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The Cochrane Database of Systematic... Jan 2015Enteral nutrition by feeding tube is a common and efficient method of providing nutritional support to prevent malnutrition in hospitalised patients who have adequate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Enteral nutrition by feeding tube is a common and efficient method of providing nutritional support to prevent malnutrition in hospitalised patients who have adequate gastrointestinal function but who are unable to eat. Gastric feeding may be associated with higher rates of food aspiration and pneumonia than post-pyloric naso-enteral tubes. Thus, enteral feeding tubes are placed directly into the small intestine rather than the stomach, and the use of metoclopramide, a prokinetic agent, has been recommended to achieve post-pyloric placement, but its efficacy is controversial. Moreover, metoclopramide may include adverse reactions, which with high doses or prolonged use may be serious and irreversible.
OBJECTIVES
To determine the effect of intravenous metoclopramide on post-pyloric placement of the naso-enteral tube in adults.
SEARCH METHODS
Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10) which includes the CUGPD group's specialised register of trials, MEDLINE (1996 to 21 October 2014), EMBASE (1988 to 21 October 2014), LILACS (2005 to 21 October 2014) We did not confine our search to English language publications. Searches in all databases were updated originally in January 2005, then in November 2008 and again in October 2014. No new studies were found in 2008 or in 2014.
SELECTION CRITERIA
We selected randomised controlled trials of adults needing enteral nutrition, who received intravenous or intramuscular metoclopramide to aid placement of transpyloric naso-enteral feeding tubes, compared to placebo or no intervention.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration. All analyses were performed according to the intention-to-treat method. We present risk ratios (RR) with 95% confidence intervals (CI).
MAIN RESULTS
Four studies, with a total of 204 participants were included and analysed. The trials compared metoclopramide with placebo (two trials) or with no intervention (two trials). Metoclopramide was investigated at doses of 10 mg (two trials) and 20 mg (two trials). There was no statistically significant difference between metoclopramide versus placebo or no intervention administered to promote tube placement (RR 0.82, 95% CI 0.61 to 1.10). Metoclopramide at doses of 10 mg (RR 0.82, 95% CI 0.60 to 1.11) and 20 mg (RR 0.62, 95% CI 0.15 to 2.62) were equally ineffective in facilitating post-pyloric intubation when compared with placebo or no intervention.
AUTHORS' CONCLUSIONS
In this review, we found only four studies that fitted our inclusion criteria. These were small, underpowered studies, in which metoclopramide was given at doses of 10 mg and 20 mg. Our analysis showed that metoclopramide did not assist post-pyloric placement of naso-enteral feeding tubes.Ideally randomised clinical trials should be performed that have a significant sample size, administering metoclopramide against control, however, given the lack of efficacy revealed by this review it is unlikely that further studies will be performed.
Topics: Antiemetics; Duodenum; Enteral Nutrition; Gastric Emptying; Humans; Injections, Intravenous; Intubation, Gastrointestinal; Jejunum; Metoclopramide; Pylorus; Randomized Controlled Trials as Topic
PubMed: 25564770
DOI: 10.1002/14651858.CD003353.pub2 -
Gastrointestinal Endoscopy Dec 2020Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy... (Comparative Study)
Comparative Study Meta-Analysis
Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis.
BACKGROUND AND AIMS
Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe).
METHODS
A literature search of publication databases was performed from their inception to February 2020 for relevant studies. The outcomes of interest were percentage total body weight loss, gastrojejunal anastomosis (GJA) diameter, and adverse events (AEs). The pooled effect estimates were analyzed using a random-effects model. Meta-regression was conducted to identify associations between GJA diameter and weight loss.
RESULTS
Nine ft-TORe (n = 737) and 7 APMC-TORe (n = 888) studies were included. APMC-TORe was performed as a series of sessions (mean number of sessions ranging from 1.2 to 3), whereas ft-TORe was mostly performed as a single session. Percentage total body weight loss was 8.0% (95% confidence interval [CI], 6.3%-9.7%), 9.5% (95% CI, 8.1%-11.0%), and 5.8% (95% CI, 4.3%-7.1%) after ft-TORe and 9.0% (95% CI, 4.1%-13.9%), 10.2% (95% CI, 8.4%-12.1%), and 9.5% (95% CI, 5.7%-13.2%) after APMC-TORe at 3, 6, and 12 months, respectively, with no weight-loss difference at 3 and 6 months (P > .05). Only one severe AE was observed after APMC-TORe and none after ft-TORe. Stricture formation was the most common AE (ft-TORe 3.3% and APMC-TORe 4.8%, P = .38). All were successfully treated by endoscopic dilation or conservative treatment. Smaller aperture of the post-TORe GJA and greater change in the GJA diameter correlated with greater weight loss in APMC-TORe and numerical trends in ft-TORe.
CONCLUSIONS
This meta-analysis demonstrates that both ft-TORe and APMC-TORe offer significant and comparable weight-loss outcomes with a high and comparable safety profile. However, APMC-TORe typically required multiple endoscopic sessions. Identifying a goal for the final and change in GJA diameter could be useful treatment targets.
Topics: Argon Plasma Coagulation; Gastric Bypass; Gastroscopy; Humans; Jejunum; Natural Orifice Endoscopic Surgery; Obesity, Morbid; Plasma Gases; Recurrence; Reoperation; Stomach; Suture Techniques; Treatment Outcome; Weight Gain
PubMed: 32692991
DOI: 10.1016/j.gie.2020.07.013 -
Advances in Nutrition (Bethesda, Md.) Sep 2017This is the first systematic review, to our knowledge, of published studies investigating the gastrointestinal effects of A1-type bovine β-casein (A1) compared with... (Review)
Review
This is the first systematic review, to our knowledge, of published studies investigating the gastrointestinal effects of A1-type bovine β-casein (A1) compared with A2-type bovine β-casein (A2). The review is relevant to nutrition practice given the increasing availability and promotion in a range of countries of dairy products free of A1 for both infant and adult nutrition. In vitro and in vivo studies (all species) were included. In vivo studies were limited to oral consumption. Inclusion criteria encompassed all English-language primary research studies, but not reviews, involving milk, fresh-milk products, β-casein, and β-casomorphins published through 12 April 2017. Studies involving cheese and fermented milk products were excluded. Only studies with a specific gastrointestinal focus were included. However, inclusion was not delimited by specific gastrointestinal outcome nor by a specific mechanism. Inclusion criteria were satisfied by 39 studies. In vivo consumption of A1 relative to A2 delays intestinal transit in rodents via an opioid-mediated mechanism. Rodent models also link consumption of A1 to the initiation of inflammatory response markers plus enhanced Toll-like receptor expression relative to both A2 and nonmilk controls. Although most rodent responses are confirmed as opioid-mediated, there is evidence that dipeptidyl peptidase 4 stimulation in the jejunum of rodents is via a nonopioid mechanism. In humans, there is evidence from a limited number of studies that A1 consumption is also associated with delayed intestinal transit (1 clinical study) and looser stool consistency (2 clinical studies). In addition, digestive discomfort is correlated with inflammatory markers in humans for A1 but not A2. Further research is required in humans to investigate the digestive function effects of A1 relative to A2 in different populations and dietary settings.
Topics: Animals; Biomarkers; Caseins; Diet; Dipeptidyl Peptidase 4; Disease Models, Animal; Endorphins; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Meta-Analysis as Topic; Randomized Controlled Trials as Topic
PubMed: 28916574
DOI: 10.3945/an.116.013953 -
World Journal of Clinical Oncology May 2021Intestinal metastases from breast cancer (BC) arerare; available data depend mainly on case reports and case series.
BACKGROUND
Intestinal metastases from breast cancer (BC) arerare; available data depend mainly on case reports and case series.
AIM
To conduct a review of the literature regarding presentation, diagnosis, treatment and survival of patients with intestinal metastasis from BC.
METHODS
We identified all articles that described patients with intestinal metastasis (from duodenum to anum) from BC using MEDLINE (1975 to 2020) and EMBASE (1975 to 2020) electronic databases.
RESULTS
We found 96 cases of intestinal metastasis of BC. Metastasization involved large bowel (cecum, colon, sigmoid, rectum) (51%), small bowel (duodenum, jejunum, ileum) (49%), and anum (< 1%). Median age of patients was 61-years. The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma. In more than half of patients, the diagnosis was made after the diagnosis of BC (median: 7.2 years) and in many cases of emergency, for bowel obstruction, bleeding or perforation. Diagnosis was achieved through endoscopy, radiological examination or both. In most of the cases, patients underwent surgery with or without systemic therapies. Survival of patients included in this review was available in less than 50% of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.
CONCLUSION
Although, intestinal metastases of BC are considered a rare condition, clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC, especially in patients with a histology of lobular carcinoma.
PubMed: 34131569
DOI: 10.5306/wjco.v12.i5.382 -
Annals of the Royal College of Surgeons... Jul 2018Introduction The free jejunal flap represents the gold standard for circumferential defects in upper digestive tract reconstruction. It is a technically demanding... (Review)
Review
Introduction The free jejunal flap represents the gold standard for circumferential defects in upper digestive tract reconstruction. It is a technically demanding procedure with significant failure rates. Unrecognised failure leads to flap necrosis and potentially fatal sequelae, including sepsis and carotid artery bleed. Despite these catastrophic consequences, however, there remains no consensus on an optimum method for postoperative flap monitoring. Our unit has pioneered the use of external colour duplex ultrasound to monitor flap vascularity. We describe this technique and systematically review other published monitoring systems. Materials and methods A patient underwent oesophageal reconstruction using a jejunal free flap. Monitoring commenced immediately via external application of a colour duplex probe over the flap's vascular pedicle to facilitate flow volume assessment. Further bi-daily assessments were successfully used to monitor the postoperative viability of the flap. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Six alternative monitoring techniques were identified: exteriorised jejunal segment, implantable Doppler probe, watch window, microdialysis, microendoscopy and reflectance photoplethysmography. Discussion Exteriorised jejunal segment and implantable Doppler probe are most commonly described, yet both are associated with high false positive rates, which is particularly significant in a patient demographic facing increased general anaesthetic risk. Most other techniques remain experimental. External colour Doppler ultrasound provides the surgeon with immediate reassurance following the reconstruction, requires minimal training to use, and eliminates the need for revisional procedures. Conclusion Our initial experience suggests that external colour Doppler ultrasound has exciting potential as an efficient and noninvasive technique for monitoring the free jejunal flap.
Topics: Esophagus; Female; Free Tissue Flaps; Humans; Jejunum; Middle Aged; Postoperative Care; Plastic Surgery Procedures; Ultrasonography, Doppler, Color
PubMed: 29543049
DOI: 10.1308/rcsann.2018.0043 -
The Cochrane Database of Systematic... Jul 2013Children with cerebral palsy can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding and,... (Review)
Review
BACKGROUND
Children with cerebral palsy can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding and, eventually, to undernutrition. It can also result in aspiration of food into the lungs. Length of feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both child and carer. For children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are increasingly being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate the feeding of children with cerebral palsy, many carers find it very emotionally difficult to accept this intervention. Moreover, the intervention is costly and there is the possibility of complications. The effectiveness and safety of the treatment requires further assessment. This review is an update of one previously published in 2004.
OBJECTIVES
To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy to children with feeding difficulties due to cerebral palsy.
SEARCH METHODS
For this update, we searched the following databases in July 2012: CENTRAL, MEDLINE , Embase, CINAHL, Science Citation Index, Conference Proceedings Citation Index, LILACS and Zetoc. We searched for trials in ICTRP and Clinicaltrials.gov, and for theses in WorldCat and Proquest Index to Theses. We also contacted other researchers and experts in this field.
SELECTION CRITERIA
We looked for randomised controlled trials that compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 years.
DATA COLLECTION AND ANALYSIS
Screening of search results was undertaken independently by two review authors. No data extraction was possible as there were no included studies.
MAIN RESULTS
No trials were identified that met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
Considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Eating; Gastrostomy; Humans; Infant; Nutrition Disorders
PubMed: 23900969
DOI: 10.1002/14651858.CD003943.pub3 -
Arquivos Brasileiros de Cirurgia... 2012Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. (Review)
Review
INTRODUCTION
Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication.
AIM
Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates.
METHODS
The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded.
RESULTS
The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain.
CONCLUSION
Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Endoscopy, Gastrointestinal; Gastric Bypass; Humans; Jejunum; Postoperative Complications; Stomach
PubMed: 23411930
DOI: 10.1590/s0102-67202012000400014 -
Journal of Gastrointestinal and Liver... Sep 2020Starting from a case presentation, this review aims to present literature data on inflammatory fibroid polyps (IFPs) of the small intestine.
AIM
Starting from a case presentation, this review aims to present literature data on inflammatory fibroid polyps (IFPs) of the small intestine.
METHODS
Case report and systematic review. A comprehensive systematic review of English literature using PubMed was conducted, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The used key words were: "inflammatory fibroid polyp" or "Vanek", including only cases with IFPs localized of the small intestine, published from 1976 to 2019.
RESULTS
We present a case of a 38-year old patient with intestinal IFP presenting with acute abdomen due to intussusception diagnosed with ultrasound (US) based on a target sign and visible solid tumor in the small intestine leading to prompt surgical treatment. A diagnosis of IFP was made based on the pathohistological findings. Moreover, a systematic review of small intestine IFPs was conducted which is, to our knowledge, the first comprehensive systematic literature review on this topic. The analysis included 53 case reports or case series concerning 77 cases of small bowel IFPs. The patients were aged from 4 to 75 years (average 45.2), with a female predominance (59.7%). The most common localization was the ileum in 77.9% cases, followed by the jejunum (13%) and the duodenum (6.5%). The most common clinical presentation was abdominal pain due to intussusception (63.6%). Regarding diagnostic methods, computed tomography (CT) was frequently used as primary diagnostic method (26%) followed by exploratory laparotomy (16.9%), endoscopy (7.8%) and US (6.5%). Combination of US and CT contributed to the diagnosis in 9.1% of cases. The majority of cases were treated surgically (92.21%), while only a minority benefited of minimally invasive techniques such as endoscopy.
CONCLUSIONS
Small bowel IFPs, ones of the least common benign tumors, are characterized by variable clinical signs and symptoms and can potentially lead to serious consequences for the patient.
Topics: Abdomen, Acute; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Intestinal Neoplasms; Intestinal Polyps; Intestine, Small; Intussusception; Male; Middle Aged; Treatment Outcome; Young Adult
PubMed: 32830812
DOI: 10.15403/jgld-2417 -
Nutricion Hospitalaria 2012Incretins are a cluster of hormones which are secreted and released into the bloodstream after food intake by gut enteroendocrine cells, reaching to pancreas where... (Meta-Analysis)
Meta-Analysis Review
Incretins are a cluster of hormones which are secreted and released into the bloodstream after food intake by gut enteroendocrine cells, reaching to pancreas where produce a potentiating effect on insulin release. The aim of this study was to perform a systematic review of incretins gene expression mediated by nutrients using specific search equations in the PubMed database. The two most relevant incretins are GLP-1 and GIP, which come from proglucagon and proGIP precursor respectively. GLP-1 is mainly synthesized and released by ileum and colon L cells, in contrast to GIP which does it by K cells in duodenum and proximal jejunum. It has been shown that canonical Wnt signalling pathway is closely related to the production of these hormones, since transcription factor TCF7L2 affects proglucagon and proGIP gene expression in L and K enteroendocrine cells. On the other hand, it has been shown that the hexosamine biosynthetic pathway can produce N-linked glycosylation of -catenin, an essential component of canonical Wnt signalling. This process hinders β-catenin phosphorylation and, thereby prevents proteasome degradation. Increasing glucose concentration enhances the hexosamine pathway and thus β-catenin glycosylation. This causes a β-catenin cytoplasmic accumulation allowing entry into nucleus, where it exerts its action by binding to a clump of molecules and transcription factors, allowing to express the target genes, including the incretin hormones. There is also evidence that glucose, through the hexosamine pathway, can induces autocrine activation of Wnt signalling pathway by stimulating secretion of Wnt proteins.
Topics: Animals; Gene Expression; Gene Expression Regulation; Hexosamines; Humans; Incretins; Nutritional Physiological Phenomena; Wnt Proteins
PubMed: 22566303
DOI: 10.1590/S0212-16112012000100006 -
European Journal of Surgical Oncology :... Dec 2014The aim of this meta-analysis was to evaluate the necessity of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of this meta-analysis was to evaluate the necessity of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer.
METHODS
Medline, Embase and the Cochrane Library were searched. Only prospective randomized controlled trials (RCTs) that compared subjects with and without nasogastric or nasojejunal decompression after gastrectomy were eligible in this meta-analysis. Time to flatus, time to first oral intake, length of hospital stay, reinsertion rate, anastomotic leakage, pulmonary complications, morbidity and mortality were evaluated.
RESULTS
Eight studies finally fulfilled the inclusion criteria. This meta-analysis enrolled 1141 patients, 570 randomized to routine decompression and 571 randomized to no decompression. Time to first oral intake was significantly shorter in the non-decompression group (WMD = 0.53, 95% CI: 0.28 to 0.77; p < 0.001). Additionally, subjects with nasogastric or nasojejunal decompression experienced a longer hospital stay (p = 0.001). Time to flatus, anastomotic leakage, reinsertion rates, pulmonary complications, morbidity and mortality rates were similar between the two groups.
CONCLUSION
Nasogastric or nasojejunal decompression does not facilitate the recovery of bowel function or reduce the risk of postoperative complications. Therefore, routine nasogastric or nasojejunal decompression is unnecessary after gastrectomy for gastric cancer.
Topics: Anastomotic Leak; Eating; Flatulence; Gastrectomy; Humans; Intubation, Gastrointestinal; Jejunum; Length of Stay; Morbidity; Postoperative Complications; Randomized Controlled Trials as Topic; Respiratory Insufficiency; Retreatment; Stomach Neoplasms; Time Factors
PubMed: 25043988
DOI: 10.1016/j.ejso.2014.05.013