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1.
Esophageal dysmotility and gastroesophageal reflux disease 总被引:4,自引:0,他引:4
Urs Diener M.D. Marco G. Patti M.D. Daniela Molena M.D. Piero M. Fisichella M.D. Lawrence W. Way M.D. 《Journal of gastrointestinal surgery》2001,5(3):260-265
Gastroesophageal reflux disease (GERD) produces a spectrum of symptoms ranging from mild to severe. While the role of the lower esophageal sphincter in the pathogenesis of GERD has been studied extensively, less attention has been paid to esophageal peristalsis, even though peristalsis governs esophageal acid clearance. The aim of this study was to evaluate the following in patients with GERD: (1) the nature of esophageal peristalsis and (2) the relationship between esophageal peristalsis and gastroesophageal reflux, mucosal injury, and symptoms. One thousand six consecutive patients with GERD confirmed by 24-hour pH monitoring were divided into three groups based on the character of esophageal peristalsis as shown by esophageal manometry: (1) normal peristalsis (normal amplitude, duration, and velocity of peristaltic waves); (2) ineffective esophageal motility (IEM; distal esophageal amplitude < 30 mm Hg or >30% simultaneous waves); and (3) nonspecific esophageal motility disorder (NSEMD; motor dysfunction intermediate between the other two groups). Peristalsis was classified as normal in 563 patients (56%), IEM in 216 patients (21%), and NSEMD in 227 patients (23%). Patients with abnormal peristalsis had worse reflux and slower esophageal acid clearance. Heartburn, respiratory symptoms, and mucosal injury were all more severe in patients with IEM. These data show that esophageal peristalsis was severely impaired (IEM) in 21% of patients with GERD, and this group had more severe reflux, slower acid clearance, worse mucosal injury, and more frequent respiratory symptoms. We conclude that esophageal manometry and pH monitoring can be used to stage the severity of GERD, and this, in turn, should help identify those who would benefit most from surgical treatment. 相似文献
2.
Daniel S. Oh M.D. Jeffrey A. Hagen M.D. Martin Fein M.D. Cedric G. Bremner M.D. Christy M. Dunst M.D. Steven R. DeMeester M.D. John Lipham M.D. Tom R. DeMeester M.D. 《Journal of gastrointestinal surgery》2006,10(6):787-797
The components of refluxed gastric juice are known to cause mucosal injury, but their effect on esophageal function is less
appreciated. Our aim was to determine the effect of acid and/or bile on mucosal injury and esophageal function. From 1993–2004,
402 patients with reflux symptoms had 24-hour pH and Bilitec monitoring, manometry, and endoscopy with biopsies. Mucosal injury
(esophagitis or Barrett’s esophagus) and esophageal function (lower esophageal sphincter [LES] characteristics and body contractility)
in patients with acid reflux, bile reflux, or both were compared with patients without reflux. Reflux was present in 273/402
patients; of these, 37 (13.5%) had increased exposure to bile, 82 (30.0%) had increased exposure to acid, and 154 (56.4%)
had increased exposure to both. Mucosal injury was most common with increased mixed acid and bile exposure, followed by acid
alone, and was uncommon with bile alone (P<0.0001). Functional deterioration paralleled mucosal injury (P<0.0001). Mixed acid and bile exposure was present in more than half of patients with reflux and was associated with the most
severe mucosal injury and the greatest deterioration of esophageal function. This suggests that composition of gastric juice
is the primary determinant of inflammatory mucosal injury and subsequent loss of esophageal function.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–19,
2005 (oral presentation). 相似文献
3.
Reginald V. N. Lord Steven R. DeMeester Jeffrey H. Peters Jeffrey A. Hagen Dino Elyssnia Corinne T. Sheth Tom R. DeMeester 《Journal of gastrointestinal surgery》2009,13(4):602-610
Background and Aims Gastroesophageal reflux disease (GERD) is a spectrum of disease that includes nonerosive reflux disease (NERD), erosive reflux
disease (ERD), and Barrett’s esophagus (BE). Treatment outcomes for patients with different stages have differed in many studies.
In particular, acid suppressant medication therapy is reported to be less effective for treating patients with NERD and Barrett’s
esophagus. The aims of this study were to investigate (1) the role of mechanical factors including hiatal hernia and lower
esophageal sphincter (LES) competence in the spectrum of GERD and (2) outcomes of Nissen fundoplication.
Methods From the records of patients who had undergone laparoscopic Nissen fundoplication after an abnormal pH study, we identified
50 symptomatic consecutive patients with each of the GERD stages: (1) NERD, (2) mild ERD, defined as esophagitis that was
healed with acid suppression therapy, (3) severe ERD, defined as esophagitis that persisted despite medical therapy, and (4)
BE. Exclusion criteria were normal distal esophageal acid exposure, esophageal pH monitoring performed elsewhere, antireflux
surgery less than 1 year previously or previous fundoplication, and a named esophageal motility disorder or distal esophageal
low amplitude hypomotility. Patients who could not be contacted for the study were also excluded. All patients completed a
detailed preoperative questionnaire; underwent preoperative upper gastrointestinal endoscopy, stationary manometry, and distal
esophageal pH monitoring; and were interviewed at least 1 year after operation.
Results One hundred sixty patients meeting the entry criteria were studied. The mean follow-up period was 36.7 months. The only significant
preoperative symptom difference was that patients with BE had more moderately severe or severe dysphagia compared to patients
with NERD. Patients with severe ERD or BE had a significantly higher prevalence of hiatal hernia, lower LES pressures, and
more esophageal acid exposure. Hiatal hernia and hypotensive LES were present in most patients with severe ERD or BE but in
only a minority of patients with NERD or mild ERD. Surgical therapy resulted in similarly excellent symptom outcomes for patients
in all GERD categories.
Conclusions Compared to mild ERD and NERD, severe ERD and BE are associated with significantly greater loss of the mechanical antireflux
barrier as reflected in the presence of hiatal hernia and LES measurements. Restoration of the antireflux barrier and hernia
reduction by laparoscopic Nissen fundoplication provides similarly excellent symptom control in all patients. 相似文献
4.
目的研究伴或不伴食管黏膜损伤的胃食管反流病(gastroesophageal reflux disease,GERD)患者在食管动力方面的差异。
方法回顾性分析2015年1月至2017年12月,解放军总医院就诊的有反酸、烧心、胸痛等症状的患者,24 h食管pH监测Demeester积分≥14.72分,根据内镜检查结果分为糜烂性反流病(ERD)组和非糜烂性反流病(NERD)组,比较2组患者食管动力学指标的变化。
结果NERD组与ERD组UESP平均值数值相似,差异无统计学意义(P=0.168)。其余指标UESRP平均值、LESP最小值、LESP平均值、LESRP平均值、LESRP最大值、DCI中NERD组均高于ERD组,差异均有统计学意义(P<0.001)。NERD组平均年龄明显小于ERD组,差异有统计学意义(P<0.000 1)。NERD组患者身高较ERD组偏低,体重较轻,身体质量指数(body mass index,BMI)也较小,差异有统计学意义(P<0.000 1)。
结论随着年龄的增大或BMI的增加,可能增加GERD患者食管黏膜损伤的风险。此外,糜烂性反流病患者较非糜烂性反流病的上、下食管括约肌动力障碍更严重。 相似文献
5.
Martin K. Schilling M.D. Daniel Mettler D.V.M. Michael Feodorovici M.D. Markus W. Büchler M.D. 《Journal of gastrointestinal surgery》2000,4(1):63-69
Premalignant lesions of the gastroesophageal junction are treated conservatively or by antireflux surgical procedures. We
describe a novel technique that replaces the distal esophagus after resection of the gastroesophageal junction. After resection
of the gastroesophageal junction, 16 pigs were divided into two groups. In group 1 (n = 9) the gastroesophageal junction was
replaced with a 3 cm wide horizontal gastric corpus tube, pedicled at the lesser curvature. In group 2 (n = 7) the tube was
pedicled at the greater curvature. Tube length, volume, and compliance of the gastric remnant and blood flow in the tube (by
laser Doppler flowmetry given in perfusion units [PU]) were measured before and after tube formation and 2 weeks postoperatively.
Group 1 tubes were 9.5 ±1.5 cm long and group 2 tubes were 8.2 ± 0.7 cm long. Tube formation decreased volume and compliance
of the gastric remnant. After tube formation, blood flow at the tip of the tube decreased from 254 PU to 64 ±22 PU (group
1) and 87 ±36 PU (group 2). Volume, compliance, and blood flow returned to baseline values 2 weeks postoperatively. No anastomoric
leakage was found on postmortem examination. Horizontal gastric corpus tubes might offer an alternative to replace the distal
esophagus and proximal stomach after resection of premalignant lesions of the gastroesophageal junction. 相似文献
6.
Stefan Öberg M.D. Manfred P. Ritter M.D. Peter F. Crookes M.D. Martin Fein M.D. Rodney J. Mason M.D. Michael Gadenstätter M.D. Cedric G. Bremner M.D. Jeffrey H. Peters M.D. Tom R. DeMeester M.D. 《Journal of gastrointestinal surgery》1998,2(6):547-554
Gastroeosphageal reflux disease has been associated with long segments of Barrett’s esophagus (≥3 cm), but little is known
about its association with shorter segments. The aim of this study was to evaluate anatomic and physiologic alterations of
the cardia and esophageal exposure to gastric and duodenal juice in patients with short and long segments of Barrett’s esophagus.
Furthermore, these patients were compared to each other and to patients with erosive esophagitis and those with no mucosal
injury. Two hundred sixty-two consecutive patients with foregut symptoms were divided into the following four groups based
on endoscopic and histologic findings: group 1, no mucosal injury; group 2, erosive esophagitis; group 3, short-segment Barrett’s
esophagus; and group 4, long-segment Barrett’s esophagus. Esophageal exposure time to acid and bilirubin, lower esophageal
sphincter characteristics, and endoscopie anatomy of the cardia were compared between the groups. Patients with short-segment
Barrett’s esophagus had elevated esophageal acid and bilirubin exposure, decreased lower esophageal sphincter pressure and
length, and a high incidence of hiatal hernia. These abnormalities were similar to those in patients with esophagitis and
in general less profound than those found in patients with long-segment Barrett’s esophagus. The length of intestinal metaplasia
was higher in patients with a defective lower esophageal sphincter. Short-segment Barrett’s esophagus is a complication of
severe gastroesophageal reflux disease and is associated with the reflux of both gastric and duodenal juice similar to that
seen in patients with long-segment Barrett’s esophagus.
Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14,1997. 相似文献
7.
The Pathogenesis of Barrett’s Esophagus: Secondary Bile Acids Upregulate Intestinal Differentiation Factor CDX2 Expression in Esophageal Cells 总被引:4,自引:0,他引:4
Yingchuan Hu Valerie A. Williams Oliver Gellersen Carolyn Jones Thomas J. Watson Jeffrey H. Peters 《Journal of gastrointestinal surgery》2007,11(7):827-834
8.
Gabor Varga Agnes Kiraly Laszlo Cseke Katalin Kalmar Ors Peter Horvath 《Journal of gastrointestinal surgery》2008,12(2):304-307
For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently,
the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically
proven hypertensive lower esophageal sphincter was performed. Laparoscopic floppy Nissen fundoplication was performed in all
cases. The first follow up was performed 6 weeks after the operation. The mean follow up time was 56 months (range 50–61).
Before the operation, all patients had abnormal esophageal acid exposure. Mean DeMeester score was 41.7 (range 16.7–86). Average
LES pressure before the operation was 50.5 mmHg (range 35.6–81.3). Six weeks after operation, all patients were symptom free.
DeMeester score returned to a normal level of 2.9. Furthermore, a marked decrease in the lower esophageal sphincter pressure
(24.7 mmHg) was detected. At late follow up, all patients were symptom-free, and only two patients agreed to undergo functional
testing. The mean DeMeester score of this two patients was 1.2. The pressure remained at normal value (15.7 mmHg). In our
study, an antireflux operation normalized lower esophageal sphincter pressure suggesting that abnormal esophageal acid exposure
may be an etiologic factor in the development of hypertensive lower esophageal sphincter. 相似文献
9.
Glutathione S-transferase-Pi expression is downregulated in patients with Barrett’s esophagus and esophageal adenocarcinoma 总被引:1,自引:1,他引:0
Jan Brabender M.D. Reginald V. Lord M.B.B.S. Kumari Wickramasinghe M.D. Ralf Metzger M.D. Paul M. Schneider M.D. Ji-Min Park M.S. Arnulf H. Hölscher M.D. Tom R. DeMeester M.D. Kathleen D. Danenberg B.S. Peter V. Danenberg Ph.D. 《Journal of gastrointestinal surgery》2002,6(3):359-367
10.
BACKGROUND: Barrett's esophagus affects 5-10% of patients with gastroesophageal reflux disease (GERD) and is associated with a 40-fold increased risk of malignant transformation. Ablative therapies may lead to esophageal perforation or stricture formation if applied too liberally and residual glandular tissue and persistent cancer risk if utilized too sparingly. METHODS: Ten pigs underwent gastrotomy. Mucosa below the gastroesophageal (GE) junction was elevated by saline injections, circumferentially incised, and secured to an orogastric tube. By traction, the distal esophageal mucosa was inverted 10 cm proximally, then returned to the gastric lumen. In group A (n = 4), the mucosa (5 cm) was resected and the remnant was allowed to retract. In group B (n = 4), the mucosa was simply sutured back into its native position. In group C (n = 2), the mucosa (5 cm) was resected and the proximal segment was advanced and sutured to the gastric mucosa. At 6 weeks, or sooner if stricture developed, the animals were killed. Stricture formation was determined by ex vivo barium esophagram and gross assessment. The extent of fibrosis and epithelial healing were established histologically. RESULTS: Group A (mucosa resected) developed weight loss and anorexia within 4 weeks. Pathology revealed dense fibrotic stricture without reepithelialization. Group B (mucosa elevated/replaced) gained weight after the operation. Histology demonstrated mucosal healing without significant stricture or fibrosis. Group C (mucosa resected/advanced) also thrived postoperatively. Histology confirmed mucosal healing without evidence of retraction or dense stricture. CONCLUSIONS: Exposure of submucosal tissues causes esophageal stricture. Mucosal coverage minimizes submucosal fibrosis after injury. Mucosal resection and advancement allows healing without stricture and may have therapeutic potential for patients with Barrett's esophagus. 相似文献
11.
Background: Laparoscopic Nissen fundoplication is an increasingly utilized option for the treatment of gastroesophageal reflux disease (GERD). However, many questions remain as to the mechanism by which this operation prevents GERD in those without hiatal hernias or incompetent lower esophageal sphincters (LES). It is known that these patients experience reflux due to excess transient lower esophageal sphincter relaxations (TLESR), inappropriate and short-lived relaxation of the LES and crural diaphragm. The purpose of this study was to determine if Nissen fundoplication affects the neural pathways involved in the TLESR reflex. Methods: Five dogs were anesthetized and intubated. Both vagal nerves and the right phrenic nerve were isolated. A continuous water perfusion manometric catheter was situated at the LES. The nerves were then electrically stimulated and the resultant pressure at the LES measured at baseline, and during and after an open Nissen fundoplication. Results: The mean LES pressures before dissection, after esophago-gastric mobilization, and after fundoplication were 47 ± 13 mmHg, 21 ± 9 mmHg, and 14 ± 4 mmHg, respectively. All differences were significant. There was no change noted in LES pressure with stimulation of either or both of the phrenic nerves without concomitant vagal stimulation. Conclusion: Nissen fundoplication may prevent GERD in those without a hiatal hernia or incompetent LES by disrupting the efferent vagal fibers to the LES. Such fibers mediate TLESR which are responsible for GERD in these patients. 相似文献
12.
Background Endoscopic endoluminal radiofrequency ablation using the Barrx device is a new technique to treat Barrett’s esophagus. This
procedure has been used in patients who have not had antireflux surgery. This report is presents an early experience of the
effects of endoluminal ablation on the reflux symptoms and completeness of ablation in post-fundoplication patients.
Methods Seven patients who have had either a laparoscopic or open Nissen fundoplication and Barrett’s esophagus underwent endoscopic
endoluminal ablation of the Barrett’s metaplasia using the Barrx device (Barrx Medical, Sunnyvale, CA). Preprocedure, none
of the patients had significant symptoms related to gastroesophageal reflux disease. One to two weeks after the ablation,
patients were questioned as to the presence of symptoms. Preprocedure and postprocedure, they completed the GERD-HRQL symptom
severity questionnaire (best possible score, 0; worst possible score, 50). Patients had follow-up endoscopy to assess completeness
of ablation 3 months after the original treatment.
Results All patients completed the ablation without complications. No patients reported recurrence of their GERD symptoms. The median
preprocedure total GERD-HRQL score was 2, compared to a median postprocedure score of 1. One patient had residual Barrett’s
metaplasia at 3 months follow-up, requiring re-ablation.
Conclusions This preliminary report of a small number of patients demonstrates that endoscopic endoluminal ablation of Barrett’s metaplasia
using the Barrx device is safe and effective in patients who have already undergone antireflux surgery. There appears to be
no disruption in the fundoplication or recurrence of GERD-related symptoms. Nevertheless, longer-term follow-up with more
patients is needed.
Presented in part at the 2006 Annual Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons 相似文献
13.
Marco G. Patti M.D. Massimo Arcerito M.D. Carlo V. Feo M.D. Steven Worth M.D. Mario De Pinto M.D. Verna C. Gibbs M.D. Walter Gantert M.D. Dana Tyrrell M.D. Linda F. Ferrell M.D. Lawrence W. Way M.D. 《Journal of gastrointestinal surgery》1999,3(4):397-404
Barrett’s metaplasia can develop in patients with gastroesophageal reflux disease (GERD), and metaplasia can evolve into dysplasia
and adenocarcinoma. The optimal treatment for Barrett’s metaplasia and dysplasia is still being debated. The study reported
herein was designed to assess the following: (1) the incidence of Barrett’s metaplasia among patients with GERD; (2) the ability
of laparoscopic fundoplication to control symptoms in patients with Barrett’s metaplasia; (3) the results of esophagectomy
in patients with high-grade dysplasia; and (4) the character of endoscopic follow-up programs of patients with Barrett’s disease
being managed by physicians throughout a large geographic region (northern California). Five-hundred thirty-five patients
evaluated between October 1989 and February 1997 at the University of California San Francisco Swallowing Center had a diagnosis
of GERD established by upper gastrointestinal series, endoscopy, manometry, and pH monitoring. Thirty-eight symptomatic patients
with GERD and Barrett’s metaplasia underwent laparoscopic fundoplication. Eleven other consecutive patients with high-grade
dysplasia underwent transhiatal esophagectomies. Barrett’s metaplasia was present in 72 (13 %) of the 53 5 patients with GERD.
The following results were achieved in patients who underwent laparoscopic fundoplication (n = 38): Heartburn resolved in
95% of patients, regurgitation in 93% of patients, and cough in 100% of patients. With regard to transhiatal esophagectomy
(n = 11), the average duration of the operation was 339 ±89 minutes. The only significant complications were two esophageal
anastomotic leaks, both of which resolved without sequelae. Mean hospital stay was 14 ±5 days. There were no deaths. The specimens
showed high-grade dysplasia in seven patients and invasive adenocarcinoma (undiagnosed preoperatively) in four (36%). These
results can be summarized as follows: (1) Barrett’s metaplasia was present in 13 % of patients with GERD being evaluated at
a busy diagnostic center; (2) laparoscopic fundoplication was highly successful in controlling symptoms of GERD in patients
with Barrett’s metaplasia; (3) in patients with high-grade dysplasia esophagectomy was performed safely (invasive cancer had
eluded preoperative endoscopic biopsies in one third of these patients); and (4) even though periodic endoscopic examination
of Barrett’s disease is universally recommended, this was actually done in fewer than two thirds of patients being managed
by a large number of independent physicians in this geographic area.
Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20,
1998. 相似文献
14.
15.
Ozmen V Oran ES Gorgun E Asoglu O Igci A Kecer M Dizdaroglu F 《Surgical endoscopy》2006,20(2):226-229
Background The effectiveness of laparoscopic Nissen fundoplication for the regression of Barrett’s esophagus in gastroesophageal reflux
disease remains controversial. The aim of this study, therefore, was to review endoscopic findings and clinical changes after
laparoscopic Nissen fundoplication for gastroesophageal reflux disease, particularly for patients with Barrett’s esophagus.
Methods From September 1995 through June 2004, 127 patients with gastroesophageal reflux disease underwent laparoscopic Nissen fundoplication.
All the patients had clinical and endoscopic follow-up evaluation. We further analyzed the course of 37 consecutive patients
with Barrett’s esophagus (29% of all laparoscopic fundoplications performed in our institution) using endoscopic surveillance
with appropriate biopsies and histologic evaluation. The median follow-up period for all the patients after fundoplication
was 34 months (range, 3–108 months). The median follow-up period for the patients with Barrett’s esophagus was 19 months (range,
3–76 months).
Results During the 9-year period, 70 women (55 %) and 57 (45%) men were treated with laparoscopic Nissen fundoplication. The median
age of these patients was 42 years (range, 7–81 years). The clinical results were considered excellent for 67 patients (53%),
good for 51 patients (40%), fair for 7 patients (6%), and poor for 2 patients (1%). Endoscopic surveillance showed regression
of the macroscopic columnar segment in 23 patients with Barrett’s esophagus (62%). Regression at a histopathologic level occurred
for 15 patients (40%). The histopathology remained unchanged for 14 patients with Barrett’s esophagus (38%).
Conclusion Laparoscopic Nissen fundoplication effectively controls intestinal metaplasia and clinical symptoms in the majority of patients
with Barrett’s esophagus. 相似文献
16.
Manfred P. Ritter M.D. Jeffrey H. Peters M.D. Tom R. DeMeester M.D. Peter F. Crookes M.D. Rodney J. Mason M.D. Lydia Green Lemeneh Tefera Cedric G. Bremner M.D. 《Journal of gastrointestinal surgery》1998,2(6):567-572
With the advent of laparoscopic surgery and the recognition that gastroesophageal reflux disease often requires lifelong medication,
patients with normal resting sphincter characteristics are now being considered for surgery. The outcome of these patients
after fundoplication is unknown and formed the basis of this study. The study population consisted of 123 patients undergoing
laparoscopic Nissen fundoplication between 1992 and 1996. All patients had increased esophageal acid exposure on 24-hour esophageal
pH monitoring. Patients were divided into those with a normal (n = 36) and those with a structurally defective (n = 87) lower
esophageal sphincter (LES), based on LES resting pressure (normal >6 mm Hg), overall length (normal >2 cm), and abdominal
length (normal > 1 cm), and their outcomes were assessed. Each group was subsequently divided into patients presenting with
a primary symptom that was "typical" (heartburn, regurgitation, or dysphagia) or "atypical" (gastric, respiratory, or chest
pain) of gastroesophageal reflux, and outcome was assessed. Median duration of follow-up was 18 months after surgery. Overall,
laparoscopic fundoplication was successful in relieving symptoms of gastroesophageal reflux in 90% of patients. Patients with
a typical primary symptom had an excellent outcome irrespective of the resting status of the LES (95% and 97%, respectively).
Atypical primary symptoms were significantly more common in patients with a normal LES (29%) than in those with a structurally
defective LES (10%; P <0.05), and these symptoms were less likely (50%) to be relieved by antireflux surgery. Laparoscopic
antireflux surgery is highly successful and not dependent on the status of the resting LES in patients with increased esophageal
acid exposure and primary symptoms "typical" of gastroesophageal reflux. Antireflux surgery should be applied cautiously in
patients with atypical primary symptoms.
Presented in part at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C.,
May 11–14,1997. 相似文献
17.
Constantine T. Frantzides Mark A. Carlson Ali Keshavarzian Jacob E. Roberts 《American journal of surgery》2010,200(2):305-307
Background
The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.Methods
Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed.Results
Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation.Conclusions
Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus. 相似文献18.
Cecilia Hagedorn M.D. Hans Lönroth M.D. Ph.D. Lars Rydberg M.D. Ph.D. Magnus Ruth M.D. Ph.D. Lars Lundell D. Ph.D. 《Journal of gastrointestinal surgery》2002,6(4):540-545
The efficacy of fundoplication operations in the long-term management of gastroesophageal reflux disease (GERD) has been documented.
However, only a few prospective controlled series support the longterm (>10 years) efficacy of these procedures, and further
data are required to also determine whether the type of fundoplication affects the frequency of postfundoplication complaints.
The aim of this study was to conduct a randomized, controlled clinical trial to assess the long-term symptomatic outcome of
a partial posterior fundoplication as compared to a total fundic wrap. During the years 1983 to 1991, a total of 13 7 patients
with chronic gastroesophageal reflux disease were enrolled in the study; 72 were randomized to semifundoplication (Toupet)
and 65 to total fundoplication (Nissen-Rossetti). A standardized symptom questionnaire was used for follow-up of these patients.
A total of 110 patients completed a median follow-up of 11.5 years; 54 had a total wrap and 56 underwent a partial posterior
fundoplication. During this period, seven patients required reoperation (Nissen-Rossetti in 5 and Toupet in 2), 11 patients
died, and nine patients were lost to follow-up or did not comply with the follow-up program. Control of heartburn (no symptoms
or mild, intermittent symptoms) was achieved in 88% and 92% in the total and partial fundoplication groups, respectively,
and the corresponding figures for control of acid regurgitation were 90% and 94%. We observed no difference in dysphagia scoring
between the two groups, although odynophagia was somewhat more frequently reported in those undergoing a total fundoplication.
On the other hand, a significant difference was observed in the prevalence of rectal flatus and postprandial fullness, which
were recorded significantly more often in those undergoing a total fundoplication (P < 0.001 and P < 0.03, respectively).
Posterior partial fundoplication seems to maintain the same high level of reflux control as total fundoplication. Earlier
observations demonstrating the advantages of a partial fundoplication, which included fewer complaints associated with gas-bloat,
continue to be valid after more than 10 years of follow-up.
prasented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23,
2001 (poster presentation). 相似文献
19.
Lily C. Chang M.D. Brant K. Oelschlager M.D. Elina Quiroga M.D. Juan D. Parra M.D. Michael Mulligan M.D. Doug E. Wood M.D. Carlos A. Pellegrini M.D. 《Journal of gastrointestinal surgery》2006,10(3):341-346
Endoscopic surveillance is recommended for patients with Barrett’s esophagus to detect high-grade dys-plasia (HGD) or cancer.
We studied the outcome of esophagectomy in a cohort of patients who devel-oped HGD or cancer between 1995 and 2003 while under
surveillance for Barrett’s. Outcomes were measured by analysis of clinical records, symptom questionnaire, and SF-36 (version
2). In 34 patients, mean surveillance time was 48 months (range, 4–132); the mean number of endoscopies was 10 (range, 3–30).
Preoperative diagnosis was HGD in 9 patients (26.5%), carcinoma in situ in 16 (47%), and ad-enocarcinoma in 9 (26.5%). There
was no esophagectomy-related mortality; 10 patients (29%) had com-plications. At mean follow-up of 46 months (range, 13–108),
SF-36 (version 2) results showed quality of life scores equal to or better than those of healthy individuals. Incidence and
severity scores (VAS 1–10) for postoperative symptoms were reflux, 59% (2.8); dysphagia, 28% (3.7); bloating, 45% (2.6); nausea,
28% (2.1); and diarrhea, 55% (2.5). Twenty-nine patients (85%) have no clinical, radiographic, or en-doscopic evidence of
recurrent esophageal cancer or metastasis. One patient has metastatic disease. En-doscopic surveillance in Barrett’s patients
yields malignant lesions at an early, generally curable, stage. Esophagectomy is curative in the great majority and can be
accomplished with minimal mortality and excellent quality of life.
This work was supported in part by the Mary and Dennis Wise Fund and in part by an educational grant from United States Surgical
Corpo-ration, Tyco Healthcare. 相似文献
20.
Xenos ES 《Surgical endoscopy》2002,16(6):914-920
Background: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. This study evaluates the relationship
between esophageal exposure to acid, the presence or absence of a hiatal hernia, and manometric indicators of esophageal motility.
Methods: A total of 51 patients with foregut symptoms were evaluated with upper gastrointestinal series or endoscopy, 24-h
pH testing, and esophageal manometry. The DeMeester score was used to distinguish patients with physiologic reflux (DeMeester
score <14.72) FROM PATIENTS WITH PATHOLOGIC REFLUX (DEMEESTER SCORE >14.72). Results: Patients with physiologic reflux had
fewer hypotensive contractions and a smaller percentage of uncoordinated and hypotensive contractions combined, as compared
to patients with pathologic reflux. The amplitude of distal esophageal contractions was greater in patients with physiologic
reflux. Also, patients with a hiatal hernia had a higher incidence of pathologic reflux, regardless of the lower esophageal
sphincter pressure. Conclusion: Patients with pathologic reflux have abnormal acid exposure associated with pump failure of
the esophagus and/or a mechanical defect of the cardia associated with a hiatal hernia. 相似文献