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Amaya-Fragoso E, Hernández-Guerrero A, de la Mora Levy JG, Ramírez-Solís ME, Alonso-Lárraga JO, Beltrán-Galindo LG. Mortality in patients with unresectable gastric cancer complicated with tumor bleeding. Rev Esp Enferm Dig 2024; 116:132-139. [PMID: 37170581 DOI: 10.17235/reed.2023.9508/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND gastric cancer (GC) is a gastrointestinal (GI) neoplasia which often complicates with GI bleeding. It is uncertain if bleeding worsens mortality in this group of patients. AIMS to compare 30- and 90-day mortality in patients with unresectable GC (uGC) and tumor bleeding versus patients with the same neoplasia without bleeding. METHODS a retrospective analysis of patients with uGC, with and without tumor bleeding was performed. Survival analysis for 30- and 90-days mortality was performed using Cox regression. Logistic regression was used to identify risk factors associated with mortality and first bleeding episode. RESULTS 202 patients were included in the analysis (105 cases). Mortality at 90 days was 37.14 % for cases and 20.62 % for controls (p = 0.04). There was a significant difference in hazard ratio (HR) at 90 days for cases compared to controls (HR 1.95, 95 % CI 1.14-3.34, p = 0.02). Cases without palliative chemotherapy had the highest 90-days mortality (HR 5.43, 95 % CI 2.12-13.87, p < 0.01), compared to controls treated with chemotherapy. Predictors for first tumor bleeding were clinical stage IV (OR 2.93, 95 % CI 1.04-8.26, p = 0.04), Helicobacter pylori infection (OR 2.80, 95 % CI 1.35-5.80, p < 0.01) and histologic intestinal-subtype (OR 2.14, 95 % CI 1.07-4.30, p = 0.03). CONCLUSIONS tumor bleeding increases 90-days mortality in patients with uGC. Prevention of the first bleeding episode might improve outcome in these patients and the recognition of high-risk patients might help decision-making.
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Jiménez-Gutiérrez JM, de la Mora-Levy JG, Alonso-Lárraga JO, Hernández-Guerrero AI, Soriano-Herrera BA, Villegas-González LF, Uscanga-Domínguez LF, López-Romero S, Téllez-Ávila FI. EUS-guided tissue acquisition in patients with solid pseudopapillary neoplasms of the pancreas. Postgrad Med 2024; 136:78-83. [PMID: 38315145 DOI: 10.1080/00325481.2024.2313446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has been the most common method used for the preoperative cytopathological diagnosis of solid tumors of the pancreas. There are only a few reported cases about the role of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) in the pre-operative diagnosis of solid pseudopapillary neoplasms (SPN). This study aimed to evaluate the diagnostic yield of EUS-TA,including endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) andEUS-FNB, in patients with SPN. METHODS We performed a retrospective analysis of patients with EUS-TA for SPN diagnosis in 2 referral centers. The primary outcome was the diagnostic yield of EUS-TA compared to the surgical specimen. RESULTS Seventy-four patients with SPN of the pancreas were identified. Eighteen had a EUS-TA (10 EUS-FNB and 8 EUS-FNA). The median age of the patients was 31 years (IQR 21-38), and all patients were women. The most common presenting symptom was abdominal pain. Most of the tumors were in the head of the pancreas (9/18; 50%). The median tumor size by EUS was 4.5 cm (min-max 2-15 cm). The most common appearance on EUS was a solid lesion (n = 8/18, 44.4%). A definitive presurgical cytopathological diagnosis was obtained in 16/18 patients (88.8%) with EUS-TA. The sensitivity and positive predictive value of the EUS-TA were 94% each. One patient in the EUS-FNB group developed mild acute pancreatitis. CONCLUSION The diagnostic yield of the EUS-TA in SPN is high. In most cases, the diagnosis was obtained with the first procedure. No differences in the diagnostic yield or AEs between EUS-FNA vs. EUS-FNB needles were seen.
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Affiliation(s)
| | | | - Juan O Alonso-Lárraga
- Department of Endoscopy, Instituto Nacional de Cancerología, Ciudad de México, México
| | | | | | | | - Luis F Uscanga-Domínguez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Stephanie López-Romero
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Félix I Téllez-Ávila
- Division of Gastroenterology & Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Suder-Castro LS, Ramírez-Solís ME, Hernández-Guerrero AI, de la Mora-Levy JG, Alonso-Lárraga JO, Hernández-Lara AH. Predictors of self-expanding metallic stent dysfunction in malignant gastric outlet obstruction. Rev Gastroenterol Mex (Engl Ed) 2020; 85:275-281. [PMID: 32229056 DOI: 10.1016/j.rgmx.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/16/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Self-expanding metallic stents (SEMS) are the ideal treatment for malignant gastric outlet obstruction (MGOO) in patients with a short life expectancy, but stent dysfunction is frequent. The primary aim of our study was to identify the predictive factors of SEMS dysfunction in MGOO and the secondary aim was to determine the technical success, clinical success, and nutritional impact after SEMS placement. MATERIAL AND METHODS A retrospective, longitudinal study was conducted at the gastrointestinal endoscopy department of the Instituto Nacional de Cancerología in Mexico City. Patients diagnosed with MGOO that underwent SEMS placement within the time frame of January 2015 to May 2018 were included. We utilized the gastric outlet obstruction scoring system (GOOSS) to determine clinical success and SEMS dysfunction. RESULTS The study included 43 patients, technical success was 97.7% (n=42), and clinical success was 88.3% (n=38). SEMS dysfunction presented in 30.2% (n=13) of the patients, occurring in<6 months after placement in 53.8% (n=7) of them. In the univariate analysis, the histologic subtype, diffuse gastric adenocarcinoma (p=0.02) and the use of uncovered SEMS (p=0.02) were the variables associated with dysfunction. Albumin levels and body mass index did not increase after SEMS placement. Medical follow-up was a mean 5.8 months (1-24 months). CONCLUSIONS SEMS demonstrated adequate technical and clinical efficacy in the treatment of MGOO. SEMS dysfunction was frequent and diffuse type gastric cancer and uncovered SEMS appeared to be dysfunction predictors.
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Affiliation(s)
- L S Suder-Castro
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México.
| | - M E Ramírez-Solís
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - A I Hernández-Guerrero
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - J G de la Mora-Levy
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - J O Alonso-Lárraga
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
| | - A H Hernández-Lara
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Ciudad de México, México
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González-Sánchez CB, Alonso-Lárraga JO, Maldonado Vázquez A, Gallegos-Garza C, Castillo González FA. Granular cell tumor of the esophagus. Rev Gastroenterol Mex (Engl Ed) 2017; 83:69-70. [PMID: 28366624 DOI: 10.1016/j.rgmx.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/08/2016] [Accepted: 06/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
- C B González-Sánchez
- Servicio de Gastroenterología y Endoscopia Gastro-Intestinal, Hospital Ángeles Pedregal, Ciudad de México, México.
| | - J O Alonso-Lárraga
- Servicio de Gastroenterología y Endoscopia Gastro-Intestinal, Hospital Ángeles Pedregal, Ciudad de México, México
| | - A Maldonado Vázquez
- Servicio de Cirugía General, Hospital Ángeles Pedregal, Ciudad de México, México
| | - C Gallegos-Garza
- Servicio de Patología, Hospital Ángeles Pedregal, Ciudad de México, México
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Alonso-Lárraga JO, Hernández Guerrero A, Ramírez-Solís ME, de la Mora Levy JG. OTSC ® system for the treatment of gastrointestinal perforations. Rev Gastroenterol Mex 2016; 82:266-267. [PMID: 27667761 DOI: 10.1016/j.rgmx.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- J O Alonso-Lárraga
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México.
| | - A Hernández Guerrero
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - M E Ramírez-Solís
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - J G de la Mora Levy
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
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Alonso-Lárraga JO, de la Mora Levy JG, Hernández Guerrero A, Rodarte-Shade M, Ramírez-Solís ME. Fully covered metal stents for the treatment of leaks after esophagogastric oncologic surgery. Rev Gastroenterol Mex 2016; 82:100-102. [PMID: 27161793 DOI: 10.1016/j.rgmx.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J O Alonso-Lárraga
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México.
| | - J G de la Mora Levy
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - A Hernández Guerrero
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - M Rodarte-Shade
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - M E Ramírez-Solís
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
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Alonso-Lárraga JO. [Treatment of biliary obstruction in pancreatic cancer]. Rev Gastroenterol Mex 2012; 77 Suppl 1:65-6. [PMID: 22939486 DOI: 10.1016/j.rgmx.2012.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sobrino-Cossío S, Fenocchi E, Hernández-Guerrero A, Alonso-Lárraga JO, De la Mora-Levy JG, Larracilla-Salazar I. Immunological fecal occult blood test vs. serum ferritin for detection of colorectal neoplasia in high risk asymptomatic population. Rev Gastroenterol Mex 2011; 76:191-198. [PMID: 22041307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Fecal occult blood tests (FOBT) (biochemical or immunological) are based on the fact that most of the polyps or cancers bleed. Anemia due to iron deficiency is a wellknown sign for colorectal cancer (CRC). Ferritin is frequently used to select candidates for colonoscopy. OBJECTIVE To determine and compare the diagnostic value of immunological fecal occult blood test vs. ferritin for the detection of colorectal neoplasia (cancer or polyps) in high-risk patients. METHODS A transversal prospective study at National Cancer Institute, Mexico City, in consecutive asymptomatic subjects at high risk for CRC was performed, comparing two tests (immunological against serum ferritin) with colonoscopy plus histopathology. Both tests were performed in a blindly fashion previous to colonoscopy. RESULTS Fifty patients were included in the study; twenty-eight patients had colorectal neoplasia (21 CRC, 7 adenomas). All immunologic tests for fecaloccult blood were positive in patients with colorectal lesions (sensitivity, 98%). There was no difference between the mean ferritin levels in patients with CRC or adenomas vs. those with negative colonoscopy (p = 0.58). The cutoff point where significant relationship between serum ferritin levels and colon lesions was established was ?46 ng/mL. In anemic patients with serum ferritin levels <46 ng/mL, the test had a sensitivity 53%, specificity 86%, positive predictive value 83%, and negative predictive value of 59% (p = 0.003). CONCLUSIONS The immunological FOBT is a better diagnostic tool than serum ferritin for screening of colonic neoplasms.
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Affiliation(s)
- S Sobrino-Cossío
- Gastrointestinal Endoscopy Department, Instituto Nacional de Cancerología, México.
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Reyes-Bastidas MR, Sobrino-Cossio S, Hernández-Guerrero A, Alonso-Lárraga JO, De La Mora-Levy JG, Herrera-Goepfert R. [The value of targeted biopsies with endoscopic magnification and narrow band image vs. chromoendoscopy for the diagnosis of gastric metaplasia]. Rev Gastroenterol Mex 2011; 76:224-230. [PMID: 22041311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Endoscopy is the better test to detect premalignant lesions, but its main problem is the sampling error. OBJECTIVES To evaluate the diagnostic usefulness of endoscopic biopsies using narrow band imaging (NBI) vs. chromoendoscopy for diagnosing gastric intestinal metaplasia. METHODS Forty one patients were studied with conventional endoscopy, NBI magnification endoscopy and chromoendoscopy (3% acetic acid, 0.6% indigo carmine) for examination of gastric antrum. Biopsies were taken randomly from the antrum, body and incisura angularis. Additional biopsies were taken from areas with villous or crypt pattern according to NBI and chromoendoscopy examination (targeted biopsies). RESULTS 240 biopsies were taken, 205 randomized biopsies and 35 targeted biopsies. Intestinal metaplasia was found in 25 randomized biopsies and 9 directed samples (12% vs. 25.7%). The NBI and chromoendoscopy had sensitivity of 70% vs. 77%, specificity of 97% vs. 98%, with diagnostic accuracy of 96% vs. 97%, respectively. Random biopsies and targeted biopsies had a sensitivity of 91% vs. 74%, specificity of 51% vs. 95%, and diagnostic accuracy of 93% vs. 86%, respectively. The intra-observer variability showed a k value of 0.86 (range 0.74 to 0.99). CONCLUSION Targeted biopsies are more specific than random biopsies to detect gastric intestinal metaplasia. NBI and chromoendoscopy may be used similarly to guide biopsies.
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Alonso-Lárraga JO, Reyes-Bastidas MR, Sobrino-Cossio S, Hernández-Guerrero A, López-Alvarenga JC. [IT-Knife-2 electroincision as primary treatment of anastomotic strictures]. Rev Gastroenterol Mex 2011; 76:217-223. [PMID: 22041310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Dysphagia is a common problem after surgical stenosis (5% to 55%) and can be refractory to conventional endoscopic treatment in 22% of cases. It has been proposed that electro-incision is an alternative and effective treatment. OBJECTIVE To evaluate the effectiveness of electro-incision with the insulation-tipped diathermic Knife-2 (IT-Knife-2) in the treatment of dysphagia produced by surgical anastomotic strictures. METHODS Longitudinal and case-series study from August 2009 to June 2010. Eight consecutive patients with anastomotic stricture-associated dysphagia and naive to endoscopic treatment were included. We performed three or more radiated cuts in the stricture until passage of the gastroscope was achieved with IT-Knife-2 and electrocautery (ERBE IC 200) with a 70-100 W energy cut-off and 25 W coagulation. We carried out measurements at baseline and 15 days after the intervention, evaluating the dysphagia by the Atkinson grading scale and endoscopic changes. RESULTS The majority of patients were at clinical stage IV with an Eastern Cooperative Oncology Group score of 1 - 3 and Karnofsky between 40 and 90. At the time of endoscopic diagnosis, patients had dysphagia grade II and III. Strictures in all of the cases were short in length and had a diameter of minor than 5 mm. At 15 days of the intervention, no patient demonstrated dysphagia (p = 0.0013) and the anastomotic diameters was more than 9.5 mm and without evidence of stenosis (p = 0.0001). None of our patients presented postincisional complications. CONCLUSIONS Electro-incision with IT-Knife-2 is effective as primary treatment for the relief of benign dysphagia associated with postsurgical anastomotic stenosis."
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Affiliation(s)
- J O Alonso-Lárraga
- Adscrito al Servicio Endoscopia Digestiva, Instituto Nacional de Cancerología, SSA, México, D F.
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Figueroa-Barojas P, Sobrino-Cossío S, Hernández-Guerrero A, Ramírez-Solís ME, Alonso-Lárraga JO, Rodríguez-Brambila V, Álvaro-Villegas J. [Endoscopic inanimate biological simulators for training in endoscopic mucosal dissection]. Rev Gastroenterol Mex 2010; 75:380-388. [PMID: 21169104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Simulators have been used as a training method; they allow training, skill development, standardization of techniques and the performance of a greater number of risk-free procedures. Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer since it allows en bloc resection of larger lesions however requires longer procedure time and has more complications than endoscopic mucosal resection. OBJECTIVE To evaluate the use of biological inanimate simulators in endoscopic training for the development of skills required for ESD. METHODS Experimental design using a biological inanimate simulator to evaluate the development of endoscopic skills. Five trained endoscopists with knowledge of the ESD technique, but without previous experience were selected. Technical success, complication rate and procedure time were evaluated. Each participant performed a self-evaluation. RESULTS 18 lesions of 10-20 mm in diameter were dissected, with a mean area of 2.64 ± 2 cm2 and a mean procedure time of 21.08 ± 14.01 minutes (5.48 - 48.61). Self-evaluation and instructor's evaluation showed a strong positive correlation. There was no correlation between lesion size and procedure time. There was one perforation (5.8%), which was successfully managed with one endoclip. Complications such as bleeding could not be assed. CONCLUSIONS The use of inanimate biological simulators allows training in complex endoscopic procedures such as ESD with a wide safety margin. Lesion size did not correlate with procedure time. It is necessary to increase the number of procedures to improve the learning curve. This simulator does not allow evaluation of complications other than perforations.
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Affiliation(s)
- P Figueroa-Barojas
- Departamento de Endoscopia, Instituto Nacional de Cancerología, México, D.F. México.
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