Efficacy of chemotherapy after self-expanding metal stent placement for gastric outlet obstruction caused by an unresectable malignant tumor.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 484-484
Author(s):  
Taikan Yamamoto ◽  
Kouichirou Miyashita ◽  
Ken Shimada ◽  
Takashi Sekikawa ◽  
Yu Uto ◽  
...  
Keyword(s):  
Survival Time ◽  
Gastric Outlet Obstruction ◽  
Malignant Tumors ◽  
Palliative Therapy ◽  
Outlet Obstruction ◽  
Oral Intake ◽  
Metal Stent ◽  
Sems Placement ◽  
Group A ◽  
Group B

484 Background: Gastric outlet obstruction (GOO) is a late complication of advanced and metastatic malignant tumors. Self-expanding metal stent (SEMS) placement is a safe and effective palliative treatment for patients with GOO. In general, the median survival time after SEMS placement for GOO is approximately 90 days, and advanced chemotherapeutic treatment could further improve prognosis. Methods: This retrospective study aimed to analyze the efficacy of chemotherapy after SEMS placement on improvement of oral intake and survival time. Eight patients with symptomatic malignant GOO were treated by SEMS placement in our hospital. Surgical bypass could not be performed due to severe advanced malignant tumors. Patients were classified into two groups depending on whether they received chemotherapy after SEMS placement. Group A included five patients who were treated with palliative therapy alone (median age: 72 years; cases 1, 2, 3, and 4 with advanced gastric cancer, and case 5 with advanced pancreatic carcinoma). Group B included three patients who were treated with palliative therapy, followed by chemotherapy (median age: 68 years; case 6 with advanced pancreatic cancer treated with gemcitabine chemotherapy; case 7 with advanced gastric carcinoma treated with TS-1 and paclitaxel chemotherapy; and case 8 with duodenal stenosis due to advanced colonic carcinoma treated with irinotecan and cetuximab chemotherapy after SEMS placement). We estimated the gastric outlet obstruction scoring system (GOOSS ; no oral intake: 0; only liquids: 1; soft solids: 2; low-residue or full diet: 3) and survival time as the main outcomes. Results: SEMS placement using endoscopy was successful in all cases. No complications occurred after the procedure. Performance status did not change after SEMS placement. GOOSS improved from 0 to 1 in group A and from 0 to 2 in group B. Median survival time was 68 days in group A and 188 days in group B. We considered chemotherapy after SEMS contributed lifetime. Conclusions: Our study findings indicate that SEMS placement is a safe and effective method for managing malignant GOO and that chemotherapy after SEMS placement can improve diet intake and prognosis.

GASTRIC OUTLET OBSTRUCTION POST ACID INGESTION IN PEDIATRICS

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Burkan Nasr
Keyword(s):  
Sulfuric Acid ◽  
Surgical Procedures ◽  
Gastric Outlet Obstruction ◽  
Diagnostic Tool ◽  
Outlet Obstruction ◽  
Barium Swallow ◽  
Significant Difference ◽  
Group A ◽  
Braun Anastomosis ◽  
Group B

Aim: Evaluate clinical pattern, diagnosis, surgical management and outcome of Gastric outlet obstruction in children post accidental ingestion corrosive (sulfuric acid of battery) , also role  of continuing public education to reduce and avoid  incidence these unfortunate events. Patients & method: prospective study for 20 patients’ children with isolated gastric outlet obstruction post corrosive sulfuric acid ingestion was admitted and operated in Saudi hospital at Hajjah Yemen in period April 2015_April 2021.  The study evaluates patients’ demographic data, clinical presentation, diagnosis and management, also included in this study the Comparison proportions between two surgical procedures used for management this patient (group (A) pyloric resection and gastroduodenostomy and group (B) gastrojejunostomy with Braun anastomosis) with P value >0.05 was non-significant. Results: Twenty patients with gastric outlet obstruction (12 boys and 8 girls), (Mean age was 4.5). Main presenting symptom recurrent attacks vomiting and loss of weight. The interval between acid ingestion and presentation ranged from 3_4weeks(mean=3.5weeks). The History, Barium swallow and meal used as diagnostic tool because safe, inexpensive. Surgical procedure included group (A)pyloric resection and gastroduodenostomy (n=10) and group (B) gastrojejunostomy with Braun anastomosis (n=10). Comparison between the two surgical procedures show all safe, less morbid, no mortality and no significant difference in end outcome result follow-up period up 2 years, all patients are symptoms free and gained adequate weight. Conclusion:  for patients children post corrosive accident ingestion with gastric outlet obstruction The History, barium swallow and meal used as diagnostic tool. Early surgery between 4_6 weeks by resection or bypass remains the treatment of choice with best result. To prevent these unfortunate events by encourage the Family education about clear labelling of dangerous substances and keeps this substance Far from reaching the kids. Key word: corrosive induce gastric outlet obstruction; pyloric stricture; gastric outlet obstruction in pediatrics

scholarly journals Management of walled-off necrosis with nasocystic irrigation with hydrogen peroxide versus biflanged metal stent: randomized controlled trial

2021 ◽  
Vol 09 (07) ◽  
pp. E1108-E1115
Author(s):  
Sudhir Maharshi ◽  
Shyam Sunder Sharma ◽  
Sandeep Ratra ◽  
Bharat Sapra ◽  
Dhruv Sharma
Keyword(s):  
Hydrogen Peroxide ◽  
Adverse Events ◽  
Clinical Success ◽  
Controlled Trial ◽  
Procedure Time ◽  
Metal Stent ◽  
Technical Success ◽  
Group A ◽  
Group B ◽  
Walled Off Necrosis

Abstract Background and study aims Walled-off necrosis (WON) is a known complication of acute necrotizing pancreatitis (ANP). There is no study comparing nasocystic irrigation with hydrogen peroxide (H2O2) versus biflanged metal stent (BMS) in the management of WON. The aim of this study was to compare the clinical efficacy of both the treatment strategies. Patients and methods This study was conducted on patients with symptomatic WON who were randomized to nasocystic irrigation with H2O2 (Group A) and BMS placement (Group B). Primary outcomes were clinical and technical success while secondary outcomes were procedure time, adverse events, need for additional procedures, duration of hospitalization, and mortality. Results Fifty patients were randomized into two groups. Group A (n = 25, age 37.8 ± 17.6 years, 16 men) and Group B (n = 25, age 41.8 ± 15.2 years, 17 men). There were no significant differences in baseline characteristics between the two groups. The most common etiology of pancreatitis was alcohol, observed in 27 (54 %) patients. Technical success (100 % vs 96 %, P = 0.98), clinical success (84 % vs 76 %, P = 0.76), requirement of additional procedures (16 % vs 24 %, P = 0.70) and adverse events (4 vs 7, P = 0.06) were comparable in both the groups. The duration to clinical success (34.4 ± 12 vs 14.8 ± 10.8 days, P = 0.001) and procedure time (36 ± 15 vs 18 ± 12 minutes, P = 0.01) were longer in Group A compared to Group B. Conclusions Nasocystic irrigation with H2O2 and BMS are equally effective in the management of WON but time to clinical success and procedure time is longer with nasocystic irrigation.

scholarly journals Su1449 EUS-GUIDED GASTROJEJUNOSTOMY USING A LUMEN APPOSING METAL STENT IN PATIENTS WITH SYMPTOMATIC GASTRIC OUTLET OBSTRUCTION

2018 ◽  
Vol 87 (6) ◽  
pp. AB359
Author(s):  
Adeel Urrehman ◽  
Christopher J. Khor ◽  
Chin Yung Ka ◽  
Ravishankar Asokkumar ◽  
Damien Tan
Keyword(s):  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Metal Stent

Decrement of the Purkinje Cells Diameter after Oral Intake of Lithium in Albino Rats

2021 ◽  
Vol 15 (8) ◽  
pp. 1788-1789
Author(s):  
Tazeen Kohari ◽  
Farah Malik ◽  
Aftab Ahmad
Keyword(s):  
Purkinje Cell ◽  
Purkinje Cells ◽  
Gray Matter ◽  
Oral Intake ◽  
Lithium Carbonate ◽  
Albino Rats ◽  
Cell Diameter ◽  
Group A ◽  
Cerebellar Gray Matter ◽  
Group B

Background: The histology of Cerebellar gray matter consists of a middle Purkinje cells layer with flask shaped Purkinje cells. The field of Neurology has documented that different organic compounds and metals are lethal to the excitatory Purkinje Neurons. Researches have proved Lithium to be hazardous to nervous tissue and especially Cerebellum For the past sixty years Lithium is the favorable drug for treatment of Bipolar Disorder. Aim: To Analyse and record the changes of decrement of the size of Purkinje cell Diameter after chronic Lithium ingestion. Methods: Sixteen albino rats were selected and were treated with lithium for a period of fifteen days and the data for changes in Purkinje cells Diameter was observed. Results: The Observations of Our study showed highly significantly decreased diameter of the Purinje cells in Group B (Lithium Carbonate) animals as compared to Group A Animals which were on Lab Diet Conclusion: The Morphometric Data proved that Lithium Carbonate is Toxic to Purkinje cells, and it educated our Population to use Lithium with caution. Keywords: Purkinje cell Diameter, Gray matter, Hazardous

scholarly journals Influence of the primary malignant tumor site on the incidence and features of metastatic ovarian tumors

2007 ◽  
Vol 64 (10) ◽  
pp. 691-696 ◽  
Author(s):  
Zorica Stanojevic ◽  
Biljana Djordjevic ◽  
Danijela Zivanovic
Keyword(s):  
Malignant Tumor ◽  
Malignant Tumors ◽  
Statistical Significance ◽  
Menopausal Status ◽  
Ovarian Tumors ◽  
Metastatic Tumors ◽  
Primary Tumors ◽  
Primary Malignant Tumor ◽  
Group A ◽  
Group B

Background/Aim. Ovary is the organ of the female reproductive system most commonly affected by metastases. The aim of the study was to determine the frequency and features of metastatic ovarian tumors (MOT) depending on the site of the primary malignant tumor. Methods. The study group consisted of 488 patients with histopathologically confirmed ovarian cancers treated at the Clinic of Oncology, Clinical Center Nis, in the period from 1 January 1998 to 31 December 2005. MOT were found in 41 patients. Regarding the site of the primary malignant tumor, those with secondary ovarian tumor were divided into two groups: group A - primary malignant tumor involving the genital organs (n = 30) and group B - primary malignant tumor of extragenital origin (n = 11). Results. MOT were confirmed in 8.40% (41/488) of the patients. Secondary ovarian malignancies were the consequence of endometrial carcinoma spreading in 73.17%, breast carcinoma in 19.51%, stomach carcinoma in 4.88% and colon carcinoma in 2.44% of the cases. No significant differences were found between the group A and group B by the factors of age, body mass index, parity and menopausal status. Contrary to the group A, metastatic tumors in the group B patients were more commonly asymptomatic (p < 0.001), bilateral (p < 0.05), with larger ovarian diameter (p < 0.05), associated with ascites (p < 0.001) and abdominal metastases (p < 0.01), all of statistical significance. Conclusions. Metastatic tumors made up 8.40% of ovarian neoplasmas. With non-genital primary tumors, secondary ovarian deposits were frequently asymptomatic, bilateral, associated with larger ovarian diameter, ascites and abdominal metastatic deposits, compared to malignant tumors of genital origin.

scholarly journals Therapeutic effect of local photothermal heating of gold nanoparticle-coated self-expandable metallic stents for suppressing granulation tissue formation in the mouse colon

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249530
Author(s):  
Yeong-Cheol Heo ◽  
Dong-Kyoon Han ◽  
Min Tae Kim
Keyword(s):  
Therapeutic Effect ◽  
Granulation Tissue ◽  
Stent Placement ◽  
Local Heating ◽  
Tissue Formation ◽  
Sems Placement ◽  
Granulation Tissue Formation ◽  
Mouse Colon ◽  
Group A ◽  
Group B

Purpose To investigate the therapeutic effect of local photothermal (PT) heating on suppression of stent-induced granulation tissue formation in mouse colon. Materials and methods A gold nanoparticle (GNP)-coated self-expandable metallic stent (SEMS) was prepared using a two-step synthesis process for local PT heating under near-infrared laser irradiation. Twenty-four mice were randomly divided into two groups of 12 and subjected to SEMS placement in the colon. Group A received a GNP-coated SEMS without local heating and Group B received a GNP-coated SEMS and underwent local heating at 55°C after SEMS placement. The therapeutic effect of local heating was assessed by comparing the histopathological, immunohistochemical, and endoscopic results. Results Four mice were excluded because of stent migration (n = 3, group B) or death (n = 1, group A). Stent-induced granulation tissue-related variables were significantly lower in group B than in group A (p < 0.001). In vivo endoscopic images, 4 weeks after stent placement, showed granulation tissue formation over the wire mesh in group A and relatively good patency of the stented colon with no definite irregularities in group B. There was more vascular endothelial growth factor (VEGF) positivity in group A than in group B. Conclusion Local PT heating suppresses granulation tissue formation after stent placement in mouse colon.

scholarly journals A pilot study of novel duodenal covered self-expandable metal stent fixation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yasuki Hori ◽  
Kazuki Hayashi ◽  
Itaru Naitoh ◽  
Katsuyuki Miyabe ◽  
Makoto Natsume ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Gastric Outlet Obstruction ◽  
Clinical Success ◽  
Performance Status ◽  
Outlet Obstruction ◽  
Poor Performance ◽  
Stent Migration ◽  
Poor Performance Status ◽  
Sems Placement

AbstractMigration of duodenal covered self-expandable metal stents (C-SEMSs) is the main cause of stent dysfunction in patients with malignant gastric outlet obstruction (mGOO). Because endoscopic SEMS placement is frequently selected in patients with poor performance status, we concurrently focused on the safety of the treatment. This pilot study included 15 consecutive patients with mGOO who underwent duodenal partially covered SEMS (PC-SEMS) placement with fixation using an over-the-scope-clip (OTSC). Technical feasibility, clinical success for oral intake estimated by the Gastric Outlet Obstruction Scoring System (GOOSS) score, and adverse events including stent migration were retrospectively assessed. All procedures were successful, and clinical success was achieved in 86.7% (13/15). Mean GOOSS scores were improved from 0.07 to 2.53 after the procedure (P < 0.001). Median survival time was 84 days, and all patients were followed up until death. Stent migration occurred in one case (6.7%) at day 17, which was successfully treated by removal of the migrated PC-SEMS using an enteroscope. For fixation using an OTSC, additional time required for the procedure was 8.9 ± 4.1 min and we did not observe OTSC-associated adverse events. Poor performance status was associated with clinical success (P = 0.03), but we could provide the treatment safely and reduce mGOO symptoms even in patients with poor performance status. In conclusion, duodenal PC-SEMS fixation using an OTSC is feasible for preventing stent migration in patients with mGOO including those with poor performance status.

Surgical treatment of multiple brain metastases

1993 ◽  
Vol 79 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Rajesh K. Bindal ◽  
Raymond Sawaya ◽  
Milam E. Leavens ◽  
J. Jack Lee
Keyword(s):  
Brain Metastases ◽  
Survival Time ◽  
Prognostic Indicators ◽  
Survival Duration ◽  
Surgical Removal ◽  
Complication Rates ◽  
Multiple Brain Metastases ◽  
Significant Difference ◽  
Group A ◽  
Group B

✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.

Feasibility of Duodenal Covered Self-Expandable Metal Stent Fixation: A Pilot Study (With Video)

2021 ◽  
Author(s):  
Yasuki Hori ◽  
Kazuki Hayashi ◽  
Itaru Naitoh ◽  
Katsuyuki Miyabe ◽  
Makoto Natsume ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Gastric Outlet Obstruction ◽  
Clinical Success ◽  
Performance Status ◽  
Outlet Obstruction ◽  
Poor Performance ◽  
Stent Migration ◽  
Poor Performance Status ◽  
Sems Placement

Abstract Migration of duodenal covered self-expandable metal stents (C-SEMSs) is the main cause of stent dysfunction in patients with malignant gastric outlet obstruction (mGOO). Because endoscopic SEMS placement is frequently selected in patients with poor performance status, we concurrently focused on the safety of the treatment. This pilot study included 15 consecutive patients with mGOO who underwent duodenal C-SEMS placement with fixation using an over-the-scope-clip (OTSC). Technical feasibility, clinical success for oral intake estimated by the Gastric Outlet Obstruction Scoring System (GOOSS) score, and adverse events including stent migration were assessed. All procedures were successful, and clinical success was achieved in 86.7% (13/15). Mean GOOSS scores were improved from 0.07 to 2.53 after the procedure (P < 0.001). Stent migration occurred in one case (6.7%) with no other adverse events. For fixation using an OTSC, additional time required for the procedure was 8.9 ± 4.1 minutes. Poor performance status was associated with clinical success (P = 0.03), but we could provide the treatment safely and reduce mGOO symptoms even in patients with poor performance status. In conclusion, duodenal C-SEMS fixation using an OTSC is feasible for preventing stent migration in patients with mGOO including those with poor performance status.

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