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Hans Gregersen, Kar Man Lo
This review provides a biomechanical perspective on the pathophysiology and treatment of achalasia. The esophagus is efficient in transporting ingested material to the stomach in healthy subjects. A fine balance exists between the peristaltic forces generated in the esophageal body (which herein is defined as the preload) and the resistance in the outlet, the esophago-gastric junction (which is defined as the afterload). Achalasia is a rare esophageal disease that progressively over many years challenges esophageal efficacy...
May 14, 2018: Annals of the New York Academy of Sciences
Hisham Sharif, Shaoping Hou
Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes...
September 2017: Neural Regeneration Research
John H Rodriguez, Ivy N Haskins, Andrew T Strong, Ryan L Plescia, Matthew T Allemang, Robert S Butler, Michael S Cline, Kevin El-Hayek, Jeffrey L Ponsky, Matthew D Kroh
INTRODUCTION: Gastroparesis is a debilitating disease characterized by delayed gastric emptying in the absence of mechanical obstruction. A new intramural technique, per oral endoscopic pyloromyotomy (POP), has been proposed as an alternative to surgical pyloroplasty for the management of medical refractory gastroparesis. Herein, we detail the short-term results of POP at our institution. METHODS: POP was first performed at our institution in January 2016. All patients undergoing POP for management of gastroparesis from January 2016 through January 2017 were prospectively followed...
December 2017: Surgical Endoscopy
Daniel Gilsdorf, Eric Volckmann, Abbie Brickley, Linda Jo Taylor, Robert E Glasgow, John Fang
BACKGROUND: Endoscopic intrapyloric Botox (onabotulinumtoxin A; Allergan Pharmaceuticals) injections can improve postfundoplication gastroparesis, but responses are not durable. Surgical pyloroplasty may relieve gastroparetic symptoms, but patient selection criteria are poorly defined. We hypothesize that pyloroplasty provides durable improvement in patients whose symptoms improved after Botox injection. STUDY DESIGN: A retrospective chart review was performed of patients with postfundoplication gastroparesis who improved after Botox injection and then underwent pyloroplasty...
November 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Mouen A Khashab, Saowanee Ngamruengphong, David Carr-Locke, Amol Bapaye, Petros C Benias, Sam Serouya, Shivangi Dorwat, Dalton M Chaves, Everson Artifon, Eduardo G de Moura, Vivek Kumbhari, Yamile Haito Chavez, Majidah Bukhari, Gulara Hajiyeva, Amr Ismail, Yen-I Chen, Hyunsoo Chung
BACKGROUND AND AIMS: Gastric per-oral endoscopic myotomy (G-POEM) recently has been reported as minimally invasive therapy for gastroparesis. The aims of this study were to report on the first multicenter experience with G-POEM and to assess the efficacy and safety of this novel procedure for patients with gastroparesis with symptoms refractory to medical therapy. METHODS: All patients with gastroparesis who underwent endoscopic pyloromyotomy (G-POEM) at 5 medical centers were included...
January 2017: Gastrointestinal Endoscopy
Naueen Akbar Chaudhry, Kamran Zahid, Roxana Coman, Qing Zhang
A 52-year-old Caucasian woman presented with progressive nausea and vomiting, weight loss, and burning epigastric and chest pain. Initial oesophagogastroduodenoscopy (OGD) with biopsies demonstrated gastritis in absence of Helicobacter pylori A gastric emptying study, CT scan with pancreatic protocol and a colonoscopy revealed no concerning findings. Calcium channel blockers and proton pump inhibitors offered little improvement. A high-resolution oesophageal impedance manometry was performed, which was significant for jackhammer oesophagus with maximum distal contractile index 11 052 mm Hg-s-cm...
May 12, 2016: BMJ Case Reports
Hans F Fuchs, Ryan C Broderick, Cristina R Harnsberger, Francisco Alvarez Divo, Alisa M Coker, Garth R Jacobsen, Bryan J Sandler, Michael Bouvet, Santiago Horgan
BACKGROUND: Esophagectomy may lead to impairment in gastric emptying unless pyloric drainage is performed. Pyloric drainage may be technically challenging during minimally invasive esophagectomy and can add morbidity. We sought to determine the effectiveness of intraoperative endoscopic injection of botulinum toxin into the pylorus during robotic-assisted esophagectomy as an alternative to surgical pyloric drainage. MATERIALS AND METHODS: We performed a retrospective analysis of patients with adenocarcinoma and squamous cell carcinoma of the distal esophagus or gastroesophageal junction who underwent robotic-assisted transhiatal esophagectomy (RATE) without any surgical pyloric drainage...
June 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Carter Lebares, Lee L Swanstrom
A growing body of literature supports the use of laparoscopic pyloroplasty as a minimally invasive treatment of refractory gastroparesis that has failed conservative measures and for benign gastric outlet obstruction. Endoscopic pyloric dilation, stent placement, and Botox have been described for similar indications, but often with transient or mixed results. Per-oral pyloromyotomy has recently been proposed as an endoscopic alternative to surgical pyloroplasty or pylormyotomy because it is less invasive by its nature and potentially more durable than current endoscopic treatments...
April 2016: Gastrointestinal Endoscopy Clinics of North America
Mena Boules, Ricard Corcelles, Andrea Zelisko, Esam Batayyah, Dvir Froylich, John Rodriguez, Stacy Brethauer, Kevin El-Hayek, Matthew Kroh
BACKGROUND: Obesity is an epidemic on the rise. Increasing body mass index (BMI) has been associated with a number of comorbid diseases, including rarely reported motility disorders such as achalasia. Motility disorders are prevalent in obese patients, possibly more prevalent when compared to the nonobese population. Identification of motility disorders is important before bariatric surgery and may alter the planned type of procedure performed. Limited data exist regarding the development or existence of esophageal motility disorders after bariatric surgery...
June 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Ozan Unlu, Alexis Okoh, Bulent Yilmaz, Emir C Roach, May Olayan, Abdullah Shatnawei
BACKGROUND: Obesity is an epidemic leading to high morbidity, mortality, and therefore health-related costs. Thus, there is a huge need for development of safe and effective treatments. Even though success rates of conservative methods are highly limited, the surgical approaches lead to major complications in as many as 25% of the patients. In this study, we aimed to review the currently available, less-invasive, endoscopic bariatric techniques which provides an option to reduce the risks of the patients and the medical costs...
December 2015: Acta Gastro-enterologica Belgica
Kevin L Grimes, Haruhiro Inoue, Manabu Onimaru, Haruo Ikeda, Amarit Tansawet, Robert Bechara, Shinwa Tanaka
BACKGROUND: Since its introduction in 2010, per oral endoscopic myotomy (POEM) has offered an alternative to laparoscopic Heller myotomy for the treatment of achalasia. A gastric myotomy length of 3 cm has been recommended; however, it can be difficult to ensure that adequate submucosal dissection has been performed during the procedure. Commonly accepted endoscopic markers of the gastric side can be inaccurate, particularly in patients with prior endoscopic treatments, such as balloon dilation or Botox injection of the lower esophageal sphincter...
April 2016: Surgical Endoscopy
Moshim Kukar, Steven N Hochwald
This video demonstrates our technique for a minimally invasive esophagectomy with side-to-side stapled cervical esophagogastric anastomosis. This technique is routinely utilized in most patients undergoing esophagectomy for esophageal or gastroesophageal junction malignancy, excluding type III gastroesophageal junction tumors. Absolute contraindications include significant tumor involvement of the fundus which may necessitate an intrathoracic anastomosis. Relative contraindications include poor pulmonary function or prior extensive surgical history that may either preclude surgery altogether or prevent the ability of the conduit from reaching the cervical region, or could preclude utilization of a minimally invasive approach...
December 2015: Annals of Surgical Oncology
S Arya, S R Markar, A Karthikesalingam, G B Hanna
Delayed emptying of the gastric conduit following esophagectomy can be associated with an increased incidence of complications including aspiration pneumonia and anastomotic leak. The aim of this systematic review is to evaluate the current modalities of pyloric drainage following esophagectomy and their impact on anastomotic integrity and postoperative morbidity. Medline, Web of Science, Cochrane library, trial registries, and conference proceedings were searched. Five pyloric management strategies following esophagectomy were evaluated: no intervention, botulinum toxin (botox) injection, finger fracture, pyloroplasty, and pyloromyotomy...
May 2015: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Reza Bagheri, Seyed Hossein Fattahi, Seyed Ziaollah Haghi, Kamran Aryana, Ali Aryanniya, Saeed Akhlaghi, Fateme Naghavi Riyabi, Shima Sheibani
BACKGROUND: Esophageal cancer is among the most common gastrointestinal cancers for which the main treatment is surgery. This study was undertaken to analyze the results of Botox injection in preventing gastric stasis in these patients. PATIENTS AND METHODS: 60 patients with esophageal cancer in the middle and lower third parts were included in our study between 2010 and 2011, and were randomly divided into two groups. In group A, 30 patients underwent pyloroplasty, and in group B, injection of botulinum toxin into the pyloric sphincter muscle was used in 30 patients...
December 2013: Asian Cardiovascular & Thoracic Annals
Naga Venkatesh G Jayanthi, Simon P L Dexter, Abeezar I Sarela
BACKGROUND: Severe, drug-resistant gastroparesis is a debilitating condition. Several, but not all, patients can get significant relief from nausea and vomiting by gastric electrical stimulation (GES). A trial of temporary, endoscopically delivered GES may be of predictive value to select patients for laparoscopic-implantation of a permanent GES device. MATERIALS AND METHODS: We conducted a clinical audit of consecutive gastroparesis patients, who had been selected for GES, from May 2008 to January 2012...
October 2013: Journal of Minimal Access Surgery
Karen J Dickinson, Conrad G Beckett, John C May, James C Halstead
Obesity is endemic and bariatric surgery is increasing in an attempt to reduce the physiological and social cost. As the prevalence of bariatric surgery increases, in particular laparoscopic roux-en-Y gastric bypass (LRYGB), the need to investigate and treat subsequent pathology in the gastric remnant and biliary tree will accrue. We describe a novel combined surgical and endoscopic technique addressing the challenges of postoperative anatomy, allowing investigation and treatment of the gastric remnant and biliary tract...
2013: BMJ Case Reports
Lee L Swanstrom, Ashwin Kurian, Christy M Dunst, Ahmed Sharata, Neil Bhayani, Erwin Rieder
BACKGROUND: Esophageal achalasia is most commonly treated with laparoscopic myotomy or endoscopic dilation. Per-oral endoscopic myotomy (POEM), an incisionless selective myotomy, has been described as a less invasive surgical treatment. This study presents 6-month physiological and symptomatic outcomes after POEM for achalasia. METHODS: Data on single-institution POEMs were collected prospectively. Pre- and postoperative symptoms were quantified with Eckardt scores...
October 2012: Annals of Surgery
Yuanyuan Zhang, Guihua Liu, Bradley P Kropp
UNLABELLED: Re-epithelialization demucosa stomach patch is important to prevent the patch being exposed to urine that might cause patch shrinkage and fibrosis formation due to urine-derived chemical irritation. Additionally, Botox A acts by blocking the transmission of nerve impulses to smooth muscles and so paralysing the muscles, which is commonly used to relax muscle for treatment of oesophageal achalasia due to overactive smooth muscle and sphincters of gastrointestinal tract. We fabricated in vitro tissue engineered urothelial mucosa with multi-layers of urothelium and smooth muscle layers seeded on SIS scaffold and then used this cell-scaffold construct to cover nuke gastro patch combining with Botox A for gastrocystoplasty in a canine model...
July 2012: BJU International
K-H Fuchs, W Breithaupt
Gastroesophageal reflux disease (GERD) is the most frequent benign disorder of the upper gastrointestinal (GI) tract and other defined disease entities, such as achalasia and diffuse esophageal spasm, also belong to this group. In addition to surgical therapy, medicinal therapy also has an important role in all 3 of these disorders. Therefore, it is very important to follow precise indication criteria based on diagnostic evaluation and patient selection as well as to use an optimal operative technique.The therapeutic spectrum for achalasia varies from Botox injections and endoscopic dilatation to laparoscopic myotomy which achieves a success rate up to 90%...
March 2011: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Ninh T Nguyen, Chirag Dholakia, Xuan-Mai T Nguyen, Kevin Reavis
Pyloroplasty is performed during esophagectomy to avoid delayed gastric emptying. However, studies have shown that gastric function is minimally impaired even without a pyloroplasty when a gastric tube rather than the whole stomach is used for reconstruction. The aim of this study was to evaluate outcomes of minimally invasive esophagectomy without performance of a pyloroplasty. We performed a retrospective review of 145 patients who underwent a minimally invasive esophagectomy. The 30-day mortality was 2.1 per cent with an in-hospital mortality of 3...
October 2010: American Surgeon
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