Predictors of self-expanding metallic stent dysfunction in malignant gastric outlet obstruction. / Predictores de disfunción del stent metálico autoexplandible en la obstrucción de salida gástrica maligna.

INTRODUCTION AND OBJECTIVES: Self-expanding metallic stents (SEMS) are the ideal treatment for malignant gastric outlet obstruction (MGOO) in patients with a short life expectancy, but stent dysfunction is frequent. The primary aim of our study was to identify the predictive factors of SEMS dysfunction in MGOO and the secondary aim was to determine the technical success, clinical success, and nutritional impact after SEMS placement. MATERIAL AND METHODS: A retrospective, longitudinal study was conducted at the gastrointestinal endoscopy department of the Instituto Nacional de Cancerología in Mexico City. Patients diagnosed with MGOO that underwent SEMS placement within the time frame of January 2015 to May 2018 were included. We utilized the gastric outlet obstruction scoring system (GOOSS) to determine clinical success and SEMS dysfunction. RESULTS: The study included 43 patients, technical success was 97.7% (n=42), and clinical success was 88.3% (n=38). SEMS dysfunction presented in 30.2% (n=13) of the patients, occurring in<6 months after placement in 53.8% (n=7) of them. In the univariate analysis, the histologic subtype, diffuse gastric adenocarcinoma (p=0.02) and the use of uncovered SEMS (p=0.02) were the variables associated with dysfunction. Albumin levels and body mass index did not increase after SEMS placement. Medical follow-up was a mean 5.8 months (1-24 months). CONCLUSIONS: SEMS demonstrated adequate technical and clinical efficacy in the treatment of MGOO. SEMS dysfunction was frequent and diffuse type gastric cancer and uncovered SEMS appeared to be dysfunction predictors.

Aplicación del sistema de puntuación del daño múltiple de órganos en autopsias / Application of the scoring system of multiple organ failure at autopsy

Introducción: el estudio sistemático de las autopsias ha permitido caracterizar el daño múltiple de órganos. El sistema de puntuación, comprobado primero en un modelo experimental y adaptado posteriormente a la morfología humana, permite modificar los criterios diagnósticos sobre dicho daño, y por ende, una interpretación más objetiva del estudio. Objetivo: caracterizar el empleo del referido sistema de puntuación en la práctica del trabajo asistencial para estudiar las autopsias.Métodos: se revisaron las autopsias contenidas en la base de datos del Sistema Automatizado de Registro y Control de Anatomía Patológica para identificar el diagnóstico del daño y reevaluarlos con los criterios actuales.Resultados: la reevaluación de los casos mostró la presencia del daño múltiple de órganos en el 87 por ciento de los casos estudiados, excluyendo al 13 por ciento de este criterio diagnóstico. Conclusiones: el sistema de puntuación para el diagnóstico del daño múltiple de órganos aplicado en la reevaluación de autopsias, permite caracterizar con mayor precisión y objetividad este diagnóstico(AU)

Introduction: the systematic study of autopsies has allowed the characterization of multiple organ failure. The scoring system, first tested in experimental and subsequently adapted to human morphology, allows modifying the diagnostic criteria for such damage, and therefore a more objective interpretation of the study. Objective: To describe the use of this scoring system in practice care to study the autopsies. Methods: The autopsies, contained in the database of the Automated System of Registration and Control of Pathology, were reviewed to identify the diagnosis of the damage and reassess current criteria. Results: Re-assessment of cases showed the presence of multiple organ failure in 87 percent of the cases studied, excluding 13 percent from this diagnostic criterion. Conclusions: The scoring system for the diagnosis of multiple organ failure, applied for reassessing autopsies allows characterizing this diagnosis much precisely and objectively(AU)

Aplicación del sistema de puntuación del daño múltiple de órganos en autopsias / Application of the scoring system of multiple organ failure at autopsy

Introducción: el estudio sistemático de las autopsias ha permitido caracterizar el daño múltiple de órganos. El sistema de puntuación, comprobado primero en un modelo experimental y adaptado posteriormente a la morfología humana, permite modificar los criterios diagnósticos sobre dicho daño, y por ende, una interpretación más objetiva del estudio. Objetivo: caracterizar el empleo del referido sistema de puntuación en la práctica del trabajo asistencial para estudiar las autopsias. Métodos: se revisaron las autopsias contenidas en la base de datos del Sistema Automatizado de Registro y Control de Anatomía Patológica para identificar el diagnóstico del daño y reevaluarlos con los criterios actuales. Resultados: la reevaluación de los casos mostró la presencia del daño múltiple de órganos en el 87 % de los casos estudiados, excluyendo al 13 % de este criterio diagnóstico. Conclusiones: el sistema de puntuación para el diagnóstico del daño múltiple de órganos aplicado en la reevaluación de autopsias, permite caracterizar con mayor precisión y objetividad este diagnóstico.

Introduction: the systematic study of autopsies has allowed the characterization of multiple organ failure. The scoring system, first tested in experimental and subsequently adapted to human morphology, allows modifying the diagnostic criteria for such damage, and therefore a more objective interpretation of the study. Objective: To describe the use of this scoring system in practice care to study the autopsies. Methods: The autopsies, contained in the database of the Automated System of Registration and Control of Pathology, were reviewed to identify the diagnosis of the damage and reassess current criteria. Results: Re-assessment of cases showed the presence of multiple organ failure in 87 % of the cases studied, excluding 13 % from this diagnostic criterion. Conclusions: The scoring system for the diagnosis of multiple organ failure, applied for reassessing autopsies allows characterizing this diagnosis much precisely and objectively.