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Osorio J, Admella V, Merino D, Sobrino L, Tuero C, Vilarrasa N, Lazzara C. One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis. Obes Surg 2024; 34:2293-2302. [PMID: 38758514 DOI: 10.1007/s11695-024-07280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION One Anastomosis Duodenal Switch (OADS/SADI-S) is used both as a one stage and a second-step procedure, either planned or revisional after a failed sleeve gastrectomy. However, there is lack of adjusted comparative evidence validating its use. MATERIAL AND METHODS Propensity-score matched comparison between patients submitted to one-stage vs. two-step OADS, adjusted by age, gender, and initial body mass index (BMI). RESULTS One hundred ninety-five patients (130 one-stage and 65 two-step OADS) were included, with mean initial BMI 52.4 kg/m2. Overall complication rate was 6.6% in the short-term (3.3% Clavien-Dindo ≥ III), and 7.3% in the long-term, with no differences between groups. Follow-up at 1 and 3 years was 83.6% and 61.5%. After one-stage OADS, total weight loss was 36.6 ± 8.2% at 1 year and 30.4 ± 10.3% at 3 years, vs. 30.2 ± 9.4% and 25.6 ± 10.2% after two-steps OADS (p = 0.021). Resolution rates of diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea were 86.4%, 80.4%, 78.0%, and 73.3%, with no differences between groups. CONCLUSION One-stage OADS is a safe and effective bariatric technique for patients with grade III and IV obesity. The two-step strategy does not reduce postoperative risks and may compromise weight loss results at mid-term.
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Affiliation(s)
- Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Víctor Admella
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Merino
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Sobrino
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Tuero
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Claudio Lazzara
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Shukla A, Kalayarasan R, Gnanasekaran S, Pottakkat B. Appraisal of gastric stump carcinoma and current state of affairs. World J Clin Cases 2023; 11:2864-2873. [PMID: 37215417 PMCID: PMC10198071 DOI: 10.12998/wjcc.v11.i13.2864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Gastric stump carcinoma, also known as remnant gastric carcinoma, is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition. Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma. The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases. The tumor location is predominantly at the anastomotic site towards the stomach. However, it can occur anywhere in the remnant stomach. The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer. Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes, thereby providing novel therapeutic targets. Also, reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis, staging, and treatment of these tumors. The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.
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Affiliation(s)
- Ankit Shukla
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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Basso L, Gallo G, Biacchi D, Carati MV, Cavallaro G, Esposito L, Giuliani A, Izzo L, Izzo P, Lamazza A, Polistena A, Tarallo M, Micarelli A, Fiori E. Role of New Anatomy, Biliopancreatic Reflux, and Helicobacter Pylori Status in Postgastrectomy Stump Cancer. J Clin Med 2022; 11:1498. [PMID: 35329824 PMCID: PMC8952228 DOI: 10.3390/jcm11061498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/14/2023] Open
Abstract
Distal gastrectomy for benign gastroduodenal peptic disease has become rare, but it still represents a widely adopted procedure for advanced and, in some countries, even for early distal gastric cancer. Survival rates following surgery for gastric malignancy are constantly improving, hence the residual mucosa of the gastric stump is exposed for a prolonged period to biliopancreatic reflux and, possibly, to Helicobacter pylori (HP) infection. Biliopancreatic reflux and HP infection are considered responsible for gastritis and metachronous carcinoma in the gastric stump after oncologic surgery. For gastrectomy patients, in addition to eradication treatment for cases that are already HP positive, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the residual mucosa of any metaplastic-atrophic-dysplastic features following surgery.
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Affiliation(s)
- Luigi Basso
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Operative Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
| | - Daniele Biacchi
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Maria Vittoria Carati
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Giuseppe Cavallaro
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Luca Esposito
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Andrea Giuliani
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Luciano Izzo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Paolo Izzo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Antonietta Lamazza
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Andrea Polistena
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Mariarita Tarallo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), 02032 Rome, Italy;
- Eurac Research, Institute of Mountain Emergency Medicine, 39100 Bolzano, Italy
| | - Enrico Fiori
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
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Cryptic Early Gastric Carcinoma in Gastric Stump: Challenges in Diagnostic Evaluation. Case Rep Pathol 2019; 2019:1794370. [PMID: 31929929 PMCID: PMC6935802 DOI: 10.1155/2019/1794370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/29/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Partial gastrectomy, performed for any indication, is a well-recognized risk factor for carcinoma developing in the gastric remnant (so-called “gastric stump carcinoma”). In symptomatic patients with gastro-enteric anastomosis, it is a common practice to endoscopically evaluate the patency and the status of the anastomosis and procure biopsy samples when endoscopic abnormalities are noted. We describe a case with Billroth I gastroduodenal anastomosis with oozing and friability at the anastomosis site which was biopsied. The biopsies showed invasive intestinal-type adenocarcinoma. Subsequent completion gastrectomy showed no grossly visible tumor and required extensive initial and additional sampling of the anastomosis and the surrounding stomach to locate a small focus of invasive adenocarcinoma limited to the mucosa (“early gastric carcinoma”). This case illustrates a known complication of partial gastrectomy and highlights challenges in diagnostic evaluation of early gastric carcinoma after gastrectomy.
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Ravacci GR, Ishida R, Torrinhas RS, Sala P, Machado NM, Fonseca DC, André Baptista Canuto G, Pinto E, Nascimento V, Franco Maggi Tavares M, Sakai P, Faintuch J, Santo MA, Moura EGH, Neto RA, Logullo AF, Waitzberg DL. Potential premalignant status of gastric portion excluded after Roux en-Y gastric bypass in obese women: A pilot study. Sci Rep 2019; 9:5582. [PMID: 30944407 PMCID: PMC6447527 DOI: 10.1038/s41598-019-42082-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
We evaluated whether the excluded stomach (ES) after Roux-en-Y gastric bypass (RYGB) can represent a premalignant environment. Twenty obese women were prospectively submitted to double-balloon enteroscopy (DBE) with gastric juice and biopsy collection, before and 3 months after RYGB. We then evaluated morphological and molecular changes by combining endoscopic and histopathological analyses with an integrated untargeted metabolomics and transcriptomics multiplatform. Preoperatively, 16 women already presented with gastric histopathological alterations and an increased pH (≥4.0). These gastric abnormalities worsened after RYGB. A 90-fold increase in the concentration of bile acids was found in ES fluid, which also contained other metabolites commonly found in the intestinal environment, urine, and faeces. In addition, 135 genes were differentially expressed in ES tissue. Combined analysis of metabolic and gene expression data suggested that RYGB promoted activation of biological processes involved in local inflammation, bacteria overgrowth, and cell proliferation sustained by genes involved in carcinogenesis. Accumulated fluid in the ES appears to behave as a potential premalignant environment due to worsening inflammation and changing gene expression patterns that are favorable to the development of cancer. Considering that ES may remain for the rest of the patient’s life, long-term ES monitoring is therefore recommended for patients undergoing RYGB.
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Affiliation(s)
- Graziela Rosa Ravacci
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Robson Ishida
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Raquel Suzana Torrinhas
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Sala
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natasha Mendonça Machado
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Danielle Cristina Fonseca
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gisele André Baptista Canuto
- Departamento de Quimica Analitica, Instituto de Quimica, Universidade Federal da Bahia, Salvador, BA, Brazil.,Departamento de Quimica Fundamental, Instituto de Quimica, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ernani Pinto
- Faculdade de Ciências Farmacêuticas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Paulo Sakai
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joel Faintuch
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | | | - Dan Linetzky Waitzberg
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients. Obes Surg 2017; 27:1153-1167. [PMID: 27783366 PMCID: PMC5403902 DOI: 10.1007/s11695-016-2428-1] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Excellent results have been reported with mini-gastric bypass. We adopted and modified the one-anastomosis gastric bypass (OAGB) concept. Herein is our approach, results, and long-term follow-up (FU). METHODS Initial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6-12-year FU. Mean age was 43 years (12-74) and body mass index (BMI) 46 kg/m2 (33-86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions. RESULTS Mean operating time (min) was as follows: (a) primary procedure, 86 (45-180); (b) with other operations, 112 (95-230); and (c) revisions, 180 (130-240). Intraoperative complications led to 4 (0.3 %) conversions. Complications prompted operations in 16 (1.3 %) and were solved conservatively in 12 (1 %). Long-term complications occurred in 12 (1 %). There were 2 (0.16 %) deaths. Thirty-day and late readmission rates were 0.8 and 1 %. Cumulative FU was 87 and 70 % at 6 and 12 years. The highest mean percent excess weight loss was 88 % (at 2 years), then 77 and 70 %, 6 and 12 years postoperatively. Mean BMI (kg/m2) decreased from 46 to 26.6 and was 28.5 and 29.9 at those time frames. Remission or improvement of comorbidities was achieved in most patients. The quality of life index was satisfactory in all parameters from 6 months onwards. CONCLUSIONS Laparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.
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Affiliation(s)
- Miguel A. Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - Enrique Luque-de-León
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - José M. Jiménez
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - Javier Ortiz-de-Solórzano
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - Manuel Pérez-Miranda
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - María J. Castro-Alija
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
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Diogo Filho A, Botelho LF, Nishiyama A, Zumpano LE, Monte RC, Rosa SC. GASTRIC STUMP CANCER AFTER GASTRECTOMY BY GASTRODUODENAL PEPTIC ULCER. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:65. [PMID: 27120745 PMCID: PMC4851156 DOI: 10.1590/0102-6720201600010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Andréa Nishiyama
- Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
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Zhang F, Bao ZJ, Shi DM, Xiang P, Xiao L, Huang YQ, Zhang GS, Yin SM. Efficacy of a quadruple therapy regimen for Helicobacter pylori eradication after partial gastrectomy. Braz J Med Biol Res 2016; 49:e5080. [PMID: 26871968 PMCID: PMC4742974 DOI: 10.1590/1414-431x20155080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/21/2015] [Indexed: 01/06/2023] Open
Abstract
We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.
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Affiliation(s)
- F Zhang
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - Z J Bao
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - D M Shi
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - P Xiang
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - L Xiao
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - Y Q Huang
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - G S Zhang
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
| | - S M Yin
- Huadong Hospital, Shanghai Medical College, Division of Gastroenterology, Fudan University, Shanghai, China
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9
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Boteon YL, Alves IPF, da Silva APC, Junior VT, de Souza Coelho Neto J, Lopes LR, de Carvalho Ramos M, Andreollo NA. Obstructive Gastric Pseudotumor Caused by Cytomegalovirus in an AIDS Patient: A Case Report and Review of Surgical Treatment. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:536-541. [PMID: 26277259 PMCID: PMC4542526 DOI: 10.12659/ajcr.894070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a common opportunistic pathogen in patients with HIV. It is also a major cause of gastrointestinal ulcers in patients with acquired immunodeficiency syndrome (AIDS). CMV pseudotumor in the stomach is a rare cause of digestive tract obstruction. CASE REPORT In this study we report a male patient infected with HIV in 2002. In 2014 he evolved C3 stage AIDS with pre-pyloric gastric ulcer which provoked deformity and pseudotumoral aspect of the gastric outlet. Endoscopic biopsy confirmed CMV infection. He underwent Roux-en-Y gastroenteroanastomosis with good recovery. CONCLUSIONS CMV infection should be considered as an agent in gastric lesions in HIV-infected patients. Roux-en-Y gastroenteroanastomosis is a surgical option for this group of patients, allowing improvements in quality of life and decreasing risks of perioperative complications.
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Affiliation(s)
- Yuri Longatto Boteon
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - Iuri Pedreira Filardi Alves
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - Amanda Pinter Carvalheiro da Silva
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - Valdir Tercioti Junior
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - João de Souza Coelho Neto
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - Luiz Roberto Lopes
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - Marcelo de Carvalho Ramos
- Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
| | - Nelson Adami Andreollo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (Unicamp) and in the Diagnostic Center for Digestive Diseases (Gastrocentro), Unicamp, Campinas, Sao Paulo, Brazil
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Kwon IG, Cho I, Choi YY, Hyung WJ, Kim CB, Noh SH. Risk factors for complications during surgical treatment of remnant gastric cancer. Gastric Cancer 2015; 18:390-6. [PMID: 24705942 DOI: 10.1007/s10120-014-0369-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment for remnant gastric cancer is related to high mortality and morbidity. The aim of this study was to identify risk factors that predispose to postoperative complications after gastrectomy for remnant gastric cancer. METHODS A total of 210 patients who underwent a gastrectomy for remnant gastric cancer between January 1998 and December 2012 were retrospectively analyzed. Surgical complications were reviewed and graded using the Clavien-Dindo classification. Univariate and multivariate analysis was performed to identify the risk factors for development of complications. RESULTS The incidence of postoperative complications was 46% (96/210), and major complications occurred in 14% (30/210). The operation-related mortality rate was 1.0%. Multivariate analysis revealed that only a BMI ≥25 (P = 0.001) and blood transfusion (P < 0.001) were significant independent risk factors for major complication. Indication for the initial gastrectomy and previous anastomosis type were not related to the development of surgical complications. CONCLUSIONS Although surgery for remnant gastric cancer is a complex procedure because of the previous operation, factors related to the previous operation do not affect the development of postoperative complications.
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Affiliation(s)
- In Gyu Kwon
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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Abstract
Mini gastric bypass is a modification of Mason loop gastric bypass with a longer lesser curvature-based pouch. Though it has been around for more than 15 years, its uptake by the bariatric community has been relatively slow, and the procedure has been mired in controversy right from its early days. Lately, there seems to be a surge in the interest in this procedure, and there is now published experience with more than 5,000 procedures globally. This review examines the major controversial aspects of this procedure against the available scientific literature. Surgeons performing this procedure need to be aware of these controversies and counsel their patients appropriately.
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Nemoto H, Tate G, Yokomizo K, Umemoto T, Matsubara T, Mizukami H, Kigawa G, Matsumiya A, Tanaka J. Gastric mixed adenoneuroendocrine carcinoma occurring 50 years after a gastroenterostomy with braun anastomosis. Case Rep Oncol 2014; 7:330-6. [PMID: 24987352 PMCID: PMC4067710 DOI: 10.1159/000363222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A 75-year-old man was diagnosed with gastric cancer. Fifty years previously, he had undergone gastroenterostomy with a Braun enteroenterostomy. At present, a distal gastrectomy and small intestinal partial resection were performed. Intraoperatively, the tumor was localized to the previous stomal site. HE staining showed that the tumor comprised two elements: a tubular adenocarcinoma on the gastric side and a neuroendocrine carcinoma (NEC) on the jejunal side. The final pathologic diagnosis was mixed adenoneuroendocrine carcinoma based on an immunohistochemical analysis of endocrine markers and an elevated Ki-67 labeling index. The risk of later cancer development cancer recurrence near the gastrojejunostomy site is well known. Potentially, chronic enterogastric bile reflux may irritate the gastric mucosa and act as a promoter. Gastric NEC has a strong malignant potential. We suspect that, in the present case, the constant exposure to secondary bile may have induced a gastric mucosal adenocarcinoma, which finally differentiated into a NEC.
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Affiliation(s)
- Hiroshi Nemoto
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Genshu Tate
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Kazuaki Yokomizo
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Takahiro Umemoto
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Taketo Matsubara
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroki Mizukami
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Gaku Kigawa
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Akihiko Matsumiya
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Junichi Tanaka
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
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