Complications of the Angelchik prosthesis in the management of gastroesophageal reflux.

There have been a number of reports on the complications of the Angelchik silicone prosthesis since Angelchik and Cohen first reported the use of the device in 46 patients with gastroesophageal reflux. The exact incidence of complications is difficult to estimate; however, the company estimates 0.81 per cent for migration and 0.15 per cent for erosion of the prosthesis. The purpose of this paper is to review our experience with 13 complications related to the Angelchik prosthesis in eight patients referred to Emory University Hospital. These complications consisted of recurrent reflux esophagitis in six patients, intractable dysphagia in two, esophageal stricture in two, displacement of the prosthesis in two, disruption of the prosthesis in one patient, and gastric erosion in two patients. The management of these complications required removal of the prosthesis and performance of a Nissen fundoplication in six patients. Distal esophagectomy with esophagogastrostomy was performed in one patient, and colon interposition was performed in another patient. In summary, serious complications of the Angelchik prosthesis implanted for gastroesophageal reflux and their management are presented.