Slipped Nissen, severe esophagitis - Forum

User avatar
A Doctor

Slipped Nissen, severe esophagitis - Ärzteforum

Post#1 »

I have an extremely old patient with a slipped Nissen done about 10
years ago for severe reflux. She has severe erosive esophagitis with
Barrett's on usual high doses of H2 blockers. She got a rash from
omeprazole.

She has severe kyphosis and is quite frail. I really don't want to
operate on her and she doesn't want surgery either. Is there any safe
way to non-surgically disrupt the Nissen wrap? I think it would be
better to not have the Nissen at all instead of this slipped Nissen.
Would an achalasia balloon dilator work or would this be too dangerous
to even try?


User avatar
Surgeon

Re: Slipped Nissen, severe esophagitis - Ärzteforum

Post#2 »

An interesting case. What are here complaints now? Reflux or disphagia?

It is an opinion (no references, no evidences), but probably you can disrupt
esophageal wall before the fundoplicaton.
If your concern is just the Barrett, then consider laser ablation or PDT.

User avatar
A Doctor

Re: Slipped Nissen, severe esophagitis - Ärzteforum

Post#3 »

Complaint is severe heartburn and mild to moderate swallowing problems.
Scope shows severe erosive esophagitis and mild stricture with the
slipped Nissen several inches distal.

User avatar
Doctor Green

Re: Slipped Nissen, severe esophagitis - Ärzteforum

Post#4 »

How do you know this nissen "slipped" and why do you think no nissen is
better. To answer your question, I can't see how a ballon will be able to
disrupt this nissen. I think if you try it you may disrupt the stomach or
esophagus.

User avatar
A Doctor

Re: Slipped Nissen, severe esophagitis - Ärzteforum

Post#5 »

Well the Nissen wrap is clearly visible around the stomach about 6 cm distal
to the GE junction. I presume that is not where it is supposed to be and
that the original surgeon probably did not place it this distally. I also
presume that this is increasing acid reflux instead of decreasing it.

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