OBJECTIVETo investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia.

METHODSFrom September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed.

RESULTSAfter POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients.

CONCLUSIONPOEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Adolescent ; Adult ; Aged ; Esophageal Achalasia ; physiopathology ; surgery ; Esophagoscopy ; methods ; Esophagus ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Hiatal hernia is a common disease, which is always complicated with gastro-esophageal reflux. However, owing to restriction of diagnosis ability, the finding of hiatal hernia is still at low level in China. How to increase the finding or diagnosis of this disease and improve the life quality of patients, is an important task of radiologists and hernial surgeons. Surgery has been integrated into the therapy of hiatal hernia for a long time, but most surgeons still need to improve their recognition about its essence and the anti-reflux mechanism of lower esophagus. The purpose of surgery of hiatal hernia is not only to repair the defect, but to recover the anatomic structure and function of lower esophagus, as well as to rebuild anti-reflux barrier in stomach at the mean time. The key principle of surgery is to recover structure of GEJ, location of LES and the length of lower esophagus through fundoplication and firm fixation, which prevent it from dislocating to thoracic cavity. By adhering to the principle of this, we can combine the anatomy and function in repair of hiatal hernia, and recover and keep the anti-reflux function of LES utmost. MDT, specialized precision program and standardization will play more and more important roles in hiatal hernia therapy in the future. In this article, we made a review about the diagnosis and therapy history of hiatal hernia, as well as prospected the progress in the near future.
China ; Esophagus ; physiopathology ; Fundoplication ; Gastroesophageal Reflux ; Hernia, Hiatal ; diagnosis ; surgery ; Humans

OBJECTIVETo study the changes of lower esophageal sphincter (LES) high-pressure zone, and to determine the accurate length of myotomy on the esophageal and gastric sides.

METHODSThere were 15 patients undergoing the Heller's cardia-myotomies and Toupet fundoplications from May 2006 to December 2007. Among them, 9 patients were female and 6 was male. The age ranged from 28 to 61 years old, and the disease duration ranged from 6 months to 9 years. The intraoperative oesophageal manometry underwent in the surgical procedures to investigate the changes of the lower esophageal sphincter pressure and the length of myotomy.

RESULTSThere was no postoperative death. After (5.3 +/- 1.5) cm of esophageal side myotomy and (0.8 +/- 0.4) cm of gastric side myotomy, the mean LES pressure decreased from (33.6 +/- 13.3) mm Hg (1 mm Hg = 0.133 kPa) to (9.7 +/- 4.6) mm Hg and (4.8 +/- 3.1) mm Hg respectively (P < 0.05). The lower esophageal sphincter length ranged from 5 to 8 cm.

CONCLUSIONIntraoperative esophageal manometry helps determine the accurate myotomy length of myotomy on the esophageal and gastric sides of the gastroesophageal junction and provides valuable information for the Heller's myotomy.

Adult ; Esophageal Achalasia ; surgery ; Esophagus ; physiopathology ; surgery ; Female ; Humans ; Intraoperative Care ; Male ; Manometry ; Middle Aged ; Monitoring, Intraoperative

Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients' life. Esophagogastric devascularization (EGDV) has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV (sEGDV) for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group (n=90) or the non-sEGDV (n-sEGDV) group (n=90). Patients' demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference (P<0.01) in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy (P>0.05). It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body's voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.
Adult ; Esophagus ; blood supply ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; pathology ; physiopathology ; Hepatic Encephalopathy ; pathology ; physiopathology ; Humans ; Hypertension, Portal ; pathology ; physiopathology ; surgery ; In Vitro Techniques ; Male ; Middle Aged ; Postoperative Complications ; pathology ; physiopathology ; Prospective Studies ; Stomach ; blood supply ; surgery ; Thrombosis ; etiology ; pathology ; physiopathology

OBJECTIVETo investigate the motility function of remnant esophagus and stomach, and the gastroesophageal reflux after esophagectomy and esophagogastric anastomosis following esophageal bed.

METHODSEsophageal manometry and 24-hour pH monitoring were performed in 10 healthy volunteers and 20 patients who underwent esophagectomy and esophagogastric anastomosis through esophageal bed as a treatment for mid-esophageal carcinoma. These 20 patients, received examinations within 3 to 6 months after operations, were defined as study group, and 10 healthy volunteers as control group.

RESULTS(1) All the pH monitoring indexes in study group were significantly higher than those in control group (P<0.01). (2) Rest pressures of stomach, remnant esophagus and upper esophageal sphincter significantly increased in comparison with control group(P<0.01). (3) The contracting pressure, amplitude of primary peristalsis and amplitude of swallow peristalsis of remnant esophagus were reduced as compared to control group(P<0.01). (4) The contraction pressure of upper esophageal sphincter was obviously higher than that of control group (P<0.01). (5) There were no significant differences among stomach rest pressure, anastomosis rest pressure and remnant esophagus rest pressure in study group (F=3.08, P>0.05).

CONCLUSIONAfter esophagectomy and esophagogastric anastomosis through esophageal bed in upper aortic site, the peristalsis function of remnant esophagus is poor, the function of acid clearance is reduced, no high pressure zone at the anastomosis orifice is found, the anastomosis orifice has no anti-reflux effect, and gastroesophageal reflux exists in the postoperative patients prevalently.

Anastomosis, Surgical ; Case-Control Studies ; Esophageal Neoplasms ; physiopathology ; surgery ; Esophagectomy ; Esophagus ; physiopathology ; surgery ; Female ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Male ; Manometry ; Middle Aged ; Peristalsis ; Pressure

Aged ; Esophagus ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; complications ; diagnostic imaging ; physiopathology ; surgery ; Male ; Spondylosis ; complications ; Tomography, X-Ray Computed

OBJECTIVEThe distribution of upper airway obstruction sites can be identified quantitatively and dynamically with continuous airway pressure measurements in obstructive sleep apnea hypopnea syndrome ( OSAHS) patients. Its value as a clinical predictor for the outcome of revised uvulopalatopharyngoplasty was evaluated.

METHODSThe upper airway obstruction sites (transpalatal level, tongue base or hypolarynx level) were determined preoperatively with overnight upper airway pressure monitoring and concurrent polysomnography (PSG). Of one's total amount of obstructive events, the proportion of apnea/hypopnea events located at Transpalatal level was quantified as contribution of transpalatal obstruction. Of all OSAHS patients, 26 males and 1 female underwent revised uvulopalatopharyngoplasty (2 had same stage transpalatal advancement pharyngoplasty) and had follow-up PSG 6. 33 +/- 0.84 months after surgery. The relationship of transpalatal obstruction proportion, age, tonsil size and body mass index (BMI) and the reduction in apnoea hypopnea index (AHI) was analyzed.

RESULTSThe AHI (times/hr) of 27 subjects decreased from 63.9 +/- 20.7 to 28.4 +/- 25.4. The response rate was 51.9% (defined as AHI reduction over 50%). Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significant (r = 0.609), so was the degree of the tonsil size (r = 0.511). The proportion of tongue base level obstruction showed a negative correlation for the AHI reduction. Patients with oropharynx obstruction percentage > or = 70% had a success rate of 90% and all patients with oropharynx obstruction percentage <60% responded poorly to the operation. The regression model showed distribution of obstructive sites, along with tonsil size and other PSG parameters could predict 66.7% of the postoperative AHI of transpalatal level surgery (F = 6.701, P = 0.001) .

CONCLUSIONSContribution of transpalatal level obstruction has significant predictive value to the outcome of transpalatal level surgery in OSAHS patients.

Adult ; Airway Resistance ; Cleft Palate ; surgery ; Esophagus ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; Palate ; surgery ; Pharynx ; surgery ; Predictive Value of Tests ; Pressure ; Sleep Apnea, Obstructive ; physiopathology ; surgery ; Treatment Outcome ; Uvula ; surgery ; Young Adult

OBJECTIVEThrough reviewing the surgical experience in the treatment of sliding hiatus hernia, the effectiveness of Nissen fundoplication using intraoperative oesophageal manometry has been evaluated.

METHODSThere were 84 undergoing the transabdominal surgery who have been divided into three groups: 27 patients were in the Nissen group, 39 in the floppy Nissen group, 18 in the intraoperative-oesophageal-manometry group.

RESULTSThere is no postoperative death. Complications occurred in 5 patients within one month after operation: in the Nissen group, 2 patients suffered from severe dysphagia and 1 from regurgitation; In the floppy Nissen group, 2 patients had regurgitation; In the intraoperative-oesophageal-manometry group, there were no one suffering severe dysphagia or regurgitation. During the long-term follow-up, excellent functional results were also observed in the intraoperative-oesophageal-manometry group, whereas 2 patients suffered from severe dysphagia and 1 from nausea in the Nissen group and 1 patient recurred in the floppy Nissen group.

CONCLUSIONSThe Nissen fundoplication (NF) should be suitable to be done in patients with sliding hiatus hernia. But if there are possibilities to perform intraoperative oesophageal manometry during the operation of anti-reflux, side effects can be decreased to the least. Intraoperative manometry is useful in standardizing the tightness of the wrap in NF. And it will contribute to reducing or avoiding the happening of complications.

Adult ; Aged ; Esophagus ; pathology ; physiopathology ; Female ; Follow-Up Studies ; Fundoplication ; Hernia, Hiatal ; surgery ; Humans ; Male ; Manometry ; methods ; Middle Aged ; Monitoring, Intraoperative ; Postoperative Complications ; prevention & control ; Treatment Outcome

Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.
Botulinum Toxins/administration & dosage ; Deglutition Disorders/etiology ; Diagnostic Errors ; Endoscopy, Digestive System ; Esophageal Achalasia/*diagnosis/etiology/physiopathology/therapy ; Esophageal Sphincter, Lower ; Esophagus/physiopathology/surgery ; Gastroesophageal Reflux/diagnosis ; Humans ; Injections, Subcutaneous ; Manometry ; Neurotransmitter Agents/administration & dosage ; Recurrence