ABSTRACT
Unresectable advanced gastric cancer is a challenge that both endoscopists and surgeons must face with more frequency than expected. For the treatment of a patient with this condition, there are a set of technical and ethical aspects that will help determine the best approach, considering the quality of life of the patient, their family and environment. The purpose of this review is to show the different options available for racing this disease, with emphasis on autoexpandible metallic prostheses, which have proved to be the most viable and safe option.
El cáncer gástrico avanzado irresecable es un desafío al que tanto endoscopistas como cirujanos nos vemos enfrentados con mayor frecuencia de la que quisiéramos. Ante un paciente afectado por esta patología, existe una serie de consideraciones técnicas y éticas que ayudarán a definir el mejor camino a seguir, considerando la calidad de vida del paciente, su familia y el entorno. Esta revisión tiene por fin mostrar las diferentes alternativas para hacer frente a esta enfermedad, haciendo especial hincapié en las prótesis autoexpandibles, que en razón de sus resultados han demostrado ser la opción más viable y segura.
Subject(s)
Humans , Palliative Care , Gastroscopy , Stomach Neoplasms/therapy , Stents , Laser TherapyABSTRACT
Objetivo: caracterizar a los pacientes con cáncer gástrico y precisar su evolución con el tratamiento indicado. Métodos: se realizó un estudio observacional, descriptivo de 50 pacientes con diagnóstico de cáncer gástrico en el municipio Caimito durante 15 años. Las variables estudiadas fueron: edad, sexo, antecedentes patológicos personales de enfermedad gástrica, antecedentes familiares, laborales, nutricionales y de exposición a tóxicos y evolución según tratamiento indicado. Resultados: el mayor número de pacientes diagnosticados y fallecidos corresponden a los consejos populares Caimito y Costa Norte. Hubo 32 pacientes del sexo masculino y 18 del femenino. Se mantuvieron vivos al final del estudio cinco de los 20 pacientes que recibieron tratamiento quirúrgico, dos de los nueve tratados con cirugía más poliquimioterapia y uno de los tres tratados con radioterapia más cirugía. El 46 por ciento de los pacientes tuvo antecedentes de gastritis, el 22 por ciento de úlcera y el 60 por ciento historia familiar de tumores digestivos o no. Conclusiones: los pacientes afectados fueron fundamentalmente los ancianos del sexo masculino, con antecedentes personales de enfermedad gástrica, exposición a tóxicos y antecedentes familiares de enfermedad tumoral digestiva o extradigestiva. Tuvieron mejor pronóstico los que recibieron tratamiento quirúrgico solo o combinado
Objective: characterize patients with gastric cancer and describe their evolution with the treatment indicated. Methods: an observational descriptive study was conducted of 50 patients from the municipality of Caimito diagnosed with gastric cancer throughout 15 years. The variables studied were age; gender; personal history of gastric disease; family, occupational and nutritional history; antecedents of exposure to toxic substances, and evolution with the treatment indicated. Results: the largest number of patients diagnosed and deceased corresponds to the People's Councils of Caimito and Costa Norte. 32 patients were male and 18 female. The patients who remained alive at the end of the study period were five of the twenty who underwent surgical treatment, two of the nine who were treated with surgery plus polychemotherapy, and one of the three treated with radiotherapy plus surgery. 46 percent of the patients had a history of gastritis, 22 percent of ulcer and 60percent had family antecedents of tumors, either digestive or not. Conclusions: the patients affected were mainly male and elderly, with a history of gastric disease and exposure to toxic substances, and family antecedents of digestive or extradigestive tumoral disease. Patients who received surgical treatment, either alone or combined, had a better prognosis
Subject(s)
Humans , Male , Female , Stomach Neoplasms/pathologyABSTRACT
La búsqueda integral de mejores condiciones de vida para los pacientes con cáncer gástrico en quienes no está indicado el tratamiento quirúrgico con intención curativa, continúa siendo una situación desafiante que lleva al límite los conocimientos, las destrezas y la fundamentación ética de cualquier equipo médico. La justificación del tratamiento paliativo debe establecerse con base en una minuciosa consideración de las opciones disponibles y la situación particular de cada caso.Este artículo pretende revisar la terapia endoscópica con prótesis autoexpandibles para el tratamiento paliativo del cáncer gástrico, así como la evidencia científica que soporta su utilización y los factores que determinan su indicación.
The integral search for improved living conditions for those patients with gastric cancer who have not received curative surgical treatment continues to challenge the knowledge, dexterity and ethical foundations of medical teams. The justification for palliative treatment must be based on a thorough consideration of the available options and the particular situation in each case.This article reviews endoscopic therapy with auto expandable prosthetics for palliative treatment of gastric cancer, as well as the scientific evidence that supports its use and the factors that determine its indication.
Subject(s)
Humans , Abdominal Neoplasms , Palliative Care , Endoscopy , Prostheses and ImplantsABSTRACT
BACKGROUND/AIMS: The levels of pepsinogen (PG) I and the PGI/II ratio are useful serologic markers for chronic atrophic gastritis. This study evaluated the performance and clinical implications of these markers in patients undergoing endoscopic mucosectomy. METHODS: We enrolled 142 consecutive patients with early gastric tumors and Helicobacter pylori infection who were eligible for mucosectomy. Chronic gastritis and atrophy were assessed using four defined biopsy procedures. Serum PGs were measured by an enzyme immunoassay. Optimal diagnostic cut-offs and performance were determined using receiver operating characteristic curves. RESULTS: The PGI level and the PGI/II ratio decreased with corpus-dominant gastritis and as atrophy advanced toward the corpus greater curvature (GC). For the presence of corpus GC atrophy, the areas under the PGI and PGI/II-ratio curves were 0.82 and 0.77, respectively. The optimal cut-off levels were 59.3microg/L for PGI (sensitivity, 83.3%; specificity, 78.4%) and 3.6microg/L for PGI/II ratio (sensitivity, 70.0%; specificity, 78.4%). Using these serologic cut-off levels, we found that the frequency of corpus tumor location differed significantly (32.9% vs 11.1% for PGI or =59.3microg/L, respectively; and 31.1% vs 14.8% for PGI/II ratio or =3.5, respectively; p<0.05). CONCLUSIONS: A low PGI level and PGI/II ratio are valuable serologic markers for predicting corpus GC atrophy, and have clinical implications with respect to the corpus location of tumors in mucosectomy patients.