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In 1979, Angelchik and Cohen reported a series of 46 patients
who had reflux oesophagitis treated surgically with the insertion
of an incomplete "doughnut" shaped ring of silicon around the
gastro-oesophageal junction: the Angelchik prosthesis. The
C-shaped ring was tied around the lower oesophagus with
Dacron straps. Insertion of this prosthesis was quick, simple
to perform, and standardised and it was hoped that it would
become superior to the other surgical antireflux procedures
available at the time which were all technically difficult,
time consuming, and had variable results which were operator
dependent.2
The early short term results for the prosthesis were promising, and objective and subjective outcome measures were similar to other accepted surgical antireflux procedures.3 However the initial enthusiasm has been tempered with experience and when more long term results were analysed up to 20% of prostheses had to be removed for intractable dysphagia and there were other reports of significant problems due to migration and erosion of the prosthesis.4,5 The prosthesis has a tantulum radio-opaque marker encircling its periphery and radio-opaque clips were frequently used to reinforce the knot in the tied Dacron straps making it possible to identify the prosthesis on radiological images as seen in this case. The continued use of the Angelchik prosthesis was abandoned in most centres over 10 years ago but at least 25 000 have been inserted worldwide. In this case erosion occurred 14 years after insertion, longer than any other case reported. The presentation of new gastrointestinal symptoms should still today arouse suspicion in a patient known to have an Angelchik prosthesis. Images 1) Normal -
2 Abnormal
An abnormal filling defect in close association with a thin C-shaped radio-opaque strip can be seen in the gastric remnant (grey arrow). Radio-opaque clips can also be seen around the cardia (white arrow). These appearances are in keeping with an Angelchik prosthesis which has become detached and eroded into the stomach From: http://pmj.bmj.com
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