Analysis of outcomes of a transoral circular stapled anastomosis following major upper gastrointestinal cancer resection

2021 ◽  
Author(s):  
Daniel M Foley ◽  
Emudiaga J E Emanuwa ◽  
William R C Knight ◽  
Cara R Baker ◽  
Mark Kelly ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Significant Risk ◽  
Anastomotic Technique ◽  
Upper Gastrointestinal Cancer ◽  
Esophageal Anastomosis ◽  
The Mean ◽  
Clinically Significant ◽  
Improve Patient ◽  
Upper Gastrointestinal ◽  
Endoscopic Balloon

Summary Background Esophageal anastomoses performed following esophagectomy and total gastrectomy are technically challenging with a significant risk of anastomotic leak. A safe, reliable, and easy anastomotic technique is required to improve patient outcomes and reduce morbidity. Method This paper analyses 328 consecutive patients who underwent transoral circular stapled esophageal anastomosis (ORVIL™) from a prospectively collected single-center database between December 2011 and February 2019. Results Two hundred and twenty-seven esophagectomies and 101 gastrectomies were performed using OrVil™ anastomoses. The mean patient age was 63.7 years. Of 328 consecutive OrVil™-based anastomoses, there were 10 clinically significant anastomotic leaks requiring radiological or operative intervention (3.05%). Twenty-eight (8.54%) patients developed anastomotic stricture, all of which were successfully treated with endoscopic balloon dilatation (a median of 1 dilatation was required per patient). Conclusion The OrVil™ anastomotic technique is reliable and safe to perform. This is the largest reported series of the OrVil™ anastomotic technique to date. Leak rates and anastomotic dilations were similar to other reported series. Based on our experience, we consider the use of the OrVil™ device for reconstruction after major upper GI resection to be safe and reliable.

scholarly journals Repeated Combined Chemotherapy with Cisplatin Lowers Carnitine Levels in Gastric Cancer Patients

2017 ◽  
Vol 71 (3-4) ◽  
pp. 261-265 ◽  
Author(s):  
Akimasa Kawai ◽  
Hideo  Matsumoto ◽  
Youko Endou ◽  
Yui Honda ◽  
Hisako Kubota ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Organic Cation ◽  
Organic Cation Transporter ◽  
Combined Chemotherapy ◽  
Carnitine Level ◽  
Upper Gastrointestinal Cancer ◽  
The Mean ◽  
Total Carnitine ◽  
Gastric Cancer Patients ◽  
Upper Gastrointestinal

Background/Aims: Carnitine plays an important role in the metabolism of fatty acids. It has also been reported that the administration of anticancer drugs may lead to reductions in serum carnitine levels due to decreased activity of organic cation transporter novel 2, which plays a role in the reabsorption of carnitine in the tubules of the kidney. We therefore studied the change in carnitine levels when chemotherapy was administered repeatedly to patients with gastric cancer. Methods: Ten patients with upper gastrointestinal cancer were enrolled in this study between December 2014 and August 2015. All patients were administered chemotherapy consisting of TS-1 and cisplatin every 3 weeks: 3 received it as adjuvant therapy post resection, the remaining 7 received it as treatment for unresectable tumors. Before the start of each chemotherapy cycle, serum was collected. Results: The mean total carnitine level was 54.5 ± 13.7 μmol/L prior to commencing chemotherapy; it was 46.7 ± 13.5 and 41.4 ± 14.8 μmol/L at the second and third cycles respectively. The total carnitine level was decreased in a statistically significant manner (p = 0.0039). The serum level of total protein and cholinesterase was also decreased significantly (p = 0.0218 and p = 0.0418). Conclusion: Carnitine levels decreased during repeated chemotherapy in patients with gastric cancer, and they are associated with the nutritional status.

scholarly journals Evaluation of the Prevalence of Upper Gastrointestinal Cancers in Khorramadad

2021 ◽  
Author(s):  
Saleh Azadbakht ◽  
Morteza Azadbakht ◽  
Salehe Azadbakht
Keyword(s):  
Esophageal Cancer ◽  
Gastrointestinal Cancer ◽  
Distal Part ◽  
Demographic Data ◽  
Histopathological Analysis ◽  
Gastrointestinal Cancers ◽  
Upper Gastrointestinal Cancer ◽  
Regional Population ◽  
The Mean ◽  
Upper Gastrointestinal

Abstract BackgroundGastrointestinal cancer is one of the leading causes of cancer-related deaths and its incidence varies based on geographical, demographic, genetic and clinical factors. In this study, we aim to investigate the frequency of upper gastrointestinal cancers in patients referred to the endoscopy department Shohada Ashayer and Shahid Rahimi Hospital of Khorramabad from 2015-2019.MethodsThis research is a descriptive observational study where patients suspected for gastrointestinal cancer were included. These patients underwent endoscopy where samples from suspected cancer patient were subjected to histopathological analysis for confirmation. Demographic data along with the findings from endoscopy and pathology and details regarding the lesions (type and location) and the causes of lesions were recorded in the checklist for all the patients. ResultsOf 1274 patients, 630 (49/5%) were male and 644 (50/5%) were female. The mean age of the patients was 50 years. The Frequency of stomach cancer was 194 (16.7%) and that of esophageal cancer was 123 (9.7%).The most common type of pathology in esophageal cancer was squamous cell carcinoma with 91 cases (73.9%) and in the stomach were all cases were of adenocarcinoma. The distal part of the esophagus was most affected, 88 cases (72.2%) and cardiac end in the stomach. with 98 cases (50.5%) . The frequency of cancer was significantly higher in men and in patients aged above 60 years, p<0.05, respectively.ConclusionAccording to the results of the study, gastric cancer is the most common upper gastrointestinal cancer in regional population, followed by esophageal cancer.

scholarly journals Aspiration in the Context of Upper Gastrointestinal Endoscopy

2007 ◽  
Vol 21 (4) ◽  
pp. 223-225 ◽  
Author(s):  
A Thomson ◽  
J Tye-Din ◽  
S Tonga ◽  
J Scott ◽  
C Mclaren ◽  
...  
Keyword(s):  
Pilot Study ◽  
Gastrointestinal Endoscopy ◽  
Pulmonary Aspiration ◽  
Upper Gastrointestinal Endoscopy ◽  
Life Threatening ◽  
The Mean ◽  
Clinically Significant ◽  
Upper Gastrointestinal ◽  
Nuclear Scanning ◽  
Present Pilot Study

BACKGROUND: Pulmonary aspiration is a life-threatening complication of upper gastrointestinal endoscopy, the incidence of which has not been determined. Endoscopy-related aspiration has not been studied in procedures in which patients swallow a radiolabelled potential aspirate immediately before endoscopy and undergo nuclear scanning postprocedure.METHODS: A pilot study was conducted in which 200 MBq of non-absorbable technetium-99m phytate in 10 mL of water was administered orally to 50 patients who were about to undergo endoscopy. Gamma camera images were obtained to ensure that there had been no aspiration before endoscopy. After endoscopy, a repeat scan was performed. Fluid aspirated through the endoscope was also collected and analyzed for radioactivity using a hand-held radiation monitor.RESULTS: No evidence of pulmonary aspiration was found in any of the patients studied. The mean estimated percentage of the initially administered radioactivity aspirated through the endoscope was 2.66% (range 0% to 10.3%).CONCLUSION: The present pilot study confirms earlier observations that clinically significant aspiration in the context of upper gastrointestinal endoscopy is uncommon. The incidence of aspiration may, however, be different in acutely bleeding patients undergoing endoscopy. For logistic reasons, this group could not be studied.

Immunologic Assessment of Patients Treated with Bovine Fibrin as a Hemostatic Agent

1996 ◽  
Vol 76 (06) ◽  
pp. 0925-0931 ◽  
Author(s):  
John F Carroll ◽  
Keith A Moskowitz ◽  
Niloo M Edwards ◽  
Thomas J Hickey ◽  
Eric A Rose ◽  
...  
Keyword(s):  
Coagulation Factors ◽  
Allergic Reactions ◽  
Factor V ◽  
Normal Range ◽  
Serum Samples ◽  
Human Fibrinogen ◽  
Bovine Thrombin ◽  
Thrombotic Complications ◽  
The Mean ◽  
Clinically Significant

SummaryTwenty-one cardiothoracic surgical patients have been treated with fibrin as a topical hemostatic/sealing agent, prepared from bovine fibrinogen clotted with bovine thrombin. Serum samples have been collected before treatment with fibrin and postoperatively between 1 and 9 days, 3 and 12 weeks, and 6 and 8 months. The titers of anti-bovine fibrinogen antibodies, measured by ELISA specific for immunoglobulins IgG or IgM, increased to maximal values after about 8 or 6 weeks, respectively. After 8 months, IgG titers were on average 20-fold lower than the mean maximal value, while IgM titers returned to the normal range. IgG was the predominant anti-bovine fibrinogen immunoglobulin as documented by ELISA, affinity chromatography and electrophoresis. Anti-bovine fibrinogen antibodies present in patients reacted readily with bovine fibrinogen, but did not cross-react with human fibrinogen as measured by ELISA or by immunoelectrophoresis. A significant amount of antibodies against bovine thrombin and factor V has been found, many cross-reacting with the human counterparts. No hemorrhagic or thrombotic complications, or clinically significant allergic reactions, occurred in any patient, in spite of antibody presence against some bovine and human coagulation factors. The treatment of patients with bovine fibrin, without induction of immunologic response against human fibrinogen, appeared to be an effective topical hemostatic/sealing measure.

scholarly journals The Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study—Defining a Threshold for Non-Cycloplegic Myopia Prevalence in Children

2021 ◽  
Vol 10 (6) ◽  
pp. 1215
Author(s):  
Aparna Gopalakrishnan ◽  
Jameel Rizwana Hussaindeen ◽  
Viswanathan Sivaraman ◽  
Meenakshi Swaminathan ◽  
Yee Ling Wong ◽  
...  
Keyword(s):  
Open Field ◽  
Tamil Nadu ◽  
Mean Difference ◽  
School Vision ◽  
Elite School ◽  
Prevalence Estimates ◽  
The Mean ◽  
Clinically Significant ◽  
Set Up ◽  
Definition Of

The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to −0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to −0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ −0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ −0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤−0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ −0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ −0.50 D.

A Modified CGM Algorithm Enhances Data Availability While Retaining iCGM Performance

2021 ◽  
pp. 193229682110075
Author(s):  
Rebecca A. Harvey Towers ◽  
Xiaohe Zhang ◽  
Rasoul Yousefi ◽  
Ghazaleh Esmaili ◽  
Liang Wang ◽  
...  
Keyword(s):  
Data Integration ◽  
Patient Experience ◽  
Real World ◽  
Data Availability ◽  
Post Processing ◽  
Sensor Error ◽  
The Mean ◽  
The Difference ◽  
Data Gap ◽  
Improve Patient

The algorithm for the Dexcom G6 CGM System was enhanced to retain accuracy while reducing the frequency and duration of sensor error. The new algorithm was evaluated by post-processing raw signals collected from G6 pivotal trials (NCT02880267) and by assessing the difference in data availability after a limited, real-world launch. Accuracy was comparable with the new algorithm—the overall %20/20 was 91.7% before and 91.8% after the algorithm modification; MARD was unchanged. The mean data gap due to sensor error nearly halved and total time spent in sensor error decreased by 59%. A limited field launch showed similar results, with a 43% decrease in total time spent in sensor error. Increased data availability may improve patient experience and CGM data integration into insulin delivery systems.

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