Multidisciplinary treatment strategy for locally advanced gastric cancer: A systematic review

BackgroundMultidisciplinary management of patients with locally advanced gastric cancer (LAGC) remains unstandardized worldwide. We performed a systemic review to summarize the advancements, regional differences, and current recommended multidisciplinary treatment strategies for LAGC.MethodsEligible studies were identified through a comprehensive search of PubMed, Web of Science, Cochrane Library databases and Embase. Phase 3 randomized controlled trials which investigated survival of patients with LAGC who underwent gastrectomy with pre-/perioperative, postoperative chemotherapy, or chemoradiotherapy were included.ResultsIn total, we identified 11 studies of pre-/perioperative chemotherapy, 38 of postoperative chemotherapy, and 14 of chemoradiotherapy. In Europe and the USA, the current standard of care is perioperative chemotherapy for patients with LAGC using the regimen of 5-FU, folinic acid, oxaliplatin and docetaxel (FLOT). In Eastern Asia, upfront gastrectomy and postoperative chemotherapy is commonly used. The S-1 monotherapy or a regimen of capecitabine and oxaliplatin (CapOx) are used for patients with stage II disease, and the CapOx regimen or the S-1 plus docetaxel regimen are recommended for those with stage III Gastric cancer (GC). The addition of postoperative radiotherapy to peri- or postoperative chemotherapy is currently not recommended. Additionally, clinical trials testing targeted therapy and immunotherapy are increasingly performed worldwide.ConclusionsRecent clinical trials showed a survival benefit of peri-over postoperative chemotherapy and chemoradiotherapy. As such, this strategy may have a potential as a global standard for patients with LAGC. Outcome of the ongoing clinical trials is expected to establish the global standard of multidisciplinary treatment strategy in patients with LAGC.     

马来酸曲美布汀对伴有无效食管动力的胃食管反流病患者食管运动功能的影响

[目的]观察马来酸曲美布汀对伴有无效食管动力的胃食管反流病患者食管运动功能的影响。[方法]对经内镜、24h食管pH-阻抗监测诊断为胃食管反流病,并行高分辨率食管压力测定(high resolution manometry,HRM),依据芝加哥3.0版标准诊断为无效食管动力的16例患者,给予马来酸曲美布汀0.2g tid、埃索美拉唑20mg、bid治疗2周后复查HRM,比较治疗前后下食管括约肌静息压(LESP)、食管体部各段波幅及时限、吞咽成功率、失蠕动比例、弱蠕动比例以及远端收缩积分(DCI)值等指标的变化。[结果]16例患者治疗前后LESP变化差异无统计学意义(P0.05),在LESP明显降低的7例患者中,与治疗前相比,治疗后LESP明显增加[(1.8±0.9)mmHg(1mmHg=0.133kPa)∶(8.2±5.4)mmHg],差异有统计学意义(P0.05);液体吞咽中,食管中段收缩波幅较治疗前明显增加[(33.7±11.4)mmHg∶(42.7±19.9)mmHg)],P0.05;黏性吞咽中,食管远端收缩波幅较治疗前明显增加[(44.7±18.4)mmHg∶(57.5±23.4)mmHg],P0.05;液体吞咽时,失蠕动比例较治疗前均显著下降,P0.05;液体及黏性吞咽时,DCI值均较治疗前明显增加,P0.05。在液体吞咽时,吞咽成功率较治疗前增加,差异有统计学意义,P0.05。[结论]马来酸曲美布汀可能增加合并下食管括约肌低压的GERD患者的LESP,通过增加食管体部收缩波幅,改善合并无效食管动力的GERD患者食管体部的廓清功能。     

Barrett's esophagus: a comprehensive review and update

Barrett's esophagus (BE) is a known precursor to esophageal adenocarcinoma. In the United States, a prevalence of up to 25% is reported in high risk populations and it is identified in about 5% of patients with gastroesophageal reflux disease (GERD). The diagnosis of BE requires endoscopically identifying columnar (“salmon colored”) mucosa, taking biopsies from targeted areas and then confirming histologically. The American College of Gastroenterologists updated its criteria in 2016, introducing a length requirement. This brief review addresses diagnosis of BE and its various associated challenges; identifying dysplasia, grading it, and management.     

Prediction of gastroesophageal reflux in otitis media with effusion in adults

Conclusions. The measurement of pepsinogen I (PGI) in middle-ear effusions (MEEs) and a questionnaire on the frequency symptoms of gastroesophageal reflux (GER) disease are tools that can be used to screen for the existence of GER. Objective. To seek methods that would be beneficial as a screen for the presence of GER among adult patients with OME. Materials and methods. Fifty-eight adult outpatients with OME were asked to answer a questionnaire of the frequency scale for symptoms of GER disease. Samples of MEEs were obtained from each subject and were measured for concentrations of PGI and PGII. Some patients were followed up after being treated with a proton pump inhibitor. Results. The percentage of patients with high PGI concentrations in their MEEs was higher in those with GER-related symptoms than in those without GER-related symptoms. Moreover, OME was present bilaterally in a higher percentage of patients with GER-related symptoms. There were patients in whom PGI levels decreased after receiving treatment for GER.     

The early use of Roux limb as surgical treatment for proximal postsleeve gastrectomy leaks

BackgroundLaparoscopic sleeve gastrectomy (LSG) is thought to be a simpler and safer operation compared with malabsorptive operations that include an enteric anastomosis. Leakage along the staple line at the gastroesophageal junction (GEJ) is difficult to treat and is a known complication of sleeve gastrectomy. Nonsurgical treatment methods often fail to heal the leaks and patients often require conversion to other procedures for definitive treatment. We report our experience with conversion to Roux-en-Y anastomosis over the leak site as a treatment option, comparing patients who had early treatment to late intervention. The purpose of the study is to stress the medical and social benefits of early surgical reintervention with conversion to Roux-en-Y anastomosis over the leak site.MethodsSix patients underwent Roux limb placement over the leak site. Four of the patients had delayed surgery (group A), and the other 2 had early intervention (group B).ResultsPatients in group A had a median increase of all medical cost by 500%, whereas the 2 patients who underwent early intervention (group B) had an increase by 200%. The mean time until complete recovery (removal of all drains, adequate oral intake, and return to normal daily activity) in group A was 131.25 days (range 99–165) versus 38 days (range 28–48) in group B.ConclusionsRoux-en-Y gastrojejunostomy over the leak site is an effective technique to treat refractory staple line leakage and can be adopted as early treatment in selected patients after stabilization, thereby reducing the cost and length of hospital stays.     

Massive gastrointestinal bleeding due to isolated jejunal varices in a patient without portal hypertension

INTRODUCTIONIsolated ectopic varices located in the small bowel are uncommon. Portal hypertension caused by liver cirrhosis is the most common predisposing risk factor.PRESENTATION OF CASEWe present an unusual case of massive gastrointestinal bleeding from idiopathic jejunal varices in a 73-year-old Caucasian male without portal hypertension. Exploratory laparotomy disclosed ectopic varices located in the small intestine. Segmental resection of the jejunum with end to end anastomosis resulted in a complete resolution of the haemorrhage. During a 5 year follow up, the patient is stable with no bleeding recurrence.DISCUSSIONInformation on aetiology, diagnosis and management of jejunal varices is reviewed.CONCLUSIONDiagnosis and management of isolated jejunal varices is challenging. Surgeons as well as acute care physicians have to consider idiopatic form of jejunal varices as a potential cause of gastrointestinal bleeding when gastroduodenoscopy and colonoscopy are negative.     

全面护理干预在肝硬化食管静脉曲张套扎术患者的实效性评价

目的探讨多样化的全面护理干预措施在肝硬化食管静脉曲张套扎术中的作用效果。方法选取2011年9月～2013年9月来我院进行食管静脉曲张套扎术的肝硬化食管静脉曲张患者40例,按照随机分配与自愿的原则将其平均分为A组和B组。A组患者治疗过程中只接受常规护理,B组患者则从治疗前、治疗中到治疗后均给予一系列有针对性的多样化的护理干预措施,分析两组患者的治疗效果与护理满意程度。结果 B组患者中有19例对治疗过程的护理措施感到满意,该组护理满意度高达95%,A组护理满意度仅为80%,B组显著高于A组。且从患者的住院时间及并发症发生比例上来看,B组也明显好于A组。且两组比较差异有统计学意义（P〈0.05）。结论在患者进行食管静脉曲张套扎术时给予一定的合理的护理干预措施,可有效引导患者积极配合治疗,提高手术治疗的成功比例。