718 DIFFERENCES BETWEEN INTRACORPOREAL AND EXTRACORPOREAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY: IS THERE A BETTER WAY?

Introduction Esophagectomy remains good option to curative intent for esophageal carcinoma. However, quality of life for post-operative symptoms such as reflux, gastric emptying delayed and dysphagia is on debate. Some studies advocate relations between those symptoms to gastric tube conformation and discrepancies between intra and extracorporeal gastric tube construction. We aimed to analyze differences between both methods. Methods During 2014–2020, patients underwent to esophagectomy by thoracoscopic approach with cervical anastomosis (McKeown procedure). The abdominal part was performed by totally laparoscopic (group A) or hybrid (group B) hand-assisted gastric tubulization. Clinical parameters, symptoms of reflux, gastric tube evaluated by tomography, post-operative endoscopic findings were assessed and compared between groups. Multivariable analysis was performed. Results 36 group A and 56 group B, 55 (59.7%) were squamous cell carcinoma and 60 (66.6%) did neoadjuvant chemoradiotherapy. Mean follow-up was 32 months. Group A had more gastric tube diameter (p < 0.001), alimentary stasis (p < 0.001), redundant conformation (p < 0.05) and distant from axial central point of the thorax (p < 0.05); all evaluated by tomography. And also, more symptoms of reflux and gastric empty delay by reflux symptoms index (RSI) (p < 0.001); and numbers of esophagitis grade B and C by upper endoscopy (p < 0.01). After multivariable analysis, intracorporeal (p < 0.001) and diameter more than 4.2 cm (p < 0.01) was related to worst RSI. Conclusion The intracorporeal gastric tube reconstruction may lead wider gastric tube conformation, which might be related to gastric empty delay, resulting in intense reflux symptoms confirmed by upper endoscopy.

CLINICAL FEATURES AND SEVERITY OF GASTRIC EMPTYING DELAY IN BRAZILIAN PATIENTS WITH GASTROPARESIS

ContextGastroparesis is defined by delayed gastric emptying without mechanical obstruction of the gastroduodenal junction, which has been increasingly investigated. Nevertheless, knowledge on the relationships between etiology, symptoms and degree of delayed gastric emptying is limited.ObjectivesThe demographic, clinical and etiological features of Brazilian patients with gastroparesis were studied and the relationships between these findings and the severity of gastric emptying were determined.MethodThis is a retrospective study of medical records of 41 patients with symptoms suggestive of gastroparesis admitted between 1998 and 2011, who had evidence of abnormally delayed gastric emptying on abdominal scintigraphy. Cases with idiopathic gastroparesis were compared with those of patients with neurologic disorders or diabetes mellitus, in whom autonomic neuropathy is likely to occur.ResultsThe majority of the patients were women (75.6%) with a median age of 41 years and a long-term condition (median: 15 years). Twelve patients (29.3%) had a body mass index of less than 20 kg/m2. The most common presenting symptoms were dyspepsia (53.6%), nausea and vomiting (46.3%), weight loss (41.4%) and abdominal pain (24.3%). Regarding etiology, 16 patients had digestive disorders including idiopathic gastroparesis (n = 12), 12 had postoperative conditions, 11 had diseases of the nervous system, five had diabetes mellitus and in three cases gastroparesis was associated to a variety of conditions. In the majority of patients (65.8%) gastric emptying was severely delayed. There was no association between etiology of gastroparesis, type of presenting symptoms and the degree of delay in gastric emptying. Gastroparesis patients with proven (neurological conditions) or presumed (diabetes) nervous system involvements were significantly younger (P= 0.001), had more recent symptom onset (P= 0:03) and a trend towards more severe gastric empty (P = 0:06). There were no significant differences between this subgroup of patients and that comprising cases of idiopathic gastroparesis regarding any of the variables studied.ConclusionsThe demographic, clinical and etiological characteristics of Brazilian patients with gastroparesis are quite varied, but there is a predominance of women with long-standing symptoms and marked delay in gastric emptying. The type of presenting symptoms and the degree of delay in gastric emptying do not predict the etiology of gastroparesis. However, severely delayed gastric emptying in younger patients with recent symptom onset should raise the suspicion of impaired neural control of gastro-duodenal motility.

Remedial Prospective of Hippophae rhamnoides Linn. (Sea Buckthorn)

Sea buckthorn (Hippophae rhamnoides L.) constitutes thorny nitrogen fixing deciduous shrub. Sea buckthorn(SBT) is primarily valued for its very rich vitamins A, B1, B12, C, E, K, and P; flavonoids, lycopene, carotenoids, and phytosterols. and therapeutically important since it is rich with potent antioxidants. Scientifically evaluated pharmacological actions of SBT are like inflammation inhibited by reduced permeability, loss of follicular aggregation of lymphocytes from the inflamed synovium and suppress lymphocyte proliferation. SBT-reduced recurrence of angina, ischemic electrocardiogram which might be due to decreased myocardial oxygen consumption and inhibition of platelet aggregation induced by collagen. SBT can kill both cancer cells of S180, P388, SGC7901 and lymphatic leukemia (L1200). The antiulcer activity may be related to reduce gastric empty time, inhibiting proteolytic activity and promoting wound reparation processes of mucosa. SBT exerts antihypertensive effect in part by blocking angiotensin-2 receptor on cell surface. SBT decreased the level of stress hormones and enhanced hypoxic tolerance in animals indicating its anti-stress, adaptogenic activity. A lot of research work is still needed to find cellular and molecular mechanisms of these activities and also yet to be explored for its activity in osteoporosis, hemorrhage, cataract, urinary stone, acne, psoriasis, polyneuritis, cheilosis, glossities, baldness, anti-obesity, gout, and chronic prostitis.