Adolescent ; Bile Reflux ; etiology ; Child ; Child, Preschool ; Female ; Gastritis ; etiology ; Gastroscopy ; Helicobacter Infections ; complications ; diagnosis ; Helicobacter pylori ; Humans ; Male

BACKGROUNDS:Bile reflux gastritis can occur when pylorus ablation is associated with bile stasis in the stomach. It can also occur with a gastrojejunostomy when bile is continuously poured into the gastric remnant after a vagotomy and an antrectomy. The diagnosis of bile reflux gastritis can be made only when the patient has bile gastritis documented on biopsy; the simple observation of a bile-stained mucosa in a gastric remnant is not sufficient to make the diagnosis of bile reflux gastritis. METHODS: Technetium-99m diisopropyl iminodiacetic acid (Tc-99m DISIDA) scintigraphy was used to study bile reflux into the gastric remnant in 31 patients with gastric operations. All patients had gastrofibroscopic biopsies in order to identify the bile reflux gastritis. RESULTS: Tc-99m DISIDA Scintigraphy identified bile reflux in 15 (83.2%) of 18 patients after a subtotal gastrectomy and a Billroth II gastrojejunostomy. Hewever, no bile reflux occured in either the 10 patients with a hemigastrectomy plus Billroth I gastoduodenostomy or the 3 patients with a truncal vagotomy plus pyloroplasty. Also, gastrofibroscopic biopsies identified bile reflux gastritis in only 3 patients (9.7%) with a subtotal gastrectomy plus Billroth II reconstruction. CONCLUSIONS: The patients who underwent a subtotal gastrectomy and Billroth II reconstruction showed higher bile reflux rates than did the patients who underwent a hemigastrectomy plus Billroth I reconstruction and a truncal vagotomy plus pyloroplasty (p<0.05). Also, only 9.7% of the postgastrectomy patients developed bile reflux gastritis.
Bile Reflux ; Bile* ; Biopsy ; Diagnosis ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Mucous Membrane ; Pylorus ; Radionuclide Imaging* ; Reflex* ; Stomach ; Vagotomy ; Vagotomy, Truncal

An esophageal perforation is a condition requiring emergency treatment. Although previously spontaneous ruptures were the most common etiology, as endoscopic and radiologic diagnosis and treatment have developed recently, iatrogenic ruptures due to instrumentation have increased to become the most common cause of esophageal perforations. Generally, the treatment of esophageal stenosis is composed of esophageal dilatation using a Maloney or a Mercury dilator and medical treatment for reflux esophagitis. Recently, balloon-catheter dilatation of the esophagus has produced safe and excellent results, and self-expansible metallic stents has been very useful in controlling malignant strictures of the esophagus with low mortality and morbidity. We experienced an esophageal perforation after balloon dilatation and the insertion of a self-expanding silicone-covered Gianturco stent to the site of the esophageal stenosis which was due to reflux esophagitis. The abdomen was opened through an upper midline incision. There was a 3-cm-long longitudinal laceration on the distal esophagus which was closed transversely as with a Heinecke-Mikulicz pyloroplasty after a debridement. To reinforce the site of esophageal laceration and to prevent esophageal reflux, the gastric fundus was pulled and sutured over the esophageal sutures, and the second-layer mattress suture was made 1 cm proximal to the first sutures, including central ligaments of the diaphragm. To prevent bile reflux, we converted from a Billroth-II to a Roux- en-Y gastrojejunostomy. We followed up for 30 months and found no signs of any esophageal stenosis or gastroesophageal reflux. Surgeons rarely encounter variability of the extrabiliary system. However we experienced an anomaly of the extrahepatic bile duct, an incompletely septated double ductus choledochus consisting of two chambers, a proximal-blinded right-down-sided chamber and a left-upper-sided one, which drained from both intrahepatic bile ducts. A large stone was in the proximal-blinded lower choledochus which contained the cystic duct orifice. In this case, several problems were met. First, an exact preoperative diagnosis of the anomalous anatomy was not made with ultrasonogram and computed tomography. Second, the palpable stone was not visualized even on choledochotomy of the left-upper-sided chamber. Third, a surgical decision had to be made whether the septum should be removed. We performed a complete septotomy to prevent bile stasis in the down chamber. Here, we present a description of this rare extrahepatic bile duct anomaly, along with a review of the literature.
Abdomen ; Bile ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Bile Reflux ; Choledocholithiasis* ; Common Bile Duct* ; Constriction, Pathologic ; Cystic Duct ; Debridement ; Diagnosis ; Diaphragm ; Dilatation ; Emergency Treatment ; Esophageal Perforation ; Esophageal Stenosis ; Esophagitis, Peptic ; Esophagus ; Gastric Bypass ; Gastric Fundus ; Gastroesophageal Reflux ; Lacerations ; Ligaments ; Mortality ; Rupture ; Rupture, Spontaneous ; Stents ; Sutures ; Ultrasonography

OBJECTIVETo evaluate the features of gastroesophageal reflux disease (GERD) in elderly patients.

METHODS72 patients with GERD were investigated for the history of illness and the results of gastroscopy and 24 hours esophageal bile monitoring of 54 patients were simultaneously randomized to undergo ambulatory pH monitoring. The degrees of esophagitis were graded according to endoscopic findings.

RESULTSObesity was found in 48% of the elderly group (more than 65 years old) and 49% of the control group (less than 65 years old). There were longer acid and bile reflux time and higher frequency (65%) of hiatal hernia in the elderly, and more patients (35%) had complicated severe grade esophagitis. There were longer time of bile reflux and the higher incidence (76%) of both acid and bile reflux in elderly group than in control group (P < 0.05). But the acid reflux time (%) was similar in two groups (P > 0.05).

CONCLUSIONSThe GERD in elderly patients may be associated with obesity and hiatal hernia. The features of elderly GERD patients are high frequency of erosive esophagitis, and high frequency of both acid and bile reflux, as well as longer history of bile reflux time.

Age Factors ; Aged ; Bile Reflux ; complications ; Esophagitis, Peptic ; diagnosis ; Female ; Gastroesophageal Reflux ; diagnosis ; etiology ; Gastroscopy ; Hernia, Hiatal ; complications ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Monitoring, Ambulatory ; Obesity ; complications

An esophageal perforation is a condition requiring emergency treatment. Although previously spontaneous ruptures were the most common etiology, as endoscopic and radiologic diagnosis and treatment have developed recently, iatrogenic ruptures due to instrumentation have increased to become the most common cause of esophageal perforations. Generally, the treatment of esophageal stenosis is composed of esophageal dilatation using a Maloney or a Mercury dilator and medical treatment for reflux esophagitis. Recently, balloon-catheter dilatation of the esophagus has produced safe and excellent results, and self-expansible metallic stents has been very useful in controlling malignant strictures of the esophagus with low mortality and morbidity. We experienced an esophageal perforation after balloon dilatation and the insertion of a self-expanding silicone-covered Gianturco stent to the site of the esophageal stenosis which was due to reflux esophagitis. The abdomen was opened through an upper midline incision. There was a 3-cm-long longitudinal laceration on the distal esophagus which was closed transversely as with a Heinecke-Mikulicz pyloroplasty after a debridement. To reinforce the site of esophageal laceration and to prevent esophageal reflux, the gastric fundus was pulled and sutured over the esophageal sutures, and the second-layer mattress suture was made 1 cm proximal to the first sutures, including central ligaments of the diaphragm. To prevent bile reflux, we converted from a Billroth-II to a Roux- en-Y gastrojejunostomy. We followed up for 30 months and found no signs of any esophageal stenosis or gastroesophageal reflux.
Abdomen ; Bile Reflux ; Catheters* ; Constriction, Pathologic ; Debridement ; Diagnosis ; Diaphragm ; Dilatation ; Emergency Treatment ; Esophageal Perforation* ; Esophageal Stenosis* ; Esophagitis, Peptic ; Esophagus ; Gastric Bypass ; Gastric Fundus ; Gastroesophageal Reflux ; Lacerations ; Ligaments ; Mortality ; Rupture ; Rupture, Spontaneous ; Stents* ; Sutures

The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.
Adolescent ; Bile Reflux/diagnosis ; Child ; Child, Preschool ; Demography ; Domperidone/therapeutic use ; Dopamine Antagonists/therapeutic use ; Drug Administration Schedule ; Female ; Histamine H2 Antagonists/therapeutic use ; Humans ; Infant ; Male ; Parenteral Nutrition ; Retrospective Studies ; Superior Mesenteric Artery Syndrome/*diagnosis/drug therapy ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Weight Loss

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery