Enteral Stents for Malignant Gastric Outlet Obstruction: Low Reintervention Rates for Obstruction due to Pancreatic Adenocarcinoma Versus Other Etiologies.

BACKGROUND AND AIM: Enteral stents (ES) have emerged as first-line therapy for the treatment of malignant gastric outlet obstruction (GOO). Stent occlusion arising from tissue ingrowth may require endoscopic or surgical reintervention. The objective of this study was to compare rates of reintervention following palliative ES for patients with GOO due to pancreatic adenocarcinoma (PDAC) versus other malignant etiologies. METHODS: Patients who had undergone ES for palliation of malignant GOO between 2009 and 2018 were retrospectively identified and demographic, clinical, and procedural data were collected. Primary outcome was procedural reintervention for recurrent symptomatic GOO following ES placement. RESULTS: Forty-three patients were included in the study cohort. 62.8% (27/43) of patients had PDAC while 37.2% (16/43) of patients had other malignant etiologies. 11.6% (5/43) of patients were alive at follow-up. Thirty-day and 90-day mortality rates were 22.8% and 70.7% for PDAC and 25% and 56.3% for other malignant etiologies, respectively. Seven patients required reintervention for symptomatic GOO: 14.3% (1/7) had PDAC and 85.7% (6/7) had GOO due to other malignancy (P < .01). Ninety-six percent (26/27) of patients with PDAC required no further intervention for GOO prior to death or end of follow-up. On multivariate analysis, patients with PDAC were significantly less likely to require reintervention than patients with other malignant etiologies (OR 0.064, 95% CI 0.01-0.60). CONCLUSION: ES offer durable symptom palliation without requirement for reintervention for the overwhelming majority of patients with malignant GOO due to PDAC. Reintervention rates are higher following ES placement for GOO due to other malignant etiologies and future study may be needed to define the optimal palliative intervention for this group of patients.

Mucinous cystic neoplasm diagnosed by EUS-guided microforceps biopsy.

Background and study aims Mucinous cystic neoplasms (MCNs) of the pancreas have malignant potential. Current methods for diagnosing MCNs are inadequate. The aim of this case series is to present a novel method for establishing the diagnosis of MCNs. Clinical information from three patients seen at our institution was collected for a case series presentation. Patients were selected retrospectively based on diagnostic results. Three patients were diagnosed with MCNs based on histopathology obtained via microforceps biopsy. Evolving tissue acquisition techniques, such as microforceps intracystic biopsy, have improved the diagnostic yield of endoscopic ultrasound (EUS).

Patient decision-making and clinical outcomes following endoscopic therapy or esophagectomy for Barrett's neoplasia.

BACKGROUND AND STUDY AIMS: The objective of this study was to assess patient involvement in decision-making, decision confidence, and decision regret among patients who had undergone endoscopic eradication therapy (EET) or esophagectomy for Barrett's esophagus (BE) associated neoplasia. PATIENTS AND METHODS: Patients with BE high grade dysplasia or intramucosal (T1a) adenocarcinoma who had undergone EET or esophagectomy were invited to complete a survey. RESULTS: The cohort included 50 subjects, 70 % (35/50) of whom had undergone EET and 30 % (15/50) of whom had undergone esophagectomy. Subjects who underwent esophagectomy were more likely to report post-treatment dysphagia (47 % vs 14 %, P  = 0.03), post-treatment dietary modification (73 % vs 6 %, P  < 0.0001), and were less likely to view their post-treatment health favorably. However, when asked whether they had selected the right treatment, a high degree of confidence was reported by both groups (mean 9.8 for EET vs 9.3 for esophagectomy on a 0 - 10 scale, P  = 0.12). In fact, 97 % (34/35) of EET patients and 80 % (12/15) of esophagectomy patients indicated they would select the same treatment option ( P  = 0.08). CONCLUSIONS: Patients who have undergone EET or surgery for BE neoplasia report a high degree of involvement in the decision-making process. Although EET patients report fewer symptom-specific outcomes, measures of decision confidence and decision regret do not differ between the two treatment groups.

A case of sudden cardiac death following Domperidone self-medication.

The phenomenon of sudden cardiac death is usually related to the worsening of existing heart conditions leading to ventricular arrhythmia (VA). One of the well-known triggers of SCD is drug-induced prolongation of the QT interval, such as that caused by Domperidone (D). Despite its risk to prolong the QT interval and associated narrow therapeutic index, D is available as an over-the-counter (OTC) drug in many countries such as Italy, Ireland, Netherlands, China, South Africa, Mexico, New Zealand and Chile to treat gastroesophageal reflux and functional dyspepsia. The present paper reports a case of SCD that occurred some hours after D self-administration in a 47-year-old female subject with mitral valve prolapse, thus, predisposed to both VA and SCD. Despite the risks related to D administration, to the best of our knowledge, this particular issue has not been discussed in the medico-legal literature. For this reason, the forensic implications of D administration are discussed focusing on issues related to the self-administration as an OTC drug (as seen in this case), administration to incapacitated subjects, prescription to patients with contraindications and the off-label drug use of D at high and hazardous concentrations to stimulate lactation.

Effects of plyometric training and recovery on vertical jump performance and anaerobic power.

We examined the effects of 2 plyometric training programs, equalized for training volume, followed by a 4-week recovery period of no plyometric training on anaerobic power and vertical jump performance. Physically active, college-aged men were randomly assigned to either a 4-week (n = 19, weight = 73.4 +/- 7.5 kg) or a 7-week (n = 19, weight = 80.1 +/- 12.5 kg) program. Vertical jump height, vertical jump power, and anaerobic power via the Margaria staircase test were measured pretraining (PRE), immediately posttraining (POST), and 4 weeks posttraining (POST-4). Vertical jump height decreased in the 4-week group PRE (67.8 +/- 7.9 cm) to POST (65.4 +/- 7.8 cm). Vertical jump height increased from PRE to POST-4 in 4-week (67.8 +/- 7.9 to 69.7 +/- 7.6 cm) and 7-week (64.6 +/- 6.2 to 67.2 +/- 7.6 cm) training programs. Vertical jump power decreased in the 4-week group from PRE (8,660.0 +/- 546.5 W) to POST (8,541.6 +/- 557.4 W) with no change in the 7-week group. Vertical jump power increased PRE to POST-4 in 4-week (8,660.0 +/- 546.5 W to 8,793.6 +/- 541.4 W) and 7-week (8,702.8 +/- 527.4 W to 8,931.5 +/- 537.6 W) training programs. Anaerobic power improved in the 7-week group from PRE (1,121.9 +/- 174.7 W) to POST (1,192.2 +/- 189.1 W) but not the 4-week group. Anaerobic power significantly improved PRE to POST-4 in both groups. There were no significant differences between the 2 training groups. Four-week and 7-week plyometric programs are equally effective for improving vertical jump height, vertical jump power, and anaerobic power when followed by a 4-week recovery period. However, a 4-week program may not be as effective as a 7-week program if the recovery period is not employed.