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⁎3530 ANTI-REFLUX SELF-EXPANDING METAL ESOPHAGEAL STENT: CLINICAL EVALUATION IN PATIENTS.
*3529 UNDERLYING ESOPHOGEAL PATHOLOGY IN MEAT IMPACTION. Brian F. Sweeney, Saket Ambasht, Gregory R. Owens, Alan Parker, San Antonio Uniformed Service Health Education Consortium, San Antonio, TX. Goal:To determine the underlying pathology responsible for dysphagia in patients who presented with meat impaction to Wilford Hall Medical Center and Brooke Army Medical Center(2 military hospitals in San Antonio, TX). Methods:All endoscopy and pathology reports from esophogeal meat impactions were reviewed retrospectively from a 3 year period. All repeat endoscopies and other studies were reviewed to determine an etiology for the meat impaction. Results: There were 70 meat impaction cases in the time period. 81.4%(57/70) had a repeat endoscopy performed and 22.9%(16/70) had biopsies taken. 71.4%(50/70) had dilation performed at index or subsequent endoscopy. A summary of underlying pathology is listed in table 1. Conclusions: At our two institutions, nearly 75% of all meat impactions were caused by either peptic strictures or esophogeal webs/rings. Another 20% of patients had no visible pathology on endoscopy. Rare causes noted included malignancy, a non-specific motor disorder, and recently banded varices. The data indicate nearly 95% of all meat impactions reveal common or no pathology at endoscopy. Endoscopy/Pathology Finding
N
Percent
Peptic Stricture Web Ring Normal Malignancy Post-Variceal Banding Motor Disorder Lye
28 24 14 1 1 1 1
40.0% 34.3% 20.0% 1.4% 1.4% 1.4% 1.4%
*3530 ANTI-REFLUX SELF-EXPANDING METAL ESOPHAGEAL STENT: CLINICAL EVALUATION IN PATIENTS. Kulwinder S. Dua, Richard A. Kozarek, Joseph P. Kim, Jerry Evans, Walter J. Hogan, Reza Shaker, Med Coll of WI, Milwaukee, WI; Virginia Mason Med Ctr, Seattle, WA; St Agnus Hosp, Fond du Lac, WI. Introduction: SMES are used for palliation of malignant dysphagia. However, when deployed across the gastroesophageal (GE) junction, they can predispose to GE reflux and related complications. In a previous study on dogs, we showed that the Z-25-18, AR-SMES (Wilson-Cook, NC) was effective in preventing GE reflux. Aim: The aim of this study was to evaluate the clinical efficacy of the AR-SMES in patients with malignant dysphagia. Methods: 11 patients (age 68±12SD) referred for palliation of malignant dysphagia (adenoca 9, sq.ca 1, adeno & sq.ca 1) with involvement of the GEJ were prospectively studied. Two of these patients presented with reflux symptoms after having a different SMES (Ultraflex 1, Wallstent 1) placed across the GEJ. The AR-SMES was placed across the GEJ in all patients using standard techniques. All patients underwent a barium study after stent placement. Pre and post-stent dysphagia score (04), Karnofsky Performance Status (KFS, 8 pts) and symptoms of heartburn and regurgitation (visual analog scale 0-10, 10 severe; 8 pts) were recorded. Patients were followed up at regular intervals. Results: Post stent barium study showed free ante grade flow of barium in all patients. This correlated with significant improvement in dysphagia score (Table). Reflux provocation by head tilting to -30o (done in 7 pts) showed no reflux of barium. Although the anti-reflux valve can invert at high-pressure gradients, the mean daytime heartburn and regurgitation scores were 0.3±0.3 and
AB118
GASTROINTESTINAL ENDOSCOPY
0.7±0.4 respectively (Table) and no patient complained of nocturnal symptoms. Median follow up was 8 weeks (range 1 day to 37 weeks). Conclusions: AR-SMES is effective is relieving dysphagia and, as previously shown in animal studies, when deployed across the GEJ, AR-SMES is also effective in preventing GE reflux in humans.
Symptom scores and KPS scale (mean ± SE) Dysphagia Score Pre 3.4 ± 0.1
Post 1.1 ± 0.2 P<0.001
KPS Scale
Heartburn
Pre
Pre
66 ± 4.2
Post
Post
73 ± 6.9 3.8 ± 1.7 0.3 ± 0.3 P=0.4
P=0.08
Regurgitation Pre 5.8 ± 1.8
Post 0.7 ± 0.4 P=0.016
Complications: Overgrowth 2 (17wk & 4wk post); Migration 1 (23wk post). This patient received post stent chemo/radio Tx. Air embolism 1.
*3531 THE ROLE OF ENDOSCOPIC EXAMINATION AFTER THE RESACTION OF ESOPHAGEAL CANCER. Atsushi Kokawa, Hajime Yamaguchi, Tetsuya Inui, Mitsuhiro Fujishiro, Hiroyuki Ono, Hitoshi Gene Kondo, Yuji Tachimori, Hoichi Kato, Hiroshi Watanabe, Yukihiro Nakanishi, Tadakazu Shimoda, National Cancer Ctr Hosp, Tokyo, Japan. Background and aim: Squamous cell carcinoma of the esophagus is frequently associated with multiple other primary cancers. As recent advances in endoscopic diagnosis increase the cases of superficial esophageal cancer (SEC) of which prognosis is relatively good, we should pay more attention to subsequent other primary cancers (SOPC) or subsequent multiple esophageal cancers (SMEC) after the treatment of esophageal cancer. The present study was designed for determining the clinical features of SOPC and SMEC after the resection of SEC. Subjects: The study included 368 patients with SEC who underwent surgical resection or endoscopic mucosal resection (EMR) in our institute and were followed a median period of 56 months (range; 7~154 months). Surgical resection was performed in 267 patients, and EMR in 101. The presence of the past history of antecedent and/or synchronous multiple other primary cancers was noted in 149 patients. Result: Among the 368 patients, SOPC occurring after the resection of SEC were found in 43 (12%) patients. The most frequent sites of SOPC were the stomach (11 cases) and the hypopharynx (11 cases), followed by the lung (7 cases) and the colon (6 cases). SOPC were diagnosed a mean period of 47.2Å}28.9 months after the resection of SEC, and the 5-year cumulative complication rate of SOPC was 14.8%. All cases of gastric cancers and 4 cases of hypopharingeal cancers were detected by endoscopy in postoperative follow up, and all of them were T1 tumor. In comparison with patients without SOPC, SOPC were significantly more frequent in patients who were heavy smokers and those who had the past history of antecedent and/or synchronous multiple other primary cancers (p<0.05). SMEC were found in 19 (5%) patients, and occurred more frequently after EMR than after surgical resection (p<0.01). SMEC were diagnosed a mean period of 23.5Å}17.0 months after the resection of SEC, and the 5-year complication rate was 7.2%. The 5-year complication rate of subsequent cancers within the scope of endoscopy of the upper gastrointestinal tract (stomach, hypopharynx, and esophagus) was 13.8%. Conclusion: SOPC, especially gastric cancer and hypopharingeal cancer, were frequently found after the resection of SEC. The possible risk factors of SOPC were heavy smoking and the past history of antecedent or synchronous multiple other primary cancers. These results suggest that endoscopic examination of the upper gastrointestinal tract is particularly important in follow up of patients who have undergone the treatment of esophageal cancer.
VOLUME 51, NO. 4, PART 2, 2000
N
Percent
Peptic Stricture Web Ring Normal Malignancy Post-Variceal Banding Motor Disorder Lye
28 24 14 1 1 1 1
40.0% 34.3% 20.0% 1.4% 1.4% 1.4% 1.4%
*3530 ANTI-REFLUX SELF-EXPANDING METAL ESOPHAGEAL STENT: CLINICAL EVALUATION IN PATIENTS. Kulwinder S. Dua, Richard A. Kozarek, Joseph P. Kim, Jerry Evans, Walter J. Hogan, Reza Shaker, Med Coll of WI, Milwaukee, WI; Virginia Mason Med Ctr, Seattle, WA; St Agnus Hosp, Fond du Lac, WI. Introduction: SMES are used for palliation of malignant dysphagia. However, when deployed across the gastroesophageal (GE) junction, they can predispose to GE reflux and related complications. In a previous study on dogs, we showed that the Z-25-18, AR-SMES (Wilson-Cook, NC) was effective in preventing GE reflux. Aim: The aim of this study was to evaluate the clinical efficacy of the AR-SMES in patients with malignant dysphagia. Methods: 11 patients (age 68±12SD) referred for palliation of malignant dysphagia (adenoca 9, sq.ca 1, adeno & sq.ca 1) with involvement of the GEJ were prospectively studied. Two of these patients presented with reflux symptoms after having a different SMES (Ultraflex 1, Wallstent 1) placed across the GEJ. The AR-SMES was placed across the GEJ in all patients using standard techniques. All patients underwent a barium study after stent placement. Pre and post-stent dysphagia score (04), Karnofsky Performance Status (KFS, 8 pts) and symptoms of heartburn and regurgitation (visual analog scale 0-10, 10 severe; 8 pts) were recorded. Patients were followed up at regular intervals. Results: Post stent barium study showed free ante grade flow of barium in all patients. This correlated with significant improvement in dysphagia score (Table). Reflux provocation by head tilting to -30o (done in 7 pts) showed no reflux of barium. Although the anti-reflux valve can invert at high-pressure gradients, the mean daytime heartburn and regurgitation scores were 0.3±0.3 and
AB118
GASTROINTESTINAL ENDOSCOPY
0.7±0.4 respectively (Table) and no patient complained of nocturnal symptoms. Median follow up was 8 weeks (range 1 day to 37 weeks). Conclusions: AR-SMES is effective is relieving dysphagia and, as previously shown in animal studies, when deployed across the GEJ, AR-SMES is also effective in preventing GE reflux in humans.
Symptom scores and KPS scale (mean ± SE) Dysphagia Score Pre 3.4 ± 0.1
Post 1.1 ± 0.2 P<0.001
KPS Scale
Heartburn
Pre
Pre
66 ± 4.2
Post
Post
73 ± 6.9 3.8 ± 1.7 0.3 ± 0.3 P=0.4
P=0.08
Regurgitation Pre 5.8 ± 1.8
Post 0.7 ± 0.4 P=0.016
Complications: Overgrowth 2 (17wk & 4wk post); Migration 1 (23wk post). This patient received post stent chemo/radio Tx. Air embolism 1.
*3531 THE ROLE OF ENDOSCOPIC EXAMINATION AFTER THE RESACTION OF ESOPHAGEAL CANCER. Atsushi Kokawa, Hajime Yamaguchi, Tetsuya Inui, Mitsuhiro Fujishiro, Hiroyuki Ono, Hitoshi Gene Kondo, Yuji Tachimori, Hoichi Kato, Hiroshi Watanabe, Yukihiro Nakanishi, Tadakazu Shimoda, National Cancer Ctr Hosp, Tokyo, Japan. Background and aim: Squamous cell carcinoma of the esophagus is frequently associated with multiple other primary cancers. As recent advances in endoscopic diagnosis increase the cases of superficial esophageal cancer (SEC) of which prognosis is relatively good, we should pay more attention to subsequent other primary cancers (SOPC) or subsequent multiple esophageal cancers (SMEC) after the treatment of esophageal cancer. The present study was designed for determining the clinical features of SOPC and SMEC after the resection of SEC. Subjects: The study included 368 patients with SEC who underwent surgical resection or endoscopic mucosal resection (EMR) in our institute and were followed a median period of 56 months (range; 7~154 months). Surgical resection was performed in 267 patients, and EMR in 101. The presence of the past history of antecedent and/or synchronous multiple other primary cancers was noted in 149 patients. Result: Among the 368 patients, SOPC occurring after the resection of SEC were found in 43 (12%) patients. The most frequent sites of SOPC were the stomach (11 cases) and the hypopharynx (11 cases), followed by the lung (7 cases) and the colon (6 cases). SOPC were diagnosed a mean period of 47.2Å}28.9 months after the resection of SEC, and the 5-year cumulative complication rate of SOPC was 14.8%. All cases of gastric cancers and 4 cases of hypopharingeal cancers were detected by endoscopy in postoperative follow up, and all of them were T1 tumor. In comparison with patients without SOPC, SOPC were significantly more frequent in patients who were heavy smokers and those who had the past history of antecedent and/or synchronous multiple other primary cancers (p<0.05). SMEC were found in 19 (5%) patients, and occurred more frequently after EMR than after surgical resection (p<0.01). SMEC were diagnosed a mean period of 23.5Å}17.0 months after the resection of SEC, and the 5-year complication rate was 7.2%. The 5-year complication rate of subsequent cancers within the scope of endoscopy of the upper gastrointestinal tract (stomach, hypopharynx, and esophagus) was 13.8%. Conclusion: SOPC, especially gastric cancer and hypopharingeal cancer, were frequently found after the resection of SEC. The possible risk factors of SOPC were heavy smoking and the past history of antecedent or synchronous multiple other primary cancers. These results suggest that endoscopic examination of the upper gastrointestinal tract is particularly important in follow up of patients who have undergone the treatment of esophageal cancer.
VOLUME 51, NO. 4, PART 2, 2000