Expression of cyclooxygenase-2 in the mucosa of the gastroesophageal junction in patients  with Barrett&amp;#8217;s oesophagus &amp;#8211; the results of ablation therapy with argon plasma coagulation  and laparoscopic Nissen fundoplication

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IntroductionThere are four types of hiatal hernias, and diagnosis is established on the basis of gastroscopy in the majority of cases. Type III represents a mixed type in which the abdominal esophagus as well as the gastric cardia and fundus protrude into the thorax through the pathologically widened esophageal hiatus. Type IV, the so-called upside down stomach, can be considered an evolutionary form of type III, and refers to herniation of nearly the whole stomach (except for the cardia and pylorus) into the thorax. Types III and IV of hiatal hernias represent a group of rare diaphragmatic defects; thus, most centers do not possess considerable experience in their treatment. Frequently, laparoscopic treatment is implemented, although, according to some authors, conversion to laparotomy, thoracotomy, or thoracolaparotomy is necessary in selected cases.AimTo analyze the outcomes of laparoscopic treatment of the largest hiatal hernias, i.e. type III and IV hernias.Material and methodsA total of 25 patients diagnosed with type III and IV hiatal hernia were included in further analysis.ResultsAs many as 19 out of 25 patients (76%) assessed the outcome of the surgery as evidently positive and reported marked improvement in the quality of life.ConclusionsThe laparoscopic technique constitutes an excellent and safe method of repair of even the most complex defects in the esophageal hiatus. Therefore, the minimally invasive technique combined with an anti-reflux procedure should be the method of choice in patients with type III and IV hernia.

Section: Discussionmentioning

confidence: 99%

Laparoscopic treatment of type III and IV hiatal hernia - authors' experience.

Migaczewski

Grzesiak-Kuik

Pędziwiatr

et al. 2014

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“…To date there are no univocal, consistent recommendations for the treatment of BE [12]. Despite the growing interest in the management of this condition in most countries the only recommendation for patients with BE is endoscopic surveillance with the aim of early recognition of cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors also recommend resection procedures for patients with HGD. Numerous endoscopic and surgical methods of abnormal epithelium removal are currently being developed [12]. Antireflux surgery as prophylaxis against reflux of gastric contents eliminates the underlying cause of BE [12, 14].…”

Section: Discussionmentioning

confidence: 99%

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Radiofrequency ablation in the management of Barrett's esophagus - preliminary own experience.

Dąbrowski¹,

Szczepanik²,

Misiak³

et al. 2013

IntroductionBarrett's esophagus develops as a result of chronic injury of esophagus epithelium from gastroesophageal reflux disease. It is defined when metaplastic columnar epithelium replaces the stratified squamous epithelium which normally lies in the distal esophagus. The condition represents a risk factor for esophageal adenocarcinoma. The aim of the radiofrequency ablation (RFA) method is to destroy metaplastic epithelium with radiofrequency electric current and to stimulate reappearance of the flat multilayer epithelium in the distal esophagus.AimTo evaluate the efficiency and safety of the RFA technique, newly introduced in Poland, in the management of Barrett's esophagus.Material and methodsTwelve patients were treated with the RFA method. Patients with Barrett's esophagus confirmed in the histopathological report were qualified for treatment. Two RFA techniques were applied using a BARRX® device: circular based on the balloon HALO360 system or focal based on the HALO90 system mounted to the endoscopic ending. The procedures were performed at 2-month intervals. The macroscopic and microscopic effects of RFA therapy, the patients’ treatment tolerance as well as potential complications were evaluated.ResultsIn the group of 12 patients subjected to RFA therapy, 10 completed the therapeutic cycle. A total of 37 procedures were performed: 5 HALO360 and 32 HALO90. In all patients eradication of the abnormal metaplastic esophageal epithelium was achieved, as confirmed in both endoscopic and histopathological evaluation. In 2 patients with ongoing therapy progressive eradication of metaplastic epithelium was observed. No significant RFA-related complications were reported.ConclusionsBased on our preliminary results we consider this method to be promising, free of significant complications and well tolerated by patients. In most patients it results in successful eradication of metaplastic epithelium in the distal esophagus.

Cornelia de Lange syndrome - characteristics and laparoscopic treatment modalities of reflux based on own material.

Szyca¹,

Leksowski²

2011

Cornelia de Lange syndrome (typus degenerativus amstelodamensis, CdLS, Brachmann syndrome) is a complex, congenital, multi-gene anomaly characterized by mental retardation. Its features include growth inhibition, hirsutism, structural anomalies of the limbs and abnormal development of osseous structures of the face. Independent of the phenotype of the disease, 85% of patients are assumed to have symptoms of gastroesophageal reflux disease (GERD). Aspiration pneumonia is one of the complications of GERD and a main cause of death in these patients. Patients not responding to medical treatment qualify for surgery. Until recently, anti-reflux procedures for GERD in CdLS patients were performed solely via laparotomy. The contemporary gold standard is a procedure performed laparoscopically. There are a few case reports of patients with CdLS operated on for GERD with laparoscopy available in the literature. The goal of this paper is to present two cases of Cornelia de Lange syndrome treated with laparoscopic antireflux procedures. We have performed two such procedures in 14 and 16 year-old girls with typical symptoms of the syndrome, i.e. developmental and mental retardation, hirsutism, structural limb anomalies and abnormal face development. The main indications for surgery in both cases were ineffective medical treatment and persistent aspiration pneumonia and its complications as a result of the gastroesophageal reflux. Oesophageal hiatus hernia and reflux were confirmed with accessory tests in both cases. During 36 months of follow-up, according to Barents, no episode of oesophageal reflux with acidic gastric content was noted. The treated children slept well during the night and did not need hospitalization for aspiration pneumonia. Neither of them required proton pump inhibitors. It should be concluded that laparoscopic Nissen fundoplication is a safe and effective method of GERD treatment in children with CdLS.