Electrical Stimulation of the Lower Esophageal Spincter (LES) Improves Gastroesophageal Reflux Disease (GERD) in Patients with Laparoscopic Sleeve Gastrectomy (LSG)

those with new postoperative dysphagia (ND), never had dysphagia (NV), continued dysphagia (CD), and resolved dysphagia (RD).The Mann-Whitney test was used to identify significant differences in manometry criteria between groups. Results: 94 patients were included (Table 1). Median follow up was 12 months. Pre-operative dysphagia was present in 23 patients overall (24.5%): it resolved in 65.2% and persisted in 34.8%. Among those with preoperative dysphagia, there were no significant differences in preoperative DCI or other manometry criteria between those whose dysphagia resolved and those whose dysphagia continued (Table 1). Thirty-two patients (34%) had postoperative dysphagia (75% new onset dysphagia, 25% continued dysphagia). Seventy-one patients (75.5%) did not have preoperative dysphagia. Of those, 33.8% developed new dysphagia and 66.2% never developed dysphagia. Neither DCI nor other manometry criteria significantly differed between those who developed new dysphagia or those with did not develop dysphagia (Table 1). Conclusions: Preoperative dysphagia typically resolves but approximately 25% of patients develop dysphagia after LNF. The risk of dysphagia after LNF is independent of preoperative dysphagia and esophageal manometric test results. Specifically, new HRM metrics (DCI, IRP and CFV) do not predict post-Nissen dysphagia in patients who are otherwise fundoplication candidates. Table 1 - Manometry Values and Mann Whitney Test Between Dysphagia Groups

maximum PPI dose underwent LES stimulator implant procedure and were enrolled in an international patient registry prospectively tracking outcomes in GERD patients treated with LES electrical stimulation. Electrical stimulation was delivered at 5mA, 220uSec pulse in 16x20 minute sessions daily. GERD outcomes pre and post-stimulation were evaluated. Results: 22 patients, 55% (12/22) women at 9 centers have been treated; 17 and 5 patients each had LES stimulator implanted at least 1 year post-LSG or peri/pre-LSG, respectively. Median age was 49.5 (IQR=39-56) years. All (22/22) were on at least daily PPIs. At their last follow-up (median=12 months) in the post-LSG group the Body Mass Index (BMI) changed from 31.3kg/m2 to 29kg/m2 (p=0.08), GERD-HRQL scores had improved from 39.5 to 5 (p=0.0001), esophageal acid exposure had improved from 11.8% to 7.5% (p= 0.04) and PPI use had significantly decreased (p=0.001). At their last follow-up (median= 6 months) in the peri/pre-LSG group, the BMI had improved from 40.7kg/m2 to 29.6kg/ m2 (p=0.005), GERD-HRQL scores had improved from 30.5 to 7 (p=0.02), esophageal acid exposure had improved from 21% to 3.5% (p=0.02) and PPI use had significantly decreased (p=0.01). No dysphagia or other GI side effects were reported. Conclusion: Preliminary results on patients with LSG and GERD with bothersome symptoms despite maximal medical therapy, treated with LES electrical stimulation, revealed that LES stimulation is safe and results in a significant improvement in GERD symptoms and esophageal acid exposure in both pre/peri and post-LSG patients. Most patients were off their PPI therapy with remaining taking PPI at a reduced dose. Data from a larger patient experience for this indication is being collected using the international registry trial.

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Introduction:The usage of Endoscopic Ultrasound (EUS) as part of staging Oesophageal and Gastro-Oesophageal junctional (GOJ) cancer is well established.Service constraints of EUS provision by the centralized diagnostic units resulted in potential delays in the staging process and treatment pathways.Recently it has been suggested that the use of selective EUS in patients with T1 and T4b disease on other imaging modalities Computed Tomography (CT),Positron Emission Tomography (PETCT) as it provides consequential additional information for the treatment plan. Aim: To assess the value of EUS before the start of treatment in Oesophageal cancer patients and analyze the impact of a selective usage of EUS. Methods: Retrospective analysis of all patients diagnosed with Oesophageal and GOJ cancers from 2000-2016 was performed.As per protocol patients with T1/2N0 disease proceed to definitive treatment.Neoadjuvant therapy is considered in our unit for T1N1 disease and above.T4b disease is considered for palliative treatment.Data collected from prospective databases and statistical analysis performed using SPSS. Results:645 patients were identified during the study period, of which 253 patients (39.3%) were potentially curable and fully staged with CT, EUS +/- PET-CT.The introduction of PET-CT in the later stage of the study period resulted in 100 patients having triple staging modality. On CT, 23 patients were confirmed T1N0 disease(14 confirmed by EUS), 33 patients were T4Nx disease (24 confirmed by EUS, 2 upstaged to T4b disease).The remaining 197 patients with T2/3Nx disease on CT +/- PETCT, 5 patients (2.5%) were upstaged to T4b disease with EUS. 14 patients (7.1%) were upstaged by EUS for non regional lymph nodes (LN), however, only 2 of those had PETCT assessment positive for non regional LNs.For early T1N0 disease, 9 of the 23 patients (39.1%) were upstaged by EUS with change in treatment plan requiring neoadjuvant therapy.33 patients with T4 disease, 7 of which (21%) were upstaged by EUS. 23 patients had T2N0 disease, 14 of those (60.9%) were upstaged with EUS and therefore needed neoadjuvant therapy.The 100 patients who had triple modality for staging, 8 patients (8%) were upstaged by EUS, of which 4 were in the T1N0 disease group, 3 in the T2/3Nx group and 1 patient in the T4Nx group.Significant statistical reduction of EUS related change in management since the introduction of PET (Fisher's exact test, P= 0.039) Conclusion:EUS remains an essential tool in staging Oesophageal cancer.Since the introduction of PET-CT in the staging process, EUS related change in management plan has decreased and the value of EUS remains predominately in the T1 and T4b disease.However our data supports the use of EUS in staging T2 disease prior to the start of treatment and therefore we cannot support the use of selective EUS in patients with Oesophageal cancer.

DECA - Distal Esophageal Contraction Amplitude (mmHg), PP - Percent Peristalsis (%), DCI - Distal Contractile Integral (mmHg*s*cm), CFV - Contraction Front Velocity (cm/s), IRP - Integrated Relaxation Pressure (mmHg), MW - Mann-Whitney Test

Tu1294 THE IMPACT OF NEOADJUVANT THERAPY ON OUTCOMES FOLLOWING ESOPHAGECTOMY FOR MALIGNANCY: A NSQIP ANALYSIS Jahnavi Kakuturu, Ann-Kristin U. Friedrich, Jason Wiseman, Cameron Stock, Giles F. Whalen, Jennifer LaFemina BACKGROUND: Neoadjuvant therapy, in the form of radiation, chemotherapy or both, is commonly used in potentially resectable esophageal cancer. This study aims to determine the impact of neoadjuvant radiation, chemotherapy and chemoradiation on postoperative outcomes following esophagectomy for malignant indications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent esophagectomy for malignancy from 2007-2012. The sample was categorized based on whether they received neoadjuvant chemoradiation, neoadjuvant radiation or chemotherapy alone, or no therapy. 30-day postoperative outcomes were compared. RESULTS: Of 2991 patients, 417 (14%) received radiation alone, 119 (4%) chemotherapy alone, 253 (8%) chemoradiation, and 2202 (74%) no preoperative therapy. Patients given radiation only had higher incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE; 7% vs 4%, p<0.01 & 4% vs 2%, p=0.03, respectively) compared to those given no therapy. Multivariate analysis demonstrated an odds ratio of 1.9 for DVTs (95%CI 1.19-2.92, p<0.01) and 2.1 for PEs (95%CI 1.13-3.82, p=0.02). There was also a significantly lower blood transfusion rate in patients receiving radiation only compared to those receiving no therapy (8% vs 14%, OR 0.46, 95%CI 0.32-0.67, p<0.001). In the chemoradiation group, superficial surgical site infections (SSI) were more likely (12% vs 8%, OR 1.54, 95%CI 1.02-2.33, p=0.04) compared to the no therapy group. There was no difference in deep incisional or organ space SSI, suggesting equivalent anastomotic leak rates. There was also no difference in mortality or length of stay among groups. CONCLUSIONS: In this national cohort undergoing esophagectomy for malignancy, neoadjuvant radiation alone was associated with higher incidence of DVTs and PEs and lower transfusion requirement. Neoadjuvant chemoradiation, currently the standard in the US, showed higher rate of superficial SSI. There was no difference in deep incisional or organ space infections with any treatment approach. Overall, these regimens appear safe with acceptable complication profiles.

Tu1332 NEW RECONSTRUCTIVE PROCEDURE AFTER INTESTINAL RESECTION FOR CROHN'S DISEASE: ANTIMESENTERIC CUTBACK END-TO-SIDE ISOPERISTALTIC ANASTOMOSIS Kazuhiro Watanabe, Munenori Nagao, Tomoya Abe, Shinobu Ohnuma, Hideaki Karasawa, Fuyuhiko Motoi, Takeshi Naitoh, Michiaki Unno Backgrounds: The surgical management of Crohn's disease is associated with a risk for postoperative disease recurrence. The site of recurrence typically involves the bowel segment that is immediately proximal or distal to an anastomosis created after intestinal resection. Aims: We performed antimesenteric cutback end-to-side isoperistaltic anastomosis, as a method of reconstruction after intestinal resection for Crohn's disease (figure). With this procedure, the luminal diameter proximal and distal to the anastomosis became wider than the original diameter of the intestine. The aims of the present study were to assess the safety and mid-term results of this reconstructive procedure. Patients: Between August 2009 and January 2011, we performed this procedure in 12 patients (14 anastomoses) with Crohn's disease. The median follow-up period from surgery was 62 months. Six patients had a history of previous abdominal surgery for Crohn's disease (2-8 times). Results: The surgical indications were as follows: intestinal stenosis (n=11), fistula (n=6), abscess (n=1), and perforation (n=1). The sites of anastomosis were as follows: ileo-colon (n=7), ileo-ileo (n=6), ileo-rectum (n=1). There was no intraoperative complication. Early postoperative complications were found in 3 cases (surgical site infection; n=2, paralytic ileus; n=1), which treated conservatively. Nine patients used antibiotics as a postoperative maintenance therapy. The 3- and 5-year endoscopic recurrence rates at the site of anastomosis were 25% and 75%, but endoscopy could pass through the site of anastomoses. There was no patient who

Tu1295 ELECTRICAL STIMULATION OF THE LOWER ESOPHAGEAL SPINCTER (LES) IMPROVES GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN PATIENTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG) Yves M. Borbély, Alejandro Nieponice, Leonardo Antonio Rodriguez, Henning G. Schulz, Camila Ortiz, Michael Talbot, David Martin, Nicole D. Bouvy Background: LSG is the most commonly performed bariatric procedure worldwide. However, it can result in de novo GERD and may worsen preexisting GERD. LSG patients with GERD not well controlled with PPI do not have good treatment options except for more invasive, anatomy-altering gastric bypass surgery. LES electrical stimulation therapy has shown to improve outcomes in GERD patients. The aim of this study is to evaluate the safety and efficacy of LES stimulation in LSG patients with GERD not controlled with maximum dose PPI therapy. Method: Patients with LSG-associated GERD and bothersome symptoms despite

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SSAT Abstracts

SSAT Abstracts

FEASIBILITY OF USING SELECTIVE ENDOSCOPIC ULTRASOUND FOR STAGING OF OESOPHAGEAL CANCER Maged F. Farag, Ning Lo, Tarig Abdelrahman, Mahmoud A. Abdeldayem, Rhiannon Bowen, Tim Havard, Xavier Escofet, Anita Willicombe