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Esophagogastric Fistula Caused by an Angelchik Antireflux Prosthesis.

Pence MM, Hubbard M, Singla MB, Young PE - ACG Case Rep J (2015)

Bottom Line: The Angelchik prosthesis is an antireflux device that was popular in the 1980s for treatment of refractory gastroesophageal reflux disease (GERD).We present a patient who developed a gastroesophageal fistula 17 years after Angelchik prosthesis placement.The incidence of late complications continues to grow, and clinicians should consider device malfunction in patients with history of Angelchik placement presenting with abdominal symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Division of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD.

ABSTRACT
The Angelchik prosthesis is an antireflux device that was popular in the 1980s for treatment of refractory gastroesophageal reflux disease (GERD). We present a patient who developed a gastroesophageal fistula 17 years after Angelchik prosthesis placement. The incidence of late complications continues to grow, and clinicians should consider device malfunction in patients with history of Angelchik placement presenting with abdominal symptoms.

No MeSH data available.


Related in: MedlinePlus

Endoscope retroflexion (A) revealing a large fistula at the gastric fundus, and (B) traversing the fistula revealing body of stomach.
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Figure 2: Endoscope retroflexion (A) revealing a large fistula at the gastric fundus, and (B) traversing the fistula revealing body of stomach.

Mentions: An obese 55-year-old woman presented with abdominal pain 17 years after placement of an Angelchik prosthesis intended for weight loss. Six months prior to presentation, she experienced a new “ripping” sensation in her upper abdomen, followed by odynophagia to solid foods and weeks of persistent epigastric abdominal pain intermittently radiating to her back. Though most of her symptoms resolved, her abdominal pain persisted. Her past medical history included asthma, morbid obesity, and adjustment disorder with anxiety. Her surgical history, aside from the Angelchik placement, consisted of total abdominal hysterectomy and cholecystectomy. Her exam was significant for an obese abdomen with epigastric tenderness. Complete blood counts, thyroid studies, and routine chemistries were normal. She had a normal esophagogastroduodenoscopy (EGD) 12 years prior and a normal colonoscopy 5 years prior. Barium esophagram showed normal emptying of contrast from the esophagus to the stomach, and scout film prior to the barium swallow confirmed location of the Angelchik device in the left upper quadrant, consistent with placement around the GEJ (Figure 1). EGD revealed a large hiatal hernia with a widely patent fistula connecting the distal esophagus to the gastric fundus with no evidence of inflammation or recent stigmata of bleeding at the fistula site (Figure 2). The endoscope easily traversed both the GEJ and the fistula. The patient declined both endoscopic and surgical repair of the fistula and decided to pursue a strategy of watchful waiting. She is doing well on follow-up.


Esophagogastric Fistula Caused by an Angelchik Antireflux Prosthesis.

Pence MM, Hubbard M, Singla MB, Young PE - ACG Case Rep J (2015)

Endoscope retroflexion (A) revealing a large fistula at the gastric fundus, and (B) traversing the fistula revealing body of stomach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508944&req=5

Figure 2: Endoscope retroflexion (A) revealing a large fistula at the gastric fundus, and (B) traversing the fistula revealing body of stomach.
Mentions: An obese 55-year-old woman presented with abdominal pain 17 years after placement of an Angelchik prosthesis intended for weight loss. Six months prior to presentation, she experienced a new “ripping” sensation in her upper abdomen, followed by odynophagia to solid foods and weeks of persistent epigastric abdominal pain intermittently radiating to her back. Though most of her symptoms resolved, her abdominal pain persisted. Her past medical history included asthma, morbid obesity, and adjustment disorder with anxiety. Her surgical history, aside from the Angelchik placement, consisted of total abdominal hysterectomy and cholecystectomy. Her exam was significant for an obese abdomen with epigastric tenderness. Complete blood counts, thyroid studies, and routine chemistries were normal. She had a normal esophagogastroduodenoscopy (EGD) 12 years prior and a normal colonoscopy 5 years prior. Barium esophagram showed normal emptying of contrast from the esophagus to the stomach, and scout film prior to the barium swallow confirmed location of the Angelchik device in the left upper quadrant, consistent with placement around the GEJ (Figure 1). EGD revealed a large hiatal hernia with a widely patent fistula connecting the distal esophagus to the gastric fundus with no evidence of inflammation or recent stigmata of bleeding at the fistula site (Figure 2). The endoscope easily traversed both the GEJ and the fistula. The patient declined both endoscopic and surgical repair of the fistula and decided to pursue a strategy of watchful waiting. She is doing well on follow-up.

Bottom Line: The Angelchik prosthesis is an antireflux device that was popular in the 1980s for treatment of refractory gastroesophageal reflux disease (GERD).We present a patient who developed a gastroesophageal fistula 17 years after Angelchik prosthesis placement.The incidence of late complications continues to grow, and clinicians should consider device malfunction in patients with history of Angelchik placement presenting with abdominal symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Division of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD.

ABSTRACT
The Angelchik prosthesis is an antireflux device that was popular in the 1980s for treatment of refractory gastroesophageal reflux disease (GERD). We present a patient who developed a gastroesophageal fistula 17 years after Angelchik prosthesis placement. The incidence of late complications continues to grow, and clinicians should consider device malfunction in patients with history of Angelchik placement presenting with abdominal symptoms.

No MeSH data available.


Related in: MedlinePlus