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Medicine Mar 2018The incidence of tumors located in the upper third of the stomach is increasing, and the use of radical proximal gastrectomy is becoming prevalent. After a proximal... (Review)
Review
BACKGROUND
The incidence of tumors located in the upper third of the stomach is increasing, and the use of radical proximal gastrectomy is becoming prevalent. After a proximal gastrectomy, various reconstructions are performed, but surgical outcomes are controversial. This study was performed to review clinical outcomes of reconstructions after proximal gastrectomy.
METHODS
Inclusion criteria focused on postoperative complications of patients who underwent a proximal gastrectomy for gastric cancer. Exclusion criteria were case reports; targeted data not investigated; a duplicate study reported in a larger cohort; esophageal sphincter preservation surgery; near-total gastrectomy; recurrence of tumor; and combined organ resection.
RESULTS
In total, 22 retrospective and 2 prospective studies were included. The studies investigated surgical outcomes of esophagogastrostomy (n = 10), jejunal interposition (n = 12), jejunal pouch interposition (n = 7), double tract jejunal interposition (n = 1), and tube-like stomach esophagogastrostomy (n = 5). Pooled incidences of reflux esophagitis or reflux symptoms for these procedures were 28.6%, 4.5%, 12.9%, 4.7%, and 10.7%, respectively. Incidences of postoperative complications were 9.5%, 18.1%, 7.0%, 11.6%, and 9.3%, respectively.
CONCLUSIONS
Despite increasing operation complexity, which perhaps increased the risk of other postoperative complications, currently used reconstructions present excellent anti-reflux efficacy. However, the optimal reconstruction method remains to be determined.
Topics: Gastrectomy; Gastric Stump; Gastroesophageal Reflux; Humans; Postoperative Complications; Stomach Neoplasms; Treatment Outcome
PubMed: 29538208
DOI: 10.1097/MD.0000000000010121 -
Zhongguo Zhong Yao Za Zhi = Zhongguo... Apr 2023This study aimed to evaluate the efficacy and safety of Biling Weitong Granules in the treatment of stomach ache disorder. Randomized controlled trial(RCT) of Biling... (Meta-Analysis)
Meta-Analysis
This study aimed to evaluate the efficacy and safety of Biling Weitong Granules in the treatment of stomach ache disorder. Randomized controlled trial(RCT) of Biling Weitong Granules in the treatment of digestive diseases with stomach ache disorder as the primary symptom was retrieved from Chinese and English electronic databases and trial registration platforms from database inception to June 10, 2022. Two investigators conducted literature screening and data extraction according to the screening criteria. The Cochrane risk-of-bias tool(v 2.0) was used to assess the risk of bias in the included studies. Analyses were performed using RevMan 5.4 and R 4.2.2, with summary estimates measured using fixed or random effects models. The primary outcome indicators were the visual analogue scale(VAS) scores and stomach ache disorder symptom scores. The secondary outcome indicators were clinical recovery rate, Helicobacter pylori(Hp) eradication rate, and adverse reaction/events. Twenty-seven RCTs were included with a sample size of 2 902 cases. Meta-analysis showed that compared with conventional western medicine treatments or placebo, Biling Weitong Granules could improve VAS scores(SMD=-1.90, 95%CI[-2.18,-1.61], P<0.000 01), stomach ache disorder symptom scores(SMD=-1.26, 95%CI[-1.71,-0.82], P<0.000 01), the clinical recovery rate(RR=1.85, 95%CI[1.66, 2.08], P<0.000 01), and Hp eradication rate(RR=1.28, 95%CI[1.20, 1.37], P<0.000 01). Safety evaluation revealed that the main adverse events in the Biling Weitong Granules included nausea and vomiting, rash, diarrhea, loss of appetite, and bitter mouth, and no serious adverse events were reported. Egger's test showed no statistical significance, indicating no publication bias. The results showed that Biling Weitong Granules in the treatment of digestive system diseases with stomach ache disorder as the primary symptom could improve the VAS scores and stomach ache disorder symptom scores of patients, relieve stomach ache disorder, and improve the clinical recovery rate and Hp eradication rate, with good safety and no serious adverse reactions. However, the quality of the original studies was low with certain limitations. Future studies should use unified and standardized detection methods and evaluation criteria of outcome indicators, pay attention to the rigor of study design and implementation, and highlight the clinical safety of the medicine to provide more reliable clinical evidence support for clinical application.
Topics: Humans; Dyspepsia; Abdominal Pain; Stomach Diseases
PubMed: 37282913
DOI: 10.19540/j.cnki.cjcmm.20221222.501 -
Esophagus : Official Journal of the... Jul 2020Pseudoachalasia, also known as secondary achalasia, is a clinical condition mimicking idiopathic achalasia but most commonly caused by malignant tumors of...
Pseudoachalasia, also known as secondary achalasia, is a clinical condition mimicking idiopathic achalasia but most commonly caused by malignant tumors of gastroesophageal junction (GEJ). Our aim was to systematically review and present all available data on demographics, clinical features, and diagnostic modalities involved in patients with pseudoachalasia. A systematic search of literature published during the period 1978-2019 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (end-of-search date: June 25th, 2019). Two independent reviewers extracted data with regards of study design, interventions, participants, and outcomes. Thirty-five studies met our inclusion criteria and were selected in the present review. Overall, 140 patients with pseudoachalasia were identified, of whom 83 were males. Mean patient age was 60.13 years and the mean weight loss was 13.91 kg. A total of 33 (23.6%) patients were wrongly 'treated' at first for achalasia. The most common presenting symptoms were dysphagia, food regurgitation, and weight loss. The median time from symptoms' onset to hospital admission was 5 months. Most common etiology was gastric cancer (19%). Diagnostic modalities included manometry, barium esophagram, endoscopy, and computed tomography (CT). Pseudoachalasia is a serious medical condition that is difficult to be distinguished from primary achalasia. Clinical feature assessment along with the correct interpretation of diagnostic tests is nowadays essential steps to differentiate pseudoachalasia from idiopathic achalasia.
Topics: Adult; Aged; Aged, 80 and over; Animals; Child; Deglutition; Deglutition Disorders; Diagnosis, Differential; Diagnostic Errors; Endoscopy; Esophageal Achalasia; Esophagogastric Junction; Female; Humans; Male; Manometry; Middle Aged; Rumination, Digestive; Stomach Neoplasms; Time Factors; Tomography, X-Ray Computed; Weight Loss
PubMed: 31989338
DOI: 10.1007/s10388-020-00720-1 -
World Journal of Surgery Oct 2018Stricture is a common complication of gastrointestinal (GI) anastomoses, associated with impaired quality of life, risk of malnutrition, and further interventions. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Stricture is a common complication of gastrointestinal (GI) anastomoses, associated with impaired quality of life, risk of malnutrition, and further interventions. This systematic review and meta-analysis aimed to determine the association between circular stapler diameter and anastomotic stricture rates throughout the GI tract.
METHODS
A systematic literature search of EMBASE, MEDLINE and Cochrane Library was performed. The primary outcome was the rate of radiologically or endoscopically confirmed anastomotic stricture. Pooled odds ratios (OR) were calculated using random-effects models to determine the effect of circular stapler diameter on stricture rates in different regions of the GI tract.
RESULTS
Twenty-one studies were identified: seven oesophageal, twelve gastric, and three lower GI. Smaller stapler sizes were strongly associated with higher anastomotic stricture rates throughout the GI tract. The oesophageal anastomosis studies showed; 21 versus 25 mm circular stapler: OR 4.39 ([95% CI 2.12, 9.07]; P < 0.0001); 25 versus 28/29 mm circular stapler: OR 1.71 ([95% CI 1.15, 2.53]; P < 0.008). Gastric studies showed; 21 versus 25 mm circular stapler: OR 3.12 ([95% CI 2.23, 4.36]; P < 0.00001); 25 versus 28/29 mm circular stapler: OR 7.67 ([95% CI 1.86, 31.57]; P < 0.005). Few lower GI studies were identified, though a similar trend was found: 25 versus 28/29 mm circular stapler: pooled OR 2.61 ([95% CI 0.82, 8.29]; P = 0.100).
CONCLUSIONS
The use of larger circular stapler sizes is strongly associated with reduced risk of anastomotic stricture in the upper GI tract, though data from lower GI joins are limited.
Topics: Adult; Aged; Anastomosis, Surgical; Constriction, Pathologic; Esophagus; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Odds Ratio; Quality of Life; Stomach; Surgical Staplers
PubMed: 29633101
DOI: 10.1007/s00268-018-4606-x -
Obstetrics and Gynecology Jun 2015To evaluate the incidence of bowel injury in gynecologic laparoscopy and determine the presentation, mortality, cause, and location of injury within the gastrointestinal... (Review)
Review
OBJECTIVE
To evaluate the incidence of bowel injury in gynecologic laparoscopy and determine the presentation, mortality, cause, and location of injury within the gastrointestinal tract.
DATA SOURCES
The PubMed, EMBASE, ClinicalTrials.gov, and Cochrane Library databases were searched. Additional studies were obtained from references of retrieved papers.
METHODS OF STUDY SELECTION
Included retrospective studies and randomized controlled trials reported the incidence of bowel injury in gynecologic laparoscopy. Studies were excluded if they were not in English or duplicated data.
TABULATION, INTEGRATION, AND RESULTS
Two reviewers extracted data in duplicate from each study regarding incidence, cause, and location of bowel injury. Ninety studies published between 1972 and 2014 met eligibility criteria, representing 474,063 gynecologic laparoscopies. Six hundred four bowel injuries were reported for an incidence of 1 in 769 (0.13%, 95% confidence interval [CI] 0.12-0.14%). The rate of bowel injury varied by procedure, ranging from 1 in 3,333 (0.03%, 95% CI 0.01-0.03%) for sterilization to 1 in 256 (0.39%, 95% CI 0.34-0.45%) for hysterectomy. The small intestine was the most frequently damaged region of the gastrointestinal tract, representing 166 of 354 (47%) injuries. The majority of bowel injuries occurred during abdominal access and insufflation obtained using a Veress needle or trocar placement (201/366, 55% of injuries). Although most bowel injuries were recognized intraoperatively, diagnosis was delayed by more than 1 day in 154 of 375 cases (41%, 95% CI 36-46%). Bowel injuries were managed primarily by laparotomy (80%). Mortality occurred after bowel injury in 5 of 604, or 1 of 125 (0.8%, 95% CI 0.36-1.9%) cases. All deaths occurred as a result of delayed recognition of bowel injury (n=154), making the mortality rate for unrecognized bowel injury 5 in 154 or 1 in 31 (3.2%, 95% CI 1-7%). There were no deaths associated with intraoperatively diagnosed bowel injury.
CONCLUSION
The overall incidence of bowel injury in gynecologic laparoscopy is 1 in 769 but increases with surgical complexity. Delayed diagnosis is associated with a mortality rate of 1 in 31.
Topics: Colon; Female; Gynecologic Surgical Procedures; Humans; Incidence; Intestinal Perforation; Intestine, Small; Laparoscopy; Rectum; Stomach
PubMed: 26000512
DOI: 10.1097/AOG.0000000000000855 -
Journal of Gastrointestinal Surgery :... Nov 2023Resection options for early gastric cancer (EGC) include endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and surgery. In patients with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Resection options for early gastric cancer (EGC) include endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and surgery. In patients with metachronous EGC following previous resection, the optimal resection technique is not well elucidated. We conducted a systematic review and meta-analysis of studies comparing ESD to EMR, or ESD to surgery, in patients with metachronous EGC.
METHODS
We conducted an electronic search of studies reporting on outcomes and AEs following ESD versus either EMR or surgery for patients with metachronous EGC. Pooled odds ratios (OR) of included studies were obtained using DerSimonian and Laird random effects models. Funnel plots were produced and visually inspected for evidence of publication bias. The quality of the evidence was assessed using GRADE.
RESULTS
A total of 9367 abstracts were screened and 10 observational studies were included. The odds of complete resection were higher amongst patients undergoing ESD compared to EMR (OR 5.88, 95% confidence intervals, CI, 1.79-19.35), whereas the odds of complete resection were no different between ESD and surgery (OR 0.57, 95% CI 0.04-8.24). There were no differences in the odds of local recurrence with ESD versus surgery (OR 5.01, 95% CI 0.86-29.13). Post-procedural bleeding did not differ significantly between ESD and EMR (OR 0.70, 95% CI 0.16-3.00). There was no evidence of publication bias.
DISCUSSION
For metachronous EGC, ESD or surgery is preferred over EMR depending on local expertise and patient preferences, largely due to a higher risk of incomplete resection with EMR.
REVIEW REGISTRATION
PROSPERO CRD42021270445.
Topics: Humans; Endoscopic Mucosal Resection; Stomach Neoplasms; Treatment Outcome; Early Detection of Cancer; Neoplasm Recurrence, Local; Retrospective Studies; Gastric Mucosa
PubMed: 37752384
DOI: 10.1007/s11605-023-05840-4 -
ANZ Journal of Surgery Sep 2022Bochdalek hernia (BH) is characterized by the protrusion of viscera into thorax through the posterolateral section of the diaphragm. The aim of this study was to... (Review)
Review
BACKGROUND
Bochdalek hernia (BH) is characterized by the protrusion of viscera into thorax through the posterolateral section of the diaphragm. The aim of this study was to systematically review current literature concerning Bochdalek hernias in adults and elucidate their clinical characteristics and preferable treatment approach.
METHODS
A search of PubMed and Cochrane bibliographical databases for studies regarding BHs was conducted (last search: 31st March 2021).
RESULTS
Predefined inclusion criteria were met by 173 articles and concerned collectively 192 patients (50.5% males) with a mean age of 45.41 ± 20.26 years. Abdominal pain (62.0%) and pulmonary symptoms (41.1%) were the predominant symptomatology of included cases. BHs protruded mainly through the left side of the diaphragm (70.7%), with large intestine (42.7%) and stomach (37.1%) being the most commonly herniated abdominal organs. Most patients (53.8%) underwent an open surgical approach, while abdominal approach was preferred (64.8%). to the thoracic one. Thirty-day postoperative complication were encountered at 21.5% of patients, while 30-day mortality reached 4.4%.
CONCLUSION
BH is an extremely rare type of congenital diaphragmatic hernia. It rarely concerns adults, and it manifests with vague gastrointestinal or pulmonary symptoms. Surgical approach is the preferred method for their management with open procedures being preferable at emergency cases, while minimal invasive approach necessitates experienced centers. Further research is needed in order to clarify their true incidence and optimal therapeutic strategy.
Topics: Abdomen; Abdominal Cavity; Abdominal Pain; Adult; Aged; Female; Hernias, Diaphragmatic, Congenital; Humans; Male; Middle Aged; Stomach
PubMed: 35357073
DOI: 10.1111/ans.17651 -
Digestive Diseases and Sciences Apr 2023Peroral endoscopic myotomy (POEM) achieves a satisfactory short-term clinical response in patients with achalasia. However, data on mid- and long-term clinical outcomes... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Peroral endoscopic myotomy (POEM) achieves a satisfactory short-term clinical response in patients with achalasia. However, data on mid- and long-term clinical outcomes are limited. We aimed to assess the mid- and long-term efficacy and safety of POEM in achalasia patients.
METHODS
Using the pre-designed search strategy, we identified relevant studies that evaluated the efficacy and safety of POEM with a minimum of 2-year follow-up in the Embase, Cochrane, and PubMed databases from inception to January 2021. Primary outcome was pooled mid- and long-term clinical success rate based on the Eckardt score. Secondary outcome was pooled long-term reflux-related adverse events.
RESULTS
A total of 21 studies involving 2,698 patients were included. Overall, the pooled clinical success rates with 2-, 3-, 4-, and 5-year follow-ups were 91.3% (95% confidence interval [CI] 88.4-93.6%), 90.4% (95% CI 88.1-92.2%), 89.8% (95% CI 83.6-93.9%), and 82.2% (95% CI 76.6-86.7%), respectively. Besides, the pooled long-term clinical success rates for type I, II, and III achalasia were 86.1% (95% CI 80.9-90.1%; I = 0%), 87.9% (95% CI 84.2-90.8%; I = 48.354%), and 83.9% (95% CI 72.5-91.2%; I = 0%), respectively. Moreover, the pooled incidence of symptomatic reflux and reflux esophagitis was 23.9% (95% CI 18.7-29.9%) and 16.7% (95% CI 11.9-23.1%), respectively.
CONCLUSIONS
POEM is associated with a long-term clinical success of 82.2% after 5 years of follow-up. Randomized control trials comparing POEM with laparoscopic Heller myotomy or pneumatic dilation with longer follow-up periods are needed to further demonstrate the long-term safety and efficacy of POEM.
Topics: Humans; Esophageal Achalasia; Treatment Outcome; Gastroesophageal Reflux; Heller Myotomy; Dilatation; Natural Orifice Endoscopic Surgery; Esophageal Sphincter, Lower
PubMed: 36260203
DOI: 10.1007/s10620-022-07720-4 -
Future Oncology (London, England) Jun 2022To conduct a systematic review and meta-analysis on the prediction of severity of gastric intestinal metaplasia (GIM) in localized and entire gastric mucosa using... (Meta-Analysis)
Meta-Analysis Review
To conduct a systematic review and meta-analysis on the prediction of severity of gastric intestinal metaplasia (GIM) in localized and entire gastric mucosa using endoscopy. The authors searched Web of Science, PubMed, Embase and Cochrane Central Register of Controlled Trials and performed systematic searches on endoscopic grading of GIM of the entire stomach using Meta-DiSc and Stata. Sensitivity and specificity for the stratified prediction of overall GIM were 0.91 (95% CI: 0.85-0.95) and 0.91 (95% CI: 0.88-0.93), respectively. Sensitivity in predicting the different grades of GIM was higher in operative link on GIM assessment grades 0, III and IV but lower in grades I and II. Digital chromoendoscopy is well suited to predicting the severity of localized and overall GIM.
Topics: Endoscopy, Gastrointestinal; Gastric Mucosa; Humans; Metaplasia; Precancerous Conditions; Stomach Neoplasms
PubMed: 35574611
DOI: 10.2217/fon-2021-1390 -
International Journal of Environmental... Aug 2021Child labour remains a prevalent global concern, and progress toward eradicating harmful children's work appears to have stalled in the African continent and henceforth,... (Review)
Review
Child labour remains a prevalent global concern, and progress toward eradicating harmful children's work appears to have stalled in the African continent and henceforth, integrated social policy intervention is still required to address the problem. Among several forms of social policy interventions, stomach infrastructure (i.e., in-kind and/or cash transfers) have been a key policy approach to support vulnerable families to lighten households' resources burden, which forces them to consider child labour as a coping strategy. There is growing evidence on the impacts of these programs in child labour. However, this evidence is often mixed regarding children's work outcomes, and the existing studies hardly describe such heterogeneous outcomes from the child-sensitive approach. To this end, a systematic literature search was conducted for studies in African countries. From 743 references retrieved in this study, 27 studies were included for the review, and a narrative approach has been employed to analyse extracted evidence. Results from the current study also demonstrate a mixed effect of in-kind and cash transfers for poor households on child labour decisions. Hence, the finding from the current review also demonstrates a reduced participation of children in paid and unpaid work outside the household due to in-kind and cash transfers to poor households, but children's time spent in economic and non-economic household labour and farm and non-farm labour, which are detrimental to child health and schooling, has been reported increasing due to the program interventions. The question remains how these programs can effectively consider child-specific and household-related key characteristics. To this end, a child-sensitive social protection perspective has been applied in this study to explain these mixed outcomes to inform policy design.
Topics: Africa; Child; Child Health; Child Labor; Family Characteristics; Humans; Stomach
PubMed: 34444309
DOI: 10.3390/ijerph18168563