ISDE News

Massive Para-esophageal hernias

Giant para-esophageal  hernias constitute a relevant challenge for gastroenterologist and surgeons with many unanswered questions. Should the presence of a giant para-esophageal hernia prompt to surgical repair even in asymptomatic or mild symptomatic patients? Given the high recurrence rate reported after primary repair, should we modify the surgical technique by using mesh or by elongating the esophagus with a Collis gastroplasty?

Should we routinely add a fundoplication to prevent (or cure) reflux? Giant para-esophageal hernia is a frequent conditions in elderly patients: what is the best treatment for octagenarians and nonageanrians with this condition?

Andre Duranceau, a former editor of Diseases of the Esophagus and Professor of Thoracic Surgery at the University of Montreal, reviews the literature and combine it with his vast experience on this disease in the article “Massive Para-esophageal hernias” in the June issue of the Journal.

Safety and efficacy of endoscopic spray cryotherapy for Barrett’s dysplasia: results of the National Cryospray Registry

S. Ghorbani et al.

Active treatment rather than simple surveillance in case of High-grade Dysplasia in Barrett epihelium (BE) is recommended by current AGA and BSG guidelines and  the possibility of expanding  active treatment even in selected patients with Low-grade Dysplasia is suggested. Currently, the most common modality of BE ablation is by using thermal energy with Radio Frequency that has been proven effective in eradicating dysplastic lesion and BE, with acceptable rates of post-treatment stricture, post-treatment pain and persistence or recurrence of BE. The main drawback of RFA is the relative high cost of each treatment.  In the present issue of Diseases of the Esophagus, Ghorbani and co-workers present the results of the National Cryospray Registry, suggesting that, at the other end of the spectrum of thermal ablation, a similar rate of success in eradicating Dysplasia and BE may be achieved by freezing the tissue. In their consecutive series of 96 patients enrolled in the registry (321 cryotherapy sessions) with 21 months of follow up, complete ablation of HGD was achieved in 91% of patients and BE eradication was achieved in 68% of patients. One stricture (non requiring dilatation) and one bleeding (treated endoscopically) were observed. Only one patient experienced severe pain whereas mild to moderate chest pain and dysphagia were reported in 38% of the patients and after 23% of the procedures. Cryotherapy resulted particularly effective in treating Short Segment of BE (100% of success). Based on these results, cryotherapy is suggested as a safe and effective treatment to ablate dysplastic BE.