Nutritional Experiences of Patients Undergoing Total Gastrectomy Surgery: A Qualitative Study.

The aim of this study was to determine the nutritional experiences of patients who underwent total gastrectomy surgery. This qualitative study was conducted using the phenomenological research design. The sample consisted of 18 individuals who underwent total gastrectomy surgery. The research data were collected using the semistructured in-depth interview method. Interviews were conducted and recorded using audio/visual tools during the COVID-19 pandemic. Data analysis was carried out by two researchers according to the hermeneutic phenomenological approach. The nutritional experiences of the informants were organized under three themes, namely, First Feeding Experiences may remain, Gastrointestinal Problems, and Coping Methods. It was determined that individuals face various problems after total gastrectomy, both physical and psychological. They have developed coping methods to deal with the nutritional problems they experience. Development of a patient-specific nutrition program is recommended to support adaptation to new eating habits after total gastrectomy.

How does sleeve gastrectomy impact long-term eating-related symptoms, distress, and behavior? A cross-sectional study using the BODY-Q patient-reported outcome measures.

BACKGROUND: Patients undergoing sleeve gastrectomy (SG) experience transformative changes in eating-related experiences that include eating-related symptoms, emotions, and habits. Long-term assessment of these endpoints with rigorous patient-reported outcome measures (PROMs) is limited. We assessed patients undergoing SG with the Body-Q Eating Module PROMs. METHODS: All patients evaluated at the Emory Bariatric Center were given the Body-Q Eating Modules questionnaire at preoperative/postoperative clinic visits. Rasch scores and prevalence of relevant endpoints were assessed across six time-points of interest: preoperatively, post-operative months 0-6, 7-12, 12-24, 24-36, and over 36. Student's t-test and Chi-square test were used for analysis. RESULTS: Overall, 1,352 questionnaires were completed pre-operatively and 493 postoperatively. Survey compliance was 81%. Compared to the pre-operative group, the post-operative group had lower BMI (39.7 vs. 46.4, p < 0.001) and higher age (46.3 vs. 44.9, p = 0.019). Beginning one year after SG, patients experience more frequent eating-related pain, nausea and constipation compared to pre-operative baseline (p < 0.05). They also more frequently experience eating-related regurgitation and dumping syndrome-related symptoms beginning post-operative year two (p < 0.05). In the first year after SG, patients more rarely feel eating-related embarrassment, guilt, and disappointment compared to pre-operative baseline (p < 0.05). These improvements disappear one year after SG, after which patients more frequently experience feeling out of control, unhappy, like a failure, disappointed, and guilty (p < 0.05). In the first year after SG, patients experience an increased frequency in positive eating behaviors (ate healthy foods, showed self-control, stopped before full; (p < 0.05). Only two eating-related behavior improvements persist long-term: feeling in control and eating the right amount (p < 0.05). CONCLUSIONS: Patients undergoing SG may experience more frequent eating-related symptoms, distress, and behavior in the long-term. These findings can enhance the pre-operative informed consent and guide development of a more tailored approach to postoperative clinical management such as more frequent visits with the dietician.

Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery.

PURPOSE: Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. MATERIALS AND METHODS: We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. RESULTS: Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. CONCLUSION: Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

Hedonic hunger, eating behavior, and food reward and preferences 1 year after initial weight loss by diet or bariatric surgery.

OBJECTIVE: The objective of this study was to investigate changes in hedonic hunger, eating behavior, and food reward and preferences at 1-year (1Y) follow-up after an initial weight loss (WL) induced by a 10-week, very low-energy diet alone (controls) or in combination with bariatric surgery. METHODS: Patients scheduled for sleeve gastrectomy or Roux-en-Y gastric bypass and controls were recruited. Body weight/composition, hedonic hunger (Power of Food Scale), eating behavior traits (Dutch Eating Behavior Questionnaire and Three-Factor Eating Questionnaire), and food reward and preferences (computerized behavioral task) were measured at baseline, 11 weeks, and 1Y follow-up. RESULTS: Changes in anthropometric variables were comparable across groups in the initial phase (week 11), and hedonic hunger decreased overall. The bariatric-surgery groups continued to lose body weight and fat mass, whereas weight regain was seen in controls at 1Y follow-up. Decreases in emotional eating, hunger, disinhibition, and food reward and increases in dietary restraint were seen at 1Y follow-up in the bariatric-surgery groups only. CONCLUSIONS: Continued WL with bariatric surgery is paralleled by favorable changes in eating behavior and food reward and preferences. By contrast, controls experienced weight regain at 1Y follow-up and no changes in eating behavior. These striking differences are likely to be important in the long-term WL management of individuals with severe obesity.

Unmet needs in survivorship: Increased anxiety post oesophago-gastric cancer surgery.

INTRODUCTION: Despite significant surgical advancements in the treatment of oesophago-gastric cancer (OGC), patients often experience a considerable decline in health-related quality of life postoperatively. Psychological factors, such as hypervigilance and symptom-specific anxiety, may contribute to this. This study aimed to investigate the prevalence and trend of hypervigilance and symptom-specific anxiety in OGC survivors across treatment stages. MATERIALS AND METHODS: 103 patients with either gastric or oesophageal cancer, treated with surgery (and/or neoadjuvant chemotherapy), completed a specialist measure of oesophageal hypersensitivity (Oesophageal Anxiety and Hypervigilance Scale) at five time-points: spanning from diagnostic clinics to 6 months post-hospital discharge. RESULTS: The results indicate a trend of rising symptom-specific anxiety and hypervigilance scores over time post-hospital discharge. Total scores showed variations over time; elevated at diagnosis, decreasing between pre-operative assessment and 2-4 weeks post-hospital discharge, and rising again at between 3 and 6 months post-discharge, exceeding the average score at diagnosis. The patterns for the subscale scores for symptom-specific anxiety and hypervigilance followed a similar trend, though anxiety scores consistently exceeded hypervigilance scores at previous time-points. CONCLUSION: In noting the presence and variations of symptom-specific anxiety and hypervigilance in patients with OGC, this study directs attention to the previously unexplored significant psychological distress. Although specific conclusions from the data are restricted due to the study's design, it indicates the importance of assessing and addressing these psychological factors for effective management of patients with OGC.

Can We Benefit from the Preoperative Psychometric Test with Symptom Checklist-90-Revised (SCL-90-R) to Predict Weight Loss After Sleeve Gastrectomy?

BACKGROUND: The psychological assessment is crucial before bariatric surgery. Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological symptoms and distress in both clinical and research settings. We aimed to investigate the predictive value of SCL-90-R subscale scores on postoperative excess weight loss percentage (EWLP) after laparoscopic sleeve gastrectomy (LSG). METHODS: Patients who underwent primary LSG for morbid obesity and fully completed preoperative SCL-90-R between January 2016 and July 2019 were retrospectively examined. A multiple linear regression analysis was performed to investigate the relationship between descriptive and psychological variables associated with EWLP percentage at the 12th-month. RESULTS: One hundred six patients who met the inclusion criteria were analyzed. The adequate weight loss (EWLP ˃ 50%) was achieved in 90% of patients after 12 months. The multiple linear regression analysis indicated that younger patients (ß = - 0.695; 95% CI - 1.056, - 0.333; p < 0.001), and patients with preoperative lower BMI (ß = - 1.524; 95% CI - 1.974, - 1.075; p < 0.001) achieved higher EWLP at 12th-month. High somatization score (ß = 11.975; 95% CI 3.653, 20.296; p = 0.005) and a low Global Severity Index (GSI) score (ß = - 24.276; 95% CI - 41.457, - 7.095; p = 0.006) had a positive effect on EWLP at 12th-month. CONCLUSIONS: Preoperative psychological testing can help predict surgical outcomes in the bariatric population. More intense lifestyle and behavioral support can be applied by targeting patients who are expected to lose less weight after surgery, and patients' weight loss potential can be increased.

Young people's experiences of a CDH1 pathogenic variant: Decision-making about gastric cancer risk management.

The most effective option for gastric cancer risk management in individuals with a CDH1 germline pathogenic or likely pathogenic variant (PV) in Australia is prophylactic total gastrectomy (PTG). There is, however, increasing confidence in endoscopic surveillance as a risk management strategy thus affording individuals with a CDH1 PV with challenging decisions regarding their gastric cancer risk management. For young people, this decision-making comes at a complex development stage of emerging and young adulthood. This study aims to explore the factors that influence young people's decision-making about their gastric cancer risk management due to a CDH1 PV. Potential participants were identified and approached through the Parkville Familial Cancer Centre in Melbourne, Australia. Thematic analysis was used to interpret and analyze the data. Qualitative interviews were conducted with 13 people with a CDH1 PV aged 18 to 39 years, inclusive. The interviews found that participants' familial and shared experiences of cancer and risk management, perceived tolerance of uncertainty, and desire for control over their cancer risk were fundamental in their decision-making about their gastric cancer risk management. The participants' young adult life stage was also deemed particularly important in decisions about the timing of PTG. The findings of this study are vital to inform decisional counseling discussions with this unique population.

Can general surgeons perform laparoscopic surgery independently within 10 years of training? A nationwide survey on laparoscopic surgery training in Japan.

PURPOSE: There is no standard program for laparoscopic surgery training in Japan, and competency in these procedures does not require the acquisition of board certification. The purpose of this survey was to investigate the current status of laparoscopic surgery training in Japan. METHODS: A questionnaire survey was mailed to 2296 members of the Japan Society for Endoscopic Surgery who were between postgraduate year 3 and 10. The questionnaire inquired about laparoscopic surgical training conditions, operation case numbers, and autonomy in eight laparoscopic procedures. RESULTS: The total response rate was 28.1%. The number of cases required to perform procedures independently was demonstrated. Most participants felt confident in performing laparoscopic appendectomy and cholecystectomy; however, they felt less confident about performing laparoscopic colectomy and gastrectomy. CONCLUSIONS: The information from this survey may be useful for surgical educators, surgical societies, and the board certification council for rebuilding the surgical training system in Japan.

Barriers and facilitators to CDH1 carriers contemplating or undergoing prophylactic total gastrectomy.

Hereditary diffuse gastric cancer (HDGC) is an inherited cancer syndrome associated with high lifetime risk of diffuse-type gastric cancer. Current guidelines recommend individuals with HDGC undergo prophylactic total gastrectomy (PTG) to eliminate this risk. However, PTG is associated with significant lifestyle changes, post-surgical recovery, and symptom burden. This study examined factors related to decision-making about PTG in three groups of individuals who: (1) underwent PTG immediately after receiving genetic testing results; (2) delayed PTG by ≥ 1 year or; (3) declined PTG. Participants were recruited from a familial gastric cancer registry at a tertiary care hospital. Patients with CDH1 pathogenic or likely pathogenic variants who contemplated and/or underwent PTG were eligible. 24 individuals contemplated PTG: 9 had immediate surgery (within a year), 8 delayed surgery, and 7 declined surgery. Data on PTG barriers and facilitators were obtained on all participants using quantitative surveys (n = 7), qualitative interviews (n = 8) or both methods (n = 9). PTG barriers included age, positive beliefs about screening, close relatives with negative PTG experiences, fertility-related concerns, and life stress. Facilitators included social support, trust in healthcare providers, understanding risk, negative beliefs about screening, family-related factors, positive or abnormal screening results, and positive attitude toward PTG. This study highlights factors related to the PTG decision-making process among individuals with HDGC from three distinct groups. Future research should explore educational interventions aimed at addressing surgery-related concerns and the limitations of screening, and might also consider incorporating close relatives as informational supports.

Improvement in Uncontrolled Eating Behavior after Laparoscopic Sleeve Gastrectomy Is Associated with Alterations in the Brain-Gut-Microbiome Axis in Obese Women.

BACKGROUND: Bariatric surgery is proven to change eating behavior and cause sustained weight loss, yet the exact mechanisms underlying these changes are not clearly understood. We explore this in a novel way by examining how bariatric surgery affects the brain-gut-microbiome (BGM) axis. METHODS: Patient demographics, serum, stool, eating behavior questionnaires, and brain magnetic resonance imaging (MRI) were collected before and 6 months after laparoscopic sleeve gastrectomy (LSG). Differences in eating behavior and brain morphology and resting-state functional connectivity in core reward regions were correlated with serum metabolite and 16S microbiome data. RESULTS: LSG resulted in significant weight loss and improvement in maladaptive eating behaviors as measured by the Yale Food Addiction Scale (YFAS). Brain imaging showed a significant increase in brain volume of the putamen (p.adj < 0.05) and amygdala (p.adj < 0.05) after surgery. Resting-state connectivity between the precuneus and the putamen was significantly reduced after LSG (p.adj = 0.046). This change was associated with YFAS symptom count. Bacteroides, Ruminococcus, and Holdemanella were associated with reduced connectivity between these areas. Metabolomic profiles showed a positive correlation between this brain connection and a phosphatidylcholine metabolite. CONCLUSION: Bariatric surgery modulates brain networks that affect eating behavior, potentially through effects on the gut microbiota and its metabolites.

Sleeve gastrectomy vs gastric bypass in improvement of depressive symptoms following one year from bariatric surgery, Tehran Obesity Treatment Study (TOTS).

BACKGROUND: The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss after bariatric surgery. However, the effects of different bariatric techniques on depression score improvement is uncertain. METHOD: The study included 685 obese patients who underwent laparoscopic sleeve gastrectomy (SG) (n = 443) or gastric bypass (GB) (n = 242) and completed BDIs at baseline and 1 year after surgery. RESULTS: Mean age of the patients was 38.7 ±â€¯10.9 (84.8% female), and mean body mass index (BMI) was 45.1 ±â€¯6.0 kg/m2. One year after surgery, excess weight loss (EWL %) in the GB group was more than the SG group (65.4% vs 62.8% P = 0.02). At baseline, 29.9% of patients had BDI scores in the normal range (0-9), and respectively 32.4 %, 28.3 % and 9.3 % had mild (10-18), moderate (19-29) and sever (+30) depression score; these corresponding values after 1 year were 60.6, 23.2, 11.8 and 4.4%. Overall, BDI scores fell in both surgery groups after 1 year, in the GB group it was 17.2 ±â€¯10.5 vs 11.1 ±â€¯9.6, and for the SG group 16.1 ±â€¯10.2 vs 9.6 ±â€¯8.9. However BDI score change (ΔBDI) was not significantly different between two surgery groups (-6.04 ±â€¯10.6 vs -6.4 ±â€¯9.5, P = 0.149). CONCLUSION: Bariatric surgery had a beneficial effect on weight reduction and BDI score regardless of its type. Further studies with longer follow-up and more samples are needed to clarify the differences between bariatric procedures.

Psychological effects of advanced care on patients received endoscopic gastric cancer resection.

BACKGROUND: This study will systematically evaluate the psychological effects of advanced care (AC) on patients who received endoscopic gastric cancer resection (EGCR). METHODS: This study will search the following databases of Cochrane Library, Pubmed, EMBASE, Web of Science, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present with no language limitation. All randomized controlled trials on assessing the psychological effects of AC for patients with EGCR will be included. RESULTS: This study will explore the psychological effects of AC on EGCR by assessing depression, anxiety, health-related quality of life, and adverse events. CONCLUSION: This study will summarize recent evidence for the psychological effects of AC on EGCR. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019139868.

Hereditary diffuse gastric cancer: cancer risk and the personal cost of preventive surgery.

Germline CDH1 mutation carriers are at risk for early-onset diffuse gastric cancer (DGC) and female carriers have an additional risk of lobular breast cancer. The reported literature GC risk of 70% has led to the recommendation for germline mutation carriers to undergo prophylactic total gastrectomy (PTG). The objective of this research was to examine post-surgical clinical outcomes and to identify which of the domains/symptoms from the European Organisation for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30) were determinants of overall quality of life (QOL) in individuals undergoing PTG. Participants were recruited through multiple sources. Postsurgical clinical outcomes were obtained from hospital records. Participants completed validated questionnaires measuring generic and condition specific QOL (PROMIS, EORTC and SF 36v.II) at a single point in time. The mean QOL in this cohort was 70.6 (SD = 25.6), which is better than reference values from the general populations in USA and Canada Role and social function plus the symptoms anxiety, pain, taste, dyspnea and diarrhea were significant predictor variables for QOL (p < 0.05). Although this study reveals good overall QOL for individuals after PTG, attention should be given to managing symptoms as part of long term care to further enhance QOL. The function/symptom scores were associated with worse overall health and global health status and thus may mark a real need for more attentive post-surgical care.

Neuro-hormonal mechanisms underlying changes in reward related behaviors following weight loss surgery: Potential pharmacological targets.

Currently, the only available effective treatment option for obesity and its comorbidities is weight loss surgery (WLS). Long-term maintenance of weight loss after surgery cannot be explained by caloric restriction or malabsorption alone and has been attributed to unexplained changes in eating behavior. Whether these behavioral changes are related to altered taste or reward functions, or both, are subject to debate. In contrast to reduced food cravings and food addiction following WLS, recent clinical studies have revealed that bariatric surgery patients are prone to an increased risk for substance use disorder (SUD), especially alcohol use disorder (AUD). The substitution of drugs for previously stimulating foods, and the emergence of SUD after WLS, supported by preclinical studies, strongly suggest that manipulation of gut-brain signals may bring about changes in the reward system. This paper reviews current clinical and basic science research and discusses potential underlying mechanisms of reward-related behaviors. Specifically, it explores relevant neural and hormonal changes that present post WLS and their effects on dopaminergic reward pathway and highlights targets for potential pharmacological interventions. Special emphasis is given to recent work suggesting that different types of WLS procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have differential effects on alcohol consumption in humans and rats. These differential effects may hold the key not only to understanding increased substance use following WLS but may also help elucidate the contribution of gut-brain signals to regulation of reward, in general.

Associations between Weight Loss, Food Likes, Dietary Behaviors, and Chemosensory Function in Bariatric Surgery: A Case-Control Analysis in Women.

We tested the hypothesis that successful weight loss post-bariatric surgery would be associated with healthier chemosensory function, food likes, and dietary behaviors than either unsuccessful weight loss or pre-surgery morbid obesity. In a case-control design, pre-surgical women with morbid obesity (n = 49) were compared with those 1-year post-surgery (24 Roux-en-Y Bypass, 24 Sleeve Gastrectomy) and defined by excess or percent weight loss as successful/unsuccessful. For self-reported smell/taste perception, more post-surgery than pre-surgery reported improved/distorted perception, especially if weight loss successful. Measured taste function (perceived quinine and NaCl intensity) was lower among weight loss unsuccessful versus pre-surgery patients, yet a genetic variation in taste probe (propylthiouracil bitterness) matched expected frequencies without significant pre/post-surgery difference. Regarding survey-reported liking, higher diet quality was seen in the weight loss successful (independent of surgery type) versus pre-surgical patients, with differences driven by lower sweet and refined carbohydrate liking. The post versus pre-surgical patients had greater restraint but less hunger and disinhibition. Patients reporting both higher diet quality and lower hunger showed greater % weight loss, independent of surgery type. Thus, successful weight loss 1-year post-bariatric surgery was associated with improved or distorted chemosensation and patterns of liking associated with healthier diets, especially if coupled with less hunger.

Racial Comparisons of Postoperative Weight Loss and Eating-Disorder Psychopathology Among Patients Following Sleeve Gastrectomy Surgery.

OBJECTIVE: This study aimed to examine racial differences in postoperative eating-disorder psychopathology, psychosocial functioning, and weight loss among adults with loss-of-control (LOC) eating following sleeve gastrectomy. METHODS: Participants were 123 patients (n = 74 non-Hispanic White and n = 49 non-Hispanic Black) who underwent sleeve gastrectomy surgery within the previous 4 to 9 months and reported regular LOC eating during the previous month. The Eating Disorder Examination Bariatric Surgery Version assessed LOC eating, eating-disorder psychopathology, and meal patterns. Participants completed self-report measures, including the Beck Depression Inventory-II and Medical Outcomes Study Short-Form Health Survey. RESULTS: Presurgical BMI did not differ by race, but Black patients had significantly less percent total weight loss and percent excess weight loss than White patients. Black and White patients did not differ significantly in LOC eating frequency, onset time of postoperative LOC eating, eating-disorder psychopathology, depressive symptoms, or physical or mental health-related quality of life. White patients were significantly more likely to meet criteria for lifetime binge-eating disorder than Black patients. Black patients were significantly more likely to skip breakfast and dinner and engage in night eating than White patients. CONCLUSIONS: Our findings suggest that among patients with LOC eating following sleeve gastrectomy surgery, there exist few racial differences in current eating-disorder psychopathology and psychosocial functioning, although Black patients achieved less weight loss than White patients.

Current Controversies in Metabolic Surgery for Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) represents the most common liver disease, and it is expected to become the leading cause of end-stage liver disease in the near future. Bariatric operations have beneficial effects on NAFLD, inducing histological resolution of liver damage through weight loss-dependent and weight loss-independent mechanisms. Due to lack of randomized controlled trials, no specific guidelines have been established so far. Yet there is growing evidence that NAFLD will eventually become a formal indication for metabolic surgery. Data regarding the choice of procedure are conflicting, although gastric bypass seems to be slightly superior to sleeve gastrectomy. The purpose of this review is to provide an update on the ongoing research regarding the role of metabolic surgery in NAFLD management.

Structural changes in brain regions involved in executive-control and self-referential processing after sleeve gastrectomy in obese patients.

Obesity-related brain gray (GM) and white matter (WM) abnormalities have been reported in regions associated with food-intake control and cognitive-emotional regulation. Bariatric surgery (BS) is the most effective way to treat obesity and induce structural recovery of GM/WM density and WM integrity. It is unknown whether the surgery can promote structural changes in cortical morphometry along with weight-loss. Structural Magnetic Resonance Imaging and surface-based morphometry analysis were used to investigate BS-induced alterations of cortical morphometry in 22 obese participants who were tested before and one month post-BS, and in 21 obese controls (Ctr) without surgery who were tested twice (Baseline and One-month). Results showed that fasting plasma ghrelin, insulin, and leptin levels were significantly reduced post-BS (P < 0.001). Post-BS there were significant decreases in cortical thickness in the precuneus (PFDR < 0.05) that were associated with decreases in BMI. There were also significant increases post-BS in cortical thickness in middle (MFG) and superior (SFG) frontal gyri, superior temporal gyrus (STG), insula and ventral anterior cingulate cortex (vACC); and in cortical volume in left postcentral gyrus (PostCen) and vACC (PFDR < 0.05). Post-BS changes in SFG were associated with decreases in BMI. These findings suggest that structural changes in brain regions implicated in executive control and self-referential processing are associated with BS-induced weight-loss.

Prospective comparative study of endoscopic submucosal dissection and gastrectomy for early neoplastic lesions including patients' perspectives.

BACKGROUND: There are no prospective studies comparing endoscopic submucosal dissection (ESD) and gastrectomy, especially evaluating patient-reported outcomes. Our aim was to compare the safety and impact on quality of life (QoL) of ESD and gastrectomy in patients with early gastric neoplasia. METHODS: This prospective study included consecutive patients presenting with early gastric neoplasia in a tertiary center from January 2015 to August 2016. Data collection included curative resection, adverse events (AEs), and patient-reported outcomes (questionnaires: EORTC QLQ-C30, EORTC STO-22, EQ-5D-5 L, and Assessment of Survivor Concerns) before and after interventions (after 1 month, 3 - 6 months, and 1 year). RESULTS: 254 patients with early lesions were included: 153 managed by ESD and 101 by gastrectomy, the former being significantly older and with less advanced lesions. Mean procedural time and length of stay were significantly higher in the surgery group (164 vs. 72 minutes and 16.3 vs. 3.5 days; P < 0.001). Complete resection was higher in the surgical group (99 % vs. 90 %; P = 0.02); ESD was curative in 79 % of patients. Severe AEs and surgical re-intervention were significantly more frequent in the gastrectomy group (21.8 % vs. 7.8 % and 11 % vs. 1 %, respectively). Endoscopic treatment was associated with a positive impact on global health-related QoL at 1 year (net difference + 9.9; P = 0.006), role function and symptom scales (fatigue, pain, appetite, eating restrictions, dysphagia, and body image). Concerns about recurrence did not differ between the groups. CONCLUSIONS: In patients with early gastric neoplasia, ESD is safer and is associated with a positive impact on health-related QoL when compared with gastrectomy, without increasing fear of recurrence and new lesions.

Life after a gastrectomy: Experience of patients with gastric cancer. / Vivir después de una gastrectomía: experiencia de pacientes con cáncer gástrico.

OBJECTIVE: To describe the experience of patients with gastric cancer who have undergone gastrectomy. METHOD: Qualitative study with 17 adults who underwent total gastrectomy in a cancer care centre in Bogotá, Colombia. The approach was phenomenological using the analysis proposed by Colaizzi. Descriptive codes, nominal codes and categories were identified as central issues. In-depth interviews were used and theoretical saturation sampling. RESULT: From 165 descriptive codes, 27 nominal codes emerged that make up 6 subjects that describe the experience of the person who has undergone total gastrectomy: 1) a new opportunity, 2) a foreign body, 3) yearning to feel useful, 4) understanding other treatments, 5) sensing discomfort and symptoms, and 6) eating what I can. CONCLUSIONS: The patient who has undergone total gastrectomy faces an experience as a cancer survivor that involves understanding how to manage physical discomfort, adaptation to diet, economic difficulty and unemployment. Viewing the experience as a new opportunity, and the requirements of other treatments implies having a social, emotional and spiritual support network. It is essential to consolidate monitoring programmes for survivors that respond in a timely manner to their needs.