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Erosions of the angelchik prosthesis in pediatric-sized developmentally disabled patients
D Jakaite1, G R Gourley, J R Pellett
1Department of Propedeutics of Internal Diseases, Medical Faculty of Vilnius University, Lithuania.
Insights
The Angelchik prosthesis caused severe gastrointestinal erosions in 12.5% of pediatric patients with developmental disabilities. Researchers advise against using this device in this vulnerable population due to excessive erosion risks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Device Safety
Background:
- Severe gastroesophageal reflux (GER) in pediatric patients often requires surgical intervention.
- The Nissen fundoplication and the Angelchik prosthesis are surgical options for GER treatment.
- Developmentally disabled pediatric patients present unique challenges in managing GER.
Observation:
- A study reviewed 40 pediatric patients with developmental disabilities who underwent GER surgery.
- Five patients (12.5%) experienced Angelchik prosthesis erosion into the gastrointestinal tract.
- Erosions occurred 2-2.6 years post-implantation, presenting with vomiting, pain, melena, anemia, and bowel obstructions.
Findings:
- The Angelchik prosthesis erosion rate was 12.5% in this pediatric cohort.
- Symptoms of erosion included gastrointestinal bleeding and obstruction, but not peritonitis.
- Diagnosis of erosion occurred between 2 and 2 years and 8 months after surgery.
Implications:
- The high erosion rate suggests the Angelchik prosthesis is not suitable for pediatric patients with developmental disabilities.
- Alternative surgical strategies should be considered for this patient group.
- Further research is needed to identify safer, effective GER treatments for vulnerable pediatric populations.
Abstract:
We reviewed case histories of 40 pediatric-sized developmentally disabled patients who had previously participated in a study comparing the Nissen fundoplication with the Angelchik prosthesis for the surgical treatment of severe gastroesophageal reflux. Five of these patients had experienced erosions of the prosthesis into the gastrointestinal tract. These erosions were diagnosed between 2 years and 2 years 8 months following surgical insertion of the device. Erosions were associated with a variety of symptoms including vomiting, increasing discomfort, melena, anemia, coffee ground gastric residuals, and repeated small bowel obstructions. In no case was erosion associated with the development of peritonitis. Despite the documented advantages of the Angelchik prosthesis, the 12.5% erosion rate in this patient population is excessive. We recommend that use of the Angelchik prosthesis is not advisable in pediatric-sized developmentally disabled patients.