101
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Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery. Eur Surg 2006. [DOI: 10.1007/s10353-006-0295-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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102
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Köninger J, Wente MN, Müller MW, Gutt CN, Friess H, Büchler MW. Surgical palliation in patients with pancreatic cancer. Langenbecks Arch Surg 2006; 392:13-21. [PMID: 17103000 DOI: 10.1007/s00423-006-0100-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Accepted: 08/11/2006] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of palliative strategies in patients with pancreatic cancer is the relief of tumor-associated symptoms such as biliary and duodenal obstruction and tumor growth. Due to high mortality and morbidity rates of surgery, treatment of patients with advanced pancreatic cancer is mainly in the hand of gastroenterologists. RATIONALE In recent years, surgery of pancreatic cancer in specialized centres developed strongly, which makes it a viable option even in the treatment of advanced disease. CONCLUSION We advocate for an aggressive strategy in the treatment of pancreatic cancer with surgical exploration and tumor resection whenever possible.
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Affiliation(s)
- Jörg Köninger
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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103
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Kantsevoy SV, Niiyama H, Jagannath SB, Chung SSC, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Kawano H, Shimonaka H, Kalloo AN. The endoscopic transilluminator: an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy. Gastrointest Endosc 2006; 63:1055-8. [PMID: 16733125 DOI: 10.1016/j.gie.2005.11.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 11/07/2005] [Indexed: 12/27/2022]
Abstract
BACKGROUND Localization of the proximal jejunum is important for creation of gastrojejunal anastomosis to palliate gastric outlet obstruction or for treatment of obesity with gastric bypass. OBJECTIVE To facilitate identification of the proximal jejunum during transgastric endoscopic gastrojejunostomy with the use of an endoscopic transilluminator (ET). DESIGN AND SETTING Acute experiments in a live porcine model. INTERVENTIONS The ET is a 3500-mm long, 6F radio-opaque tube with a fiberoptic core that lights up at its distal end. When situated in the intestinal lumen, it transilluminates the bowel wall. With the animal under general anesthesia with endotracheal intubation, a colonoscope was advanced to the proximal jejunum. A plastic tube (3500-mm long, 3.5 mm in diameter) was passed through the biopsy channel and placed into the small bowel. The colonoscope was withdrawn, leaving the tube in place. The ET was introduced into the jejunum through the tube. A gastric wall incision was made and the endoscope was advanced to the peritoneal cavity. The transilluminated loop of the proximal jejunum was identified and gastrojejunal anastomosis was made by use of a previously reported endoscopic technique. MAIN OUTCOME MEASUREMENTS Identification of the proximal jejunum. RESULTS Eleven pigs (average weight 55 kg) had ET placement. In all of the pigs, placement of the ET was performed easily to the proximal small bowel, and the proximal jejunum was successfully localized by either direct visualization of the transilluminated loop only or with the aid of fluoroscopy. The tip of the ET was usually located about 50 to 70 cm distal to the ligament of Treitz. There were no complications related to the use of ET. LIMITATIONS The device has not yet been evaluated in humans. CONCLUSIONS The ET is a safe instrument and can be used to identify the proximal jejunum to facilitate endoscopic gastrojejunostomy.
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Affiliation(s)
- Sergey V Kantsevoy
- Division of Gastroenterology, Johns Hopkins Hospital, 1830 E. Monument Street, Baltimore, MD 21205, USA
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104
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Espinel J, Sanz O, Vivas S, Jorquera F, Muñoz F, Olcoz JL, Pinedo E. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc 2006; 20:1083-7. [PMID: 16703436 DOI: 10.1007/s00464-005-0354-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 12/29/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Malignant gastrointestinal obstruction is a secondary complication of cancers in an advanced state. Treatment has consisted of gastrojejunostomy. However, the endoscopic placement of metallic stents has provided positive results. This study aimed to compare the efficiency of both therapeutic options. METHODS A total of 41 patients with gastrointestinal obstruction caused by inoperable neoplasm were treated endoscopically with enteral stent (24 patients) or gastrojejunostomy (17 patients). RESULTS In the endoscopic group (EG) 24 patients (100%) achieved efficient gastric emptying, as compared with 82.3% in the surgical group (SG). The difference was not significant. The average time for initiating oral food tolerance was 2.4 days for the EG and 5 days for the SG (p < 0.001). The average inpatient time was 7.1 days for the EG and 11.5 days for the SG (p < 0.001). Mortality at 30 days was lower in the EG (16.6%) than in the SG (29.4%) (p < 0.05). The survival time was 20 weeks for the EG and 21.6 weeks for the SG. The difference was not significant. The rate of complications was 4% in the (EG) and 17.6% in the (SG), with the difference was not significant. CONCLUSION Endoscopic treatment of malignant gastrointestinal obstruction provides an adequate palliation of the symptoms. It is less invasive, avoids the morbidity associated with open gastrojejunostomy, and achieves a faster start to oral food and a shorter hospital stay, leading to a higher quality of life.
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Affiliation(s)
- J Espinel
- Department of Gastroenterology, Hospital de León, 24071, Leon, Spain.
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105
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Peschaud F, Alves A, Berdah S, Kianmanesh R, Laurent C, Mabrut JY, Mariette C, Meurette G, Pirro N, Veyrie N, Slim K. [Indications for laparoscopy in general and gastrointestinal surgery. Evidence-based recommendations of the French Society of Digestive Surgery]. ACTA ACUST UNITED AC 2006; 143:15-36. [PMID: 16609647 DOI: 10.1016/s0021-7697(06)73598-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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106
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Maire F, Hammel P, Ponsot P, Aubert A, O'Toole D, Hentic O, Levy P, Ruszniewski P. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 2006; 101:735-42. [PMID: 16635221 DOI: 10.1111/j.1572-0241.2006.00559.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown. AIM To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer. PATIENTS AND METHODS All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival. RESULTS One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment. CONCLUSION Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.
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Affiliation(s)
- Frédérique Maire
- Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
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107
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Meier PN, Manns MP. [Advantages of endoscopic stenting for malignant gastrointestinal obstructions]. Chirurg 2006; 77:203-9. [PMID: 16508784 DOI: 10.1007/s00104-006-1166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-expanding stents play a major role in the interdisciplinary treatment of gastrointestinal obstructions in patients with local nonresectable tumors, advanced metastasis, and pronounced comorbidity. Reinstenting the passage and sealing esophagotracheal fistulae is very effective as palliative treatment for esophageal tumor complications. In hepatobiliary occlusions, the success rate against cholestasis is also high. Enteral and colorectal stents are gaining favor. Required are an experienced endoscopy team and adequate equipment. The rate of procedural complications is generally low, but rare and severe complications such as perforation must be considered. Further improvements in the materials and construction of stents can be expected.
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Affiliation(s)
- P N Meier
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover.
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108
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Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SSC, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN. Transgastric endoscopic splenectomy: is it possible? Surg Endosc 2006; 20:522-5. [PMID: 16432652 DOI: 10.1007/s00464-005-0263-x] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 07/29/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND We have previously reported the feasibility of diagnostic and therapeutic peritoneoscopy including liver biopsy, gastrojejunostomy, and tubal ligation by an oral transgastric approach. We present results of per-oral transgastric splenectomy in a porcine model. The goal of this study was to determine the technical feasibility of per-oral transgastric splenectomy using a flexible endoscope. METHODS We performed acute experiments on 50-kg pigs. All animals were fed liquids for 3 days prior to procedure. The procedures were performed under general anesthesia with endotracheal intubation. The flexible endoscope was passed per orally into the stomach and puncture of the gastric wall was performed with a needle knife. The puncture was extended to create a 1.5-cm incision using a pull-type sphincterotome, and a double-channel endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated with air through the endoscope. The spleen was visualized. The splenic vessels were ligated with endoscopic loops and clips, and then mesentery was dissected using electrocautery. RESULTS Endoscopic splenectomy was performed on six pigs. There were no complications during gastric incision and entrance into the peritoneal cavity. Visualization of the spleen and other intraperitoneal organs was very good. Ligation of the splenic vessels and mobilization of the spleen were achieved using commercially available devices and endoscopic accessories. CONCLUSIONS Transgastric endoscopic splenectomy in a porcine model appears technically feasible. Additional long-term survival experiments are planned.
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Affiliation(s)
- S V Kantsevoy
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD 21205, USA
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109
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Peschaud F, Alves A, Berdah S, Kianmanesh R, Laurent C, Mabrut JY, Mariette C, Meurette G, Pirro N, Veyrie N, Slim K. [Indications of laparoscopic general and digestive surgery. Evidence based guidelines of the French society of digestive surgery]. ACTA ACUST UNITED AC 2006; 131:125-48. [PMID: 16448622 DOI: 10.1016/j.anchir.2005.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- F Peschaud
- Service de Chirurgie Générale et Digestive, CHU de Clermont-Ferrand, Hôtel-Dieu, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand, France
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110
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Abstract
The majority of patients with pancreatic carcinoma (hepaticojejunostomy) unfortunately will have palliative treatment and palliation of symptoms is important to improve Quality of Life. The most common symptoms that require palliation are jaundice, gastric outlet obstruction and pain. Obstructive jaundice should be treated with a biliary bypass, the optimal palliation in relatively fit patients and endoscopic stenting is preferred in patients with short survival (3-6 months). To prevent gastric outlet obstruction a prophylactic gastroenterostomy should be performed routinely during bypass surgery. Symptomatic patients after earlier stenting of the bile duct can be treated nowadays by duodenal stenting. Pain management is according to the progressive analgesic ladder but a (percutaneous) neurolytic celiac plexus block may be indicated. Currently a R1 (palliative) resection is acceptable in high volume centres but so far there is a very limited role for planned R2 palliative resections.
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Affiliation(s)
- D.J. Gouma
- Department of Surgery, Academic Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - O.R.C. Busch
- Department of Surgery, Academic Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - T.M. Van Gulik
- Department of Surgery, Academic Medical Center, University of AmsterdamAmsterdamThe Netherlands
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111
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Simmons DT, Baron TH. Technology insight: Enteral stenting and new technology. ACTA ACUST UNITED AC 2005; 2:365-74; quiz 1 p following 374. [PMID: 16265404 DOI: 10.1038/ncpgasthep0236] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Accepted: 06/24/2005] [Indexed: 02/07/2023]
Abstract
Self-expandable metal stents (SEMS) have gained acceptance for use in the gastrointestinal tract in order to relieve malignant luminal obstruction. In the upper gastrointestinal tract SEMS are used as an alternative to surgical bypass for palliation of malignant gastric-outlet obstruction. In the colon, SEMS are used to avoid colostomy during palliation and as a bridge to surgery for left-sided colonic obstruction. Enteral SEMS appear to be cost effective. This article reviews the latest in stent technology as well as the outcomes following their placement.
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Affiliation(s)
- Dia T Simmons
- Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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112
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Denley SM, Moug SJ, Carter CR, McKay CJ. The outcome of laparoscopic gastrojejunostomy in malignant gastric outlet obstruction. ACTA ACUST UNITED AC 2005; 35:165-9. [PMID: 16110117 DOI: 10.1385/ijgc:35:3:165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The development of gastric outlet obstruction (GOO) in patients with advanced pancreatic cancer is regarded by some as a terminal event. There are several interventional options available, one of which is laparoscopic gastrojejunostomy (LGJ). To date, there are little data on the effectiveness of this intervention. Using patient records we sought to analyze our own experience of LGJ in patients with terminal pancreatic cancer. METHODS A retrospective analysis of all patients with pancreatic or peri-ampullary cancer that underwent LGJ for GOO. All LGJ were performed by two consultant surgeons at Glasgow Royal Infirmary. Patient notes were assessed for survival time after LGJ; post-operative complications; resumption of oral intake; time to discharge and recurrence of GOO after surgery. RESULTS A total of 18 patients underwent LGJ for GOO between 2000 and 2004. Median age at time of procedure was 66.5 yr (range 40 to 79). Two patients were converted to an open procedure for technical reasons, both of whom died in the post-operative period. Of the remaining 16, 15 had successful relief of GOO. The remaining patient underwent revisional open surgery 15 d post-operatively due to persistent GOO. Two patients died in hospital but 14 were discharged with symptom relief. Median survival for these patients was 59 d (range 12 to 248). CONCLUSION The development of GOO in pancreatic and peri-ampullary cancer should not be regarded as a terminal event. LGJ should be considered as a treatment option in these patients.
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Affiliation(s)
- Simon M Denley
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK
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113
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Tsukada K. Metallic stent placement or gastroenterostomy for gastric outlet obstruction caused by gastric cancer? J Gastroenterol 2005; 40:1007-8. [PMID: 16261444 DOI: 10.1007/s00535-005-1700-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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114
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115
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Maetani I, Akatsuka S, Ikeda M, Tada T, Ukita T, Nakamura Y, Nagao J, Sakai Y. Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol 2005; 40:932-7. [PMID: 16261429 DOI: 10.1007/s00535-005-1651-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 05/20/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND In patients with gastric outlet obstruction (GOO), palliative enteral stenting is a less invasive procedure compared with gastroenterostomy. Most diseases analyzed in previous studies of such stenting were pancreaticobiliary malignancies. METHODS We reviewed the medical records of patients with GOO secondary to gastric cancer who were admitted to our institution between September 1994 and September 2004. The outcome of stent placement for GOO was compared with the outcome in patients who underwent palliative open gastrojejunostomy during the same period. Enrolled patients from both groups displayed symptomatic GOO. Patients with recurrent gastric cancer were excluded from this study. RESULTS Twenty-two patients underwent palliative enteral stenting, and 22 patients were subjected to surgical gastrojejunostomy (bypass). There were no significant differences between the two groups regarding patient baseline characteristics. Technical success and clinical success were obtained in 100% and 77.3%, respectively, of both groups. The operating time was shorter in the stent group (30 vs 118 min; P<0.0001). The time from the procedure to the resumption of food intake was shorter in the stent group than in the bypass group (2 days vs 8 days; P<0.0001). An improvement in performance score after the procedure was observed in both groups (stent group; P=0.0264; bypass group; P=0.0235). No significant differences were observed regarding the possibility of discharge. In patients discharged, the median postoperative hospital stays were 19 days and 28 days (P=0.0558). The median survival periods were 65 days and 90 days. Minor complications were observed in 1 patient in the stent group and in 4 in the bypass group. No mortality or severe complications were observed for either group. CONCLUSIONS Self-expandable metallic stent placement is a safe and efficacious procedure for palliation, with shorter operating time and more prompt restoration of oral intake, compared to surgical alternatives in patients with GOO caused by gastric cancer.
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Affiliation(s)
- Iruru Maetani
- Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
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116
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Abstract
PURPOSE OF REVIEW Endoscopic therapies have become an indispensable modality in the treatment and palliation of complications from pancreatic adenocarcinoma. This review focuses on treatment of biliary obstruction, malignant gastric outlet obstruction, and intractable abdominal pain resulting from unresectable pancreatic adenocarcinoma. Novel and emerging endoscopic approaches are also briefly discussed. RECENT FINDINGS Endoscopic placement of a biliary stent is the modality of choice for palliation of biliary obstruction. Biliary self-expanding metal stents should be placed if expected survival is more than 6 months and plastic stents if expected survival is less than 6 months. For endoscopic palliation of gastric outlet obstruction, enteral self-expanding metal stents should be placed. Biliary self-expanding metal stents should be considered prior to the placement of a duodenal stent. Palliation of intractable abdominal pain can safely be performed with endoscopic ultrasound-guided celiac plexus neurolysis using bupivacaine and absolute alcohol. Exciting novel endoscopic approaches are being evaluated especially in the area of drug-eluted biliary stents, endoscopic creations of enteral anastomoses, and endoscopic ultrasound-guided injection of gene vectors. SUMMARY The frontier of endoscopic palliative therapies for pancreatic adenocarcinoma is expanding. Clinical trials are needed to evaluate novel endoscopic approaches.
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Affiliation(s)
- Wichit Srikureja
- Division of Gastroenterology, University of California-Irvine, Orange, California, USA
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117
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Kantsevoy SV, Jagannath SB, Niiyama H, Chung SSC, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 2005; 62:287-92. [PMID: 16046997 DOI: 10.1016/s0016-5107(05)01565-8] [Citation(s) in RCA: 329] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We have previously reported the feasibility and the safety of an endoscopic transgastric approach to the peritoneal cavity in a porcine model. We now report successful performance of endoscopic gastrojejunostomy with survival. METHODS All procedures were performed on 50-kg pigs, with the pigs under general anesthesia, in aseptic conditions with sterilized endoscopes and accessories. The stomach was irrigated with antibiotic solution, and a gastric incision was performed with a needle-knife and a sphincterotome. A standard upper endoscope was advanced through a sterile overtube into the peritoneal cavity. A loop of jejunum was identified, was retracted into the stomach, and was secured with sutures while using a prototype endoscopic suturing device. An incision was made into the jejunal loop with a needle-knife, and the filet-opened ends of the jejunal wall were secured to the gastric wall with a second line of sutures, completing the gastrojejunostomy. OBSERVATIONS Two pigs survived for 2 weeks. Endoscopy and a radiographic contrast study performed after gastrojejunostomy revealed a patent anastomosis with normal-appearing gastric and jejunal mucosa. Postmortem examination demonstrated a well-healed anastomosis without infection or adhesions. CONCLUSIONS The endoscopic transgastric approach to create a gastrojejunostomy is technically feasible and can be performed, with survival, in a porcine model.
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Affiliation(s)
- Sergey V Kantsevoy
- Division of Gastronenterology, Johns Hopkins Hospital, Baltimore, MD 21205, USA
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118
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Hamade AM, Al-Bahrani AZ, Owera AMA, Hamoodi AA, Abid GH, Bani Hani OI, O'Shea S, Lee SH, Ammori BJ. Therapeutic, prophylactic, and preresection applications of laparoscopic gastric and biliary bypass for patients with periampullary malignancy. Surg Endosc 2005; 19:1333-40. [PMID: 16021372 DOI: 10.1007/s00464-004-2282-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 05/10/2005] [Indexed: 12/27/2022]
Abstract
BACKGROUND Laparoscopic bypass surgery for the palliation of gastric and biliary obstruction is associated with a rapid recovery. This study aimed to extend its application to other aspects in the management of patients with periampullary cancer. METHODS Between 2001 and 2004, 21 patients (median age, 68 years) underwent laparoscopic gastric (n = 8), biliary (n = 5), and combined gastric and biliary (n = 8) bypass. In addition to its therapeutic role (n = 12), indications included a concomitant prophylactic gastric (n = 3) and biliary (n = 2) bypass as well as pre- 1 Whipple's relief of deep jaundice at the time of staging laparoscopy (n = 3). Construction of the biliary bypass to the gallbladder (n = 11) or bile duct (n = 2) was based on preoperative imaging. RESULTS All procedures were completed laparoscopically. The median operating times for gastric, biliary, and combined bypass were 75, 60, and 130 min, respectively. The addition of a prophylactic bypass did not significantly prolong the operating time, as compared with a single therapeutic bypass. One patient died postoperatively of aspiration pneumonia. The postoperative hospital stay (median, 4 days) was not significantly influenced by the type of bypass. No recurrence of or new obstructive symptoms developed during the follow-up period after a therapeutic or prophylactic bypass. CONCLUSIONS Applications of laparoscopic gastric and biliary bypass can safely be expanded to include a prophylactic role and preresection relief of obstructive jaundice. Prophylactic bypass surgery does not prolong operating time or hospital stay significantly and prevents future onset of obstructive symptoms.
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Affiliation(s)
- A M Hamade
- Department of Surgery, Manchester Royal Infirmary, M13 9WL, Manchester, UK
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119
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Abstract
Endoluminal palliation involves the application of endoscopic techniques or devices to relieve the symptoms of malignant gastrointestinal obstruction. This is most often achieved with the use of self-expandable metal stents (SEMS). SEMS can be deployed as far distally or proximally in the gastrointestinal tract as the reach of an adult colonoscope. This article outlines the use of endoscopic techniques to provide endoluminal palliation.
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Affiliation(s)
- Dia T Simmons
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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121
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Date RS, Siriwardena AK. Laparoscopic Biliary Bypass and Current Management Algorithms for the Palliation of Malignant Obstructive Jaundice. Ann Surg Oncol 2004; 11:815-7. [PMID: 15313739 DOI: 10.1245/aso.2004.12.925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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122
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Abstract
PURPOSE OF REVIEW This review includes a summary of articles that have affected the study and treatment of pancreatic neoplasms over the past year. RECENT FINDINGS Over the past year, there have been several reports of new animal models of pancreatic cancer that recapitulate the human disease and hold promise for preclinical studies. The hope of proteomic and DNA technologies for detecting pancreatic cancer and new genes involved in the biology of this disease are described. New studies examining neoadjuvant and adjuvant treatment of pancreatic cancer show some promise. The surgical treatment and palliation of pancreatic cancer continues to advance. Experiences of the treatment of intraductal pancreatic mucinous neoplasms shed some light on the management of this entity. Two large series of cystic neoplasms point to the evolving management of these often asymptomatic lesions. SUMMARY The treatment of pancreatic neoplasm continues to change and improve as more is learned about these diseases. A renewed clinical and scientific focus on this organ will certainly shape the management of pancreatic neoplasm and holds the promise of improved outcomes.
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Affiliation(s)
- Oscar J Hines
- Section of Gastrointestinal Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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123
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Abstract
Most of the patients with advanced gastric cancer have incurable disease at presentation and require palliative treatment to reduce symptoms as vomiting, nausea and inability to eat. Treatment options are palliative surgery and endoscopic techniques. Insertion of self-expanding metal stents is nowadays a well-established method of treating biliary and esophageal strictures and is also effective in gastric tumors. The indication and application technique are described in this review. In addition, enteral nutrition is indicated if the gastrointestinal tract functions but swallowing or mastication is compromised by disease or if it is needed to pass an obstructed area, especially in gastric tumor patients. This article reviews the enteral nutrition techniques and their clinical value for patients with advanced gastric cancer.
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Affiliation(s)
- A J Dormann
- Department of Medicine, Krankenhaus Holwelde, Koln, Germany.
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