Factors influencing anastamotic stricture following gastric bypass
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914 RETROSPECTIVE STUDY OF EGD IN GERIATRIC POPULATION ABOVE AGE OF 90 YEARS, FROM 1995 TO 2002. SINGLE CENTER EXPERINCE Vipin K. Gupta, M.D., Rajender Parmar, M.D., Mayuri Patni, M.D., Adanan Kdhair, M.D.*, Irwin Grosman, M.D. Long Island College Hospital, Brooklyn, NY. Purpose: To study the safety of EGD placement in patients above age of 90 years. Methods: Charts and endoscopy reports of 120 patients were reviewed who had upper endoscopy as outpatients or inpatients. The study popula- tion included Patients aging 90 and above. We looked at the indications, medications used, findings at endoscopy and complications of the proce- dure. Results: Study population included 55 males and 65females. Upper en- doscopy was indicated for Gastrointestinal bleed in 43 patients, Dysphagia in 18 patients, abdominal pain in 13 patients, Dyspepsia in 10 patients, History of peptic ulcer disease in 4 patients, Vomiting in 4 patients, and 6 patients has other indications. Some patients had more than one indication for the procedure. All these patients had comorbid conditions. Most of them had HTN, DM, COPD, CAD, CVA and malignancies. Concious sedation used in 96% of patients. No medication was used in 4% of the patients. Demerol was used in 48 patients out of which 22 received 25 mg of demerol, 10 patients received 12.5 mg of demerol, 5 patients received 15mg, 4 patients received 10 mg of demerol, 3 patients received 35 mg, 4 patients received 50 mg of demerol, One patient received only demerol while others needed demerol along with versed or valium. 105 patients received Valium- out of which 20 patients received between 1-2 mg, 28 patients received between 2–3 mg, 13 patients received between 3-4 mg, 33 patients 5– 6 mg, 7 patients received 7–10 mg. 58 patients received valium alone, out of which 28 patients received less than 3 mg, 25 patients received between 4 – 6 mg and only 4 patients received between 7–10 mg. 8 patients received versed between 0.5 to 2.0 mg- out of these six received only versed-dose 0.5 to 1.5 mg. EGD findings were gastritis in 67, hiatal hernia in 30, esophagitis in 19, gastric ulcer 18, esophageal stricture in 6, esoph- ageal ulcer in 2, gastric mass in 9, gastric polyp in 3, duodenitis in 4, and duodenal ulcer in 8 patients, others 5 patients. The procedure had to be terminated in two patients due to patient intolerance. One patient required narcan for reversal of Demerol effect. Conclusions: Upper endoscopy is a safe procedure in elderly patients despite the comorbid conditions. Most of our patients tolerated conscious sedation very well. 915 LONG TERM (3 YEARS) HEARTBURN CONTROL AFTER STRETTA PROCEDURE Alvaro Reymunde, M.D.*, Karelia Ruiz, M.D., Nilda Santiago, M.D. Ponce Gastroeneterology Research, Ponce, PR. Purpose: To evaluate the control of GERD symptoms 3 years after Stretta Procedure, the efficacy of Stretta versus medical treatment for GERD and to assess the development of long term complications associated to the procedure. Methods: Patients who had undergone Stretta Procedure at our center between 2000 and 2001 were contacted. The patients were interviwed on the phone and asked to answer questions from a standard questionnaire. The questionnaire assessed symptom severity on and off drugs and the percent of symptom control on medication before the procedure as well as severity of symptoms and percent of symptom control after the procedure. The questionnaire also inquired about the timing of onset of symptom improvement after stretta ( Immediate-2 months, Continued over 12 months, Improvement began after 6 months, No improvement). Patients were also questioned regarding, recurrence of their symptoms and the development of any long term complications such as dysphagia. The data gathered underwent statistical analysis. Results: A total of 90 patients had undergone Stretta Procedure at our center since mid 2000 to mid 2001 (36 to 25 mo, mean 31.66 mo) . Of the ninety patients we tried to contact, only 50 where available for questioning. Forty could not be contacted. Ages ranged from 35– 84 year-old (mean, 61), subjects were paired for sex. The percent of symptom control expressed by patients while on antisecretory mediacations was 54.4% compared to 74.3% of symptom control off medication after Stretta Procedure. This value was statistically significant (p0.005). Eighty two percent of patients experienced immediate symptom improvement while 2% experienced im- provement over a six and twelve month period respectively, for a total of 86% overall symptom improvement. Fourteen percent of the patients ex- perienced no improvement after the procedure. Of the 86% of patients with symptom improvement, 81% remain symptom free after a follow up period of average 2.6 years. The recurrence of symptoms in most cases occurred at a much lower degree of severity than before. None of the patients interviewd reported any long term complications which could be attributed to the procedure such as dysphagia. Conclusions: Stretta procedure is a safe and well tolerated procedure for the treatment of GERD. It is superior to medical therapy in a significant number of cases. We have shown the long term efficacy of symptom improvement as evidenced by an 81% persistance of heartburn symptoms control as long as three years after the procedure. 916 FACTORS INFLUENCING ANASTAMOTIC STRICTURE FOLLOWING GASTRIC BYPASS Duc Vu, M.D., Donald Rawls, M.D.*, Joseph White, M.D., Tim Pfanner, M.D., Kim Culp, M.D., Rick Symmonds, M.D., John Rodriquez, M.D., Mark Riggs, Ph.D. Scott and White Hospital, Temple, TX. Purpose: The use of gastric bypass as a mechanism for weight loss has increased over the last several years. A known complication of this pro- cedure is an anastamotic stricture; usually presenting as dysphagia and/or nausea and vomiting. The purpose of this study was to examine factors that might predict predisposition to anastamotic strictures. Methods: Patients who have undergone gastric bypass within the past five years were identified with the Scott & White Electronic Database using CPT codes. Those who developed anastamotic strictures requiring subse- quent dilation were identified using similar methods. The medical records of these patients were then reviewed for possible correlations between stricture formation and type of surgery, surgeon, age, race, perioperative BMI and various co-morbidities. Results: Three hundred and twenty-one patients were found to have undergone gastric bypass over the past five years, of which 63 patients (20%) developed stricture requiring subsequent dilation. Using Chi-Square analysis, no significant difference could be attributed to age (p 0.3268), BMI (p 0.9400), type of surgery (Open vs. Laparoscopic, p 0.1021), surgeon (p 0.3766), or gender (p 0.6801). Various co-morbidities were also reviewed for possible correlation with anastamotic stricture. None of these were significant [HTN (p 0.9059), GERD (p 0.9823), hyper- lipidemia (p 0.0982), CAD (p 0.1124), NIDDM (p 0.8684), IDDM (p 0.4094), hypothyroidism (p 0.6248) and history of PUD (p 0.9831)]. It was noted that all those who developed stricture did so within the first six months after surgery. The mean follow up for those without stricture was one year. Conclusions: Of the factors analyzed, none appear to predispose an indi- vidual to develop an anastamotic stricture following gastric bypass. How- ever, it is important to note that all anastamotic strictures developed within the first six months following surgery. S305 AJG – September, Suppl., 2003 Abstracts
Transcript of Factors influencing anastamotic stricture following gastric bypass
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RETROSPECTIVE STUDY OF EGD IN GERIATRICPOPULATION ABOVE AGE OF 90 YEARS, FROM 1995 TO2002. SINGLE CENTER EXPERINCEVipin K. Gupta, M.D., Rajender Parmar, M.D., Mayuri Patni, M.D.,Adanan Kdhair, M.D.*, Irwin Grosman, M.D. Long Island CollegeHospital, Brooklyn, NY.
Purpose: To study the safety of EGD placement in patients above age of90 years.Methods: Charts and endoscopy reports of 120 patients were reviewedwho had upper endoscopy as outpatients or inpatients. The study popula-tion included Patients aging 90 and above. We looked at the indications,medications used, findings at endoscopy and complications of the proce-dure.Results: Study population included 55 males and 65females. Upper en-doscopy was indicated for Gastrointestinal bleed in 43 patients, Dysphagiain 18 patients, abdominal pain in 13 patients, Dyspepsia in 10 patients,History of peptic ulcer disease in 4 patients, Vomiting in 4 patients, and 6patients has other indications. Some patients had more than one indicationfor the procedure. All these patients had comorbid conditions. Most of themhad HTN, DM, COPD, CAD, CVA and malignancies. Concious sedationused in 96% of patients. No medication was used in 4% of the patients.Demerol was used in 48 patients out of which 22 received 25 mg ofdemerol, 10 patients received 12.5 mg of demerol, 5 patients received15mg, 4 patients received 10 mg of demerol, 3 patients received 35 mg, 4patients received 50 mg of demerol, One patient received only demerolwhile others needed demerol along with versed or valium. 105 patientsreceived Valium- out of which 20 patients received between 1-2 mg, 28patients received between 2–3 mg, 13 patients received between 3-4 mg, 33patients 5–6 mg, 7 patients received 7–10 mg. 58 patients received valiumalone, out of which 28 patients received less than 3 mg, 25 patients receivedbetween 4–6 mg and only 4 patients received between 7–10 mg. 8 patientsreceived versed between 0.5 to 2.0 mg- out of these six received onlyversed-dose 0.5 to 1.5 mg. EGD findings were gastritis in 67, hiatal herniain 30, esophagitis in 19, gastric ulcer 18, esophageal stricture in 6, esoph-ageal ulcer in 2, gastric mass in 9, gastric polyp in 3, duodenitis in 4, andduodenal ulcer in 8 patients, others 5 patients. The procedure had to beterminated in two patients due to patient intolerance. One patient requirednarcan for reversal of Demerol effect.Conclusions: Upper endoscopy is a safe procedure in elderly patientsdespite the comorbid conditions. Most of our patients tolerated conscioussedation very well.
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LONG TERM (3 YEARS) HEARTBURN CONTROL AFTERSTRETTA PROCEDUREAlvaro Reymunde, M.D.*, Karelia Ruiz, M.D., Nilda Santiago, M.D.Ponce Gastroeneterology Research, Ponce, PR.
Purpose: To evaluate the control of GERD symptoms 3 years after StrettaProcedure, the efficacy of Stretta versus medical treatment for GERD andto assess the development of long term complications associated to theprocedure.Methods: Patients who had undergone Stretta Procedure at our centerbetween 2000 and 2001 were contacted. The patients were interviwed onthe phone and asked to answer questions from a standard questionnaire.The questionnaire assessed symptom severity on and off drugs and thepercent of symptom control on medication before the procedure as well asseverity of symptoms and percent of symptom control after the procedure.The questionnaire also inquired about the timing of onset of symptomimprovement after stretta ( Immediate-2 months, Continued over 12months, Improvement began after 6 months, No improvement). Patientswere also questioned regarding, recurrence of their symptoms and thedevelopment of any long term complications such as dysphagia. The datagathered underwent statistical analysis.
Results: A total of 90 patients had undergone Stretta Procedure at ourcenter since mid 2000 to mid 2001 (36 to 25 mo, mean 31.66 mo) . Of theninety patients we tried to contact, only 50 where available for questioning.Forty could not be contacted. Ages ranged from 35–84 year-old (mean, 61),subjects were paired for sex. The percent of symptom control expressed bypatients while on antisecretory mediacations was 54.4% compared to74.3% of symptom control off medication after Stretta Procedure. Thisvalue was statistically significant (p�0.005). Eighty two percent of patientsexperienced immediate symptom improvement while 2% experienced im-provement over a six and twelve month period respectively, for a total of86% overall symptom improvement. Fourteen percent of the patients ex-perienced no improvement after the procedure. Of the 86% of patients withsymptom improvement, 81% remain symptom free after a follow up periodof average 2.6 years. The recurrence of symptoms in most cases occurredat a much lower degree of severity than before. None of the patientsinterviewd reported any long term complications which could be attributedto the procedure such as dysphagia.Conclusions: Stretta procedure is a safe and well tolerated procedure forthe treatment of GERD. It is superior to medical therapy in a significantnumber of cases. We have shown the long term efficacy of symptomimprovement as evidenced by an 81% persistance of heartburn symptomscontrol as long as three years after the procedure.
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FACTORS INFLUENCING ANASTAMOTIC STRICTUREFOLLOWING GASTRIC BYPASSDuc Vu, M.D., Donald Rawls, M.D.*, Joseph White, M.D.,Tim Pfanner, M.D., Kim Culp, M.D., Rick Symmonds, M.D.,John Rodriquez, M.D., Mark Riggs, Ph.D. Scott and White Hospital,Temple, TX.
Purpose: The use of gastric bypass as a mechanism for weight loss hasincreased over the last several years. A known complication of this pro-cedure is an anastamotic stricture; usually presenting as dysphagia and/ornausea and vomiting. The purpose of this study was to examine factors thatmight predict predisposition to anastamotic strictures.Methods: Patients who have undergone gastric bypass within the past fiveyears were identified with the Scott & White Electronic Database usingCPT codes. Those who developed anastamotic strictures requiring subse-quent dilation were identified using similar methods. The medical recordsof these patients were then reviewed for possible correlations betweenstricture formation and type of surgery, surgeon, age, race, perioperativeBMI and various co-morbidities.Results: Three hundred and twenty-one patients were found to haveundergone gastric bypass over the past five years, of which 63 patients(20%) developed stricture requiring subsequent dilation. Using Chi-Squareanalysis, no significant difference could be attributed to age (p � 0.3268),BMI (p � 0.9400), type of surgery (Open vs. Laparoscopic, p � 0.1021),surgeon (p � 0.3766), or gender (p � 0.6801). Various co-morbidities werealso reviewed for possible correlation with anastamotic stricture. None ofthese were significant [HTN (p � 0.9059), GERD (p � 0.9823), hyper-lipidemia (p � 0.0982), CAD (p � 0.1124), NIDDM (p � 0.8684), IDDM(p � 0.4094), hypothyroidism (p � 0.6248) and history of PUD (p �0.9831)]. It was noted that all those who developed stricture did so withinthe first six months after surgery. The mean follow up for those withoutstricture was one year.Conclusions: Of the factors analyzed, none appear to predispose an indi-vidual to develop an anastamotic stricture following gastric bypass. How-ever, it is important to note that all anastamotic strictures developed withinthe first six months following surgery.
S305AJG – September, Suppl., 2003 Abstracts
