Modified period application of Neosophagus. Modified pulp for the management of some retention in gastric plastic. A 72-year-old woman with partial esophagectomy due to adenocarcinoma of the gastroesophageal junction in 2019, followed by the construction of a new esophagus by gastroplasty, presented with the following symptoms. Early society, her band works by lying down, with findings of transit showing post-surgical gastroparesis with a light gastric emptying. So, the diagnosis came of retention in the neosophagus sump. Therapy, including dietary adjustments and medication, failed. Due to clinical worsening with oral intolerance and the need for toccatal parenteral nutrition, after multidisciplinarity in discussion, modified perioral application of neosophagus was recommended. Here you can see the sump with retention in the gastroplasty. Modify both steps and patterns performed in this case. First, EMR plastics and suturing along the stomach axis in the distal part of the sump, proximal to the angulation of the gastroplasty. Second, EMR plus U suturing pattern, with anchor and stitch placed on the anterior wall of the plasty, proximal to the previous suture, where another delayed declivity zone was identified. Third, a zigzag suturing along the stomach axis at the proximal level, immediately below the squamous columnar junction, where a very delayed area with greater declivity was observed. Fourth, zigzag suturing along the stomach axis in a small delayed area on the greater curvature that was remaining. And finally, proper remodeling is confirmed endoscopically, with greater straightness and improved ease of passage through the pylorus with no declivity in the plasty. In this video sequence, you can see argon marking dots following path EMR of this area. For more information, visit www.FEMA.gov After EMR was complete, suturing in a zigzag pattern was performed. The same process was repeated, using a U-shaped shutter placed proximal to the first shuttering site. Argon was the only method used to prepare the area for the third and fourth suturing, as you can see in this video sequence. The endoscopic evaluation showed proper remodeling with greater straightening and improved ease-of-passage through the pylorus, with no declivities observed in the plastic. An esophagogram was performed 48 hours after the procedure, showing improvement. The patient was discharged after 48 hours without complications. Diet was well tolerated and parenteral nutrition was discontinued. Three months of follow-up, the patient showed clinical improvement with remission of symptoms and was tolerating regular diet. In conclusion, modified per-hora application of neoesophagus is feasible and could be a promissory treatment for refractory gastric plastic delay emptying.

gastroparesis

neosophagus

modified procedure

suturing techniques

gastric plastic delayed emptying