ABSTRACT
Percutaneous endoscopic gastrostomy (PEG) is the modality of choice for long-term enteral feeding in patients in whom oral intake is challenging. Compared with parenteral nutrition, gastrostomy feeding is the preferred choice for sustained nutritional support. Delivery of nutrients directly to the gastrointestinal tract and enhanced cellular immunity associated with this approach are clinically beneficial to patients. Endoscopic gastrostomy is favored for its high clinical success rates and economic advantages and is associated with minor discrepancies with regard to morbidity, mortality, and tube function compared with surgical gastrostomy. PEG procedures can be broadly classified into the pull- and push-types. Although PEG is a comparatively safe procedure, high risk of bleeding is a well-known complication of PEG placement, which necessitates prophylactic antibiotic therapy and careful periprocedural management in patients who receive antiplatelet and anticoagulant agents. Tube dislodgement, peristomal leakage, or infection following PEG placement may require tube replacement or removal. In this review, we investigated the concerns associated with early vs. delayed feeding in concordance with current guidelines. We also describe the indications for PEG tube insertion, post-procedural care strategies, and management of complications.
ABSTRACT
Background/Aims@#Chitosan, a natural polymer widely used in the biomaterials field, has been proposed as a potential submucosal injection solution. The purpose of this study was to compare the performance and efficacy of aqueous chitosan solution and commercialized submucosal injection fluids using a three-dimensional sensor and to evaluate the efficacy of the measured parameters. @*Methods@#Normal saline (0.9% NaCl), as a control, Eleview ® (Poloxamer 188), Blue Eye TM (0.4% hyaluronic acid), and aqueous chitosan solution (2.0%) were injected into the submucosa of porcine stomachs ex vivo. The mucosal elevation height, elevated surface area, and angle of the tangent of the submucosal fluid cushion were measured using a three-dimensional sensor. The rates of change for each variable were calculated, and the correlation between parameters was analyzed. Tissue specimens were stained with hematoxylin and eosin. @*Results@#All variables exhibited the highest values under chitosan injection. The mucosal elevation height rate of change differed significantly between normal saline and chitosan solution (p=0.024). The elevated surface area rates of change for normal saline and Eleview® were significantly different from those for TS-905 and chitosan solution (p=0.006 and p=0.009, respectively). Further, height, area, and angle showed a positive correlation (p<0.001). A histological examination revealed an even distribution of aqueous chitosan within the submucosa without tissue damage. @*Conclusions@#Aqueous chitosan was superior to normal saline and Eleview® and was noninferior to TS-905. A three-dimensional sensor and the measured parameters were effective and useful for evaluating the performance of submucosal fluids.
ABSTRACT
Ablative therapy has drawn attention for cancer treatment as minimally invasive therapy. Recently, irreversible electroporation which has a different concept from the existing ablation method has emerged. Although gastrointestinal tract cancer is commonly managed by ablation such as liver, pancreas cancer, hollow viscus cancer is extremely challenging for applying ablative therapy because of its high perforation risk. Therefore, several studies about hollow viscus irreversible electroporation will be introduced in this review regarding its pre‐clinical relevance.
ABSTRACT
Ablative therapy has drawn attention for cancer treatment as minimally invasive therapy. Recently, irreversible electroporation which has a different concept from the existing ablation method has emerged. Although gastrointestinal tract cancer is commonly managed by ablation such as liver, pancreas cancer, hollow viscus cancer is extremely challenging for applying ablative therapy because of its high perforation risk. Therefore, several studies about hollow viscus irreversible electroporation will be introduced in this review regarding its pre‐clinical relevance.
ABSTRACT
Liver cancer is the 2nd most common cause of cancer related death in Korea. Especially, patients who present extrahepatic spread of hepatocellular carcinoma (HCC) have a shorter life expectancy (50% survival at 1 year and less than 4 months of median overall survival). Molecular target agent like sorafenib was usually mentioned as a treatment for them, but that was still not firmly established. We present a 75 year-old who had expanding nodular type of HCC. The mass was removed by resection and radiofrequency ablation. However, lung metastasis were revealed shortly after surgery. That lesions were treated with lenvatinib and systemic chemotherapy.