Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease

Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.

Incidence and Concurrent Laparoscopic Repair of ypertrophic Pyloric Stenosis and Patent Processus Vaginalis

INTRODUCTIONAlthough laparoscopic herniorrhaphy is the most common procedure performed by pediatric surgeons at present, herniorrhaphy with an asymptomatic patent processus vaginalis （PPV） remains controversial. The incidence of contralateral PPV on laparoscopy in previous studies was reported as 20%-50%, but it is believed to approach 100% in premature infants. It has been reported that 4%-34% patients have the risk of developing subsequent metachronous contralateral hernia after a repair of an ipsilateral hernia.Iu If this is true, then the identification and closure of a PPV at the time of ipsilateral hernia repair will obviate the need for a second operation in thousands of children every year. With recent advances in minimally invasive surgery, transinguinal diagnostic laparoscopy has emerged as a safe and effective method for evaluating a pediatric patient with PPV. Meanwhile, the laparoscopy has been widely used to manage the infantile hypertrophic pyloric stenosis （IHPS）, due to equally high success rate, minimal complications, and a shorter hospital stay.

Do Immaturity, Dehydratation or Alkalosis Predispose to Intraoperative Complications at Pyloromyotomy?

Background: Hypertrophic pyloric stenosis is the most important cause for propulsive non-bilious vomiting in infants of the first trimester. Extramucous splitting of the hypertrophic pyloric muscle is the surgical gold standard for treatment. Serious major complications of pyloromyotomy (PM) are mucosal perforation and incomplete muscle splitting. The aim of the presented study is to find out if intraoperative complications are predisposed by biometric or biochemical factors. Furthermore, we looked for the influence of the board certification of the primary surgeon. Patients and Methods: 162 infants with IHPS were operated during a six-year period (n = 150 laparoscopic operations). We had 8 major complications (4.9%): iatrogenic mucosal perforation occurred in 6 cases, and incomplete PM in 2 infants. Preoperative demographic data and data resulting from the blood acid-base- and ion-analysis were compared with data of a previously published reference group from our institution (Tr?bs RB. Open J Pediatr, 2014;4: 208-215). Results: The duration of vomiting, the grade of dehydration and the severity of blood alkalosis did not differ between both groups. Furthermore, we found no influence of the gestational age and birth weight on the occurrence of intraoperative complications. It seems that early postnatal age (p = 0.07) and low body weight at surgery (p = 0.055) may contribute to surgical problems. Board certification as a paediatric surgeon did not influence the rate of intraoperative complications. Conclusions: Laboratory data did not show any predisposition to intraoperative complications. It is assumed that small infants with early occurring symptoms carry an elevated risk for intraoperative events. Our data support the hypothesis that the rate of intraoperative complications at PM is mainly influenced by skills and experience of the surgeon.

Food Allergy Mimicking Pylorus Hypertrophy

Food allergy (FA) is a disease with increasing prevalence and a wide spectrum of clinical manifestations. These include the eosinophilic disorders, which can involve any segment of the gastrointestinal tract (GIT), including the stomach. In this context, three patients with a confirmed diagnosis of food allergy, who were initially diagnosed with pyloric hypertrophy, are presented. All cases showed an adequate response to nutritional management. It is essential to consider food allergy, such as eosinophilic gastroenteritis, as part of the differential diagnosis of gastric outlet obstruction in those patients who present vomiting secondary to pyloric hypertrophy.