The Effect of the Angelchik Prosthesis on Esophageal and Gastric Function

Maddern, Guy J.; Myers, Jennifer C.; McIntosh, Neil; Bridgewater, Franklin H.G.; Jamieson, Glyn G.

doi:10.1001/archsurg.1991.01410350112018

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…13 Nissen fundoplication accelerated gastric emptying for both solids and liquids in most of our patients. These results are consistent with other studies confirming enhancement of gastric emptying by Nissen fundoplication, [23][24][25] whereas partial fundoplication 26 or Angelchik prosthesis 27 had either no or only a limited effect on emptying rates. Altered reservoir function of the fundus after fundoplication with increased gastric tone as the result of a decreased capacity 23 or a redistribution of gastric contents from fundus to antrum caused by the change in gastric anatomy are the mechanisms proposed for enhancement of gastric emptying.…”

Section: Discussionsupporting

confidence: 93%

Impact of Delayed Gastric Emptying on the Outcome of Antireflux Surgery

Bais¹,

Samsom²,

Boudesteijn³

et al. 2001

Annals of Surgery

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ObjectiveTo study the effect of Nissen fundoplication on the pattern of gastric emptying and intragastric distribution of symptoms in patients with normal and delayed gastric emptying before surgery, especially in those with delayed emptying before surgery. Summary Background DataGastroesophageal reflux disease is associated with delayed gastric emptying and dyspeptic symptoms in approximately 40% of the patients. After Nissen fundoplication, dyspeptic symptoms are also not uncommon. MethodsThirty-six patients (26 men, 10 women, mean age 43.1) were studied before and 3 months after Nissen fundoplication. Gastric emptying (dual-isotope, expressed in lag phase, emptying rate, T 50 , and intragastric distribution) was not included in the decision for surgery. Reflux-related and dyspeptic symptoms were scored before and at 3, 6, and 12 months after surgery. ResultsTwenty-six patients had normal and 10 had delayed gastric emptying before surgery. Nissen fundoplication on average enhanced gastric emptying for solids in both subgroups by a combination of a decrease in mean lag phase, emptying rate, and T 50 . The preoperative difference in intragastric distribution between patients with and without delayed gastric emptying was abolished by fundoplication. Patients with normal gastric emptying before surgery showed an increase in early postprandial satiety; in those with delayed emptying, this was not observed. A correlation was found between preoperative T 50 for liquid gastric emptying and postoperative nausea at 3 months in patients with normal gastric emptying. In patients with delayed emptying, preoperative correlations between lag phase for liquids and nausea respectively early satiety were significant, as well as for T 50 for liquids and vomiting. ConclusionsNissen fundoplication equalizes the preoperative difference in intragastric distribution and accelerates gastric emptying without an effect on symptoms in patients with preexisting delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying. Delayed gastric emptying is not a contraindication for antireflux surgery.Gastroesophageal reflux disease (GERD) is associated with delayed gastric emptying for solids and liquids in approximately 40% of the patients. [1][2][3][4][5] Whereas several studies showed that enhancement of delayed gastric emptying by prokinetic drugs improves symptoms of gastroesophageal reflux, 6 -9 others found no correlation between reflux and delayed emptying.3,10 -12 Delayed gastric emptying probably plays a causative role in GERD, and delayed gastric emptying has even been considered a contraindication for antireflux surgery. It has been shown that antireflux surgery accelerates gastric emptying, but this does not imply that gastric function has been improved and will have a positive effect on upper gastrointestinal symptoms. 13,14 In the studies presented, patients have not been subdivided in those with and those without delayed emptying before surgery, and such a subdivision has not been rela...

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Section: Discussionsupporting

confidence: 93%

Impact of Delayed Gastric Emptying on the Outcome of Antireflux Surgery

Bais¹,

Samsom²,

Boudesteijn³

et al. 2001

Annals of Surgery

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“…Similar enhancement was not found with the Angelchik prosthesis. 20 Functional studies showed that the proximal stomach initially stores the solid component of food before its redistribution and emptying from the stomach, 21 and removal of this reservoir may lead to accelerated emptying. It also has been suggested that delayed proximal rather than total gastric emptying could be important in the induction of transient lower esophageal sphincter relaxation.…”

Section: Commentmentioning

confidence: 99%

Antireflux Surgery Enhances Gastric Emptying

Viljakka

Saali²,

Koskinen³

et al. 1999

Arch Surg

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To evaluate the influence of antireflux surgery on gastric emptying.Design: Nonrandomized controlled trial 3 months before and after surgical intervention.Setting: Secondary and tertiary referral center.Patients and Control Subjects: Twenty consecutive patients (7 women, 13 men), mean age 49.2 years, with symptomatic, objectively confirmed gastroesophageal reflux disease and 10 healthy control subjects (3 women, 7 men), mean age 37.3 years. Intervention: Laparoscopic or open Nissen fundoplication (in 1 case Toupet 180°posterior hemifundoplication).Main Outcome Measures: Gastric emptying scintigraphy, using solid food, in control subjects and patients 3 months before and 3 months after the operation; time to halving of the maximal activity and the activity remaining at 60, 100, and 120 minutes.Results: Preoperative symptoms included pyrosis in 19 of 20 patients and regurgitation in 18. Three months postoperatively, 19 patients were symptom-free. The mean time to halving of the maximal activity decreased from 113 to 78 minutes (P = .001). Delayed gastric emptying was found postoperatively in 3 patients, compared with preoperative values, using activity at 60, 100, 120 minutes and the mean time to halving of the maximal activity as the variables. Compared with control subjects, gastric emptying was slower in patients preoperatively and faster postoperatively, but the difference was not statistically significant. Conclusion:Gastric emptying is enhanced after antireflux surgery, along with cessation of symptoms and healing of esophagitis.

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“…This prosthesis consisted of a collar with a circular section made of silicone that was surgically placed around the abdominal esophagus to prevent GER in the eighties of last century. The Angelchik prosthesis was used for almost 15 years, due to good results against reflux obtained in several studies[ 34 - 36 ]. Some prospective randomized trials demonstrated that the Angelchik prosthesis was as effective in preventing GER, as the Nissen fundoplication[ 37 ], and with similar 24-h pH monitoring results[ 38 ].…”

Section: The Msa Devicementioning

confidence: 99%

Magnetic challenge against gastroesophageal reflux

Bortolotti¹

2021

WJG

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Almost 15 years have passed since the first paper on the possibility of using magnets to prevent gastro-esophageal reflux (GER) was published and so it is time to assess the results obtained with the first magnetic device available on the market, the Linx magnetic sphincter augmentation (MSA) and to consider what other options are forthcoming. MSA demonstrated an anti-reflux activity similar to that of Nissen fundoplication, considered the “gold standard” surgical treatment for GER disease, and caused less gas-bloating and a better ability to allow vomiting and belching. However, unlike Nissen fundoplication, this magnetic device is burdened by complications, which are roughly similar to those of the non-magnetic anti-reflux Angelchik prosthesis, that, after considerable use in the eighties, was shelved due to these complications. It is interesting to note that some of these complications show the same pathophysiological mechanism in both devices. The upcoming new magnetic devices should avoid these complications, as their anti-reflux magnetic mechanism is completely different. The experiments in animals regarding these new magnetic appliances were examined, remarking their advantages and drawbacks, but the way to apply them in surgical practice is long and difficult, although worthy, as they represent the future of magnetic surgery.

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The Effect of the Angelchik Prosthesis on Esophageal and Gastric Function

Cited by 11 publications

References 13 publications

Impact of Delayed Gastric Emptying on the Outcome of Antireflux Surgery

Impact of Delayed Gastric Emptying on the Outcome of Antireflux Surgery

Antireflux Surgery Enhances Gastric Emptying

Magnetic challenge against gastroesophageal reflux

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