Efficacy and safety of self-expanding metal stents in patients with inoperable esophageal cancer: a real-life study.

Background: Dysphagia is the most frequent symptom in patients diagnosed with esophageal cancer. Self-expanding metal stents (SEMS) are the current palliative treatment of choice for dysphagia in patients with non-curable esophageal cancer. This study aimed to evaluate the efficacy and adverse events (AEs) of different types of SEMS for palliation of dysphagia. Methods: We performed a retrospective cohort study of patients with advanced esophageal cancer and SEMS placement for dysphagia palliation in a tertiary care center. The primary outcome was the clinical success defined as an improvement in dysphagia (reduction of at least 2 points in the Mellow-Pinkas scoring system for dysphagia) after SEMS placement. Results: Between January 1999 and May 2020, 295 patients with esophageal cancer were identified. Among them, 75 had a SEMS placement for dysphagia palliation. The mean age of the patients was 61.3 years (standard deviation: 13.4), 69 patients (92%) were men, and the mean Mellow-Pinkas scoring for dysphagia pre- and post-SEMS placement were 3.1 and 1.4 (change from baseline -1.7), respectively. Technical success and clinical success were achieved in 98.6% and 58.9%, respectively. AEs were identified in 35/75 patients (46.7%), and SEMS migration was the most frequent AE in 22/75 patients (29.3%). There were no significant differences in improvement in dysphagia (p = 0.054), weight changes (p = 0.78), and AE (p = 0.73) among fully covered SEMS (fc-SEMS) and partially covered SEMS (pc-SEMS). The median follow-up was 89 days (interquartile range: 29-221). Conclusion: SEMS placement was associated with a rapid improvement in dysphagia, high technical success, and a modest improvement in dysphagia with no major AE among fc-SEMS and pc-SEMS.

Comparison between Two Types of 22-Gauge Fine-Needle Biopsy for Solid Pancreatic Tumors.

Background: Tissue sampling using endoscopic ultrasound-guided fine-needle aspiration is the gold standard for diagnosing malignant pancreatic tumors; however, its sensitivity and specificity are highly variable. Thus, fine-needle biopsy using cutting needles has been developed to overcome current limitations and improve diagnostic yield. Our study compared two fine-needle biopsy needles for tissue sampling for pancreatic solid lesions. Materials and Methods: Samples obtained from patients with pancreatic solid lesions using the 22-gauge fine-needle biopsy needles (Franseen needle or reverse bevel needle) were retrospectively analyzed. The primary outcomes were diagnostic yield and sample adequacy. The secondary outcome was diagnostic performance. The analysis was performed using 2 × 2 tables to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for each needle type. Proportions were compared using the Z test. For quantitative variables, a comparative analysis was performed using Student's t test. Qualitative and unpaired outcome variables were described using Fisher's exact test. Results: Sixty-three patients with pancreatic lesions were included in the analysis. The fine-needle biopsy Franseen and reverse bevel groups included 33 and 30 patients, respectively. An adequate sample was obtained in 97% of patients in the Franseen needle group versus 80% in the reverse bevel needle group; the diagnostic yields in these groups were 93.9 and 66.7%, respectively. Neither differences between needle passes nor complications were noted. The sensitivity and specificity were 93.5 and 100%, respectively, in the fine-needle biopsy Franseen group, versus 71 and 100%, respectively, in the reverse bevel needle group. Conclusions: The Franseen needle was more effective for sampling pancreatic tumors than the reverse bevel needle.

Introdução: A aquisição de tecido através de punção com agulha fina guiada por ecoendoscopia é o padrão para o diagnóstico de neoplasias pancreáticas malignas; contudo, a sua sensibilidade e especificidade é altamente variável. A biópsia por agulha fina (FNB) usando agulhas cortantes foi desenvolvida para ultrapassar as limitações atuais. Este estudo comparou duas agulhas de FNB na aquisição de tecido de lesões pancreáticas sólidas. Métodos: Amostras obtidas de doentes com lesões pancreáticas sólidas utilizando agulha de FND de 22 gauge (Franseen ou reverse bevel) foram avaliadas retrospetivamente. Os outcomes primárias foram a rentabilidade diagnóstica e a adequabilidade das amostras. O outcome secundário foi a performance diagnóstica. A análise estatística foi realizada através de tabelas de contingência 2 × 2 para cálculo da sensibilidade, especificidade, valor preditivo positivo e negativo e acuidade para cada tipo de agulha. As proporções foram calculadas utilizando o teste-Z. Para variáveis quantitativas foi realizada análise comparativa com teste t-Student. Variáveis qualitativas e não pareadas foram comparadas com teste exato de Fisher. Resultados: Foram incluídos 63 doentes com lesões pancreáticas (33 no grupo FNB Franseen e 30 no grupo reverse bevel). Foram obtidas amostras adequadas em 97% do grupo Franseen vs 80% no grupo reverse bevel, sendo a rentabilidade diagnóstica de 93.9 e 66.7%, respetivamente. Não houve diferenças no número de passagens nem nas complicações. A sensibilidade e especificidade foram, respetivamente, de 93.5 e 100% no grupo Franseen versus 71 e 100% no grupo reverse bevel. Conclusões: A agulha Franseen foi mais efetiva na aquisição de amostras de lesões pancreáticas do que a agulha reverse bevel.

Somatic Mutational Landscape in Mexican Patients: CDH1 Mutations and chr20q13.33 Amplifications Are Associated with Diffuse-Type Gastric Adenocarcinoma.

The Hispanic population, compared with other ethnic groups, presents a more aggressive gastric cancer phenotype with higher frequency of diffuse-type gastric adenocarcinoma (GA); this could be related to the mutational landscape of GA in these patients. Using whole-exome sequencing, we sought to present the mutational landscape of GA from 50 Mexican patients who were treated at The Instituto Nacional de Cancerología from 2019 to 2020. We performed a comprehensive statistical analysis to explore the relationship of the genomic variants and clinical data such as tumor histology and presence of signet-ring cell, H. pylori, and EBV. We describe a potentially different mutational landscape between diffuse and intestinal GA in Mexican patients. Patients with intestinal-type GA tended to present a higher frequency of NOTCH1 mutations, copy number gains in cytobands 13.14, 10q23.33, and 12q25.1, and copy number losses in cytobands 7p12, 14q24.2, and 11q13.1; whereas patients with diffuse-type GA tended to present a high frequency of CDH1 mutations and CNV gains in cytobands 20q13.33 and 22q11.21. This is the first description of a mutational landscape of GA in Mexican patients to better understand tumorigenesis in Hispanic patients and lay the groundwork for discovering potential biomarkers and therapeutic targets.

Eficacia y seguridad de la ablación por radiofrecuencia endoscópica en pacientes con estenosis biliar maligna irresecable / No disponible

INTRODUCCIÓN: se ha observado que la ablación endoscópica por radiofrecuencia en tumores irresecables de vía biliar prolonga la sobrevida. OBJETIVO: evaluar sobrevida, permeabilidad de prótesis y efectos adversos de la ablación contra un grupo control. METODOLOGÍA: estudio observacional en pacientes con estenosis biliar maligna irresecable. RESULTADOS: cuarenta pacientes, 12 radiofrecuencia, no hubo diferencias entre variables basales de ambos grupos. Hubo mayor sobrevida en el grupo de radiofrecuencia sin diferencia estadísticamente significativa (217 vs. 129 días, log-rank 0,31). No hubo diferencia en permeabilidad de prótesis o efectos adversos. CONCLUSIÓN: se encontró ganancia de tres meses en sobrevida a favor de la radiofrecuencia sin alcanzar diferencia estadísticamente significativa

No disponible

Efficacy and safety of radiofrequency ablation in patients with unresectable malignant biliary strictures.

INTRODUCTION: previous studies have shown that endoscopic radiofrequency ablation in unresectable biliary duct tumors prolongs survival. METHODS: this was an observational study of patients with an unresectable malignant stricture. The aim was to evaluate survival, stent patency and adverse events of radiofrequency compared with a matched control group. RESULTS: the study included 40 patients, 12 with radiofrequency. There were no differences between baseline parameters in both groups. The survival time was longer in the radiofrequency group with no statistically significant difference (217 vs 129 days, log-rank 0.31). There was no difference in stent permeability or adverse events. CONCLUSION: the radiofrequency group had a three-month increase in survival, which did not reach statistical significance.

Comparación de prótesis autoexpandibles cubiertas frente a no cubiertas para el tratamiento de la obstrucción biliar maligna / Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

Antecedentes y objetivo: el drenaje con prótesis metálicas es el tratamiento de elección de la ictericia obstructiva maligna. El éxito técnico y el éxito clínico con las prótesis metálicas se logran en más del 90% y el 80% de los casos, respectivamente. Existen prótesis metálicas autoexpandibles cubiertas con el propósito de prolongar su permeabilidad. El objetivo del estudio fue describir los resultados de utilizar prótesis metálicas autoexpandibles totalmente cubiertas y prótesis metálicas autoexpandibles no cubiertas en la paliación de la obstrucción biliar maligna. Pacientes y métodos: de manera retrospectiva fueron incluidos 68 pacientes con ictericia obstructiva maligna secundaria a patología pancreatobiliar o metastásica no candidatos a cirugía. Se formaron dos grupos: grupo A (prótesis metálicas autoexpandibles cubiertas) (n = 22) y grupo B (prótesis metálicas autoexpandibles no cubiertas) (n = 46). Resultados: en ambos grupos se observó la disminución en los valores séricos de bilirrubina total, bilirrubina directa, fosfatasa alcalina y gammaglutamiltransferasa. Sin embargo, no hubo una diferencia estadísticamente significativa (p = 0,800; p = 0,190; p = 0,743; p = 0,521). La migración fue mayor con las prótesis cubiertas, pero no tuvo significación estadística (p = 0,101). La obstrucción fue mayor en el grupo con prótesis no cubiertas y tampoco fue estadísticamente significativa (p = 0,476). Conclusión: no hay diferencia entre utilizar prótesis autoexpandibles totalmente cubiertas y prótesis autoexpandibles no cubiertas con respecto al éxito técnico, éxito clínico, y complicaciones cuando se utilizan para paliar la ictericia obstructiva maligna (AU)

Background and objective: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. Patients and methods: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents) (n = 22) and group B (uncovered self-expandable metallic stents) (n = 46). Results: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521). Migration was greater with covered stents but it was not statistically significant either (p = 0.101). Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476). Conclusion: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice (AU)

Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction.

BACKGROUND AND OBJECTIVE: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. PATIENTS AND METHODS: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents) (n = 22) and group B (uncovered self-expandable metallic stents) (n = 46). RESULTS: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521). Migration was greater with covered stents but it was not statistically significant either (p = 0.101). Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476). CONCLUSION: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.

Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum.

BACKGROUND: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum. METHODS: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected data included: age, gender, performance status (Karnofsky's score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival. RESULTS: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky's score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival. CONCLUSIONS: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter in-hospital stay and lower rate of complications.

Prótesis metálicas autoexpandibles versus antrectomía en el tratamiento paliativo del adenocarcinoma obstructivo del antro gástrico / Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum

Introducción: los pacientes con cáncer gástrico tienen un tumor irresecable hasta en el 40% de los casos. La obstrucción de salida gástrica ocasiona vómito, deshidratación y desnutrición. El objetivo de este estudio fue comparar las prótesis metálicas autoexpandibles con la antrectomia en el tratamiento paliativo del adenocarcinoma obstructivo del antro gástrico. Método: estudio restrospectivo en pacientes con adenocarcinoma obstructivo del antro gástrico. Los pacientes fueron divididos en dos grupos: grupo A) sujetos que fueron tratados mediante prótesis metálica autoexpandible y grupo B) aquellos que fueron tratados mediante antrectomía y gastroyeyunoanastomosis en Y de Roux. Las variables recogidas fueron: edad, género, índice de masa corporal, histopatología, estadio clínico (TNM), estado general (escala de Karnofsky), días de estancia intrahospitalaria, necesidad de re-intervención, complicaciones relacionada con el tratamiento y sobrevida. Resultados: fueron incluidos 39 pacientes, 21 hombres y 18 mujeres. Diecinueve pacientes correspondieron al grupo A y 20 al grupo B. No hubo diferencias estadísticamente significativas con respecto a la edad, índice de masa corporal, calificación de Karnofsky y estadio clínico. El éxito técnico y clínico fue similar en ambos grupos. Hubo diferencia estadísticamente significativa entre ambos grupos, favoreciendo a las prótesis metálicas autoexpandibles en tiempo de inicio de la vía oral (1 ± 0 vs. 4,9 ± 0,6 días, p = 0,0001) y estancia intrahospitalaria (0,94 ± 1,18 vs. 7,8 ± 7,7 días, p = 0,0005). No encontramos diferencia estadísticamente significativa con respecto a la sobrevida entre los dos grupos. Conclusiones: en pacientes con obstrucción gástrica secundaria a cáncer gástrico avanzado, el tratamiento con prótesis metálicas autoexpandibles proporciona un intervalo mas corto para el inicio de la vía oral, una estancia intrahospitalaria mas corta y una frecuencia de complicaciones menor(AU)

Background: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum. Methods: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected Data included: age, gender, performance status (Karnofsky’s score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival. Results: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky’s score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring Self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival. Conclusions: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter inhospital stay and lower rate of complications(AU)

Loss of expression of DNA mismatch repair proteins in aberrant crypt foci identified in vivo by magnifying colonoscopy in subjects with hereditary nonpolyposic and sporadic colon rectal cancer.

PURPOSE: The aims of this study are to characterize the frequency, density, and distribution of aberrant crypt foci (ACF) and its histological features and to determine the frequency of loss of expression of DNA mismatch repair (MMR) proteins of subjects with hereditary nonpolyposic colorectal cancer (HNPCC) and sporadic colon rectal cancer (CRC). METHODS: Patients with HNPCC, first-degree relatives of subjects with HNPCC, sporadic CRC, and average risk subjects of sporadic CRC were included prospectively. Total colonoscopy with chromoendoscopy using methylene blue 0.5% and magnification in the right colon (cecum and 20 cm of the ascending colon) and in the left colon (rectum) was performed; loss of expression of MLH1 and MSH2 was evaluated by immunohistochemistry in confirmed ACF. RESULTS: Fifty-two subjects were included. Thirty-eight of the 119 ACF detected by endoscopy were biopsied. In 14 of the 38 specimens (36.8%), ACF were confirmed by histology (Cohen's kappa, 0.44). In subjects with HNPCC, ACF were identified more frequently in the right segment of the colon than in the left (73.1% vs. 26%); in contrast, ACF predominated in the left segment of the colon (89.3% vs. 10.6%) in subjects with sporadic CRC. There was a loss of MLH1 expression in ACF in subjects with HNPCC. CONCLUSIONS: In HNPCC, we found a greater density of ACF in the right colon, and in sporadic CRC, greater density in the left. ACF present loss in the expression of DNA MMR protein and can be used as an early marker in patients with a risk of HNPCC in whom carcinogenesis appears to be accelerated.

Argon plasma coagulation and hyperbaric oxygen therapy in chronic radiation proctopathy, effectiveness and impact on tissue toxicity.

BACKGROUND: chronic radiation proctopathy (CRP) is associated with recurrent rectal bleeding and transfusional requirements. Argon plasma coagulation (APC) and hyperbaric oxygen therapy (HOT) have been shown to be effective in the control of CRP. No prospective comparisons have been reported between these treatments. AIM: the aim was to evaluate the effectiveness, safety and impact on tissue toxicity of APC compared to HOT in patients with CRP. MATERIAL AND METHODS: a prospective study for evaluating treatment response was conducted. Patients with cervical cancer and CRP with rectal bleeding were recruited. They had not received previous treatment. Collected data included: demographics, previous radiation dosage, duration and severity of rectal bleeding. Hemoglobin, transfusional requirements, and tissue toxicity (SOMA LENT questionnaire) at baseline and at 1, 2, and 3 months follow up were recorded. RESULTS: thirty-one patients were included, 14 in the APC group and 17 in the HOT group. No response was noted in 13 and 18% of patients in the APC and HOT group respectively (p = NS). At the 1 and 2 months follow-up, the APC group showed a significantly better response in terms of transfusional requirements (0.6 vs. 3.4 and 0.7 vs. 2.5) and tissue toxicity score (5.3 vs. 8.6 and 3.8 vs. 7.248). After 3 months, both groups showed further improvement in all parameters without significant differences between them. CONCLUSIONS: APC and HOT were effective, safe and decreased the tissue toxicity scores in patients with CRP. However, response rate was higher and faster in the APC group.

Argón plasma y oxígeno hiperbárico para el control de la rectorragia crónica secundaria a la proctopatía por radiación / Argon plasma coagulation and hyperbaric oxygen therapy in chronic radiation proctopathy, effectiveness and impact on tissue toxicity

Introducción: la proctopatía por radiación (PPR) se asocia con rectorragía recurrente y requerimientos de trasfusiones. La coagulación con argón plasma (APC) y la terapia con oxígeno hiperbárico (HOT) han sido efectivas en el control de la PPR. No hay estudios prospectivos comparativos entre ambas técnicas. Objetivo: el objetivo del estudio es evaluar la efectividad, seguridad y el impacto en la toxicidad tisular de la APC comparado con el HOT en los pacientes con PR. Material y métodos: se realizó un estudio prospectivo para evaluar la respuesta al tratamiento. Se incluyeron a pacientes con cáncer cervicouterino y PPR con rectorragia recurrente, sin haber recibido tratamientos previos. Se tomaron datos demográficos, dosis de radiación, duración y severidad de la rectorragia, niveles de hemoglobina, requerimientos de trasfusiones y la toxicidad tisular (Cuestionario de SOMA-LENT) al inicio, y a los 1, 2 y 3 meses del tratamiento. Resultados: se incluyeron a 31 pacientes con PPR, 14 en el grupo de APC y 17 en el grupo de HOT. No hubo respuesta en el 13 y 18% de los pacientes en el grupo de APC y OHT respectivamente (p = NS). Al primer y segundo mes de seguimiento, el grupo APC mostró una mejoría significativa en los parámetros de requerimientos trasfusionales (0,6 vs. 3,4 y 0,7 vs. 2,5) y en la toxicidad tisular (5,3 vs. 8,6 y 3,8 vs. 7,2). Después de 3 meses de seguimiento, ambos grupos mostraron mejoría en todos los parámetros sin haber diferencias estadísticamente significativas. Conclusiones: APC y HOT fueron efectivos, seguros y disminuyeron la toxicidad tisular en los pacientes con PPR. Sin embargo la respuesta fue más efectiva y rápida en el grupo del APC(AU)

Background: chronic radiation proctopathy (CRP) is associated with recurrent rectal bleeding and transfusional requirements. Argon plasma coagulation (APC) and hyperbaric oxygen therapy (HOT) have been shown to be effective in the control of CRP. No prospective comparisons have been reported between these treatments. Aim: the aim was to evaluate the effectiveness, safety and impact on tissue toxicity of APC compared to HOT in patients with CRP. Material and methods: a prospective study for evaluating treatment response was conducted. Patients with cervical cancer and CRP with rectal bleeding were recruited. They had not received previous treatment. Collected data included: demographics, previous radiation dosage, duration and severity of rectal bleeding. Hemoglobin, transfusional requirements, and tissue toxicity (SOMA LENT questionnaire) at baseline and at 1, 2, and 3 months follow up were recorded. Results: thirty-one patients were included, 14 in the APC group and 17 in the HOT group. No response was noted in 13 and 18% of patients in the APC and HOT group respectively (p = NS). At the 1 and 2 months follow-up, the APC group showed a significantly better response in terms of transfusional requirements (0.6 vs. 3.4 and 0.7 vs. 2.5) and tissue toxicity score (5.3 vs. 8.6 and 3.8 vs. 7.248). After 3 months, both groups showed further improvement in all parameters without significant differences between them. Conclusions: APC and HOT were effective, safe and decreased the tissue toxicity scores in patients with CRP. However, response rate was higher and faster in the APC group(AU)

[Self-expandable prostheses for palliation of gastric cancer: report of four cases]. / Prótesis autoexpandibles para el tratamiento paliativo del cáncer gástrico. Reporte de cuatro casos.

Self-expandable prostheses have gained in popularity for palliation tumors of the gastrointestinal tract. We present four cases of patients with gastric adenocarcinoma who were palliated by self-expandable metallic prostheses. Two patients had undergone total gastrectomy with esophago-jejunal anastomosis. In one there was recurrent cancer in the anastomosis and the other had non-malignant stenosis. The remaining two patients had unresectable tumors. Correct placement of prostheses was possible in all cases; however, maintenance of adequate hydration and acceptable nutritional status per orem was possible only in three of four patients. In all cases there was temporary slight pain, in one, slight hemorrhage, and in one the prosthesis migrated and it was necessary to withdraw it surgically. Although these are only a few cases, we can say that self-expandable prostheses are a promising alternative to palliate gastric cancer.