Upper Digestive

The upper digestive tract is the first part of the digestive system. In surgery it mainly concerns the esophagus, the stomach and the duodenum.

Conditions of the esophagus, stomach and duodenum that may be treated surgically include:

• Hiatal hernia and gastroesophageal reflux disease: reflux occurs when the lower esophageal sphincter does not work properly and is often the result of a hiatal hernia.
• Esophageal achalasia: a rare disorder in which the lower esophageal sphincter does not open sufficiently and food remains in the esophagus.
• Stomach cancer: adenocarcinoma is responsible for about 90% of all cases.
• Superior mesenteric artery syndrome: a rare disorder caused by compression of the third part of the duodenum by the artery.
• Duodenal tumors: duodenal cancer is commonly treated with partial duodenectomy or the Whipple procedure (pancreaticoduodenectomy).

Chronic heartburn, difficulty swallowing, weight loss, and abdominal pain or a feeling of fullness can be linked to a condition of the esophagus or stomach. Heartburn that occurs more than once a week, becomes more severe or wakes the patient at night may signal a more serious condition, and a doctor’s advice is recommended. Stomach cancer often causes no symptoms in its early stages.

Chest pain can be caused by reflux but is often confused with a heart attack and always needs immediate medical attention.

Diagnosis relies on tests chosen according to the condition:

• Endoscopy: gastroscopy is the first test when achalasia is suspected, mainly to rule out other conditions such as esophageal cancer, while upper gastrointestinal endoscopy and tissue biopsy are used for stomach cancer.
• Barium swallow, which may make the initial diagnosis of achalasia.
• Esophageal manometry, which measures pressures along the entire length of the esophagus and confirms the diagnosis of achalasia.
• Measurement of esophageal pH over 24 hours, for hiatal hernia and reflux.
• Computed tomography (CT) and endoscopic ultrasound (EUS), for stomach cancer.

Dr. Konstantinidis and his surgical team use minimally invasive laparoscopic and robotic techniques, with the da Vinci Xi system at Athens Medical Center:

• Hiatal hernia and reflux: if conservative treatment is not effective, fundoplication is performed, either Nissen or, if the esophagus is not functional, Toupet or Dor.
• Achalasia: Heller myotomy, in some cases with a Dor or Toupet fundoplication, followed by a hospital stay of a day or two.
• Stomach cancer: subtotal or total gastrectomy with the adjacent lymph nodes, which Dr. Konstantinidis has performed robotically since 2006.
• Superior mesenteric artery syndrome: if conservative treatment does not work, the Strong procedure is usually preferred, ideally performed robotically.