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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Cassidy and coauthors used data from a prospective database of patients (n = 157) who underwent placement of a gastric electric stimulation (GES) device for treatment of refractory gastroparesis. Patient characteristics such as etiology and duration of gastroparesis, as well as age and smoking history, were recorded. Severity of gastroparesis and symptom improvement following treatment were quantified using standard scales.
A preoperative optimization protocol involving multiple specialists was used to prepare patients for the procedure. The protocol is described in the article. 1-year follow-up data were available for 141 patients, and 5-year data were available for 110 patients. Significant improvements in symptom scores were documented at 1 and 5 years; use of prokinetic and antiemetic medications was reduced significantly.
Stimulation devices were explanted in five patients and reoperation for generator exchange or displaced leads was required in 19 patients.
The authors concluded that GES in patients who completed their optimization protocol was effective and safe for treatment of gastroparesis.
Can More Liberal Use of Collis Gastroplasty in Laparoscopic Paraesophageal Hernia Repair Reduce Recurrence?
Reflux symptoms in patients with paraesophageal hernia are commonly associated with “shortened” esophagus. Surgical management of paraesophageal hernia attempts to provide symptom relief and reduce the risk of recurrence.
Recent data have suggested that Collis gastroplasty is associated with reduced risk of recurrence in patients with shortened esophagus, but determining the need for Collis gastroplasty during preoperative evaluation is challenging. Data cited in the article confirmed that paraesophageal hernia repair is associated with a high recurrence rate.
In this series, Collis gastroplasty was combined with mesh repair of the diaphragmatic hernia; recurrence rates of less than 9% were achieved with consistent relief of symptoms and long-term improvements in quality of life.
Roth noted that improved preoperative evaluations that accurately identify patients who will benefit from Collis gastroplasty are needed.
Preoperative GLP-1 Receptor Agonist Guidelines to Avoid Respiratory Complications Should Be Reconsidered
Reports of delayed gastric emptying leading to aspiration following induction of general anesthesia in patients with diabetes treated by glucagon-like peptide-1 (GLP-1) receptor agonists have led to promulgation of practice guidelines recommending withholding of GLP-1 receptor agonists for 1 week prior to operative procedures to be performed under general anesthesia. This requirement has resulted in delays and cancelations of surgical procedures and significant burdens for patients.
The authors used data from national databases to determine the rate of significant postoperative respiratory complications in diabetic patients treated with this agent. The patient sample (n = 23,679) contained 3,502 diabetic patients treated with a GLP-1 receptor agonist. The rate of postoperative respiratory complications was 3.5% for patients receiving the drug and 4% in patients who did not receive the drug.
The authors recommended that the guidelines should be reconsidered, and the withholding requirements liberalized.
Updated Guideline for Lower GI Hemorrhage includes CTA-First Approach
Imran and coauthors presented an updated guideline for management of lower gastrointestinal hemorrhage promulgated by the American College of Gastroenterology
The guideline provides a conditional recommendation that the Oakland score be used to identify patients who could be managed without hospital admission. The most significant change from previous guidelines is the recommendation (conditional) that CT angiography (CTA) be performed within 4 hours of bleeding onset and that CT-guided angioembolization be used as the primary therapeutic modality in patients with positive angiographic findings.
The authors noted that the CTA-first approach is less likely to be delayed because of hemodynamic abnormalities and, because of this, CTA-first achieves hemostasis sooner. This approach may not be feasible in institutions with limited access to interventional radiology resources.
The guideline recommends anticoagulant reversal in patients with severe hemorrhage with resumption within 7 days of bleeding resolution. Patients should have colonoscopy after bleeding resolution if there has been no colonoscopy confirming diverticulosis without neoplasia within the past 12 months.
In the discussion section of the guideline document the authors noted that risk scores should not supplant clinical judgment. Resuscitation and stabilization of hemodynamic parameters should be achieved prior to angiographic or endoscopic interventions.
