Previous Gastric Surgery Research Articles

Duodenal Bezoar: A Rare Cause of Acute Pancreatitis

Gastrointestinal bezoars often occur as a complication of previous gastric surgery or in patients with altered gastrointestinal motility. Complications associated with gastrointestinal bezoars include perforation, peritonitis, protein-losing enteropathy, and acute appendicitis. Acute pancreatitis secondary to a duodenal bezoar is rare, and few studies have reported this complication. We report a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal phytobezoar.

Bezoar as a cause of gastric perforation in young female patient: A case report.

Introduction: Bezoars are rare accumulations of indigestible contents within the gastrointestinal tract. These are commonly found in patients with previous psychiatric illness, learning disabilities and gastric surgery. Computed tomography (CT) is non invasive imaging modality of choice as it can not only diagnose but recognize associated complications as well. Case discussion: We present a case of young 16 years old female who presented with nausea, dull abdominal pain and distension. She underwent Contrast enhanced CT scan and was diagnosed as a case of gastric bezoar with gastric perforation and frank pneumoperitoneum. Patient underwent exploratory laparotomy and repair of stomach. Per operative findings were consistent with trichobezoar. Patient recovered well after surgery. Discussion: Bezoar is accumulation of partially digested foreign material in the gastrointestinal (GI) tract. Bezoar can occur in any part of GIT, however, are most common in stomach. Muliple risk factors are recognized however can occur without risk factor. Bezoars are classified into several main types. Proper clinical history, examination and imaging can play important role in its diagnosis. Conclusion: Non specific abdominal pain in young female patients with psychiatric disorder can result from uncommon causes such as bezoars and is important for clinician and radiologist to be aware of this uncommon entity.

Meat Bolus Bezoar Leading To Small Bowel Obstruction: A Case Report

Introduction: Foreign body ingestion and food bolus impaction are common causes of emergency interventions. Among them, bezoars, indigestible materials accumulated in the gastrointestinal tract, constitute a rare but significant etiology of small bowel obstruction.Case Report: We present a case of a 71-year-old male with a history of gastrojejunostomy for gastric outlet obstruction due to peptic ulcer disease, admitted with abdominal distension, vomiting, and constipation. Imaging revealed acute small bowel obstruction with a transition point approximately 100 cm proximal to the ileocecal junction. Given the non-resolving small bowel obstruction, emergency emergency surgical exploration via exploratory laparotomy was done which suggested a foreign body lodged in the ileum. Enterotomy was done to successfully remove the foreign body which was found to be a meat bolus bezoar.Discussion: Bezoars, although uncommon, should be considered in cases of small bowel obstruction, with phytobezoars being the most frequently reported type. Contributing factors such as previous gastric surgery and poor mastication play a role in bezoar formation. Diagnosis typically involves imaging modalities like CT scans, with surgical intervention often necessary for resolution. Management options include enterotomy, particularly for proximally located bezoars, or bowel resection for complicated cases.Conclusion: This case underscores the importance of considering bezoars as a differential diagnosis in small bowel obstruction, particularly in patients with predisposing factors such as previous gastric surgery. Early recognition and appropriate surgical management are crucial for successful outcomes.

Post-bariatric pregnancy is associated with vitamin K1 deficiency, a case control study

BackgroundMaternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy.MethodsIn this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17–20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5).ResultsThe women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030).ConclusionPost-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.

Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study.

We aimed to estimate the association of glucagon-like peptide 1 (GLP-1) receptor agonist therapy with the incidence of endoscopically visible gastric contents after preprocedural fasting. We reviewed the records of esophagogastroduodenoscopy (EGD) performed at our institution between 2019 and 2023 and determined the presence of residual gastric contents from the procedure notes and saved images. We compared patients taking GLP-1 agonists at the time of the procedure (GLP group, 90 procedures) with patients who started GLP-1 agonist therapy within 1,000 days after undergoing EGD (control, 102 procedures). We excluded emergent procedures without fasting, combined EGD/colonoscopy procedures, and patients with known gastroparesis or previous gastric surgery. We estimated the association between GLP-1 agonist therapy and residual gastric contents with a confounder-adjusted generalized linear mixed effect model. Compared with controls, the GLP cohort had a higher age, American Society of Anesthesiologists' Physical Status, and incidence of nausea and diabetes mellitus. Body mass index and fasting duration were comparable between groups. Visible gastric content was documented in 17 procedures in the GLP group (19%) and in five procedures in the control group (5%), with an associated confounder adjusted odds ratio of 5.8 (95% confidence interval, 1.7 to 19.3; P = 0.004). There were five instances of emergent endotracheal intubation in the GLP group vs one case in control and one case of pulmonary aspiration vs none in control. In fasting patients, GLP-1 agonist therapy was associated with an increased incidence of residual gastric contents, potentially posing an additional risk of periprocedural pulmonary aspiration.

Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia

Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is rapidly increasing in the US, driven by its expanded approval for weight management in addition to hyperglycemia management in patients with type 2 diabetes. The perioperative safety of these medications, particularly with aspiration risk under anesthesia, is uncertain. To assess the association between GLP-1 RA use and prevalence of increased residual gastric content (RGC), a major risk factor for aspiration under anesthesia, using gastric ultrasonography. This cross-sectional study prospectively enrolled patients from a large, tertiary, university-affiliated hospital from June 6 through July 12, 2023. Participants followed preprocedural fasting guidelines before an elective procedure under anesthesia. Patients with altered gastric anatomy (eg, from previous gastric surgery), pregnancy, recent trauma (<1 month), or an inability to lie in the right lateral decubitus position for gastric ultrasonography were excluded. Use of a once-weekly GLP-1 RA. The primary outcome was the presence of increased RGC, defined by the presence of solids, thick liquids, or more than 1.5 mL/kg of clear liquids on gastric ultrasonography. Analysis was adjusted for confounders using augmented inverse probability of treatment weighting, a propensity score-based technique. Secondarily, the association between the duration of drug interruption and the prevalence of increased RGC was explored. Among the 124 participants (median age, 56 years [IQR, 46-65 years]; 75 [60%] female), the prevalence of increased RGC was 56% (35 of 62) in patients with GLP-1 RA use (exposure group) compared with 19% (12 of 62) in patients who were not taking a GLP-1 RA drug (control group). After adjustment for confounding, GLP-1 RA use was associated with a 30.5% (95% CI, 9.9%-51.2%) higher prevalence of increased RGC (adjusted prevalence ratio, 2.48; 95% CI, 1.23-4.97). There was no association between the duration of GLP-1 RA interruption and the prevalence of increased RGC (adjusted odds ratio, 0.86; 95% CI, 0.65-1.14). Use of a GLP-1 RA was independently associated with increased RGC on preprocedural gastric ultrasonography. The findings suggest that the preprocedural fasting duration suggested by current guidelines may be inadequate in this group of patients at increased risk of aspiration under anesthesia.

Primary Trichobezoar in Small Intestine: A Case Report

Trichobezoar is a rare surgical condition that mostly occurs in the stomach and often causes a surgical emergency when left untreated. It is often predisposed by psychiatric conditions, mental retardation, previous gastric surgery, or abnormal anatomy. Trichobezoar progresses extremely slowly and is diagnosed through imaging such as a barium series, endoscopy, or computed tomography. Surgical removal is typically required. The patient in this case was a 12-year-old girl who presented with symptoms of abdominal pain, vomiting, nausea and constipation. She was found to be anaemic and underweight. Contrast-enhanced Computed Tomography (CECT) diagnosed acute intussusception and small bowel obstruction, which were treated by emergency laparotomy. During the operation, a large primary ileal trichobezoar was found in the distal part of the ileum with hair strands extending up to the transverse colon. The absence of masses elsewhere made the diagnosis even more peculiar, as primary intestinal trichobezoar is highly uncommon. Primary closure of the enterotomy was performed as it was viable, and the postoperative period was uneventful. A history of trichophagia was elicited, and a psychiatric assessment of the patient was conducted. Behavioural therapy was initiated for the trichophagia. In conclusion, trichobezoar is a rare surgical entity with modifiable predisposing factors that require a multidisciplinary management approach.

Gastritis cystica profunda in a Western population without previous gastric surgery.

Gastritis cystica profunda (GCP) is a rare entity characterized by foveolar hyperplasia and cystic dilation of the gastric mucosa and submucosal glands. Its etiopathogenesis remains unknown. It has been associated with chronic inflammatory conditions, such as gastric surgery or bile reflux. The diagnosis is histological, although endoscopic ultrasound (EUS) may be useful for initial suspicion. We present a series of cases from our center, where six cases of GCP were collected between 2012 and 2022, with no history of gastric surgery. The most common locations were the antrum (50%), fundus (33%), and body (17%). Endoscopic findings included polyps ranging from 7 to 50 mm. The treatment was en bloc mucosectomy for lesions ≤20 mm and piecemeal mucosectomy for lesions >20 mm. Recurrence was observed in four patients (67%). Histologically, displaced gastric glands were found in the submucosa with cystic dilation, without dysplastic changes.

Gastrointestinal bezoars. Review of the literature and report of a rare case of pumpkin seed rectal impaction.

In science, bezoar is a mass of hair or undigested vegetable matter, found in a human or animal's intestines, similar to a hairball. Usually, it is found trapped in every part of the gastrointestinal system and must be distinguished by pseudobezoar which is an indigestive object voluntarily introduced into the digestive tract. The term Bezoar is from Arabic bāzahr, "bezoar" or ultimately from Middle Persian p'tzhl pādzahr, "antidote, bezoar"ægagropile o egagropile It should be a universal antidote that works against any poison, and could neutralize any poison. Otherwise, the name could derive from a kind of Turkish goat whose name is just bezoar. Authors report a case of fecal impaction by pumpkin seeds bezoar with abdominal pain: a difficulty to void with subsequent rectal inflammation and hemorrhoid enlargement was observed. The patient underwent a successful manual disimpaction. Guidelines do not require IRB approval Authors examined the literature about occlusion from bezoar The most common causes of occlusion from bezoar are: a previous gastric surgery such as a gastric band (for weight loss) or gastric bypass, a reduced stomach acid (hypochlorhydria) or decreased stomach size, a delayed gastric emptying, typically due to diabetes, autoimmune disorders, or mixed connective tissue disease. Seed bezoars are usually found in the rectum of patients without predisposing factors, causing constipation and pain. Rectal impaction is common after ingestion of seeds while a true occlusion is rare. Although several cases of phytobezoars composed of various types of seeds are reported in literature, bezoars of pumpkin seeds have rarely been reported.

Safety and efficacy of direct percutaneous endoscopic jejunostomy placement in patients with previous upper gastrointestinal resection: A retrospective cohort study.

Percutaneous jejunal enteral access can be obtained with percutaneous endoscopic gastric jejunostomy (PEGJ) and direct percutaneous endoscopic jejunostomy (DPEJ) tubes. PEGJ may not be feasible in patients with previous gastric resection (PGR) and DPEJ may be the only option. Our aim is to determine if DPEJ tubes can be placed successfully in patients with history of gastrointestinal (GI) surgery and if success rates are comparable to DPEJ or PEGJ in those without prior GI surgery. We reviewed all tube placements performed from 2010 to present. Procedures were performed using a pediatric colonoscope. Previous upper GI surgery was defined as PGR or esophagectomy with gastric pull-up. Adverse events (AEs) were graded perAmerican Society for Gastrointestinal Endoscopy criteria. Mild events included unplanned medical consultation or hospitalization <3 days, and moderate events included repeat endoscopy without surgical intervention. Successful placement rates were high regardless of GI surgical history. Patients receiving a DPEJ with a history of GI surgery were significantly less likely to experience an AE compared with those receiving DPEJ with no history and compared with PEGJ patients with or without a history. DPEJ placement in patients with previous upper GI surgery has very high success rate. It is associated with lower AE rates than patients receiving DPEJ without previous gastric surgery, or PEGJ regardless of previous gastric surgery. Patients with a history of upper GI surgery requiring enteral access may benefit from DPEJ over PEGJ placement considering its very high success rate and lower incidence of AEs.

(407) Buried Penis in Morbidly Obese Patient: Surgical Technique of Fat Pad Excision, Malleable Penile Prosthesis Insertion and Penile Split Skin Graft

Abstract Introduction Buried penis has a significant impact on quality of life affecting voiding and sexual function. Central and suprapubic deposition of adipose tissue related to obesity is a common cause. Objective This video shows the surgical approach of a complex case of buried penis managed with a suprapubic fat pad excision and simultaneous malleable penile prosthesis insertion. Methods We present a case of buried penis in a morbidly obese patient (BMI:43) with a history of two previous gastric bypass surgery and an apronectomy. affecting micturition and sexual function. A skin incision is made with a transverse incision at the level of the anterior superior iliac spine and a curvilinear inferior border. The apex of the inferior border should be approximately 2 finger breadth above the level of the penopubic junction. The incision is extended down to the rectus sheath and the spermatic cords at the lateral boundaries and the penile shaft at the midline are exposed. A malleable implant is inserted using the infrapubic approach and a split skin graft harvested to replace the unhealthy penile shaft skin. The dermis of the skin edges are secured to the rectus sheath with 0/0 vicryl sutures and the wound is closed in layers. Results Post-operative recovery was complicated by partial necrosis of the skin graft. At 3 months, the patient was able to stand to void and engage in sexual intercourse at 6 months. Conclusions The prevalence of obesity is increasing and in men, the presence of a suprapubic fat bad can result in a buried penis and affect voiding and sexual function. Although weight loss should be advised in the first instance, this may often not be enough. A combination of a suprapubic fat pad excision with malleable penile implantation and spit skin graft is a treatment option that can be considered. Disclosure No

Pancreatitis sepsis: Evolution and principles in the management of necrotizing pancreatitis

Outcomes from some recent clinical trials have helped to improve the management of necrotizing pancreatitis over the last 2 decades. The location of the retroperitoneal collection, previous gastric surgery, patient preference, and medical expertise dictates a minimally invasive surgical step-up versus endoscopic approach. Endoscopic drainage is facilitated by either a plastic or metallic stent. Direct endoscopic necrosectomy is performed for lack of improvement after endoscopic drainage. The surgical approach is accomplished by minimally invasive surgery with either video-assisted retroperitoneal debridement or laparoscopic drainage. A multidisciplinary team with appropriate expertise should care for patients with necrotizing pancreatitis. This brief review summarizes the landmark clinical trials, compares the benefits and roles of endoscopic, surgical, and percutaneous interventions, and discusses treatment algorithms for necrotizing pancreatitis in the modern era.

Segmental cervical esophagectomy with free jejunal flap reconstruction for cervical esophageal cancer in patients with previous history of gastric surgery: a report of two cases.

Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has not been reported. We encountered two patients with esophageal cancer and previous gastric surgeries who eventually underwent segmental esophagectomy with free-flap jejunal reconstruction. Case one involved a 75-year-old man who underwentabdominal abscess and duodenal ulcer perforation surgeries (abdominal drainage and subsequent gastrojejunal bypass). A type 0-IIa tumor was located posterior to the cervical esophagus's right wall, 21cm from the incisor, without lymph node swelling or distant metastasis. The left lobe of the thyroid gland was mobilized to ensure an oral resection margin. Severe abdominal adhesions required careful adhesiolysis to harvest the jejunum (20cm long) 40cm from the jejunojejunostomy. An end-to-side and side-to-end esophagojejunostomy were performed for the proximal and distal ends, respectively. Case two involved a 75-year-old male with a history of distal gastrectomy with Billroth I reconstruction for early gastric cancer. A submucosal tumor-like lesion was located on the cervical esophageal wall on the left side, 21cm from the incisor. The distal esophagus requiredadditional segmental resection because the anal resection line was close to the tumor. Jejunum (10cm long) 30cm from Ligament of Treitz was harvested. An end-to-side and end-to-end esophagojejunostomy for the proximal and distal ends, respectively, was performed. This surgery requires a thorough preoperative examination to ensure an adequate surgical margin and a careful free-flap harvest based on post-gastric surgery anatomy.

Feasibility of a single-port thoracoscopy-assisted five-step laparoscopic procedure via transabdominal diaphragmatic approach for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma

Objective: We aimed to explore the feasibility of a single-port thoracoscopy- assisted five-step laparoscopic procedure via transabdominal diaphragmatic(TD) approach(abbreviated as five-step maneuver) for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma (AEG). Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) age 18-80 years; (2) diagnosis of Siewert type II AEG; (3) clinical tumor stage cT2-4aNanyM0; (4) meeting indications of the transthoracic single-port assisted laparoscopic five-step procedure incorporating lower mediastinal lymph node dissection via a TD approach; (5) Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1; and (6) American Society of Anesthesiologists classification I, II, or III. The exclusion criteria included previous esophageal or gastric surgery, other cancers within the previous 5 years, pregnancy or lactation, and serious medical conditions. We retrospectively collected and analyzed the clinical data of 17 patients (age [mean ± SD], [63.6±11.9] years; and 12 men) who met the inclusion criteria in the Guangdong Provincial Hospital of Chinese Medicine from January 2022 to September 2022. No.111 lymphadenectomy was performed using five-step maneuver as follows: superior to the diaphragm, starting caudad to the pericardium, along the direction of the cardio-phrenic angle and ending at the upper part of the cardio-phrenic angle, right to the right pleura and left to the fibrous pericardium , completely exposing the cardio-phrenic angle. The primary outcome includes the numbers of harvested and of positive No.111 lymph nodes. Results: Seventeen patients (3 proximal gastrectomy and 14 total gastrectomy) had undergone the five-step maneuver including lower mediastinal lymphadenectomy without conversion to laparotomy or thoracotomy and all had achieved R0 resection with no perioperative deaths. The total operative time was (268.2±32.9) minutes, and the lower mediastinal lymph node dissection time was (34.0±6.0) minutes. The median estimated blood loss was 50 (20-350) ml. A median of 7 (2-17) mediastinal lymph nodes and 2(0-6) No. 111 lymph nodes were harvested. No. 111 lymph node metastasis was identified in 1 patient. The time to first flatus occurred 3 (2-4) days postoperatively and thoracic drainage was used for 7 (4-15) days. The median postoperative hospital stay was 9 (6-16) days. One patient had a chylous fistula that resolved with conservative treatment. No serious complications occurred in any patient. Conclusion: The single-port thoracoscopy-assisted five-step laparoscopic procedure via a TD approach can facilitate No. 111 lymphadenectomy with few complications.

Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery.

Bezoars are foreign bodies developed due to the swallowing of indigestible substances in the stomach that accumulate in the lumen of the gastrointestinal tract. This study aimed to compare the location, size, and diameter of bezoars between patients with and without a history of previous gastrointestinal surgery and between operated and non-operated patients retrospectively. A total of 188 patients who presented to our gastroenterology clinic and in whom bezoar was suspected on clinical examination and the diagnosis confirmed through abdominal CT scans were included in the study. The patients were divided into two groups; patients with a history of previous gastrointestinal surgery were assigned to Group 1 (n = 70), and those who had no history of previous surgery (n = 118) to Group 2. The mean age was found as 56.16 ± 15.75years in Group 1 and 57.71 ± 15.95years in Group 2. The mean bezoar width was significantly higher in Group 1 (p = 0.049). The mean bezoar length was significantly higher in Group 1 (p = 0.004). Considering localization of bezoars, the rate of patients who underwent enterotomy (80%) was statistically significantly higher than the patients who underwent gastrotomy (23.50%), gastrotomy + milking (28.60%) and milking (44.70%) in the operations performed in the jejunum. Bezoars are a rare cause of intestinal obstruction. The median width and length of the bezoars were significantly higher in patients with a history of previous gastric surgery. There was no significant difference in other parameters. The most common localization was jejunum.

Intralipid administration in case of a severe venlafaxine overdose in a patient with previous gastric bypass surgery

Intralipid administration in case of a severe venlafaxine overdose in a patient with previous gastric bypass surgery

EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement.

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES). This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed. Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15-48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%. EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result.

Short-Term Surgical Outcomes of Robotic Gastrectomy Compared to Open Gastrectomy for Patients with Gastric Cancer: a Randomized Trial

BackgroundRobotic gastrectomy (RG) has been shown to be a safe and feasible method in gastric cancer (GC) treatment. However, most studies are in Eastern cohorts and there is great interest in knowing whether the method can be used routinely, especially in the West. ObjectivesThe aim of this study was to compare the short-term surgical outcomes of D2-gastrectomy by RG versus open gastrectomy (OG). MethodsSingle-institution, open-label, non-inferiority, randomized clinical trial performed between 2015 and 2020. GC patients were randomized (1:1 allocation) to surgical treatment by RG or OG. Da Vinci Si platform was used. Inclusion criteria: gastric adenocarcinoma, stage cT2-4 cN0-1, potentially curative surgery, age 18–80 years, and ECOG performance status 0–1. Exclusion criteria: emergency surgery and previous gastric or major abdominal surgery. Primary endpoint was short-term surgical outcomes. The study is registered at clinicaltrials.gov (NCT02292914). ResultsOf 65 randomized patients, 5 were excluded (3 palliatives, 1 obstruction and emergency surgery, and 1 for material shortage). Consequently, 31 and 29 patients were included for final analysis in the OG and RG groups, respectively. No differences were observed between groups regarding age, sex, BMI, comorbidities, ASA, and frequency of total gastrectomy. RG had similar mean number of harvested lymph nodes (p = 0.805), longer surgical time (p < 0.001), and less bleeding (p < 0.001) compared to OG. Postoperative complications, length of hospital stay, and readmissions in 30 days were equivalent between OG and RG. ConclusionsRG reduces operative bleeding by more than 50%. The short-term outcomes were non-inferior to OG, although surgical time was longer in RG.

Current scenario of Gastric cancer (GC): A systematic review

Gastric cancer (GC) is amongst the most difficult cancers to treat and, hence, has to be studied from the roots to be properly analysed. The disease starts as precancerous lesions which have to be observed. This includes dysplasia, atrophic gastritis and intestinal metaplasia. This is effective for detecting the prognosis of GC so that it can be resolved in early stages. This is dependent on a variety of risk factors which include blood type, gender, age, geography, gene polymorphisms, acid secretion, pernicious anemia, oxidative damage, previous gastric surgery, etc. Probably the most important, however, is infection by H. Pylori. With respect to virulence factors and host factors, both are significant players in the development of several cases of malignancies. Other genetic factors and lifestyle choices including alcohol use, tobacco usage and obesity, will also be analysed. There are also several genetic conditions that cause high risk of development into a malignancy including Menetrier’s disease, hereditary diffuse GC, Lynch syndrome, Peutz-Jeghers syndrome, Li Fraumani syndrome etc. Several diagnostic procedures such as lab tests, physical examinations and biopsy are used. The current review analysed the factors which are involved in the prognosis and causative agents in the development of GC. This is to better understand how GC can be diagnosed and confirmed. This may include molecular testing, including genes, which can be of high risk followed by modern treatment methods discussing surgery, chemotherapy, immunotherapy and radiotherapy. Chemotherapy includes discussion of several drugs and how they target the malignancy in question. By understanding the disease in detail, through causes, prognosis, detection and treatment, we can go one step closer to find the cure for GC.

Endoscopic treatment of a large gastric bezoar: A Case report

Bezoars are concretions of undigested or partially digested foreign material in the gastrointestinal tract. They occur in patients with altered gastrointestinal motility or anatomy (previous gastricsurgery, diabetes mellitus, neurological disorders). They are rare, with an estimated %0.3 on upper endoscopy. The most common symptoms include abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss. We present a patient who diagnosed with 8-9 cm phytobezoar, and treated by endoscopic method. An 87 years old woman presented to our emergency room with upper abdominal pain, nausea, and postprandial emesis for 3 days. Emergency esophagogastroduodenoscopy revealed prepyloric antrum, gastric phytobezoar (8-9 cm) and ulcers (10-12 mm). We used an endoscopic snare to cut the bezoar into several pieces. After endoscopy, all bezoars disappeared. There was no recurrence during 1-year follow-up. In conclusion, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with gastric outlet obstruction. This is the rare case that such a large phytobezoar (8×9 cm) has been fragmented with an ordinary polypectomy snare.