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PubMed2000

Endoscopic retrieval of a broken and migrated esophageal metal stent.

In patients with inoperable malignant tumors of the esophagus or cardia, self-expanding metal stents are increasingly used to improve dysphagia. Usually, they are not difficult to place and, as compared to conventional plastic stents, complications such as stent migration or perforation, seem to occur less frequently. This is a report on a young patient with metastatic adenocarcinoma of the cardia, who was treated with a self expanding metal stent after endoscopic dilatation of a tumor stenosis in the distal esophagus. Immediately after the procedure, he was able to eat and gained weight. Within 6 weeks and while on continuous infusion of 5-fluorouracil, the patient complained about recurrent severe dysphagia. Plain x-ray demonstrated a broken and migrated stent, the 2 parts of which were seen in the stomach and the duodenum. The stent could be extracted endoscopically without any complication, but the procedure was difficult and lasted 4 h, as the stent broke 2 more times during retrieval.

Adenocarcinoma↗
PubMed1997

Comparison of anterior, posterior and total fundoplication using a viscera model.

OBJECTIVE: To determine the contribution of mechanical factors to the function of different types of fundoplication. DESIGN AND SETTING: An experimental bench-top study using abattoir-sourced pig esophagus and stomach placed on a tray. Preliminary esophageal myotomy ensured free reflux of 'intragastric fluid'. INTERVENTIONS: Anterior, posterior, and total fundoplications were performed on each of ten sets of viscera. MAIN OUTCOME MEASURES: Lower esophageal sphincter pressure was measured using a conventional esophageal manometry catheter. Intragastric pressure was measured with a single channel intragastric manometry catheter, whilst the stomach was inflated with coloured water. The maximum intragastric pressure or the pressure measured when the fundoplication yielded to gastric distension was recorded. RESULTS: All three types of fundoplication restored adequate competence to the gastroesophageal junction, although high-volume gastric infusions resulted in fundoplication yield in 4/10 anterior and 4/10 posterior fundoplications. Gastric distension resulted in fundal dilatation and consequent compression of the adjacent esophagus. Fundoplication generated a median rise of 11-13.5 mmHg in lower esophageal sphincter pressure, comparable to pressures reported in the postoperative clinical setting. Significantly greater intragastric volumes and pressures were tolerated following total fundoplication. CONCLUSIONS: This study suggests that mechanical factors could be major contributors to the ability of a fundoplication to restore gastroesophageal competence. Anterior, posterior and total fundoplications are all effective procedures.

Animals↗
PubMed2000

Portal vein and its tributaries: evaluation with thin-section three-dimensional contrast-enhanced dynamic fat-suppressed MR imaging.

PURPOSE: To evaluate the visibility of the main portal vein (MPV) and its tributaries in healthy subjects at thin-section three-dimensional (3D) contrast material-enhanced dynamic fat-suppressed magnetic resonance (MR) imaging and to determine whether this technique provides useful information in the evaluation of patients with cirrhosis. MATERIALS AND METHODS: Seventy-two patients (37 control subjects, 35 patients with cirrhosis) underwent imaging with a high-performance-gradient (25 mT/m) system. RESULTS: In the 37 subjects in the control group, the MPV was visualized in 37; splenic vein (SV), in 37; superior mesenteric vein (SMV), in 37; inferior mesenteric vein (IMV), in 35; posterior superior pancreaticoduodenal vein (PSPDV), in 35; gastrocolic trunk (GT), in 34; right gastroepiploic vein (RGEV), in 31; right colic vein, in 30; anterior superior pancreaticoduodenal vein, in 22; middle colic vein (MCV), in 29; and first jejunal vein (FJV), in 36. Satisfactory visualization (mean ratings of 2 or higher) was achieved in the MPV, SV, SMV, IMV, PSPDV, GT, RGEV, and FJV in the control group. Mean diameters of the SV, SMV, MCV, and FJV were significantly larger in the cirrhosis group than in the control group (P <.001, P <.001, P =.048, and P =.002, respectively). CONCLUSION: Thin-section 3D contrast-enhanced dynamic fat-suppressed MR imaging can facilitate precise visualization of the MPV and its tributaries. Dilatation of the tributaries may be a nonspecific secondary finding that is suggestive of cirrhosis.

Adipose Tissue↗
PubMed2002

Effect of intragastric barostat bag on proximal and distal gastric accommodation in response to liquid meal.

The barostat is the gold standard for measurement of proximal gastric accommodation. Ultrasonography can be used to measure gastric volume. The aim was to investigate the effects of the barostat bag on gastric accommodation and transpyloric flow. Accommodation after a liquid meal (300 ml, 450 kcal) was measured twice at random in eight healthy volunteers. Proximal accommodation was measured once using barostat and once using ultrasound (US). Antrum accommodation was measured using US. Bag volume (BV), antral area (AA), proximal gastric area, and proximal gastric diameter (PGD) data were assessed before and 1, 5, 15, 30, 40, 50, and 60 min postprandially. Transpyloric flow was measured using Doppler 1-5 min postprandially. Fasted, AA size was not affected by the barostat bag (1 mmHg > minimal distension pressure; 2.7 +/- 0.5 vs. 2.6 +/- 0.3 cm(2)). Postprandially, AAs were larger with the bag present (ANOVA, P < 0.04). Maximum AA was reached with the bag in 5 min, without the bag in 1 min postprandially (15.1 +/- 2.3 vs. 9.4 +/- 1.5 cm(2); P < 0.03). Furthermore, AAs were related to BVs (r = 0.57; P < 0.01). After bag deflation, AA decreased (11.9 +/- 1.8 to 7.0 +/- 0.9 cm(2); P = 0.02) and was comparable with the 60-min AA size without the bag (7.1 +/- 1.2 cm(2); P = 0.76) present. Proximal gastric radius calculated from the BVs and PGDs was larger with the bag present (ANOVA, P < 0.001). No effect on early gastric emptying was observed. Postprandially, the barostat bag causes dilatation of the antrum due to meal displacement without influencing early gastric emptying. This antral dilatation is likely to induce exaggerated proximal gastric relaxation observed in studies using the barostat to evaluate fundic accommodation.

Adaptation, Physiological↗
PubMed2002

Gastrointestinal glomus tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 32 cases.

Glomus tumors usually occur in the peripheral soft tissues, but similar tumors have also been reported in the stomach and occasionally in the intestines. However, the relationship of these tumors to peripheral glomus tumors and gastrointestinal stromal tumors has not been fully clarified because previous series of gastrointestinal glomus tumors predate availability of immunohistochemistry. This clinicopathologic study examined 32 gastrointestinal glomus tumors. All but one of the tumors were located in the stomach and the remaining tumor was from the cecum. The tumors occurred with a strong female predominance (23 females and 9 males) and a median age of 55 years (range 19-90 years). The gastric tumors typically presented with gastrointestinal bleeding or ulcer-like symptoms, and 14 tumors had mucosal ulceration. Five tumors were incidental findings. The tumor sizes varied from 1.1 to 7 cm (median 2 cm), and most were located in the antrum. Histologically, the tumors typically had a solid pattern of sharply demarcated, round glomus cells with prominent, mildly dilated pericytoma-like vessels. Vascular invasion and focal atypia were relatively common (seen in 11 and 13 cases, respectively), and low mitotic activity (1-4 per 50 high power fields), was seen in 10 cases. Immunohistochemically, all tumors were positive for alpha-smooth muscle actin and calponin, and nearly all had a net-like pericellular laminin and collagen type IV positivity. All tumors were negative for desmin and S-100 protein. Three tumors had focal synaptophysin positivity, but none was positive for chromogranin. All tumors lacked KIT expression and the GIST-specific mutations in the c-kit gene. Follow-up revealed one patient death of metastatic disease to liver at 50 months; this tumor had 1 mitosis per 50 high power fields, but had spindle cell foci, mild atypia, and vascular invasion. Thirteen patients were well and alive after long-term follow-up. Gastrointestinal glomus tumors occur almost exclusively in the stomach, and they have a good overall prognosis, but a small, unpredictable potential for malignant behavior exists. These tumors are phenotypically similar to peripheral glomus tumors and differ from epithelioid GISTs.

Actins↗
PubMed1986

[Gastrointestinal amyloidosis as a differential diagnostic problem].

The diagnostic radiologist may have problems with the differential diagnosis of gastrointestinal amyloidosis combined with only uncharacteristic clinical symptoms. In the stomach upper gastrointestinal series show in most cases stenosing submucosal masses in the gastric antrum with diminished peristalsis and pliability. Sonography reveals a circular thickening of the gastric antrum wall. Only a synopsis of radiologic changes, the patients's history, laboratory tests and biopsies render a clue to the correct diagnosis. In the small bowel segmental or total intestinal dilatation with sonographically demonstrable thickening of the bowel wall and diminished motility, prolonged transit and eventually obstruction or paralytic ileus can be demonstrated. In patients with simultaneous plasmocytoma the radiologist has to take a gastrointestinal involvement by concurrent amyloidosis into account.

Aged↗
PubMed2006

Anesthetic management of a patient with a history of Batista procedure for dilated cardiomyopathy undergoing gastric surgery.

We experienced anesthetic management for an operation to remove a hemorrhagic gastric submucosal tumor in a patient who had undergone left ventricular volume reduction (the Batista procedure) for dilated cardiomyopathy (DCM) 2 years previously. Preoperative evaluations indicated the relapse of severe DCM. Intravenous and epidural anesthesia was employed with the aid of an intraaortic balloon pump (IABP). Safe anesthetic management was achieved under the guidance of a Swan-Ganz catheter without inducing overreduction of afterload or excessive preload.

Anesthesia, Epidural↗
PubMed1985

Gastroplasty as a treatment for massive obesity. A clinical and biochemical evaluation.

Twenty-four grossly obese patients were operated on with horizontal gastroplasty. One patient died postoperatively of pulmonary embolism. The remaining 23 were extensively studied before and repeatedly after surgery. Eighteen months postoperatively the average weight loss was 34.4 kg (range, 1-71 kg). Seven patients had a weight reduction of less than 20% after 18 months. Postoperatively, biochemical variables reflecting glucose and lipid metabolism and liver function improved. B-hemoglobin, S-iron levels, and serum concentrations of folate and cobalamins decreased significantly. No negative histological changes could be found in the gastric mucosa during the follow-up period. Although only positive metabolic changes have been registered, we feel that gastroplasty, which is not without early postoperative complications and has a failure rate of about 30%, cannot be generally recommended until the problem of postoperative dilation of the stoma has been successfully solved.

Adult↗
PubMed1992

[Stomal stenosis following gastrectomy in the elderly].

Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p < 0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p < 0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean) +/- 7.7 (SD) days in group (1), 29.7 +/- 12.6 days in group (2) and 62.1 +/- 30.0 days in group (3). These mean periods were significantly different from each other (p < 0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

Gastrointestinal obstruction from phytobezoar in childhood: report of two cases.

This is a report of two children aged twenty seven months and six years respectively presenting with gastrointestinal obstruction from phytobezoar. In the 27-month old child, laparotomy and gastrotomy was performed to evacuate the bezoar. However, death occurred from hypokalaemia. The six-year old child had a sacro-abdomino-perineal pull through for anorectal malformation previously and the bezoar lodged just above the neoanus. Neoanal dilatation allowed removal of the bezoar and relief of the obstruction. There has been no recurrence. The literature on bezoar is briefly reviewed.

Bezoars↗
PubMed2002

Eosinophilic gastroenteritis involving the distal small intestine and proximal colon.

Eosinophilic gastroenteritis (EG) is an unusual disorder. It is characterized by eosinophil infiltration of the gut wall histologically and is manifested by gastrointestinal (GI) symptoms clinically. This disease entity preferentially affects the stomach and proximal small intestine. Mucosal layer disease is the most common form of this uncommon disease. We present a case of EG with transmural distal small intestinal and proximal colonic involvement whose clinical symptoms included watery diarrhea, abdominal pain, and body weight loss. Colonoscopy showed non-specific colitis in the proximal colon. Small bowel series showed diffuse jejunal dilatation with wall thickening and rigidity. Abdominal computed tomography also showed a thickened bowel wall with partial ileus and ascites. Diagnosis was established through endoscopic biopsy and ascites paracentesis, while at the same time excluding the possibility of parasite infection. Treatment with prednisolone produced a dramatic response. A high index of suspicion in cases of peripheral eosinophilia with concomitant GI symptoms is needed for the early diagnosis of this uncommon disease.

Adult↗
PubMed1989

Balloon dilatation of gastro-gastrostomy strictures in gastroplasty revisions.

Several gastric operations have been developed for the control of morbid obesity. Further surgical intervention may be necessary because of failure to lose weight or complications associated with the previous operation such as intolerable reflux symptoms. Revision from a horizontal to a vertical staple line may result in a stenosis at the site of the gastro-gastrostomy. This study examines the authors' experience with balloon dilation of these strictures. Between May, 1981 and September, 1987, 12 of 113 patients who had revision of previous gastric reduction procedures developed either gastro-gastrostomy stenosis or stenosis above the Marlex collar (2 patients). Endoscopic balloon dilatation was attempted in all 12 patients. Eight females and four males (average age, 42 years) had undergone either a previous vertical banded gastroplasty (VBG) (2 patients), gastric bypass, or horizontal gastroplasty as their initial operation. Revision was performed for failure of the initial operation to control weight, obstructive symptoms, or gastroesophageal reflux. Balloon dilatation was possible in 11 of 12 patients. The majority required less than four dilations to alleviate obstructive symptoms. Balloon dilatation is effective in the management of gastro-gastrostomy stenosis following revision of gastric stapling procedures.

Adult↗
PubMed1994

The effect of distension of the stomach on plasma renin activity in the anesthetized pig.

It has recently been shown that distension of the stomach in anesthetized pigs causes reflex hemodynamic responses through efferent sympathetic mechanisms. The present study was undertaken to investigate whether these mechanisms include activation of the renin-angiotensin system. In twelve anesthetized pigs, intragastric balloons were distended for periods of 30 minutes by 0.81 of warm Ringer solution (mean gastric transmural pressure of about 12 mmHg). Changes in arterial blood pressure and heart rate were respectively prevented by a pressurized reservoir connected to the left femoral artery and by atrial pacing. Plasma renin activity was measured during the last minute of distension by radioimmunoassay of angiotensin I. In each of the twelve pigs distension of the stomach caused an increase in plasma renin activity. In five pigs, this response was graded with step increments of the distension. The increase in plasma renin activity to gastric distension was abolished by bilateral subdiaphragmatic vagotomy (six pigs) and by bilateral section of the renal nerves (six pigs). The present study showed that innocuous distension of the stomach in the anesthetized pig reflexly increased plasma renin activity. The afferent limb of the reflex was in the vagal nerves and the efferent limb involved renal nerves.

Animals↗
PubMed1994

Gastroschisis: can antenatal ultrasound predict infant outcomes?

OBJECTIVE: To test previously proposed but unproven antenatal ultrasound prognostic criteria in fetal gastroschisis. METHODS: Thirty consecutive gastroschisis-affected pregnancies and their outcomes were reviewed retrospectively. Data were tabulated by review of antenatal ultrasound videotapes, with blinded comparison to indicators of short- and long-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their ability to prognosticate effectively. RESULTS: Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant outcomes. However, a stricter 17-mm criterion for clinically important bowel dilatation provided prognostic information, with remarkable improvement in specificity (75 versus 37%) and positive predictive value (55 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%). CONCLUSIONS: Bowel dilated more than 17 mm on antenatal ultrasound appears to be associated with increased short- and long-term infant morbidity. Whether this finding warrants obstetric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.

Congenital Abnormalities↗
PubMed1998

Survival of proximal third gastric carcinoma.

BACKGROUND AND OBJECTIVES: Proximal third gastric carcinoma is a distinct clinical entity compared with tumors located in other parts of the stomach with a rapid increasing incidence and a poor prognosis. This study was done to evaluate therapy for, and survival of, patients with gastric cardia carcinoma. METHODS: Clinical features and prognosis of 49 patients with proximal third gastric carcinoma between 1985 and 1995 (mean age 69.7 years) were evaluated. RESULTS: In 20 of the 49 patients, laparotomy was excluded because of widespread disease and/or poor clinical condition at presentation. Palliative therapy consisted of gastric tube implantation (n = 4), dilation (n = 3), or radiotherapy (n = 4). In 9 patients, no specific palliative therapy was indicated. Twenty-nine patients underwent laparotomy (59%). In 13 patients, a total gastrectomy with esophagojejunostomy was performed, and in 7 patients a partial gastrectomy was performed. In 9 cases, the tumor was irresectable. In 8 of these 9 patients, a Celestin tube was implanted. Median survival in all patients was 7 months and the expected probability of survival after 50 months was zero. The median survival of patients who underwent a resection was significantly better than in those in whom no resection was performed (23 vs. 4 months, P = 0.047). CONCLUSIONS: We conclude that long-term survival of patients with proximal third gastric carcinoma is poor. However, long-term survival may be best warranted when patients present at an early stage and resection can be performed.

Adult↗
PubMed1990

"Healed" experimental gastric ulcers remain histologically and ultrastructurally abnormal.

The present study was designed to assess histologic and ultrastructural features of gastric mucosa in the areas of grossly healed ulcers (acetic acid-induced gastric ulcers) in rats. The specific question we studied was whether the structure and cellular composition of the gastric mucosa in an area of grossly healed ulcer were fully restored. Eighty Sprague-Dawley rats underwent laparotomy; 100% acetic acid was applied to the lower gastric corpus serosa for 30 s and the abdomen was closed. The stomachs were reopened after 2 weeks or after 2, 3, or 4 months. Standardized gastric wall specimens from the area of grossly healed ulcers were obtained, processed, and evaluated by light microscopy and by transmission electron microscopy. The gastric mucosa of grossly healed ulcers demonstrated re-epithelialization at each study time but the mucosa beneath the surface epithelium displayed prominent histologic and ultrastructural abnormalities. Two different patterns of scar could be distinguished: (a) the mucosa in the area of healed ulcer was thinner (25-45% reduction vs. normal), with increased connective tissue and poor differentiation and/or degenerative changes in the glandular cells; or (b) the mucosa displayed ballooning dilatation of gastric glands, reduction in the microvascular network, and poor differentiation of glandular cells. We conclude that (i) the subepithelial mucosa of grossly healed gastric ulcer displays disorganized restoration of glandular and vascular structures and remains histologically and ultrastructurally abnormal; (ii) these abnormalities may interfere with oxygenation, nutrient supply, and with mucosal resistance and defense, and therefore could be the basis for ulcer recurrence.

Acetates↗