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Oesophago-gastric surgery spans benign disease, cancer and obesity. The domain covers reflux and hiatus hernia, achalasia and the motility disorders, oesophageal perforation, strictures and foreign bodies; Barrett’s oesophagus and early neoplasia, the staging and treatment of oesophageal, junctional and gastric cancer, GIST, lymphoma and gastroduodenal polyps; peptic ulcer disease and its complications, and reconstruction after gastrectomy; and obesity and metabolic surgery — selection, the operations, and their early and late complications, including the bariatric patient who presents to a general surgeon on call.
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A 41-year-old man has had heartburn and regurgitation for six years. Symptoms are only partly controlled on twice-daily omeprazole and he asks about antireflux surgery. Endoscopy on treatment shows a 2 cm sliding hiatus hernia and normal mucosa. High-resolution manometry is arranged.
Which additional investigation is most important before offering fundoplication?
A 61-year-old man has a gastroscopy for reflux symptoms. There is a C4M6 segment of columnar-lined oesophagus above a 3 cm hiatus hernia, with no visible lesion. Quadrantic biopsies show intestinal metaplasia with no dysplasia. He is fit and wishes to have surveillance.
At what interval should his next surveillance endoscopy be planned?
Yes. Morbid obesity is in the oesophago-gastric section of the syllabus, and every general surgeon on call will see the complications of bariatric surgery.
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