Michael Sedrak

Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

AIM To determine if esophageal capsule endoscopy (ECE) is an adequate diagnostic alternative to esophagogastroduodenoscopy (EGD) in pre-bariatric surgery patients. METHODS We conducted a prospective pilot study to assess the diagnostic accuracy of ECE (PillCam ESO2, Given Imaging) vs conventional EGD in pre-bariatric surgery patients. Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled. All patients underwent ECE followed by standard EGD. Two experienced gastroenterologists blinded to the patients history and the findings of the EGD reviewed the ECE and documented their findings. The gold standard was the findings on EGD. RESULTS Ten patients with an average body mass index of 50 kg/m(2) were enrolled and completed the study. ECE identified 11 of 14 (79%) positive esophageal/gastroesophageal junction (GEJ) findings and 14 of 17 (82%) combined esophageal and gastric findings identified on EGD. Fishers exact test was used to compare the findings and no significant difference was found between ECE and EGD (P = 0.64 for esophageal/GEJ and P = 0.66 for combined esophageal and gastric findings respectively). Of the positive esophageal/GEJ findings, ECE failed to identify the following: hiatal hernia in two patients, mild esophagitis in two patients, and mild Schatzki ring in two patients. ECE was able to identify the entire esophagus in 100%, gastric cardia in 0%, gastric body in 100%, gastric antrum in 70%, pylorus in 60%, and duodenum in 0%. CONCLUSION There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.

Single-incision laparoscopic surgery through an ostomy site: A natural approach by an unnatural orifice

Single-incision laparoscopic surgery (SILS) is gaining popularity for a wide variety of surgical operations and capitalizes on the benefits of traditional laparoscopic surgery without incurring multiple incision sites. Traditionally, SILS is performed by a midline periumbilical approach. However, such a minimally invasive approach may be utilized in patients who already have an abdominal incision. Our series retrospectively reviews 7 cases in which we utilized the fascial defect at the time of after ostomy reversal as our SILS incision site. In turn, we performed a variety of concurrent intra-abdominal procedures with excellent technical success and outcomes. Our study is the largest single-institution case series of this novel approach and suggests that utilizing an existing ostomy-site abdominal incision is a safe and effective location for SILS port placement and should be considered in patients undergoing concurrent procedures.

Gastric band removal and conversion to sleeve gastrectomy for vasovagal syncopal episodes associated with adjustable gastric banding placed using pars flaccida technique

The morbidity and complications seen with laparoscopic adjustable gastric banding can be associated with the surgical technique used, with fewer complications noted with the pars flaccida technique than with the perigastric approach [1]. In patients who underwent gastric banding using he perigastic technique, vasovagal presyncope was not an ncommon occurrence during band adjustments owing to rritation and stimulation of the anterior vagus during adjustents. However, this phenomenon is not common in patients ho undergo gastric banding using the pars flaccida approach. e present the case of 1 patient who underwent laparoscopic djustable gastric banding placed using the pars flaccida techique who experienced vasovagal syncopal episodes when the and was inflated, requiring removal of the gastric band and onversion to laparoscopic sleeve gastrectomy.

Mo1183 Screening Pre-Bariatric Surgery Patients for Esophageal Disease With Esophageal Capsule Endoscopy Compared to Esophagogastroduodenoscopy

INTRODUCTION: Endoscopic methods, especially the intragastric balloon (IGB), have been shown to be effective for the treatment of excess weight. OBJECTIVE: To assess the efficacy and complications of excess weight treatment with an IGB in patients seen at the Endogastro Med Service clinic. METHODS: A total of 418 patients were analyzed. An Allergan IGB (BIB®) with a volume of 600 to 700 ml was used. The patients had a minimum initial body mass index (BMI) of 27 kg/m2 and were followed up by a multidisciplinary team consisting of a nutritionist, a doctor and a psychologist. For statistical analysis, the patients were divided into groups according to sex and degree of excess weight (overweight and grade I, II and III obesity). Data were analyzed using descriptive statistical methods, the Student t-test, Spearman correlation, and analysis of variance followed by the Tukey post-test. The level of significance was set at p<0.05. RESULTS: 40 patients were excluded from the analysis: 24 (5.74%) due to early IGB removal, 4 (0.95%) due to absence of weight loss, 2 (0.48%) due to weight gain, and 10 (2.39%) due to incomplete data. The incidence of fungus was 0.95% (n=4) and the incidence of leakage was 0.48% (n=2). Of the 378 remaining patients, 295 were women and 83 were men. Mean age was 37.02 years. The patients showed a significant weight loss, with a significantly lower final BMI (mean: 29.57±5.06 kg/m2; range: 19.81-48.18) than the initial BMI (mean: 36.70±5.53 kg/m2; range: 27.04-60.4) (p<0.0001). Mean BMI reduction was 7.13±2.76 kg/m2 (range: 1.59-16.09). Mean percent weight loss was 19.38±6.75% and mean percent excess weight loss was 70.73±38.78% (range: 11,16336,14). There was no difference between BMI ranges regarding percent initial weight loss (p=0.5026) and there was no difference between men and women regarding BMI reduction (p=0.0944) or percent initial weight loss (p=0.7902). There was a positive correlation between the numbers of visits to a nutritionist and a greater loss of initial weight (p=0.0001). CONCLUSION: Endoscopic treatment of excess weight with an IGB has been established as an excellent therapeutic option for patients of both genders with overweight or different degrees of obesity.

Transesophageal Endoscopic Myotomy (TEEM) for the Treatment of Achalasia – The United States Human Experience

The stem cell spheroids were infected with NV1066, a third-generation herpesvirus, or NDV-F3aa-GFP, a Newcastle Disease virus mutant. Both viruses carried the marker gene green fluorescent protein (GFP), which allowed monitoring by fluorescent microscopy. Cell cycle analysis and cell migration assay were also performed. Results: Viral infection of cancer stem cells was rapid (GFP expression was seen by 24 hours). The viruses from both families each produced efficient infection and killing of cancer. At doses of multiplicity of infection (MOI, number of viruses per tumor cell) of 0.5 or 1, >95% of cells were dead by day 6. Infection with virus also produced decreased migratory capacity of the cancer stem cells and shifted the population to a higher fraction in S phase. Conclusion: Multiple types of oncolytic viruses effectively target the stem cell subpopulation of pancreatic cancer cells. Infection decreases metastatic potential and effects killing of such stem cells. These data support clinical studies of oncolytic viruses in the treatment of chemoand radioresistant tumors.