Gastric Obstruction Research Articles

Laparoscopic repair of gastric conduit obstruction after robot-assisted minimally invasive esophagectomy: a case report

BackgroundGastric conduit obstruction (GCO) is a known complication after esophagectomy. Laparoscopic revision surgery for GCO is relatively rare, with limited reports in the literature. Here, we report a case of GCO after robot-assisted subtotal esophagectomy and posterior mediastinal gastric conduit reconstruction, which was successfully repaired laparoscopically.Case presentationA 66-year-old man presented with a passage disorder that became noticeable 14 months after surgery. Fluid passage was difficult, and the patient opted for revision surgery. The conduit had entered and deflected into the mediastinum; it also twisted due to band formation. The revision surgery was performed laparoscopically through five ports. The bands were dissected, esophageal hiatus was sutured, and conduit re-fixed. The intraoperative endoscopy was used to confirm that the obstruction had been released. The lack of adhesion of the posterior half of the gastric conduit wall, combined with postoperative weight loss leading to a decrease in omental volume, as well as inadequate fixation during the initial surgery, are believed to have contributed to the ease of the conduit deviation into the intrathoracic cavity. In addition, the twisting of the conduit due to band formation exacerbated the obstruction.ConclusionsLaparoscopic revision surgery may become an effective treatment option as the number of minimally invasive esophagectomies is expected to increase in the future. Furthermore, the fixation method during initial surgery should be carefully considered and optimized to prevent gastric conduit obstruction. Additionally, the use of intraoperative endoscopy to evaluate the lumen of the conduit during surgery proved beneficial in this case, highlighting its potential value in identifying and addressing obstruction.

Gastric variceal obstruction improves the efficacy of endoscopic management of esophageal variceal bleeding in GOV type I.

Background and study aims Limited data exist regarding endoscopic obstruction of type I gastroesophageal (GOV I) in managing bleeding from esophageal varices. In this multicenter retrospective cohort study, we aimed to access the efficacy of blocking gastric varices in management of bleeding from esophageal varices in patients with GOV1. Patients and methods Cirrhotic patients experiencing bleeding from esophageal varices and having GOV I gastric varices in four centers were screened. All included patients were followed up for 180 days, or until death. Results A total of 93 cirrhotic patients with GOV I and bleeding esophageal varices were included. Among them, 58 patients underwent endoscopic cyanoacrylate injection (ECI) for gastric varices in addition to treatment for esophageal varices (EV), while the remaining 35 patients received treatment for EV only. Kaplan-Meier analysis demonstrated that the cumulative 180-day rebleeding rate was significantly lower in the ECI plus EV treatment group (7.9%) compared with the EV treatment group (30.7%) ( P = 0.0031). The cumulative incidence of 180-day mortality was 1.9% in the ECI plus EV treatment group and 23.9% in the EV treatment group ( P = 0.0010). Multivariable Cox regression analysis revealed that concomitant ECI treatment was an independent protective factor against 180-day rebleeding and overall mortality. Conclusions In conclusion, obstruction of gastric varices in addition to endoscopic treatment for bleeding from esophageal varices in patients with GOV 1 proved superior to endoscopic treatment alone for esophageal variceal bleeding.

990 A Rare Case of Adenomyoma in Gastric Pylorus of a Young Adult Female: A Case Report

Abstract Introduction Gastric adenomyoma is a rare benign tumour which occurs 85% in antrum and 15% in pylorus. Although adenomyomas are benign, diagnosis is difficult as they are commonly found alongside with adenocarcinomas. Case report A 20-year-old previously healthy female presented with epigastric pain, gastric outflow obstruction features and weight loss for 3 months. Initial USS was followed by a CECT which, showed intramural mass lesion with necrotic centre arising from the inferior wall of the pre pyloric area of the stomach with acute inflammatory changes of the adjacent omental fat, giving differential diagnosis of GIST or gastrinoma at pyloric region. Subsequent upper GI endoscopy revealed a protruding pyloric mass without mucosal lesions. Unfortunately, the unavailability of EUS and biopsy posed a diagnostic hurdle. Intraoperatively, a mass intricately adhered to the transverse colon and omentum was discovered, leading to a surgical intervention involving distal gastrectomy, gastrojejunostomy, and jejunojejunostomy. Unexpectedly, histological analysis unveiled adenomyoma at the prepyloric area, characterized by Brunner’s glands, dilated glands, and heterotrophic small intestinal tissue. Discussion This rare manifestation of adenomyoma in the gastric pylorus, particularly in a young adult, highlights the challenges in accurate preoperative diagnosis. The favourable postoperative outcome prompts reflection on the potential role of advanced diagnostic tools, emphasizing the significance of EUS and biopsy in steering clear of extensive surgeries. Conclusions This case report underscores the crucial role of personalized diagnostic methods, especially in cases like ours where a rare adenomyoma mimicking other tumours.

Surgical treatment of multiple magnet ingestion by children: A single-center experience from China.

The incidence of magnet ingestion in children has escalated concurrent with the rise in popularity of magnetic playthings, bearing the capacity to induce substantial morbidity. The objective of this study was to encapsulate our accumulated expertise in handling pediatric cases featuring multiple magnetic foreign bodies within the gastrointestinal tract sometimes necessitating surgical intervention, as well as to formulate a clinical management algorithm. This was a retrospective review of patients with multiple magnetic foreign bodies in the digestive tract, admitted to Shenzhen Children's Hospital, between January 2018 and December 2022. A total of 100 cases were included in this study, including 66 males and 34 females. The main clinical manifestation ns were abdominal pain and vomiting. All patients had abdominal x-ray, all of which indicated foreign bodies in the digestive tract. 33 patients had to undergo a surgical intervention. Among these cases, the gastrointestinal complications occurred in 31 patients, including gastric rupture (n = 9), intestinal obstruction (n = 11) and intestinal perforation (n = 30). Postoperative intestinal obstruction occurred in 6 children. There was no statistical significant difference in age and gender between the Surgical group and Non-surgical group, but the Surgical group had a higher number of magnets ([7.5(2-44) vs 4(2-20)], p = 0.009), a longer interval between time of misingestion to clinical visit ([48(7.2-480) vs 5(2-336)]hours, p < 0.001), and a longer length of hospital stay ([10(6-19) vs 2(1-8)]days, p < 0.001). Multiple magnet ingestion in children can lead to serious complications and carry severe risks. Timely diagnosis and effective treatment are crucial for managing such patients.

Reports of Gastric Banding and Bowel Obstruction: A Narrative Review of the Literature.

The utilization rates of laparoscopic gastric banding (LAGB) declined worldwide from 42.3% in 2008 to 1.8% in 2018. Rates of complications requiring removal may reach 40-50% in the medium to long term. Bowel obstruction is a rare but severe complication that occurs after LAGB. A comprehensive literature search in PubMed was carried out to identify all available case reports of intestinal obstruction after gastric banding. The search terms were as follows: "intestinal obstruction", "small bowel obstruction", "gastric band", "gastric banding", "gastric band complications", and "laparoscopic gastric band obstruction". The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart was used. Forty-three case reports were included in our review. Laparotomy was necessary in 18/43 (41%) of patients. Vomit was not always reported, while abdominal pain was constantly present. A CT scan was the preferred diagnostic tool. The main causes of occlusion were found to be the erosion of the gastrointestinal tract or internal hernia due to a loose tube loop. Forty-six percent of cases occurred within 5 years from insertion. Even if rare, small bowel obstruction after LAGB requires surgical intervention often with an open approach. The absence of vomit masks symptoms, but an obstruction must be always suspected in the case of severe colicky abdominal pain. A CT scan is recommended for making diagnoses.

Evaluación mediante TC de las complicaciones de la úlcera gastroduodenal

Gastric and duodenal ulcers (GDUs) are decreasing both in frequency and rate of mortality. However, GDUs with complications continue to have higher mortality rates and are seldom suspected in patients presenting with acute abdomen. Although upper endoscopy plays a central role in the diagnosis and treatment of GDUs, CT is crucial when serious complications appear, namely uncontrolled acute haemorrhage, perforation, organ penetration, or gastric obstruction. Radiologists have a special role to play in these situations, providing the diagnosis and extent of complications, thus contributing to decision making which can range from conservative management to endoscopic, surgical or interventional radiology procedures. The aim of our study is to describe the CT indications and protocols for patients with a suspected GDU with complications and present the main imaging findings for the different types of complications, while providing differential diagnoses.

Abstract PR06: CD40 agonist mitazalimab in combination with mFOLFIRINOX in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC): Interim efficacy results of the OPTIMIZE-1 phase 1b/2 study

Abstract Mitazalimab is a human CD40 agonistic IgG1antibody. Targeting CD40 kickstarts the cancer immunity cycle by licensing dendritic cells leading to tumor specific T cell priming and activation. Furthermore, in PDAC CD40 agonists on myeloid cells promote degradation of the desmoplastic tumor stroma, improving influx of T cells and sensitizing the tumor to chemotherapeutic agents. OPTIMIZE-1 (NCT04888312) is a Phase 1b/2, open label, multicenter study designed to evaluate safety, tolerability, and efficacy of mitazalimab in combination with mFOLFIRINOX (Oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2, 5-FU 2.4 g/m2) in patients with previously untreated mPDAC. In the first part of the study (phase 1b), 900 µg/kg mitazalimab was selected as the recommended phase 2 dose (RP2D). In the first 21-day treatment cycle, mitazalimab is administered IV at RP2D on day 1 and 10 and mFOLFIRINOX infusion started on day 8. In subsequent cycles, treatment follows a 14-day cycle where mitazalimab is administered 2 days after mFOLFIRINOX. The primary endpoint of this ongoing study is overall response rate (ORR) per RECIST v1.1. Secondary and exploratory endpoints include duration of response, progression free and overall survival, safety, PK and PD biomarker assessments. As of May 24, 2023, study enrolment was complete, 65 patients were treated with mFOLFIRINOX and mitazalimab 900 µg/kg (RP2D). Interim efficacy analysis comprised of 57 evaluable patients. Median follow up was 6.5 months and median exposure to treatment was 5 months. 28 patients (49%) remain on treatment, 18 (32%) continued treatment beyond 6 months, the longest being 17 months (ongoing). ORR was 43.9% (25 patients with partial response), an additional 19 patients achieved stable disease, resulting in a 77.2% disease control rate. Median time to response was 2.2 months and median duration of response was 8.7 months. The most common grade (Gr) ≥3 TEAEs were neutropenia (21.5%), anemia (12.3%), thrombocytopenia (12.3%) and hypokalemia (12.3%). Mitazalimab related Gr &amp;gt;3 AEs occurring in more than one patient were fatigue in 3 (4.6%) patients, increased ALT in 3 (4.6%) patients, diarrhea in 2 (3.1%) patients, asthenia in 2 (3.1%) patients, increased AST in 2 (3.1%) patients, and hypokalemia in 2 (3.1%) patients. 25 patients (38.5%) experienced infusion reactions (all Gr 1-2, managed with symptomatic treatment, none amounting to cytokine release syndrome) and 7 (10.8%) patients discontinued treatment due to TEAEs (pneumonia, gastric obstruction, neuropathy, bacteremia, ileal obstruction, stroke, skin reaction). In this ongoing phase 1b/2 trial, 900 µg/kg mitazalimab has shown no evidence of additive toxicity when administered in combination with mFOLFIRINOX, allowing extended treatment until progression. Interim efficacy results demonstrate encouraging antitumor activity in mPDAC with good durability of responses, meriting continued development. Citation Format: Jean-Luc Van Laethem, Karen P. Geboes, Philippe A. Cassier, Ivan Borbath, Aurélien Lambert, Emmanuel Mitry, Hans Prenen, Jean-Frédéric Blanc, Lorenzo Pilla, Mercedes Rodriguez Garrote, Roberto A. Pazo Cid, Inmaculada Gallego, Jaime Feliú, Karin Nordbladh, Peter Ellmark, Malin Carlsson, Yago Pico de Coaña, Sumeet V. Ambarkhane, Teresa Macarulla. CD40 agonist mitazalimab in combination with mFOLFIRINOX in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC): Interim efficacy results of the OPTIMIZE-1 phase 1b/2 study [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr PR06.

A Systematic Review and Metaanalysis of Clinical Perspective in Trichotillomania

Trichobezoar is a mass of hairs found trapped in the gastrointestinal system. They are common in children underthe age of 2 and in children and adults living in poverty. Complications such as gastric ulceration, bleeding andperforation and intestinal obstruction may occur. There is paucity of reports on trichobezoars in Psychiatricliterature however it is well described in terms of surgical diagnosis and procedure. Here, we present a case oftrichotillomania and pica leading to intestinal obstruction to stress the importance of considering trichobezoarsas one of the important differentials in cases of patients presenting with abdominal pain in face of suggestivesymptoms, even if signs of trichotillomania are not present.

Gastric obstruction with cholecystoduodenal fistula in high risk patient

Gastric obstruction with cholecystoduodenal fistula in high risk patient

Gastric obstruction with cholecystoduodenal fistula in high risk patient

Gastric obstruction with cholecystoduodenal fistula in high risk patient

An update on gastroparesis in 2024

Gastroparesis is a pathology associating upper digestive symptoms, such as nausea and vomiting, with impaired gastric emptying in the absence of mechanical gastric or duodenal obstruction. It has a major impact on patients' quality of life, can lead to undernutrition, and -increases overall mortality. Several schools of thought converge on the hypothesis of a clinico--pathological spectrum of gastric neuro-muscular dysfunction encompassing gastroparesis and functional dyspepsia, in particular the subtype known as "postprandial distress syndrome". Its management includes non--pharmacological interventions, such as hygienic--dietary measures, pharmacological interventions using prokinetic, antiemetic or neuromodulatory treatments, and endoscopic interventions.

Stereotactic body radiotherapy with or without selective dismutase mimetic in pancreatic adenocarcinoma: an adaptive, randomised, double-blind, placebo-controlled, phase 1b/2 trial

Stereotactic body radiotherapy (SBRT) has the potential to ablate localised pancreatic ductal adenocarcinoma. Selective dismutase mimetics sensitise tumours while reducing normal tissue toxicity. This trial was designed to establish the efficacy and toxicity afforded by the selective dismutase mimetic avasopasem manganese when combined with ablative SBRT for localised pancreatic ductal adenocarcinoma. In this adaptive, randomised, double-blind, placebo-controlled, phase 1b/2 trial, patients aged 18 years or older with borderline resectable or locally advanced pancreatic cancer who had received at least 3 months of chemotherapy and had an Eastern Cooperative Oncology Group performance status of 0-2 were enrolled at six academic sites in the USA. Eligible patients were randomly assigned (1:1), with block randomisation (block sizes of 6-12) with a maximum of 24 patients per group, to receive daily avasopasem (90 mg) or placebo intravenously directly before (ie, within 180 min) SBRT (50, 55, or 60 Gy in five fractions, adaptively assigned in real time by Bayesian estimates of 90-day safety and efficacy). Patients and physicians were masked to treatment group allocation, but not to SBRT dose. The primary objective was to find the optimal dose of SBRT with avasopasem or placebo as determined by the late onset EffTox method. All analyses were done on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, NCT03340974, and is complete. Between Jan 25, 2018, and April 29, 2020, 47 patients were screened, of whom 42 were enrolled (median age was 71 years [IQR 63-75], 23 [55%] were male, 19 [45%] were female, 37 [88%] were White, three [7%] were Black, and one [2%] each were unknown or other races) and randomly assigned to avasopasem (n=24) or placebo (n=18); the placebo group was terminated early after failing to meet prespecified efficacy parameters. At data cutoff (June 28, 2021), the avasopasem group satisfied boundaries for both efficacy and toxicity. Late onset EffTox efficacy response was observed in 16 (89%) of 18 patients at 50 Gy and six (100%) of six patients at 55 Gy in the avasopasem group, and was observed in three (50%) of six patients at 50 Gy and nine (75%) of 12 patients at 55 Gy in the placebo group, and the Bayesian model recommended 50 Gy or 55 Gy in five fractions with avasopasem for further study. Serious adverse events of any cause were reported in three (17%) of 18 patients in the placebo group and six (25%) of 24 in the avasopasem group. In the placebo group, grade 3 adverse events within 90 days of SBRT were abdominal pain, acute cholangitis, pyrexia, increased blood lactic acid, and increased lipase (one [6%] each); no grade 4 events occurred. In the avasopasem group, grade 3-4 adverse events within 90 days of SBRT were acute kidney injury, increased blood alkaline phosphatase, haematoma, colitis, gastric obstruction, lung infection, abdominal abscess, post-surgical atrial fibrillation, and pneumonia leading to respiratory failure (one [4%] each).There were no treatment-related deaths but one late death in the avasopasem group due to sepsis in the setting of duodenal obstruction after off-study treatment was reported as potentially related to SBRT. SBRT that uses 50 or 55 Gy in five fractions can be considered for patients with localised pancreatic ductal adenocarcinoma. The addition of avasopasem might further enhance disease outcomes. A larger phase 2 trial (GRECO-2, NCT04698915) is underway to validate these results. Galera Therapeutics.

S4267 Acute Gastric Obstruction: A Case of Intragastric Balloon Obstruction and Successful Endoscopic Management

S4267 Acute Gastric Obstruction: A Case of Intragastric Balloon Obstruction and Successful Endoscopic Management

Gastric pouch obstruction in a bariatric patient caused by the ingestion of cocaine packets: a case report

The term "Body Packing" refers to individuals who carry intra-abdominal foreign objects containing illicit drugs that have been ingested to conceal them for smuggling purposes. With the increasing rates of international smuggling, drug transportation across borders has been constantly evolving among traffickers. Once introduced into the body, it becomes a matter of significant medical concern, as it can cause bowel obstruction, perforation, peritonitis, or intoxication. We present a case of a female, 44 years old, with a history of Fobi-Capella bariatric surgery, who was admitted to an Emergency Department for intractable vomiting, excessive drooling, and confirmed ingestion of 25 cocaine packages. The abdominal CT revealed multiple foreign bodies in the gastroenteroanastomosis topography, gastric pouch, and small bowel. Exploratory laparotomy with gastrostomy, enterotomy, and colotomy was performed. A second approach with intraoperative endoscopy was conducted to remove the remaining packages that were revealed by CT. This case report provides information about body packers' clinical condition, diagnosis, and treatment, to assist surgeons and clinicians with similar cases.

Efficacy and safety of mitazalimab in combination with mFOLFIRINOX in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC): An interim analysis of the optimize-1 phase 1b/2 study.

4139 Background: Mitazalimab is a human CD40 agonistic IgG1antibody. Targeting CD40 kickstarts the cancer immunity cycle by licensing dendritic cells leading to tumor specific T cell priming and activation. Furthermore, in PDAC CD40 agonists on myeloid cells promote degradation of the desmoplastic tumor stroma, improving influx of T cells and chemotherapeutic agents into the tumor. OPTIMIZE-1 (NCT04888312) is a Phase 1b/2, open label, multicenter study designed to evaluate safety, tolerability, and efficacy of mitazalimab in combination with mFOLFIRINOX (Oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2, 5-FU 2.4 g/m2) in patients (pts) with previously untreated mPDAC. In the first part of the study (phase 1b), 900 µg/kg mitazalimab was selected as the recommended phase 2 dose (RP2D). Methods: In the first 21 day treatment cycle, mitazalimab was administered IV at RP2D on day 1 and 10 and mFOLFIRINOX infusion started on day 8. In subsequent cycles, treatment followed a 14 day cycle where mitazalimab was always administered 2 days after mFOLFIRINOX. The primary endpoint of this ongoing study is overall response rate (ORR) per RECIST v1.1. Secondary and exploratory endpoints include progression free and overall survival, safety, PK and PD biomarker assessments. Futility was prespecified as ORR≤30% in pts treated at RP2D, based on historical data with FOLFIRINOX (Conroy, 2011). Results: As of December 8, 2022, 43 pts with untreated mPDAC were treated with mFOLFIRINOX and 450 µg/kg (N = 5) or 900 µg/kg (N = 38) mitazalimab and evaluated for safety. The most common grade (Gr) ≥3 TEAEs were neutropenia (16%), fatigue (12%) and hypokalemia (12%). Mitazalimab related Gr &gt;3 AEs were fatigue in 3 (7.9%) pts, hypokalemia in 2 (5.3%) pts, diarrhea in 1 (2.6%) pt, pneumonia in 1 (2.6%) pt, increased ALT in 1 (2.6%) pt, headache in 1 (2.6%) pt, acute kidney injury in 1 (2.6%) pt. 10 pts (23%) experienced infusion reactions (all Gr 1-2) and 5 (12%) pts discontinued treatment due to TEAEs (pneumonia, gastric obstruction, neuropathy, bacteremia). At cutoff, 23 pts were evaluable for futility. Median follow up was 170 days and median exposure was 163 days. 18 pts (78%) remain on treatment, 6 (26%) beyond the 6 month treatment period. ORR was 52.2% (12 partial responses), an additional 8 pts achieved stable disease, resulting in a 91.3% disease control rate. Combination with mFOLFIRINOX had no impact on mitazalimab PK. The PD biomarker profile was consistent with the mode of action of mitazalimab, including upregulation of MCP-1 and IFN-γ. Conclusions: Mitazalimab + mFOLFIRINOX is a feasible regimen with a manageable safety profile. Mitazalimab administered at 900 µg/kg in combination with mFOLFIRINOX shows encouraging antitumor activity in mPDAC, meriting continued development. The study passes futility and continues to full accrual. Clinical trial information: NCT04888312 .

A255 Case Report: Hiatal Hernia with Gastric Fundus Herniation and Obstruction After Sleeve Gastrectomy

A255 Case Report: Hiatal Hernia with Gastric Fundus Herniation and Obstruction After Sleeve Gastrectomy

Fatal gastric volvulus: forensic pathology considerations and postmortem CT findings

Gastric volvulus is a rare cause of gastric obstruction, due to the rotation of the stomach by more than 180°. It is a rare but life-threatening medical emergency that is considered difficult to diagnose at the initial clinical presentation. Forensic pathologists may be presented with gastric volvulus in several ways, for instance, as a cause of sudden and unexpected death or in the context of suspected clinical errors. The post-mortem examination of gastric volvulus may be challenging, due to the specific technical issues it presents and the various mechanisms by which volvulus may cause death. We therefore present five cases of gastric volvulus that in combination represent almost the entire spectrum of presentations and post-mortem findings, to discuss how gastric volvulus may come to the attention of a forensic pathologist, the approach and findings at post-mortem examination (including post-mortem CT), and the variety of mechanisms by which gastric volvulus may result in death.

Gastric impaction in a 7-month-old Rottweiler: a postmortem examination

A dead seven-month-old female Rottweiler dog was presented to the necropsy unit of the University of Ilorin Veterinary Teaching hospital for post-mortem examination. The owner complained of vomiting, salivating, and restlessness prior to the death of the dog. The stomach was filled with black polythene materials at necropsy, weighing 3 Kg. The gastric mucosa was hyperaemic with the right lobes of the lungs severely congested. The heart was globous with prominent coronary vessels. The liver showed areas of diffused necrosis with a slightly enlarged left kidney. Based on the above findings, it was diagnosed as a case of gastric obstruction from nylon. The cause and pathogenesis of gastric impaction are discussed.

A Meta-Analysis of Endoscopic Stenting Versus Surgical Treatment for Malignant Gastric Outlet Obstruction.

Surgical gastrojejunostomy (GJJ) and endoscopic stenting (ES) are the two most available treatments for palliation of malignant gastric obstruction (MGOO). The aim of this study is to compare these two techniques regarding efficacy, safety, time of hospitalization and survival. We performed a literature search from January 2010 to September 2020 to identify available randomized controlled studies and observational studies that compared ES and GJJ for the treatment of MGOO. A total of 17 studies were found. ES and GJJ showed similar technical and clinical success rate. ES was superior to obtain early oral re-feeding, shorter length of hospitalization and a lower incidence of complications than GJJ. Surgical palliation had a lower recurrence rate of obstructive symptoms and longer overall survival than ES. Both procedures have advantages and disadvantages. Probably we should not find the best palliation but the best approach based on the patient characteristics and tumor type.

Clinical outcomes of palliative 3-dimensional conformal external beam gastric radiotherapy: single center experience

Aim: Patients diagnosed with locally advanced and/or metastatic gastric cancer and who cannot undergo surgery may need palliative treatment during their follow-up. There is scarce data about outcomes of palliative gastric radiotherapy (RT). In this study, we aimed to investigate the effect of 3-D external beam RT on oncological outcomes, as a non-invasive method.Material and Method: From 2013 to 2017, sixteen gastric cancer patients treated with palliative external RT in our institutional clinic were evaluated. Only patients who received palliative gastric radiotherapy for obstruction, pain and bleeding were analyzed, and patients who had previously received RT to the abdomen or who were given RT for adjuvant purposes were not included in the analysis. Results: Seven patients (43%) were not able to finish the planned palliative course. Thirty Gray with 10 fractions was the most planned RT schedule. Almost half of the patients (%56) received chemotherapy before RT. Overall survival was found to be median 2 months. Median survival was better in patients who were able to receive 28 Gy bioequivalent dose (4 vs 0.3 months, p≤0.00). Purpose of palliation also found to be a significant factor on survival. Patients who were referred for pain have found to be better survival rather than bleeding and obstruction (13 vs 0.7 months, p=0.03).Conclusion: External radiotherapy is an easily applicable and effective method for palliation in gastric cancer patients. Early referral for radiotherapy in patients who need palliation may increase oncological outcomes. It has been observed that the prognosis is worse in patients who received palliative radiotherapy due to gastric bleeding and obstruction.