The effect of the Angelchik prosthesis on esophageal and gastric function
G. J. Maddern, J. C. Myers, N. McIntosh, F. H. Bridgewater and G. G. Jamieson
Department of Surgery, Royal Adelaide Hospital, Australia.
The effects of the Angelchik prosthesis on esophageal and gastric function
were investigated in 17 patients (11 men and six women; median age, 57
years; age range, 36 to 88 years) who underwent surgery for treatment of
gastroesophageal reflux disease. All patients demonstrated unequivocal
reflux, either at endoscopy or 24-hour pH testing. There was a significant
increase in lower esophageal sphincter pressure after surgery, and no
patient demonstrated abnormal reflux on pH testing. Gastric emptying of
liquids and solids was not altered by surgery. Six months after surgery,
all symptoms except dysphagia had significantly improved. Thirty-three
months after surgery, six patients described symptoms as severe as or worse
than those before surgery. Four patients had the prosthesis removed, two
because of dysphagia alone, one because of reflux and dysphagia, and one
because of flatulence and bloating. The patients who required removal of
the prosthesis because of dysphagia had gross delay of esophageal emptying.
We conclude that the Angelchik prosthesis is an effective antireflux
device, but it interferes with esophageal function in some patients,
requiring removal of the prosthesis. We think the rate of removal of the
prosthesis is too high for its routine use in the treatment of
gastroesophageal reflux disease.
