Showing papers by "Stefano Siboni published in 2020"

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease.

Abstract: The magnetic sphincter augmentation (MSA) device has been proven safe and effective in controlling typical reflux symptoms and esophageal acid exposure for up to 6-year follow-up. Longer term outcomes have not been reported yet. A prospectively maintained database was reviewed to assess long-term safety and efficacy of the laparoscopic MSA procedure at a single referral center. Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), use of proton-pump inhibitors (PPI), and esophageal acid exposure were compared to baseline. Favorable outcomes were defined as ≥ 50% improvement of GERD-HRQL total score and PPI discontinuation. Between March 2007 and March 2020, 335 patients met the study inclusion criteria, and 124 of them were followed from 6 to 12 years after surgery (median 9 years, IQR 2). Mean total GERD-HRQL score significantly improved from 19.9 to 4.01 (p 15 (OR 4.09). We confirm long-term safety and efficacy of MSA in terms of symptom improvement, decreased drug dependency, and reduced esophageal acid exposure.

High-resolution manometry findings after Linx procedure for gastro-esophageal reflux disease.

Abstract: BACKGROUND Magnetic sphincter augmentation with the Linx® system is a novel laparoscopic procedure for the treatment of gastro-esophageal reflux disease (GERD). Only few data are available regarding the impact of Linx on high-resolution manometry (HRM) variables. METHODS The prospectively collected database of patients who underwent Linx procedure at a single institution was queried. All patients who completed pre- and postoperative HRM, GERD health-related quality of life (GERD-HRQL) questionnaire, and functional outcome swallowing scale (FOSS) questionnaire were included in the study. KEY RESULTS Forty-five out of 304 patients were included. At a median follow-up of 12 months (IQR 10) after surgery, a statistically significant increase of lower esophageal sphincter (LES) total length (P = .002), intra-abdominal length (P = .001), integrated relaxation pressure (IRP), intrabolus pressure (IBP), and esophagogastric contractile integral (EGJ-CI) was noted (P < .001). Distal esophageal amplitude (P = .004), mean distal contractile integral (DCI) (P < .001), post multiple repeated swallows DCI (P = .001), and the percent of normal peristalsis increased (P = .040). All patients were relieved of reflux symptoms. Ineffective esophageal motility reversed to normal in 36% of patients after surgery. The only factor significantly associated with postoperative dysphagia was preoperative dysphagia (P = .006). Postoperatively, a significant correlation between IRP and DCI (r = 0.361 and P = .019) and between IBP and DCI (r = 0.443 and P = .003) was found. CONCLUSIONS AND INFERENCES The Linx procedure had a remarkable effect on esophageal motility in the short-term follow-up. It appears that the overall postoperative increase of IRP and IBP may justify the higher DCI values. Preoperative dysphagia was the only factor associated with postoperative dysphagia.

Transthyretin at Admission and Over Time as a Marker for Clinical Outcomes in Critically Ill Trauma Patients: A Prospective Single-Center Study.

Abstract: Transthyretin (TTR) has been described as a predictor for outcomes in medical and surgical patients. However, the association of TTR on admission and over time on outcomes has not yet been prospectively assessed in trauma patients. This is a prospective observational study including trauma patients admitted to the intensive care unit (ICU) of a large Level I trauma center 05/2014–05/2015. TTR levels at ICU admission and all subsequent values over time were recorded. Patients were observed for 28 days or until hospital discharge. The association of outcomes and TTR levels at admission and over time was assessed using multivariable regression and generalized estimating equation (GEE) analysis, respectively. A total of 237 patients with TTR obtained at admission were included, 69 of whom had repeated TTR measurements. Median age was 40.0 years and median ISS 16.0; 83.1% were male. Below-normal TTR levels at admission (41.8%) were independently associated with higher in-hospital mortality (p = 0.042), more infectious complications (p = 0.032), longer total hospital length of stay (LOS) (p = 0.013), and ICU LOS (p = 0.041). Higher TTR levels over time were independently associated with lower in-hospital mortality (p = 0.015), fewer infections complications (p = 0.028), shorter total hospital and ICU LOS (both p < 0.001), and fewer ventilator days (0.004). In critically ill trauma patients, below-normal TTR levels at admission were independently associated with worse outcomes and higher TTR levels over time with better outcomes, including lower in-hospital mortality, less infectious complications, shorter total hospital and ICU LOS, and fewer ventilator days. Based on these results, TTR may be considered as a prognostic marker in this patient population.

Effect of Body Position on High-resolution Esophageal Manometry Variables and Final Manometric Diagnosis

Abstract: Background/Aims According to the Chicago classification version 30, high-resolution manometry (HRM) should be performed in the supine position However, with the patient in the upright/sitting position, the test could more closely simulate real-life behavior and may be better tolerated We performed a systematic review of the literature to search whether the manometric variables and the final diagnosis are affected by positional changes Methods A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement Studies published in English that compared HRM results in different body positions were included Moreover, the change in diagnosis of esophageal motility disorders according to the shift of body position was investigated Results Seventeen studies including 1714 patients and healthy volunteers met the inclusion criteria Six studies showed a significant increase in lower esophageal sphincter basal pressure in the supine position Integrated relaxation pressure was significantly higher in the supine position in 10 of 13 studies Distal contractile index was higher in the supine position in 9 out of 10 studies One hundred and fifty-one patients (164%) out of 922 with normal HRM in the supine position were diagnosed with ineffective esophageal motility (IEM) when the test was performed in the upright position (P < 0001) Conclusions Performing HRM in the upright position affects some variables and may change the final manometric diagnosis Further studies to determine the normal values in the sitting position are needed (J Neurogastroenterol Motil 2020;26:335-343)

Esophageal foreign bodies: observational cohort study and factors associated with recurrent impaction.

Abstract: Background and aim Esophageal foreign bodies, including food bolus impaction, represent a common clinical problem. The prevalence of underlying esophageal disease depends on study design and degree of suspicion of a structural or functional esophageal abnormality. Aim of this study was to analyze factors associated with recurrent impaction. Methods The prospectively collected database at a University Hospital and Swallowing Center was reviewed from January 2012 to June 2019 to identify all patients admitted for esophageal foreign bodies. Patients who underwent an emergency endoscopic procedure represented the final study sample. Patient characteristics, including history of previous esophageal foreign bodies, and type of endoscopic procedure were collected. Results Sixty-five patients, 41 males and 24 females with a median age of 59 years, underwent emergency endoscopy for esophageal foreign bodies during the study period. Food bolus was the most common foreign body (n = 43, 66%). Flexible endoscopy was successful in retrieving or pushing the foreign bodies in the stomach in 91% of patients. In 54% of patients, impaction was secondary to an underlying esophageal disorder, which was previously unrecognized in half of them. Recurrent impaction was more common in patients with esophageal disease (P Conclusions Food bolus impaction is a common sentinel event in patients with underlying esophageal disease and is associated with recurrent impaction. Diagnostic endoscopy with biopsies should possibly be performed at the first episode of impaction. Patients with negative biopsies should undergo barium swallow study and high-resolution esophageal manometry.

Minimally invasive approach to esophageal lipoma.

Abstract: Esophageal lipoma is a rare neoplasm with heterogeneous and sometimes life-threatening clinical presentation. We report the case of two patients, a 77-year-old man and a 69-year-old woman presenting with heartburn and dysphagia, and with recurrent vomiting and asphyxia, respectively. Upper gastrointestinal endoscopy and computed tomography were highly suggestive of the diagnosis of esophageal lipoma and identified an intramural and an intraluminal pedunculated mass originating, respectively, from the distal and the cervical esophagus. The first patient was treated by laparoscopic transhiatal enucleation and the second by transoral endoscopic resection under general anesthesia. Both had an uneventful postoperative course and were discharged home on postoperative day 2. Minimally invasive excision of esophageal lipoma is feasible and effective. It may be life-saving in patients with pedunculated tumors who suffer from intermittent regurgitation of a bulky polypoid mass in the mouth causing asphyxia.

Combined pharmacologic antireflux therapy after esophagectomy: effect on symptoms and endoscopic findings at 1-year follow-up

Abstract: Heartburn, regurgitation, pulmonary aspiration, and remnant esophagitis represent common sequelae of esophagectomy and gastric conduit reconstruction. Proton pump inhibitors are the mainstay of treatment. The aim of the study was to focus on the efficacy of combination therapy with mucosal surface protection. Patients undergoing esophagectomy were followed up to 1 year. Patients in group A received 60 mg/day lansoprazole and those in group B received combination therapy. During follow-up, the dosage of lansoprazole was reduced to 30 mg/day in asymptomatic patients with or without grade A–B esophagitis. The Gastro-Esophageal Reflux Disease – Health-Related Quality of Life (GERD-HRQL) and the Short-Form 36 (SF-36) were used to assess postoperative quality of life, and the foregut symptom questionnaire to assess the prevalence of regurgitation, respiratory symptoms, and sleep disorders. Between August 2017 and August 2018, 56 patients were enrolled in the study. Over follow-up, the incidence of refractory symptoms and/or esophagitis grade C–D was 35.7% in group A and 21.4% in group B (p = 0.024). At 1 year, 18 (64.2%) patients in group A and 22 (78.5%) in group B remained symptom free and without severe esophagitis under treatment with 30 mg of lansoprazole (p = 0.076). The GERD-HRQL score was similar at 3 and 6 months (p = 0.790 and p = 0.812, respectively); at 12 months, patients in group B had a lower score although the difference was not significant (p = 0.216). There were no statistically significant differences in terms of SF-36 scores at 1‑year follow-up. Concerning the foregut symptom questionnaire, group B experienced less respiratory symptoms (p = 0.045) and sleep disorders (p = 0.039). At 1‑year after esophagectomy, combination therapy with 30 mg lansoprazole and Esoxx® appears to be an effective antireflux strategy.