China
Africa
Explore chapters and articles related to this topic
Symptomatic Giant Hiatal Hernia with Intrathoracic Stomach
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Surgical repair in either the emergency or elective situation is performed the same way. A laparoscopic approach is preferred whenever feasible, with a low rate (2%) of conversion to open surgery expected. The hernial sac must be excised from the hiatal pillars before being reduced entirely with its contents. The sac does not need to be excised from the stomach. An interrupted non-absorbable (e.g. 2/0 Novafil®) suture repair of the hiatal defect posteriorly should then occur. If greater than five hiatal repair sutures are required posteriorly, care should be taken to avoid anterior angulation of the esophagus over the repair, and anterior sutures may need to be placed if further hiatal closure is required. A 52- or 54-Fr bougie can be used to calibrate the repair. There is no evidence that the addition of either absorbable or non-absorbable mesh to the hiatal crural repair reduces long-term revisional surgery rates [5]. While the “short esophagus” has been described historically, the author has never encountered the situation where the gastroesophageal junction cannot be easily situated in the abdominal cavity. Theoretically, a Collis gastroplasty can be used if such a situation were ever encountered. Once the hiatal repair is appropriately snug around the esophagus, the gastroesophageal junction is secured in the abdominal cavity. This can be done with a combination of esophagopexy sutures to the hiatal rim, and either an anterior cardiopexy or partial fundoplication. Formal fundoplication is only required for those with significant reflux symptoms.
Paraesophageal Hernia
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Diagnostic modalities include: Plain x-ray of the chest (retrocardiac air−fluid level, vertically oriented loops of bowel, upward displacement of the transverse colon, nasogastric tube coiled above the diaphragm), contrast esophagrams (size and reducibility of the hiatal hernia, relationship of gastroesophageal junction to hiatus, presence of a foreshortened esophagus, or esophageal diverticula), esophagogastroduodenoscopy (presence of esophagitis, biopsies for Barrett esophagus, gastric viability, size and type of paraesophageal hernia), computed tomography (gastric volvulus, intestinal obstruction, presence of additional organs besides stomach, location of gastroesophageal junction, and type of paraesophageal hernia). pH testing to demonstrate abnormal proximal acid exposure (DeMeester score >14.7) identifies sliding-type hiatal hernias that would benefit from operative intervention but is not critical in patients with paraesophageal hernias. Esophageal manometry is critical in selecting the optimal anti-reflux procedure.
Gastrointestinal Function and Toxicology in Minipigs
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
Maria R. Jones, Alain Stricker-Krongrad
The minipig stomach includes the esophageal, cardiac, fundic, and pyloric regions. The fundus contains the majority of the parietal and chief cells and is responsible for most of the acid production in the stomach, whereas the cardiac and pyloric regions contain mostly mucous cells (Kararli 1995, Van Ginneken 2012). The esophageal region of the pig stomach is non-glandular and is predisposed to ulceration (Doster 2000). Mucins secreted by the cardiac and pyloric glands line the stomach and prevent acid and pepsin from eroding the gastric mucosa (Allen and Garner 1980, Allen and Flemstrom 2005, Van Ginneken 2012). Notable anatomical differences in the pig stomach which is not present in humans include the diverticulum ventriculi and pyloric torus. The diverticulum ventriculi is present on the stomach near gastroesophageal junction, although its purpose is not fully understood (Hooper and Haelterman 1969, Kararli 1995, Van Ginneken 2012, Suenderhauf and Parrott 2013). The pylorus is made up of a semilunar muscular sphincter, and the pylorus torus is a protuberance occupying the lumen of the pylorus. Both the sphincter and pylorus torus have contractile ability, and function together to tightly close the stomach when chyme is not emptying into the small intestine (Bal and Ghoshal 1972).
Pseudoachalasia: a diagnostic challenge. When to consider and how to manage?
Published in Scandinavian Journal of Gastroenterology, 2021
Sara N. Haj Ali, Nam Q. Nguyen, Awni T. Abu Sneineh
In contrast to primary achalasia, treatment of pseudoachalasia depends on the underlying cause(s) and thus, correct diagnosis is essential. Any delay in pseudoachalasia management, as well as the treatment of supposed achalasia instead of the true underlying cause, can have serious consequences on patient’s prognosis. According to the systematic review by Schizas et al, 24% of cases of pseudoachalasia were treated wrongly as achalasia with Heller myotomy, pneumatic dilatation, or injection of botulinum toxin [7]. Given the majority of causes of pseudoachalasia are related to malignancies, confirmation of tissue diagnosis will be critical in determining the management strategy. In cases of a tumor causing mechanical obstruction of the lower esophagus or the gastroesophageal junction, treatment approach may involve surgery, chemotherapy, radiotherapy or in combination. However, in many patients, the esophageal motor abnormalities remain unchanged even after curative therapy [44–46].
Post-ablation buried neoplasia in Barrett’s esophagus
Published in Scandinavian Journal of Gastroenterology, 2021
Prabhat Kumar, Ilyssa O. Gordon, Prashanthi N. Thota
EET with focal resection of visible abnormalities followed by ablation of the remaining flat BE to achieve CE-IM is the standard of care for BE associated dysplasia [1]. EET is remarkably successful, with a 73.1% success rate in achieving CE-IM and a 93.4% success rate for complete eradication of dysplasia (CE-D) [38]. However, recurrence of EAC, dysplasia, and IM has been reported to be 1.4%, 2.6%, and 16.1%, respectively, in this pooled analysis [38]. Therefore, during post-ablation surveillance, careful inspection of the tubular esophagus and gastroesophageal junction with four-quadrant biopsies every 1 cm, with additional targeted biopsy of any endoscopic abnormalities, is recommended. In treatment naïve patients with BE, the finding of buried BE alone does not change the patient management. Treatment of post-ablation SSIM is recommended by ablation of the affected area [1,30]. SSIM remains a diagnostic challenge due to difficulties with adequate sampling and lack of uniform diagnostic criteria. Fortunately, both the prevalence and the risk of malignant progression are low. Hence, ongoing surveillance is necessary.
Pre-treatment tumor-infiltrating T cells influence response to neoadjuvant chemoradiotherapy in esophageal adenocarcinoma
Published in OncoImmunology, 2021
R.S.A. Goedegebuure, M. Harrasser, L.K. de Klerk, T.S. van Schooten, N.C.T. van Grieken, M. Eken, M.S. Grifhorst, N. Pocorni, E.S. Jordanova, M.I. van Berge Henegouwen, R.E. Pouw, H.M.W. Verheul, J.J. van der Vliet, H.W.M. van Laarhoven, V.L.J.L Thijssen, A.J. Bass, T.D. De Gruijl, S. Derks
Patient material, as well as data on patient characteristics and disease outcome were collected as part of an IRB-approved clinical trial (METC-VUmc identifier 2013.074). Patients with histologically confirmed, stages 2 and 3 esophagus- or gastroesophageal junction tumors were eligible for inclusion in this study. After obtaining informed consent, snap frozen, formalin-fixed paraffin embedded and fresh primary tumor biopsies were collected from the patients prior to neoadjuvant chemoradiation (paclitaxel, carboplatin and concurrent radiotherapy of 41.4 Gy in 23 fractions) during endoscopy. When possible, a heparin blood sample was obtained for isolation of plasmas and PBMCs. Only patients with adenocarcinoma who had completed the entire treatment regime (including surgery) and had sufficient quality tissue obtained were selected for further analysis. In addition, nine archival pre-treatment FFPE specimen from similar patients (previously collected for genetic profiling21) were included. Histology was assessed by an expert pathologist (NvG) on H&E stains from all biopsies and representative tumor areas were carefully annotated prior to processing for downstream applications.