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2011

Chan WW, Haroian LR, Gyawali P. Value of preoperative esophageal function studies before laparoscopic antireflux surgery. Surgical endoscopy. 2011;25(9):2943-9. doi:10.1007/s00464-011-1646-9
Publisher's Version

BACKGROUND: The value of esophageal manometry and ambulatory pH monitoring before laparoscopic antireflux surgery (LARS) has been questioned because tailoring the operation to the degree of hypomotility often is not required. This study evaluated a consecutive cohort of patients referred for esophageal function studies in preparation for LARS to determine the rates of findings that would alter surgical decisions.

METHODS: High-resolution manometry (HRM) was performed for each subject using a 21-lumen water-perfused system, and motor function was characterized. Gastroesophageal reflux disease (GERD) was evident from ambulatory pH monitoring if thresholds for acid exposure time and/or positive symptom association probability were passed.

RESULTS: Of 1,081 subjects (age, 48.4 ± 0.4 years; 56.7% female) undergoing preoperative HRM, 723 (66.9%) also had ambulatory pH testing performed. Lower esophageal sphincter (LES) hypotension (38.9%) and nonspecific spastic disorder (NSSD) of the esophageal body (36.1%) were common. Obstructive LES pathophysiology was noted in 2.5% (achalasia in 1%; incomplete LES relaxation in 1.5%), and significant esophageal body hypomotility in 4.5% (aperistalsis in 3.2%; severe hypomotility in 1.3%) of the subjects. Evidence of GERD was absent in 23.9% of the subjects. Spastic disorders were more frequent in the absence of GERD (43.9% vs. 23.1% with GERD; p < 0.0001), whereas hypomotility and normal patterns were more common with GERD.

CONCLUSIONS: Findings considered absolute or relative contraindications for standard 360º fundoplication are detected in 1 of 14 patients receiving preoperative HRM. Additionally, spastic findings associated with persistent postoperative symptoms are detected at esophageal function testing that could be used in preoperative counseling and candidate selection. Physiologic testing remains important in the preoperative evaluation of patients being considered for LARS.

2010

Baez JC, Peters HE, Chan W, Glickman J, Mortelé KJ. Carcinoid tumor of the extrahepatic bile ducts: Sonographic, cholangiographic, and MDCT features. European Journal of Radiology Extra. 2010;73(3):e89-e92. doi:https://doi.org/10.1016/j.ejrex.2009.12.002
Publisher's Version
Carcinoid tumors of the biliary tree are exceedingly rare. To the best of our knowledge, this is the fourth reported case of a biliary carcinoid in the radiological literature. We herein report on a 50-year-old female with a history of breast cancer who presented with epigastric pain. Laboratory evaluation revealed results consistent with obstructive jaundice. Right upper quadrant ultrasound and multidetector-row CT scan showed an intraductal and well-defined tumor in the porta hepatis with dilated intrahepatic bile ducts. Endoscopic retrograde cholangiography showed the intraluminal growth of the tumor was arising from the right hepatic duct. Familiarity with the imaging appearances may prompt early recognition of biliary carcinoids and allow differentiation from other more common biliary neoplasms.