Complicated Barrett’s Esophagus Associated With Systemic Scleroderma

1 Jun 2023 21:00 23:00
Santiago-Chile

Introduction

Systemic sclerosis (SSc) is a rare autoimmune disease characterized by fibrosis of small arteries and abnormal collagen deposition in the skin, lungs, and gastrointestinal tract.

The esophagus is frequently involved, with up to 80% of patients potentially suffering from GERD.

The etiology of GERD in these patients is multifactorial, involving a combination of impaired saliva production, aperistaltic esophagus, incompetent LES, and gastroparesis.

Complications related to long-standing GERD include esophagitis, long-segment strictures, Barrett’s esophagus, and recurrent aspiration pneumonitis.

Case 1: Systemic Scleroderma With Complicated Barrett’s Esophagus

Presentation of the Case

Enrique Lanzarini (Chile)

Patient Profile & Clinical History

  • Patient: PV, female, 50 years old

  • Symptoms: Chronic heartburn with daily presentation for 10 years, retro-sternal pain, and dysphagia.

  • Medical Therapy: PPIs treatment for many years.

  • Underlying Disease: Systemic scleroderma.

Topics for Discussion

Definitive Diagnosis?

Treatment

  • Conservative: PPIs.

  • Dilatation?

  • Surgery?

  • Fundoplication Options: Nissen? Dor? Toupet? Other?

  • PRO and CON

Case 2: Systemic Scleroderma With Complicated Barrett’s Esophagus, Stricture and Ulcer

Presentation of the Case

Enrique Lanzarini (Chile)

Patient Profile & Clinical History

  • Patient: L J, female, 41 years old

  • Diagnosis: Systemic scleroderma with complicated Barrett’s esophagus with stricture and ulcer.

  • Previous Surgery: Operated 15 years ago.

  • Procedure: Distal gastrectomy with Roux-en-Y gastro-jejunostomy.

Topics for Discussion

  1. Distal gastrectomy + Roux-en-Y gastro-jejunostomy: Alone?

  2. Combined procedure: Combined with Dor? Toupet?

  3. Total esophagectomy?

  4. Results?

Conclusion

  • Multidisciplinary 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)