28th meeting: Complicated Barrett's esophagus associated with Systemic scleroderma
From the University of Chile, Department of Surgery, Hospital Dr José Joaquin Aguirre Hosted by Prof. Italo Braghetto (Pilot Center of Chile)
Thursday, June 1, 2023
Santiago, Chile | South America time: 3 – 5 pm
- Europe CET: Paris: 9 – 11 pm, UK: 8 – 10 pm
- North America: West Coast: 12 noon – 2 pm, East Coast: 3 – 5 pm
- South America: São Paulo: 4 – 6 pm, Buenos Aires: 4 – 6 pm
- Africa: Bomet, Kenya, 10 pm – 12 midnight
- Asia: Malaysia, Kuala Lumpur: 3 – 5 am (June 2), Beijing: 3 – 5 am (June 2)
- Australia: Melbourne: 5 – 7 am (June 2)
Complicated Barrett's esophagus associated with Systemic scleroderma
Introduction
- Systemic sclerosis (SSc) is a rare auto-immune disease
- Fibrosis of small arteries, abnomal collagen in the skin, lungs, and gastrointestinal tract
- Esophagus is frequently involved (up to 80% may suffer from GERD).
- Etiology of GERD in these patients is multifactorial: combination of impaired saliva production, aperistaltic esophagus, incompetent LES, gastroparesis.
Complications related to long-standing GERD include esophagitis, longsegment strictures, Barrett’s esophagus, and recurrent aspiration pneumonitis.
GIST OF THE CASE 1
Presenter: Enrique Lanzarini (Chile)
- PV, Female, 50 years old
- Chronic heartburn (daily presentation) (10 years)
- Retro-sternal pain
- Dysphagia
- PPIs treatment for many years
- Systemic scleroderma
Topics for discussion:
- Page 4 oDefinitive Diagnosis?
- Treatment:
– Conservative? PPIs
– Dilatation?
– Surgery?
Nissen? Dor? Toupet? Other?
– PRO and CON
GIST OF THE CASE 2
Presenter: Enrique Lanzarini (Chile)
- L J, female, 41 years
- Systemic scleroderma with complicated Barrett's esophagus with stricture and ulcer
- Operated 15 years ago
Distal Gastrectomy Roux-en-Y gastro-jejunostomy
Topics for discussion:
Distal gastrectomy + Roux–en-Y gastro-jejunostomy
- Alone?
- Combined with Dor? Toupet?
- Total esophagectomy?
- Results?
Conclusion:
- Mulidisciplinary evaluation is mandatory
- Complete study of esophageal function and anatomy
- Combined treatment/dilatation + surgery
- Best surgery?
Treatment of recalcitrant GERD in SSc patients is challenging.
Minimally invasive RYGB appears feasible and safe with promising preliminary short-term results. Esophagectomy should be reserved to selected patients. Current evidence is scarce while definitive indication about the most appropriate surgical treatment is lacking.
Panel for discussion:
- Italo Braghetto, Moderator (Chile)
- Enrique Lanzarini, Presenter (Chile)
- Claudia DeFilippi (Chile)
- George Triadafilopoulos (USA)
- Gustavo Andrade de Paulo (Brazil)
- Luis Durand (Argentina)
- Edgar Figueredo (USA)
Registration is free, but mandatory: