Antral localization worsens the efficacy of enteral stents in malignant digestive tumors.

BACKGROUND AND AIMS: Malignant gastric outlet obstruction can be treated by means of enteral stenting or surgical gastrojejunalanatomosis. We evaluated in a prospective and multicentre study the efficacy of the enteral stent on food intake, the quality of life impact, and the relationship between efficacy and determined clinical and technical parameters. PATIENTS AND METHODS: Seventy one patients affected by symptoms arising from gastroduodenal obstruction due to malignant tumors, with criteria of irresecability, metastatic disease or very high surgical risk, were treated by means of self expanding metal stents. We used the GOOSS index to evaluate efficacy, and the Euro Qol-5D index to evaluate quality of life. RESULTS: Before stenting patients with GOOSS 0 and 1 were 68 (98.5%). After stenting patients with GOOSS 2 and 3 (semisolid and solid food) were 58 (84,1%) (P<.0001). The Euro Qol-5D index measured before and a month after stenting were 10.17 and 10.04 respectively (P=.6). The median survival was 91 days (9-552). The enteral stents for localised tumors in the duodenum and the gastrojejunalanastomosis were effective in 26 patients (70.2%) and 13 patients respectively (86.6%), while the enteral stents of tumors in the antrum were effective in only 5 patients (29.4%). CONCLUSIONS: The palliative treatment of malignant gastric outlet obstruction with a uncovered metal stent produces a significant improvement of oral food intake and maintains the overall quality of life index. The antral localization is associated with a lower efficacy of the procedure.

Antral localization worsens the efficacy of enteral stents in malignant digestive tumors

Background and aims Malignant gastric outlet obstruction can be treated by means of enteral stenting or surgical gastrojejunalanatomosis. We evaluated in a prospective and multicentre study the efficacy of the enteral stent on food intake, the quality of life impact, and the relationship between efficacy and determined clinical and technical parameters. Patients and methods Seventy one patients affected by symptoms arising from gastroduodenal obstruction due to malignant tumors, with criteria of irresecability, metastatic disease or very high surgical risk, were treated by means of self expanding metal stents. We used the GOOSS index to evaluate efficacy, and the Euro Qol-5D index to evaluate quality of life. Results Before stenting patients with GOOSS 0 and 1 were 68 (98.5%). After stenting patients with GOOSS 2 and 3 (semisolid and solid food) were 58 (84,1%) (P<.0001). The Euro Qol-5D index measured before and a month after stenting were 10.17 and 10.04 respectively (P=.6). The median survival was 91 days (9-552). The enteral stents for localised tumors in the duodenum and the gastrojejunalanastomosis were effective in 26 patients (70.2%) and 13 patients respectively (86.6%), while the enteral stents of tumors in the antrum were effective in only 5 patients (29.4%). Conclusions The palliative treatment of malignant gastric outlet obstruction with a uncovered metal stent produces a significant improvement of oral food intake and maintains the overall quality of life index. The antral localization is associated with a lower efficacy of the procedure (AU)

Antecedentes y objetivos La obstrucción maligna del tracto de salida gástrico puede tratarse mediante el implante de una prótesis enteral o mediante anastomosis yeyunogástrica. Mediante un estudio multicéntrico y prospectivo, evaluamos la eficacia de las prótesis enterales en la ingesta de alimentos, su repercusión en la calidad de vida y la relación entre eficacia y parámetros clínicos y técnicos determinados. Pacientes y métodos Un total de 71 pacientes afectados por síntomas derivados de una obstrucción gastroduodenal ocasionada por neoplasia, con criterios de irresecabilidad, metástasis o riesgo quirúrgico muy elevado, fueron tratados con prótesis metálicas autoexpandibles. Utilizamos el índice GOOSS para evaluar la eficacia, y el Euro Qol-5D para evaluar la calidad de vida. Resultados Antes de implantar la prótesis, 68 (98,5%) pacientes puntuaban GOOSS 0 y 1. Después del implante, el número de pacientes con GOOSS 2 y 3 (alimentos semisólidos y sólidos) era 58 (84,1%) (p<0,0001). El valor del índice Euro Qol-5D antes y un mes después del implante fue 10,17 y 10,04, respectivamente (p=0,6). La mediana de supervivencia fue 91 días (9-552). Las prótesis enterales colocadas para tumores en el duodeno y la anastomosis yeyunogástrica resultaron eficaces en 26 (70,2%) y 13 pacientes, respectivamente (86,6%), mientras que las prótesis colocadas en el antro solo resultaron eficaces en 5 pacientes (29,4%). Conclusiones El tratamiento paliativo de la obstrucción por neoplasia del tracto de salida gástrico con una prótesis metálica sin recubrir produce una mejora significativa de la ingesta oral de alimentos y mantiene la calidad de vida general. La localización antral se asocia con una eficacia inferior del procedimiento (AU)

Acute cellular rejection in liver transplant recipients under cyclosporine immunosuppression: predictive factors of response to antirejection therapy.

BACKGROUND: Predictive factors of response to antirejection therapy in acute cellular rejection (ACR) in liver transplantation are not well established. METHODS: To investigate the possible existence of these factors, we reviewed 111 consecutive episodes of ACR fulfilling the following criteria: histologically confirmed ACR; cyclosporine-based immunosuppression; initial antirejection treatment with high-dose steroid boluses; minimum follow-up of 2 weeks after treatment; and no other graft complication interfering with evaluation of therapeutic response. ACR episodes not responding to initial steroid therapy were given additional treatment (OKT3 and/or repeated steroid boluses). We analyzed the association of the response to the antirejection treatment with different clinical, laboratory, histological, and donor-recipient compatibility variables at two times: after the initial antirejection therapy, and after all the antirejection therapy administered. RESULTS: Eighty episodes of ACR (72%) resolved after the initial therapy with high-dose steroid boluses, and another 18 (16%), initially steroid-resistant, resolved with additional antirejection treatment. Thirteen episodes (12%) were refractory to all antirejection treatment administered. Variables with independent predictive value of nonresponse to initial therapy with steroid boluses were late-onset ACR (>2 months after transplantation), high serum bilirubin and alanine aminotransferase, low blood cyclosporine concentration in the week before antirejection treatment, and severe histological endothelialitis. Late-onset ACR and high serum bilirubin were also independent predictors of refractoriness to all the treatment administered. CONCLUSIONS: Response to antirejection treatment in ACR in liver transplantation can be predicted by several clinical and laboratory data. ACR episodes with factors predictive of therapeutic unresponsiveness could benefit from more aggressive antirejection treatment.