Introduction

Gastro-oesophageal reflux disease (GORD) affects 25% of adults and impairs quality of life. Initial treatment is with lifestyle change and acid suppression however up to 1/3 will be refractory or intolerant to medical therapy. The Stretta procedure is an endoscopic treatment delivering radiofrequency energy around the gastro-oesophageal junction (GOJ). Whilst it can improve symptoms and reduce oesophageal acid exposure (AET) its mechanism of action is not fully understood. EndoFLIP is a device to measure GOJ distensibility (DI) and calcitonin gene related peptide (CGRP) is a neuropeptide marker for sensory afferents involved in GORD hypersensitivity - it is not known whether Stretta alters these factors and whether they are linked to normalisation of AET and symptoms.

Aims & Methods

This prospective study aimed to assess the effect of Stretta on UGI physiological parameters (LES pressure, IRP, DCI, AET, GOJ DI), mucosal CGRP presence, and symptom scores, by performing the following tests before and 6-months after Stretta:

• Gastroscopy, EndoFLIP, HRM, ambulatory pH testing, oesophageal biopsies analysed using immunohistochemistry (IHC) for CGRP, and symptom questionnaires (Hull airway reflux, Reflux Symptom Index, Hospital Odynophagia Dysphagia, Reflux Disease, GERD-QOL).

Results

30 pts – 13F:17M, aged 22-71y (med. 55y).

Tests before and 6 months after Stretta:

• 48.5% pts felt Stretta was “very” or “somewhat” helpful.
• Statistically significant (SS) improvements were seen in Hull (p=0.029) and RSI (p=0.028) scores.
• AET normalised for 31% however there were no SS correlations between symptom scores and AET (p>0.05).
• SS negative correlation between GOJ DI and LES pressure both before (r =-0.5, p = 0.017) and after (r=-0.5, p=0.012) Stretta.
• No SS correlations between GOJ DI, GOJ diameter, LES pressure, IRP vs AET (p>0.05).
• SS positive correlation between the percent change in GOJ DI pre/post Stretta with the percent change in DeMeester score (r= 0.4, p=0.03).
• CGRP was most prevalent in the lower oesophagus (mean 12.0% papillae), vs middle (6.8%) and upper (7.3%). There was a mean increase of 73% post stretta but this was not SS and did not correlate with symptom scores, GOJ DI nor AET.

Conclusion

The normalisation of AET in 31% is consistent with published meta-analysis (30%). There was a non-significant trend towards increased basal LES pressure without a reduction in GOJ DI. This suggests the mechanism of action of Stretta may not be related to changes in GOJ compliance. There was SS improvement in laryngopharyngeal symptoms (Hull, RSI) suggesting these pts may benefit most from Stretta, although this was not supported by concurrent improvement in AET. CGRP presence within mucosal papillae was not affected, suggesting that this neuropeptide is not involved and that Stretta may not alter oesophageal sensitivity.

References

Ford et al, BMJ (2009), Fass et al, Surg Endosc (2017), Lee et al, Gut and Liver (2021), Leech, J Gastroenterol (2024), Woodland et al, Gastroenterology (2017).

Introduction

Acute biliary pancreatitis in pregnant patients is a low-prevalence, challenging clinical situation. The current guidelines for acute pancreatitis (AP) in the general population have no specific recommendations for managing it in pregnant patients.

Aims & Methods

This study investigated the safety and effectiveness of cholecystectomy during pregnancy in AP.
This international multicentre cohort study was endorsed and announced by the four major pancreatic societies (International Association of Pancreatology [IAP], American Pancreatic Association [APA], European Pancreatic Club [EPC], and Japan Pancreas Society [JPS]). The survey encompassed questions related to demographic information, clinical presentation, management strategies, timing of cholecystectomy, approaches to the procedure, complications, and outcomes (including recurrence of AP, other gallstone-related complications, and maternal and fetal outcomes). The data were summarized as medians and interquartile ranges for continuous variables and frequencies with percentages for categorical variables, with group comparisons performed using Welch's t-test and Pearson's chi-squared or Fisher's exact tests.

Results

116 cases from 15 countries and 20 centres were enrolled. Cholecystectomy after mild AP during pregnancy had a lower rate of readmission due to recurrent AP episodes or other gallstone-related complications compared to those who did not undergo surgery after a mild AP during pregnancy (0% vs 27%; 0/17 vs 14/51, p=0.015). Cholecystectomy performed during pregnancy was associated with a low surgical complication rate, identical to that seen in postpartum procedures (12% vs 10%; 2/17 vs 3/31; p>0.999). Preterm birth occurred in 7.1% (1/14) vs. 11% (5/45) of patients with and without cholecystectomy during pregnancy, respectively. Fetal loss after surgery occurred only in the first trimester (3/17 vs 1/51).

Conclusion

Cholecystectomy is an effective and safe intervention in pregnant patients during the second or third trimester in cases of mild biliary pancreatitis.

Disclosure

None to declare.