2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
model. Material and Methods: Overall 58 sutures were placed
in the cardia of 10 complete exenterative cadaver model) at
three different suction levels, 0,4-0,6-0,8 bar using the suturing
machine EndoCinch® (BARD). After preparation of the cardia
from its anatomical bed, all sutures were fixed in formalin and
stained with HE for histological examination. Results: Absolute
and relative distribution of suction pressure and suture depth
is listed in the following table
0.4 bar 0.6 bar 0.8 bar
Mucosa 0 (0%) 1 (1,7%) 0 (0%)
Submucosa 6 (10,3%) 4 (6,9%) 1 (1,7%)
cir. M. propria 4 (6,9%) 2 (3,4%) 4 (6,9%)
lon. M. propria 5 (8,6%) 6 (10,3%) 4 (6,9%)
extramural 5 (8,6%) 6 (10,3%) 10 (17,2%)
Absolut and relativ distribution of suture depth
Conclusions: Most of the sutures were placed in the longitudinal
M.propria or were placed transmural. A submucosal placement
may lead to bunked sutures.
P303–Flexible Diagnostic &
Therapeutic Endoscopy
SYMPTOMATIC MESOCOLIC STRICTURE AFTER RETROCOLIC
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: TREATMENT
BY ENDOSCOPIC DILATION, Brian Lane MD, Samer Mattar
MD,Amy Biedenbach MS,Faisal Qureshi MD,Joy Collins
MD,Paul Thodiyil MD,Tomasz Rogula MD,Pandu Yenumula
MD,Laura Velcu MD,Giselle Hamad MD,George Eid
MD,Ramesh Ramanathan MD,Philip Schauer MD, Department
of MIS Surgery, University of Pittsburgh Medical Center
INTRODUCTION: Internal hernias at the mesocolic defect after
retrocolic laparoscopic roux-en-Y gastric bypass have been
demonstrated to be a potential site for small bowel obstruction.
Many have emphasized complete and secure closure of
all potential internal hernia defects when performing LRNYGB.
Conversely, isolated cases of obstruction at the mesocolic
defect have been reported. We report two cases of stricture at
the mesocolic opening in retrocolic, antegastric LRNYGB diagnosed
at endoscopy and treated by balloon dilation.
METHODS AND RESULTS: Two patients, ages 26 and 53, with
BMI of 46 and 42 kgm2 respectively, underwent uncomplicated
retrocolic antegastric LRNYGB. In both cases, the mesocolic
and Petersen defects were closed with a running 2-0 silk
endostitch on the medial and lateral aspects of the mesentery.
Both patients had an uneventful postoperative course. One
patient presented five weeks postop with complaints of vomiting
to solid foods. The second patient presented ten weeks
postop with complaints of progressive dysphagia to solid and
soft foods. Both initial UGI studies were initially felt to be unremarkable.
Both patients underwent esophagogastroscopy. The
gastrojejunal anastomoses were 9-10 mm in diameter, and the
endoscope could pass easily. Further investigation revealed a
tight narrowing of the jejunum at the location where the jejunal
roux limb would pass through the retrocolic space. This
narrowed area was dilated with a 16 mm balloon to 5 atm.
Subsequently the endoscope was able to be passed easily
through the jejunal stricture. Both patients had prompt resolution
of symptoms which continued through six months follow
up. Retrospective review of the pre-endoscopy UGI study
showed a focal narrowing consistent with a partial obstruction
at the mesocolic defect.
CONCLUSION: Stricture of the jejunum at the point where the
roux limb passes through the mesocolic defect in retrocolic
LRNYGB may be a cause for partial obstruction symptoms
similar to those seen with gastrojejunal stricture. Gastrojejunal
stricture is the more commonly described finding with solid
food dysphagia after LRNYGB. When this is not found, endoscopic
exam more distally should be considered to assess and
treat a jejunal stricture.
P304–Flexible Diagnostic &
Therapeutic Endoscopy
ACUTE CHOLECYSTITIS FOLLOWING COLONOSCOPY: TWO
CASE REPORTS AND LITERATURE REVIEW, Faizal Aziz
MD,Perry Milman MD, John McNelis MD, Long Island Jewish
Medical Center, New Hyde Park NY
INTRODUCTION: Sporadic reports of acute cholecystitis following
colonoscopy have previously been described. Two
cases are presented and the relatively sparse medical literature
on this subject is reviewed.
MATERIALS AND METHODS: The medical and surgical records
of two cases were reviewed retrospectively. Data acquired
included demographic, medical, surgical, and outcomes. The
available literature was then reviewed and all reported cases
were summarized.
RESULTS: CASE 1: A 63-year-old female who presented to ER
with severe epigastric pain 24 hours post colonoscopy with
polypectomy. After a diagnosis of acute cholecystitis was
made, the patient underwent uneventful laparoscopic cholecystyectomy.
The gall bladder was found to be distended,
tense and gangrenous.
CASE 2: 60 year old male who 72 hours post colonoscopy and
polypectomy, presented to the ER with acute cholecystitis. The
patient underwent uneventful cholecystectomy. Pathology
revealed acute and chronic cholecystitis with extensive hemorrhage
and reactive epithelial atypia.
DISCUSSION: Possible etiologies of our observations include
dehydration following purgative preperation or elaboration of
local inflammatory mediators inducing acute cholecystitis.
While it is entirely possible that the reported observations are
incidental, the authors? observations argue for the inclusion of
acute cholecystitis in the differential diagnosis of post
colonoscopy abdominal pain.
P305–Flexible Diagnostic &
Therapeutic Endoscopy
ENDOSCOPIC FINDINGS ON COMPLICATIONS AFTER GAS-
TRIC BAND, J A Palacios-Ruiz MD, J J Herrera-Esquivel MD,G
A López-Toledo MD,L E González-Monroy, General Hospital Dr.
Manuel Gea Gonzalez
Introduction: Nowadays obesity represents a World Health
concern, in Mexico 60% of population is overweight. Surgery
is considered last frontier in treatment. There are several
options described for surgical treatment, one of the most popular
due to low mortality and morbidity is laparoscopically
placed gastric band.
Matherial and methods: We performed endoscopies on postoperative
patients after laparoscopically placed gastric band.
The first cause of reference was disfagia followed by emesis.
Results: Most frequent findings were esophagitis, esophagic
diverticulae, gastric band migration, pseudoachalasia within
others.
Summary: Complications after gastric band placing are relatively
unknown, being band migration the most frequent; however
after times goes by and more experience is accumulated,
there are other adverse events that are presenting.
P306–Flexible Diagnostic &
Therapeutic Endoscopy
ENDOSCOPIC IDENTIFICATION OF THE JEJUNUM FACILI-
TATES MINIMALLY INVASIVE JEJUNOSTOMY TUBE INSER-
TION IN SELECTED CASES., NIAZY M SELIM MD, University of
Arkansas for Medical Sciences
Background: Percutaneous endoscopic gastrostomy tube,
Direct percutaneous endoscopic jejunostomy and laparoscopic
feeding tube insertion are established techniques for feeding
tube insertion. However, these techniques may be difficult or
contraindicated after previous gastric or upper abdominal surgery.
Methods: In one year, eight cases underwent minimally
invasive jejunostomy tube insertion via endoscopic identification
of the jejunum. Indications of the procedure were dysphagia,
poor nutritional status and prolonged ICU admission.
Seven patients had previous upper abdominal surgeries and
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