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Gomes Jr. C.A.,Gastroenterological Surgery
Cochrane database of systematic reviews (Online) | Year: 2012

A number of conditions compromise the passage of food along the digestive tract. Nasogastric tube (NGT) feeding is a classic, time-proven technique, although its prolonged use can lead to complications such as lesions to the nasal wing, chronic sinusitis, gastro-oesophageal reflux, and aspiration pneumonia. Another method of infusion, percutaneous endoscopy gastrostomy (PEG), is generally used when there is a need for enteral nutrition for a longer time period. There is a high demand for PEG in patients with swallowing disorders, although there is no consistent evidence about its effectiveness and safety as compared to NGT. To evaluate the effectiveness and safety of PEG as compared to NGT for adults with swallowing disturbances, by updating our previous Cochrane review. We searched The Cochrane Library, MEDLINE, EMBASE, and LILACS from inception to September 2011, as well as contacting main authors in the subject area. There was no language restriction in the search. We planned to include randomised controlled trials comparing PEG versus NGT for adults with swallowing disturbances or dysphagia and indications for nutritional support, with any underlying diseases. The primary outcome was intervention failure (e.g. feeding interruption, blocking or leakage of the tube, no adherence to treatment). Review authors performed selection, data extraction and evaluation of methodological quality of studies. For dichotomous and continuous variables, we used risk ratio (RR) and mean difference (MD), respectively with the random-effects statistical model and 95% confidence interval (CI). We assumed statistical heterogeneity when I 2 > 50%. We included nine randomised controlled studies. We did not identify new eligible studies published after our previous review literature search date (August 2009). Intervention failure occurred in 19/156 patients in the PEG group and 63/158 patients in the NGT group (RR 0.24, 95%CI 0.08 to 0.76, P = 0.01) in favour of PEG. There was no statistically significant difference between comparison groups in complications (RR 1.00, 95%CI 0.91 to 1.11, P = 0.93). PEG was associated with a lower probability of intervention failure, suggesting the endoscopic procedure is more effective and safe as compared to NGT. There is no significant difference of mortality rates between comparison groups, and pneumonia irrespective of underlying disease (medical diagnosis). Future studies should include previously planned and executed follow-up periods, the gastrostomy technique, and the experience of the professionals to allow more detailed subgroup analysis.

Sato T.,International University of Japan | Yamaguchi S.,International University of Japan | Harada M.,Gastroenterological Surgery | Koyama I.,International University of Japan | Brennan M.F.,Sloan Kettering Cancer Center
Anticancer Research | Year: 2013

Aim: This study assessed the feasibility of pelvic peritonectomy for carcinomatosis localized in the pelvic cavity. The survival and clinical benefits were examined, especially in colorectal cancer. Patients and Methods: Seventeen patients underwent pelvic peritoneal resection for peritoneal dissemination localized in the pelvis (10 colorectal, six ovarian, one cervical cancer). The male/female ratio was 5/12. The age range was 31-83 (median=63) years. The peritoneal cancer index was 2-16 (median=4). Perioperative intraperitoneal chemotherapy was not performed. Results: For all 17 cases, pelvic exenteration significantly increased invasiveness in the treatment of pelvic peritoneal carcinomatosis (p<0.05). Additionally, pelvic exenteration did not improve prognosis. In all cases, the serum carcinoembryonic antigen (CEA) levels decreased significantly from a mean of 15.1 (range=0.8-55.7) to 2.4 (range= 0.5-7.4) ng/ml (paired t-test, p<0.05). For colorectal cancer, serum CEA decreased significantly from 19.3 (range=1.2-55.7) to 2.7 (range=0.5-7.4) ng/ml (paired t-test, p<0.05). In the colorectal cancer series, cumulative 1- and 3-year overall survival rates were 89% and 71%, respectively. One- and 3-year recurrence-free survival rates were 78% and 67%, respectively. Conclusion: The cytoreductive effect of this method is feasible and excellent for pelvic carcinomatosis. Pelvic peritonectomy without perioperative intraperitoneal chemotherapy is a safe, effective procedure for peritoneal carcinomatosis from colorectal cancer localized in the pelvis.

Sato T.,International University of Japan | Yamaguchi S.,International University of Japan | Harada M.,Gastroenterological Surgery | Gagner M.,Florida International University
Hepato-Gastroenterology | Year: 2014

Laparoscopic surgery is recommended as an initial stage IV colorectal cancer therapy. A 57-year-old male with sigmoid colon cancer and two hepatic metastases underwent laparoscopic sigmoidectomy with lymphadenectomy. He was orally administered postoperative Tagafur/Uracil/leucovorin therapy for 10 months. However, because of regrowth of the liver metastasis, he was administered leucovorin/bolus and infusional 5-fluorouracil/irinotecan therapy for 10 months followed by extended left lobectomy of the liver and the above mentioned chemotherapy was continued for 6 months. He was diagnosed with S6 and S6/7 hepatic recurrent tumor, which were resected 14 months after the second and another 14 months after the third surgery, respectively. Forty-two months following complete response after the fourth surgery, S6 hepatic recurrent tumor was resected. Six months after the fifth surgery, he developed multiple liver metastases. He was treated successfully using leucovorin/bolus and infusional 5-fluorouracil/oxaliplatin and bevacizumab. He is alive 9 years and 3 months after initial surgery. © H.G.E. Update Medical Publishing S A, Athens.

Sato T.,International University of Japan | Yamaguchi S.,International University of Japan | Harada M.,Gastroenterological Surgery | Koyama I.,International University of Japan | Gagner M.,Florida International University
Hepato-Gastroenterology | Year: 2014

The feasibility of laparoscopic surgery for peritoneal metastasis is still controversial. A 42-year-old male presenting with bloody stool underwent small intestinal fiberscopic examination. The biopsied specimens pathologically demonstrated adenocarcinoma of the upper jejunum. Laparoscopy revealed a 10-mm nodule in the omentum. Laparoscopic partial jejunal resection with regional lymph node dissection was performed with combined resection of the nodule without conversion. No other tumor was detected The rejected specimen contained an irregular ulcerative tumor measuring 52 × 33 mm. Microscopic examination revealed that the mass and peritoneal nodule comprised moderately differentiated adenocarcinoma. After surgery, the patient was treated with leucovorm/bolus and infusional 5-fluorouracil/oxaliplatin for 6 months. Eleven months after surgery, a solitary peritoneal recurrence developed near the camera port site. Six months later, positron emission tomography, computer tomography, and exploratory laparotomy revealed multiple peritoneal recurrences. The patient was then treated with leucovorm/bolus and infusional 5-fluorouracil/innotecan. Three months and 6 months later, partial remission and complete response, respectively, were sequentially induced. The patient is alive 3 years and 9 months after initial surgery without any tumor recui rence. To our knowledge, this is the first report to demonstrate laparoscopic surgery combined with chemotherapy regimens, which induced a successful complete response. © H.G.E. Update Medical Publishing S A, Athens.

Yasueda A.,Osaka University | Mizushima T.,Osaka University | Nezu R.,Nishinomiya Municipal Central Hospital | Sumi R.,Osaka University | And 8 more authors.
Surgery Today | Year: 2015

Purpose: Ulcerative colitis (UC) is a chronic, relapsing, and refractory disorder of the intestine. Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is the preferred and standard surgical procedure for patients’ refractory to medical therapy. Pouchitis is one of the most common long-term complications after IPAA. In the present study, the safety and efficacy of Clostridium butyricum MIYAIRI (CBM) as a probiotic were examined. Methods: A randomized and placebo-controlled study was performed. Seventeen patients were recruited from 2007 to 2013. Nine tablets of MIYA-BM® or placebo were orally administered once daily. The cumulative pouchitis-free survival, pouch condition (using the modified pouch disease activity index), and blood parameters were evaluated. A fecal sample analysis was also performed. Results: Subjects were randomly allocated to receive MIYA-BM or placebo (9 and 8 subjects, respectively). One subject in the MIYA-BM group and four subjects in the placebo group developed pouchitis. No side effects occurred in either group. Characteristic intestinal flora was observed in each group. Conclusions: Our results suggest that probiotic therapy with CBM achieved favorable results with minimal side effects and might be a useful complementary therapy for the prevention of pouchitis in patients with UC who have undergone IPAA. © 2015 Springer Japan

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