2005 SAGES Abstracts

POSTER ABSTRACTS
Esophageal aperistalsis and simultaneous contractions waves
were observed in all cases. LES resting pressure was normal
in 79.5% of patients, hypertonic in 16.9% and hypotonic in
3.6%. LES segment was from 3 to 5 cms. in 66.1%, and shorter
in 33% of cases. We observed LES lack of relaxation in 2.5% of
patients, relaxation was incomplete in 87.5% and total in only
10%.
Manometric criteria in achalasia diagnosis have changed.
Despite Achalasia means lack of relaxation regarding the LES.
And that historically it was considered that LES should be
hypertonic in this disease. We found these criteria to be not
constant. Nowadays there are mandatory manometric criteria
for the diagnosis of achalasia (ESOPHAGEAL PRIMARY PERI-
STALSIS REPLACEMENT BY SIMULTANEUS WAVES
?ESOPHAGEAL APERISTALSIS?) since it is found constantly.
And there are non obligated manometric criteria for diagnosis
of this disease as the LES findings.
P299–Flexible Diagnostic &
Therapeutic Endoscopy
ESOPHAGEAL DIFFUSE SPASM. A MOTOR PATTERN THAT
PRECEDE ACHALASIA, Jose J Herrera MD, Edgardo Suarez
MD,Maria E Lopez MD,Hiosadhara E Fernandez MD,Jose A
Palacios MD, Hospital Español de México gastrointestinal
motility and endoscopy unit. Hospital General ?Dr. Manuel Gea
González?, gastrointestinal motility and general surgery division.
Esophageal diffuse spasm is a rare motor disorder characterized
for chest pain, dysphagia and segmentarial wave contractions.
Pathophysiology and natural history remains unclear
and it has been suggested that it could precede achalasia. In
both entities the proposed pathophysiology is a Nitric oxide
neuromuscular defect. Manometric findings for diffuse
esophageal spasm are simultaneous wave contractions over
30mmHg amplitude in more than 10% of swallows and for
achalasia the absence of peristalsis is the mandatory manometric
finding.
Aim: To present a patient whom has an initial diagnosis of diffuse
esophageal spasm who in further evaluation had a vigorous
esophageal achalasia.
Case report: We present a 41 years female who came in 2003
with last 3 months progressive dysphagia, heartburn, 5kgs
weight lost, chest pain and hiccups. On first evaluation the
barium esophagogastric evaluation showed esophageal dilation
with bird peak distal segment. EGD revealed dilated
esophagus with remanent food in the esophagus. The manometric
findings were compatible with diffuse esophageal
spasm. Patient was discharged with medical treatment but 7
months alter she came in again because of continuous vomiting,
severe dysphagia, and 12 kgs weight lost. In this new
evaluation the EGD revealed no organic obstruction, dilated
esophagus, and remanent food in it. The manometric pattern
in this new evaluation was compatible with esophageal vigorous
achalasia. The patient went under Heller miotomy with
partial fundoplication.
Manometric findings: First manometric study showed effective
primary peristalsis replacement with simultaneous waves in
40% of swallows. Second manometric study showed effective
primary peristalsis replacement with simultaneous waves in
100% of swallows, with amplitude waves greater than
30mmHg.
Conclusion: Pathophysiology and natural history of
esophageal diffuse spasm remains unclear. Hypersensitivity to
cholinergic stimulus as in achalasia has been observed. It has
been suggested that progression from esophageal diffuse
spasm could precede achalasia in 2 to 5% of cases.
P300–Flexible Diagnostic &
Therapeutic Endoscopy
EFFICACY OF ENDOLUMINAL GASTROPLICATION FOR GAS-
TROESOPHAGEAL REFLUX DEVELOPED AFTER LYMPH
NODES DISSECTION ALONG THE LESSER CURVATURE OF
THE STOMACH, Hitoshi Idani MD, Takashi Ishikawa
MD,Takayuki Iwamoto MD,Masahiko Muro MD,Tatsuaki Ishii
MD,Masahiko Maruyama MD,Shinichiro Kubo MD,Hiroki
Nojima MD,Shinichiro Watanabe MD,Hitoshi Kin MD,
Fukuyama City Hospital, Department of Surgery
Introduction: Endoluminal gastroplication (ELGP) is one of the
newly developed endoscopic treatments for gastroesophageal
reflux disease (GERD). However, its efficacy has been demonstrated
only for primary GERD and there have been no reports
on ELGP for post-surgical GERD. In this paper, we report a
case of GERD developed after perigastric lymph nodes dissection
successfully treated by ELGP.
Case report: 75 year-old man presented with heart burn, regurgitation
and dysphagia which had appeared after dissection of
involved lymph nodes along the lesser curvature of the stomach
performed with lateral segmentectomy for liver metastases
from rectal cancer. Esophagogastrofiberscopy showed
grade B esophagitis and small hiatal hernia. Since the symptom
had not been controlled by medical therapy and Nissen
fundoplication could not be indicated in such a post surgical
state, ELGP was performed. Using BARD endoscopic suturing
system (EndoCinchTM), two plications were placed at the
esophagogastric junction (EGJ). The procedure time was
55min. There were no adverse events without a slight chest
pain which disappeared within few days. The symptoms associated
with GER markedly reduced after the treatment. Acid
exposure time and bile reflux time were improved after the
procedure (pH