(LESP) and mean Integrated relaxation pressure (IRP) were 50.7 mmHg (range 39.2 to 61.9. mmHg) and 22.4 mmHg (range 13.8 to 30.8 mmHg) respectively.
procedure. RESULTS: The total treated pool included 227 patients (136 females, 60%). No strictures, perforation, deaths or other significant adverse events occurred. Complete followup was available for subjects at intervals as follows: 6 months (n=177), 1 year (n=149), 2 years (n=98), 3 years (n=98), 4 years (n=94), and 10 years (n=99). Heartburn, satisfaction, HRQL and medication use were significantly improved across the follow-up period (6, 12, 24, 36, 48, and 120 months; p ,10-6 for all of the outcomes) and results were superior to those achieved for baseline drug therapy (see Table). CONCLUSION: This 10-year, open, single center, prospective assessment of Stretta for refractory GERD demonstrates a significant and sustained improvement of GERD-HQoL scores, patient satisfaction, and improved PPI use and validates the long-term usefulness of this endoscopic procedure. Patients with variant anatomy such as prior Nissen fundoplication or large hiatal hernia had a similar response compared to patients with normal anatomy.
Preop chemo/XRT - Preoperative chemotherapy and radiation therapy Su1625 High-Resolution Impedance Manometry Findings in Patients With Epiphrenic Diverticulum Se Ryung Yamamoto, Kalyana C. Nandipati, Pradeep K. Pallati, Tommy H. Lee, sumeet K. mittal Aim: The objective of this study was to evaluate high-resolution impedance manometry (HRIM) findings in patients with esophageal epiphrenic diverticulum. Methods: Patients with esophageal epiphrenic diverticulum who underwent HRIM between October 2008 and March 2012 are included in the study. Manometric findings were compared to endoscopic (EGD) and barium swallow (BS) findings. Patients with previous foregut surgery were excluded. Results: Six patients (mean age 59.0 years, 3 females) are included in the study. On EGD the diverticulum was 1 to 4 cm above the gastro-esophageal junction (GEJ) and the mouth of diverticulum was 2 to 9 cm in size. Mean lower esophageal sphincter pressure (LESP) and mean Integrated relaxation pressure (IRP) were 50.7 mmHg (range 39.2 to 61.9 mmHg) and 22.4 mmHg (range 13.8 to 30.8 mmHg) respectively. Achalasia was the most common abnormality noted in 3 patients (type I=2 and type II=1). Two additional patients had isolated EGJ obstruction with preserved esophageal motility. One patient had normal IRP but weak peristalsis. A break in peristalsis corresponding to the mouth of the diverticulum could be seen in 4 patients. There was decreased bolus transit in three patients. Conclusions: There is a high prevalence of esophageal outflow obstruction and primary peristaltic abnormality in patients with epiphrenic diverticulum. This reconfirms the need to extend the myotomy down on to the GEJ even in patients in whom the diverticulum appears to be well above the GEJ.
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Introduction: Gastroesophageal reflux disease (GERD) is an increasingly prevalent health problem. This disease has been the focus of the work of many researchers in the last 50 years, these investigations has led to a transformation in the understanding and treatment of this disease. However little is known about the characteristics and trends of the scientific publications in this field. The aim of this study is to present a bibliometric analysis of the scientific publications on gastroesophageal reflux disease. Methods: A query was submitted to the Web of Science database to find all the publications in the topic of gastroesophageal reflux in the time period between January 1954 to December 2011. A total of 18136 references were retrieved, these records were then analyzed using bibliometric parameters. Results: Number of publications has increased from only two papers per year in 1954 to nearly three papers per day in 2011, with more than 700 publications per year in 21st century. Majority of these publications are in English (94%). United States, England and Italy are the most productive countries with 40%, 7% and 6% of the literature respectively. Eighty percent of the literature in the field is the result of the work of authors from 10 countries [North America (2), Europe (6), Japan and Australia], this pattern did not change when the publications from 2000-2011 were analyzed separately. Mayo clinic is the institution with the highest number of publications (268), followed by the University of Southern California (243) and Northwestern University (211). Tom DeMeester, Joel Richter and Donald Castell are the most prolific authors in this field with 194, 178 and 169 publications respectively. Gastroenterology and American Journal of Gastroenterology are the two journals with the highest number of publications about the GERD. Conclusion: Parallel to the rise in the prevalence of the gastroesophageal reflux disease, there is an increase in the research performed about reflux evidenced by the constant increase in the number of scholarly work published in this field (Figure). Two thirds of the literature about the GERD has been published in the 21st century. Only a small fraction of GERD publications (6.3%) is supported by a funding agency. Majority of the literature (80%) is the result of the work of the authors from only 10 countries.
Su1626 Surgical Management of Esophageal Perforation: A 10-Year Experience Paul Goldsmith, Bilal Alkhaffaf, Bart Decadt Introduction The management of esophageal perforation and mediastinal sepsis is challenging. Treatment strategies differ between surgical units and as a consequence outcomes can vary widely in this patient group. We present our 10-year experience of esophageal perforation and evolving treatment strategy for this condition. Methods This was a retrospective review of all esophageal perforations including both patients with a spontaneous or iatrogenic perforation and cases of mediastinal sepsis due to anastomotic leak following cardio-esophagectomy. Patients were grouped according to their treatment strategy. The primary outcome measures were in-hospital death and length of stay (total hospital stay and Intensive Care Unit (ICU) stay). Results In total, thirty-seven patients were included. Twenty-five were male with a median age of 59 (range 21-80). Seven patients suffered iatrogenic perforations (3 esophageal dilatations, 2 food bolus removal, 2 gastroscopy). Eleven patients presented following spontaneous esophageal perforations and a further Eighteen suffered anastomotic leaks following cardio-esophagectomy and one leak following cardio-myotomy. Twenty-six patients underwent surgery for their perforations compared to eleven who were conservatively managed. Surgical management involved either thoracotomy with primary repair or creation of a controlled fistula using a T-tube (20), cardio-esophagectomy (3) or thoracoscopic washout (3). All patients had enteral feeding routes inserted in conjunction with surgery. Conservative management constituted either simple insertion of chest drains (8) or stent placement (3). Death following non-operative management occurred in 4 patients compared to two (36% vs 7% p ,0.05)in those who underwent surgery. Conclusion Urgent operative management is a safe treatment option for patients who have oesophageal perforation and are fit to undergo a surgical exploration. Thoracotomy with repair of the perforation over a T-tube with defunctioning gastrostomy, feeding jejunostomy and drainage of the thorax and mediastinum, appears a safe policy and is our preferred approach. Patients with existing esophageal pathology may be considered for emergency cardio-esophagectomy.
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The Better Definition of Nodal Staging in the 7th Edition of TNM Manual Does Not Predict Survival or Translates Into Better Prognosticating Ability in Oesophago-Gastric Junctional Adenocarcinoma Ramesh Y. Kannan, Matthew L. Davies, Carys Jenkins, Majid Rashid, Ashraf M. Rasheed
Sustained Improvement in GERD-Hrql, Patient Satisfaction, and Anti-Secretory Drug Use 10-Years After Stretta for Medically Refractory GERD Mark D. Noar, Patrick Squires, Emmanuelle Noar BACKGROUND & AIMS: The Stretta procedure is an effective endoscopic modality for control of GERD symptoms. However, long term efficacy and safety at .10 years has not been assessed. We prospectively evaluated the long-term efficacy of Stretta at 10-years and assessed anti-secretory drug use, GERD symptoms, and patient satisfaction. METHODS: From 8/2000 to 9/2004, 227 patients with inadequate GERD symptom control despite BID PPI underwent Stretta and were prospectively enrolled in this study. All patients had normal esophagogastric anatomy, except 16 patients with failed Nissen fundoplication and 7 with large (.3cm) hiatal hernia. All procedures were performed by a single endoscopist in an outpatient setting with conscious sedation. Baseline and follow-up GERD-HRQL scores (050), heartburn (0-5), satisfaction (0-5) and medication use were collected at years 1, 2, 3, 4 and 10 post-procedure. The data were analyzed using a repeated measures analysis of variance to determine whether there was a significant temporal trend in the various outcomes. Any significant effect was sub-analyzed using a Bonferroni-adjusted multiple comparison
S-1077
Introduction: The 7th TNM staging defines a minimum number of nodes, recommends an optimal number for each T stage, emphasizes the prognostic importance of number of regional nodes involved and upstages based on the number of metastatic lymph nodes. Aims: To study the impact of application of 7th TNM rules on nodal staging (N) of resected and pathologically reported oesophago-gastric junctional (OGJ) adenocarcinomas during the last 10 years stratifying them according to the 7th edition TNM staging and to compare against the original staging and assess possible impact of nodal neo-staging on survival. Methods: A retrospective database was used to capture the clinico-pathological data of all consecutive curative resections of OGJ adenocarcinomas over the last 10 years in two UK Upper GI Units. Any report with less than 12 lymph nodes was considered inadequate and denoted as (Nx). All cases were re-reported and re-staged according to the 7th TNM staging rules. We compared the impact of the 7th TNM staging rules on neo-staging. Overall survival was analysed using the 6th and 7th TNM staging respectively. Overall survival was substratified into 2 years, 5 years and 10 years post curative resection. Results: Fifty seven (57)
SSAT Abstracts
SSAT Abstracts
Bibliometric Analysis of the Scientific Publications About Gastroesophageal Reflux Disease (GERD) Between 1954 and 2011 Shahin Ayazi, Thomas J. Watson, Carolyn E. Jones, Virginia R. Litle, Christian G. Peyre, Jeffrey H. Peters
