastric parietal cell is the most critical component of the ion transport system mediating acid secretion in the stomach. To study the requirement of this enzyme in the development, maintenance, and function of the gastric mucosa, we used gene targeting to prepare mice lacking the alpha-subunit. Homozygous mutant (Atp4a(-/-)) mice appeared healthy and exhibited normal systemic electrolyte and acid-base status but were achlorhydric and hypergastrinemic. Immunocytochemical, histological, and ultrastructural analyses of Atp4a(-/-) stomachs revealed the presence of chief cells, demonstrating that the lack of acid secretion does not interfere with their differentiation. Parietal cells were also present in normal numbers, and despite the absence of alpha-subunit mRNA and protein, the beta-subunit was expressed. However, Atp4a(-/-) parietal cells had dilated canaliculi and lacked typical canalicular microvilli and tubulovesicles, and subsets of these cells contained abnormal mitochondria and/or massive glycogen stores. Stomachs of adult Atp4a(-/-) mice exhibited metaplasia, which included the presence of ciliated cells. We conclude that ablation of the H,K-ATPase alpha-subunit causes achlorhydria and hypergastrinemia, severe perturbations in the secretory membranes of the parietal cell, and metaplasia of the gastric mucosa; however, the absence of the pump appears not to perturb parietal cell viability or chief cell differentiation.

Achlorhydria↗
PubMed2006

Determinants of symptom pattern in idiopathic severely delayed gastric emptying: gastric emptying rate or proximal stomach dysfunction?

BACKGROUND: Idiopathic gastroparesis is a syndrome characterised by severely delayed gastric emptying of solids without an obvious underlying organic cause. Although delayed gastric emptying is traditionally considered the mechanism underlying the symptoms in these patients, poor correlations with symptom severity have been reported. AIMS: To investigate proximal stomach function and to study the correlation of delayed gastric emptying and proximal stomach dysfunction with symptom pattern and severity in idiopathic gastroparesis. METHODS: 58 consecutive patients (19 men, mean (standard deviation) age 41 (2) years) with severely delayed solid gastric emptying (gastric half-emptying time (t(1/2))>109 min) without an organic cause were recruited. They filled out a symptom-severity questionnaire and underwent a gastric barostat study for assessment of gastric sensitivity and accommodation. Correlation of these mechanisms with symptom pattern and overall symptom severity (sum of individual symptoms) was analysed. RESULTS: At two different cut-off levels for gastric emptying (upper limit of normal t(1/2) up to 1.5 and 2 times), no significant change in symptom pattern occurred. 25 (43%) patients had impaired accommodation, and this was associated with higher prevalence of early satiety (p<0.005) and weight loss (p = 0.009). 17 (29%) patients had hypersensitivity to gastric distension, and this was associated with higher prevalences of epigastric pain (p = 0.005), early satiety (p = 0.04) and weight loss (p<0.005). Overall symptom severity was not correlated with gastric emptying or accommodation, but only with sensitivity to gastric distension (R = -0.3898, p = 0.003) and body weight (R = -0.4233, p = 0.001). CONCLUSIONS: In patients with idiopathic gastroparesis, the symptom pattern is determined by proximal stomach dysfunction rather than by the severity of delayed emptying.

Adult↗
PubMed1986

Gastric dilatation observed on radionuclide studies. Spherical approximation and effective wall thickness.

Radionuclide studies often define the gastric contents as a photopenic volume. In many cases, the volume can be described by a spherical approximation, which allows a first approach to calculating the volume and monitoring its change. With the further assumption that the stomach wall is a sphere surrounding the contents, the effective thickness of the gastric wall can be determined. This thickness is approximately 0.4-4 mm.

Gastric Dilatation↗
PubMed1990

[The watermelon stomach; linear convolutions of vascular ectasias in the antrum].

The watermelon stomach or 'gastric antral vascular ectasia' is a rare clinical entity. It may cause persistent blood loss. The endoscopic picture is highly characteristic and consists of parallel erythematous folds in the antrum. Histological characteristics are: dilated mucosal capillaries and venules, containing fibrin thrombi, along with fibromuscular hyperplasia in the lamina propria. In case of severe blood loss partial resection of the stomach or laser photocoagulation is often necessary.

Aged↗
PubMed1998

Ultrasonographic comparison of adhesions induced by two different methods of gastropexy in the dog.

Ultrasonography was used to compare adhesions induced by two different methods of gastropexy in 16 dogs. An incisional gastropexy technique was used in eight dogs (group 1) and a 'modified' gastropexy technique in the remaining eight (group 2). The length and thickness of the gastropexy and the peristaltic activity of the stomach were measured ultrasonographically and compared between groups. Measurements for the two groups were taken in the early postoperative interval (two to four days), intermediate postoperative interval (eight to 20 days) and late postoperative interval (57 to 79 days). Both techniques were equally successful in forming permanent adhesions at two months postoperatively and there was no recurrence of gastric dilatation and volvulus. The length and thickness of the gastropexy were similar for both groups at two months postoperatively and there were no surgical complications with either technique. The modified gastropexy provides a technique that can easily be performed by a single surgeon, with no increased operative time or duration of anaesthesia, and with the formation of a permanent adhesion.

Animals↗
PubMed1992

Cardiopulmonary responses to experimentally induced gastric dilatation in isoflurane-anesthetized dogs.

Gastric dilatation was experimentally induced in 6 anesthetized dogs maintained with constant-dose isoflurane in oxygen. An intragastric balloon was used to distend the stomach with a constant 30 mm of Hg pressure for 3.5 hours. The PaCO2 was maintained between 35 and 45 mm of Hg, using intermittent positive-pressure ventilation. Cardiopulmonary measurements prior to stomach distension (baseline) were compared with measurements taken during 0.1, 0.5, 1.0, 1.5, 2.5, and 3.5 hours of stomach distension by analyzing the change from baseline in a randomized-block analysis with each dog as a block. After distending the stomach, cardiac index increased (P less than 0.01) from 1.5 to 3.5 hours. Stroke volume did not change, thus the increase in the cardiac index was attributable to an increase in heart rate. During inflation, increases were observed in systemic arterial, pulmonary arterial, and right atrial pressure. Respiratory frequency was unchanged; however, to maintain PaCO2 constant, it was necessary to progressively increase peak airway pressure. Although PaO2 tended to decrease during gastric dilation, the dogs were never hypoxemic. These results indicate that when our methods are used to maintain a constant anesthetic dose of isoflurane in oxygen, an observed increase in cardiovascular performance is expected. This differs from other studies in anesthetized dogs that have shown reduction in cardiovascular performance following gastric dilatation.

Anesthesia, Inhalation↗
PubMed2006

Evaluating an optimal gastric closure method for transgastric surgery.

BACKGROUND: The transgastric approach is currently being studied as a potentially less invasive alternative to conventional laparoscopy for intra-abdominal surgery. A major obstacle to overcome is the closure of the transgastric incision in a rapid, reproducible, and safe manner. The effectiveness of various techniques for gastrotomy closure were compared by assessing leak pressures in an ex vivo porcine stomach model. METHODS: Whole stomachs from adult white pigs were suspended in a Plexiglas box to facilitate endoscopic technique. Standard gastrotomies were made by needle knife incision and dilation with a controlled radial expansion (CRE) balloon. The first arm used standard QuickClips; the second, a prototype device developed by LSI Solutions; the third, hand-sewn by a senior surgeon; the final, a control with open gastrotomy. Five stomachs were tested per study arm. After closure, each stomach was inflated by an automated pressure gauge. The pressures to achieve air leakage and liquid leakage were recorded. RESULTS: The unclosed controls demonstrated air leakage at a median pressure of 15 mmHg, representing baseline system resistance. The QuickClip closures leaked air at a median pressure of 33 mmHg. The prototype gastrotomy device yielded the highest median air leak pressure of 85 mmHg while dramatically diminishing time for incision and gastrotomy closure to approximately 5 min. The hand-sewn closures leaked air at a median pressure of 47 mmHg. Using Kruskal-Wallis statistical analysis, the comparisons were significant (p = 0.0019). Post hoc paired comparisons using MULTTEST procedure with both Bonferroni and bootstrap adjustments revealed that the difference between prototype and clips was significant; prototype versus hand-sewn was not. Liquid-leak pressures produced similar results. CONCLUSIONS: The prototype device decreases procedure time and yields leak-resistant gastrotomy closures that are superior to clips and rival hand-sewn interrupted stitches.

Animals↗