Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

Abstract

Here we describe an atypical presentation of progressive dysphagia in a 72-year-old man leading to frequent regurgitations over the course of 30 years. Investigations revealed a foreign body ring surrounding the proximal stomach and dilation of the oesophagus proximal to the gastro-oesophageal junction. An Angelchik device was extracted; however, the patient’s rapid deterioration prior to surgery, in addition to his severely dysfunctional oesophagus, required placement of a jejunostomy feeding tube. Device removal was complicated by prior abdominal surgery, necessitating a thoracic approach. This case offers guidance on the management of patients with Angelchik prostheses who develop similar complications, while drawing attention to the importance and difficulties of early, definitive diagnosis in oesophageal pathology such as achalasia and gastro-oesophageal reflux disease.

The historical Angelchik anti‐reflux device: laparoscopic removal for dysphagia

“…Since the silicone device is soft, it is likely that dysphagia is caused by scar formation from foreign body reaction at the gastro‐oesophageal junction, in addition to constriction applied by the device. In severe cases, end‐stage pseudo‐achalasia has also been described 7 …”

“…In severe cases, end-stage pseudo-achalasia has also been described. 7 Our experience and literature search suggests that surgeons in Australia may yet encounter patients with symptoms arising from an Angelchik device. This case demonstrates oesophageal obstruction due to chronic scar and extrinsic constriction, which can be relieved with removal of the device and release of the offending scar tissue.…”