Limits...
Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication.

Edriss H, El-Bakush A, Nugent K - Clin Endosc (2014)

Bottom Line: He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure.He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas.Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

No MeSH data available.


Related in: MedlinePlus

(A) Transoral incisionless fundoplication procedure with gastrogastric plications placed at the Z-line level. (B) The technique creates an esophagogastric fundoplication proximal to the Z-line. (C, D) Scope withdrawal. This creates partially circumferential fundoplication made of gastric tissue. Available under the terms of a Creative Commons Attribution Noncommercial License. Accessed from Open i beta, TTUHSC Health Sciences Center Library on October 16, 2013. Adapted from Bell et al. Surg Endosc 2011;25:2387-2399, with permission from Springer.11
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4260105&req=5

Figure 2: (A) Transoral incisionless fundoplication procedure with gastrogastric plications placed at the Z-line level. (B) The technique creates an esophagogastric fundoplication proximal to the Z-line. (C, D) Scope withdrawal. This creates partially circumferential fundoplication made of gastric tissue. Available under the terms of a Creative Commons Attribution Noncommercial License. Accessed from Open i beta, TTUHSC Health Sciences Center Library on October 16, 2013. Adapted from Bell et al. Surg Endosc 2011;25:2387-2399, with permission from Springer.11

Mentions: TIF was developed to reconstruct the antireflux barrier and treat GERD. The TIF procedure using the EsophyX system with serosa-fuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single device insertion (Fig. 2).5 Some minor and serious adverse events occurred following the use of the EsophyX system. The patient reported in this study developed distal esophageal perforation and left-sided pneumothorax, which were attributed to injury during application of the polypropylene H-fasteners. This injury was complicated by pneumomediastinum, pneumoperitoneum, mediastinitis, empyema, and respiratory failure and required chest tube placement and bilateral thoracotomies with decortications. The patient also developed acute renal injury.


Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication.

Edriss H, El-Bakush A, Nugent K - Clin Endosc (2014)

(A) Transoral incisionless fundoplication procedure with gastrogastric plications placed at the Z-line level. (B) The technique creates an esophagogastric fundoplication proximal to the Z-line. (C, D) Scope withdrawal. This creates partially circumferential fundoplication made of gastric tissue. Available under the terms of a Creative Commons Attribution Noncommercial License. Accessed from Open i beta, TTUHSC Health Sciences Center Library on October 16, 2013. Adapted from Bell et al. Surg Endosc 2011;25:2387-2399, with permission from Springer.11
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260105&req=5

Figure 2: (A) Transoral incisionless fundoplication procedure with gastrogastric plications placed at the Z-line level. (B) The technique creates an esophagogastric fundoplication proximal to the Z-line. (C, D) Scope withdrawal. This creates partially circumferential fundoplication made of gastric tissue. Available under the terms of a Creative Commons Attribution Noncommercial License. Accessed from Open i beta, TTUHSC Health Sciences Center Library on October 16, 2013. Adapted from Bell et al. Surg Endosc 2011;25:2387-2399, with permission from Springer.11
Mentions: TIF was developed to reconstruct the antireflux barrier and treat GERD. The TIF procedure using the EsophyX system with serosa-fuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single device insertion (Fig. 2).5 Some minor and serious adverse events occurred following the use of the EsophyX system. The patient reported in this study developed distal esophageal perforation and left-sided pneumothorax, which were attributed to injury during application of the polypropylene H-fasteners. This injury was complicated by pneumomediastinum, pneumoperitoneum, mediastinitis, empyema, and respiratory failure and required chest tube placement and bilateral thoracotomies with decortications. The patient also developed acute renal injury.

Bottom Line: He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure.He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas.Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

No MeSH data available.


Related in: MedlinePlus