Anastomosis gastroyeyunal con separación gástrica parcial frente al tratamiento endoscópico para el tratamiento del síndrome de obstrucción antroduodenal de causa maligna / Stomach-partitioning gastrojejunostomy versus stent placement for the treatment of malignant gastric outlet obstruction

Introducción: El síndrome de obstrucción antroduodenal es una complicación presente en neoplasias avanzadas. Se caracteriza por clínica de obstrucción gastrointestinal alta, con desnutrición progresiva, y se asocia con una disminución de la supervivencia. La derivación mediante gastroyeyunostomía y el tratamiento endoscópico (TE) son las alternativas para el tratamiento del síndrome de obstrucción antroduodenal. El objetivo de este estudio es comparar la eficacia y la supervivencia de ambas. Métodos: Estudio monocentro, observacional y prospectivo de 58 pacientes con síndrome de obstrucción antroduodenal que recibieron tratamiento quirúrgico mediante gastroyeyunostomía con separación gástrica parcial (GYSGP) o TE con prótesis enterales autoexpandibles entre los años 2007-2018. Resultados: A 30 pacientes se les realizó GYSGP y a 28 pacientes TE. La edad media de los pacientes con GYSGP fue significativamente menor (69 vs. 78 años, p = 0,001). No hubo diferencias en cuanto al sexo, el riesgo anestésico-quirúrgico ni la etiología de la neoplasia. Las complicaciones posprocedimiento fueron superiores, aunque no significativas, en el grupo de GYSGP (p = 0,156). El TE se asoció con una menor estancia hospitalaria (p = 0,02) y una mayor precocidad de la tolerancia oral (p < 0,0001). Sin embargo, los pacientes presentaron tasas más altas de obstrucción persistente y recurrente (p = 0,048 y 0,01, respectivamente), unos peores objetivos energéticos (p = 0,009) y una supervivencia menor (9,61 vs. 4,47 meses, p = 0,008). Conclusiones: La GYSGP obtiene una mayor permeabilidad luminal, una mejor tolerancia a la vía oral y una mayor supervivencia. El TE estaría recomendado para pacientes no subsidiarios de la cirugía con un pronóstico limitado a corto plazo

Introduction: Gastric outlet obstruction is a complication of advanced tumors. It causes upper gastrointestinal obstruction, with progressive malnutrition and reduced survival. Currently, gastrojejunostomy or stent placement (SP) are feasible alternatives for the treatment of malignant gastric outlet obstruction. The aim of this study is to compare the efficacy and survival of both techniques. Methods: Single-center observational and prospective study of 58 patients with gastric outlet obstruction who underwent surgical treatment with stomach-partitioning gastrojejunostomy (SPGJ) or SP with self-expanding intraluminal prostheses between 2007 and 2018. Results: Thirty patients underwent SPGJ and 28 SP. The mean age of the first group was significantly lower (69 vs. 78 years, respectively; P = .001). There were no statistically significant differences in terms of sex, perioperative risk or tumor etiology. Postoperative complications were non-significantly higher in the SPGJ group (P = .156). SP was associated with a shorter hospital stay (P = .02) and faster oral intake (P < .0001). However, SP had significantly higher rates of persistent and recurrent obstruction (P = .048 and .01, respectively), poorer energy targets (P=.009) and shorter survival (9.61 vs. 4.47 months; P = .008). Conclusions: SPGJ presents greater luminal permeability, better oral intake and greater survival than SP. SP is preferable for non-surgical patients with a limited short-term prognosis

Stomach-partitioning gastrojejunostomy versus stent placement for the treatment of malignant gastric outlet obstruction. / Anastomosis gastroyeyunal con separación gástrica parcial frente al tratamiento endoscópico para el tratamiento del síndrome de obstrucción antroduodenal de causa maligna.

INTRODUCTION: Gastric outlet obstruction is a complication of advanced tumors. It causes upper gastrointestinal obstruction, with progressive malnutrition and reduced survival. Currently, gastrojejunostomy or stent placement (SP) are feasible alternatives for the treatment of malignant gastric outlet obstruction. The aim of this study is to compare the efficacy and survival of both techniques. METHODS: Single-center observational and prospective study of 58 patients with gastric outlet obstruction who underwent surgical treatment with stomach-partitioning gastrojejunostomy (SPGJ) or SP with self-expanding intraluminal prostheses between 2007 and 2018. RESULTS: Thirty patients underwent SPGJ and 28 SP. The mean age of the first group was significantly lower (69 vs. 78 years, respectively; P=.001). There were no statistically significant differences in terms of sex, perioperative risk or tumor etiology. Postoperative complications were non-significantly higher in the SPGJ group (P=.156). SP was associated with a shorter hospital stay (P=.02) and faster oral intake (P<.0001). However, SP had significantly higher rates of persistent and recurrent obstruction (P=.048 and .01, respectively), poorer energy targets (P=.009) and shorter survival (9.61 vs. 4.47 months; P=.008). CONCLUSIONS: SPGJ presents greater luminal permeability, better oral intake and greater survival than SP. SP is preferable for non-surgical patients with a limited short-term prognosis.

Torsión de la vesícula biliar / Gallbladder torsion

No disponible

No disponible