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1.
Anticancer Res ; 40(2): 1167-1173, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014970

RESUMO

BACKGROUND: A gastrostomy feeding tube is one method for long-term feeding support in patients undergoing radio(chemo)therapy for head and neck cancer (HNC). The aim of this study was to analyze the safety of prophylactic gastrostomy tube placement and usage in HNSCC patients. PATIENTS AND METHODS: HNC patients undergoing percutaneous endoscopic gastrostomy (PEG) or radiological percutaneous gastrostomy (RPG) tube placement prior to radio(chemo)therapy from 2010-2014 were retrospectively reviewed regarding procedural and long-term gastrostomy tube-related complications, usage of PEG/RPG, weight profile, pretreatment and posttreatment body mass index. RESULTS: A total of 212 patients underwent prophylactic feeding tube placement (71% RPG, 27% PEG and 2% surgical jejunostomy). A total of 173 patients utilized their gastrostomy tubes for either total or supplemental nutrition support. Despite this, 157 patients (74%) lost weight during therapy (mean weight loss=8 kg). The rate of severe tube-related complications (peritonitis/incorrect placement) was low and similar in both groups (PEG 2.7% vs. RPG 3.4%). CONCLUSION: Although a very high proportion of patients used their PEG/RPG during radio(chemo)therapy there was a high mean weight loss. Serious complications of tube placement were rare.


Assuntos
Gastrostomia , Neoplasias de Cabeça e Pescoço/dietoterapia , Intubação Gastrointestinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Quimiorradioterapia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Feminino , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Jejunostomia , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
2.
Am Surg ; 85(11): 1308-1309, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775976

RESUMO

We present a previously undescribed complication after noninvasive ventilation (NIV) for respiratory failure in a patient who required percutaneous endoscopic gastrostomy (PEG) tube placement for long-term nutrition after a complicated coronary bypass operation. A 54-year-old female diagnosed with unilateral vocal cord paralysis after emergent coronary artery bypass grafting (CABG) underwent an uncomplicated PEG tube placement. She was placed on intermittent NIV because of respiratory failure 24 hours after PEG placement, and NIV was continued for several days. Three days later, she was noted to have pneumoperitoneum on an upright chest X-ray. Abdominal CT scan revealed a large amount of pneumoperitoneum with the PEG tube in the correct position and no extravasation of enteric contrast from the stomach. Tube feeds were held and NIV was discontinued. Nonetheless, six days later, the patient was found on CT scan to have partial displacement of the PEG tube with leakage from the gastrotomy requiring operative repair. This case highlights the vulnerability of PEG tubes to management practices in the early postoperative period. Abdominal distention secondary to NIV likely caused pressure necrosis of the PEG site with dislodgement of the tube. This case elicits considerations regarding future management practices of patients receiving NIV in the early postoperative period after PEG placement.


Assuntos
Gastrostomia/efeitos adversos , Intubação Gastrointestinal , Ventilação não Invasiva/efeitos adversos , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/etiologia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Gastrostomia/instrumentação , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Pessoa de Meia-Idade , Pneumoperitônio/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X
3.
World J Gastroenterol ; 25(31): 4427-4436, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496622

RESUMO

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.


Assuntos
Fístula Anastomótica/prevenção & controle , Nutrição Enteral/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Nutrição Parenteral/métodos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/reabilitação , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Caquexia/epidemiologia , Caquexia/etiologia , Caquexia/prevenção & controle , Nutrição Enteral/efeitos adversos , Neoplasias Esofágicas/complicações , Esofagectomia/métodos , Esofagectomia/reabilitação , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Jejunostomia/efeitos adversos , Jejunostomia/métodos , Nutrição Parenteral/efeitos adversos , Qualidade de Vida , Padrão de Cuidado , Fatores de Tempo , Resultado do Tratamento
4.
Nutrients ; 11(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31480563

RESUMO

OBJECTIVES: To determine the association between home enteral nutrition (HEN) administration modality and its complications in patients. METHODS: This is a prospective multicenter longitudinal study including 15 Spanish hospitals, from April 2015 to March 2017. A 4-month follow-up period was conducted for each patient by home visit. The study subjects were adult patients who began their nutrient intake by tube feeding, known as HEN, during the recruitment period. The variables studied included the type and modality of HEN administration and its related complications, such as vomiting, regurgitation, constipation, diarrhea, and abdominal distention. Mechanical complications and bronchoaspiration were also evaluated. Descriptive variables were used for fitting. RESULTS: The study consisted of 306 patients; 4 were lost due to death. Specific HEN modalities protected against constipation (odds ratio (OR) = 0.4) and regurgitation (OR = 0.4). The use of a nasogastric tube (NGT) resulted in a lower risk of diarrhea compared to percutaneous endoscopic gastrostomy (PEG) (OR = 0.4) but resulted in a higher risk of tube obstruction (OR = 7.4). The use of intermittent gravity versus bolus feeding was a protection factor against vomiting (OR = 0.4), regurgitation (OR = 0.3), constipation (OR = 0.3), diarrhea (OR = 0.4) and abdominal distension (OR = 0.4). The increase in the number of doses was a risk factor for the incidence of regurgitation (OR = 1.3). CONCLUSIONS: Gastrointestinal complications were the most frequent problems, but an adequate choice of the formula, route, feeding modality, number of doses, administration time, and dose volume can reduce the risk of these complications.


Assuntos
Constipação Intestinal/etiologia , Diarreia/etiologia , Nutrição Enteral/efeitos adversos , Gastroenteropatias/etiologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Vômito/etiologia , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/epidemiologia , Diarreia/epidemiologia , Nutrição Enteral/métodos , Feminino , Alimentos Formulados , Gastroenteropatias/epidemiologia , Gastrostomia/efeitos adversos , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Tempo , Vômito/epidemiologia
5.
BMJ Case Rep ; 12(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488448

RESUMO

A 53-year-old man with dysphagia underwent uneventful placement of a percutaneous endoscopic gastrostomy (PEG) tube for long-term enteral feeding access. 11 hours after the procedure, it was discovered that he had accidentally dislodged the feeding tube. On physical examination, he was found to have a benign abdomen without evidence of peritonitis or sepsis. He was observed overnight with serial abdominal examinations and nasogastric decompression. In the morning, he was taken back to the endoscopy suite where endoscopic clips were employed to close the gastric wall defect and a PEG tube was replaced at an adjacent site. The patient was fed 24 hours thereafter and discharged from the hospital 48 hours after the procedure. Early accidental removal of a PEG tube in patients without sepsis or peritonitis can be safely treated with simultaneous endoscopic closure of the gastrotomy and PEG tube replacement, resulting in earlier enteral feeding and shorter hospital stay.


Assuntos
Gastrostomia/efeitos adversos , Intubação Gastrointestinal/efeitos adversos , Transtornos de Deglutição/terapia , Nutrição Enteral/métodos , Mucosa Gástrica/lesões , Mucosa Gástrica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
6.
World Neurosurg ; 132: 4-6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31421302

RESUMO

The endoscopic endonasal transsphenoidal (EET) approach for skull base tumors has become increasingly popular. We know that bone defects in the skull base can cause cerebrospinal fluid rhinorrhea, but for patients who need to be intubated through the nose, the tube can enter the brain through a skull base bone defect. Nasogastric tube feeding into the brain is a rare occurrence, and this situation can occur only in the case of a skull base defect. We treated a patient with an unusual complication after the EET approach for pituitary adenoma resection. This particular case suggests that bone defects after EET surgery can not only cause cerebrospinal fluid rhinorrhea but also allow the entry of a nasogastric tube into the brain. For patients with a history of EET surgery, endoscopy-assisted gastric tube implantation can be performed if necessary.


Assuntos
Adenoma/cirurgia , Contusão Encefálica/etiologia , Intubação Gastrointestinal/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Base do Crânio/cirurgia , Idoso , Contusão Encefálica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Nutrição Enteral , Feminino , Humanos , Cavidade Nasal , Neuroendoscopia , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Int J Clin Pract ; 73(11): e13405, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408231

RESUMO

BACKGROUND: Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. OBJECTIVE: To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. METHODS: All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. RESULTS: A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. CONCLUSIONS: The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.


Assuntos
Nutrição Enteral/métodos , Gastrostomia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Intubação Gastrointestinal/métodos , Desnutrição/prevenção & controle , Idoso , Nutrição Enteral/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Humanos , Intubação Gastrointestinal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 98(30): e16472, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348251

RESUMO

BACKGROUNDS: Patients with central nervous system injuries present with dysphagia and may require non-oral feeding methods, like percutaneous endoscopic gastrostomy, nasogastric (NG) tube, or oroesophageal (OE) tube. The prevalence of pneumonia in patients with gastroesophageal reflux (GER) is significantly higher than that in patients without GER. We aimed to determine the most appropriate tube feeding with low risk of GER by comparing the results of 24-hour pH monitoring studies in patients who were administered 2 types of feeding: NG tube and OE tube. METHODS: In this pilot study, 6 stroke patients underwent 24-hour esophageal pH monitoring during NG tube feeding and OE tube feeding, sequentially. Parameters collected included acid exposure time, mean esophageal pH, number of reflux episode, time of bolus reflux for both total 24-hour pH study data and postprandial data, and deMeester composite score. RESULTS: Total acid reflux time (minutes) decreased more with OE tube feeding than that with NG tube feeding in the total 24-hour pH study. The number of reflux episodes decreased in both total and postprandial data with OE tube feeding versus NG tube feeding (P < .05). There were no significant differences in mean esophageal pH and total time of bolus reflux between the 2 groups. CONCLUSIONS: Although we could not definitively conclude that OE tube feeding decreased the severity of GER compared with NG tube feeding, there were significant differences in 4 out of 9 parameters. OE tube can be a substitute for NG tube in patients with dysphagia after stroke leading to GER disease.


Assuntos
Nutrição Enteral/métodos , Esôfago , Refluxo Gastroesofágico/etiologia , Intubação/efeitos adversos , Intubação/métodos , Adulto , Idoso , Monitoramento do pH Esofágico , Feminino , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo
9.
Am J Surg ; 218(4): 722-725, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31350008

RESUMO

BACKGROUND: Laparoscopic gastrostomy tube (GT) placement is a common procedure and frequent cause of morbidity. Some surgeons perform a Seldinger technique (ST), while others perform a modified open technique (MOT). We hypothesized that the modified open technique would result in more complications. METHODS: A prospective study of primary GT placed 12/2016-06/2018, ensuring at least 6 months follow up. We assessed any episode of granulation tissue, troublesome leaking, tube dislodgment, and infection requiring antibiotic or drainage. RESULTS: 92 GT were placed, with 56 were placed as modified open (60.9%). 34 children (37.0%) developed granulation tissue, 18 children (19.6%) experienced tube dislodgment, and 6 children (6.5%) developed a site infection, with no difference depending on technique (P = 0.56, 0.29, and 0.76, respectively). Following ST, 2 children developed leakage (5.6%), whereas 15 children (26.8%) had leakage following the MOT (P = 0.01). CONCLUSION: MOT resulted in significantly more leaks. Other complications were similar between groups. Surgeons choosing MOT should be mindful of the size of gastrotomy at time of surgery, as this may result in increased complications.


Assuntos
Gastrostomia/efeitos adversos , Gastrostomia/métodos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Nutrição Enteral/efeitos adversos , Feminino , Humanos , Lactente , Masculino
10.
Cochrane Database Syst Rev ; 7: CD013038, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311064

RESUMO

BACKGROUND: Preterm infants are often unable to co-ordinate sucking, swallowing and breathing for oral feeding because of their immaturity; in such cases, initial nutrition is provided by orogastric or nasogastric tube feeding. Feed intolerance is common and can delay attainment of full enteral feeds and sucking feeds, which prolongs the need for intravenous nutrition and hospital stay. Smell and taste play an important role in the activation of physiological pre-absorptive processes that contribute to food digestion and absorption. However, during tube feedings, milk bypasses the nasal and oral cavities, which limits exposure to the smell and taste of milk. Provision of the smell and taste of milk with tube feedings is non-invasive and inexpensive; and if it does accelerate the transition to enteral feeds, and then to sucking feeds, it would be of considerable potential benefit to infants, their families, and the healthcare system. OBJECTIVES: To assess whether exposure to the smell or taste (or both) of milk administered with tube feedings can accelerate progress to full sucking feeds without adverse effects in preterm infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 1 June 2018), Embase (1980 to 1 June 2018), and CINAHL (1982 to 1 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised and quasi-randomised trials. SELECTION CRITERIA: We included randomised and quasi-randomised studies that compared the provision of the smell or taste of milk (or both) immediately before or at the time of tube feedings, with no provision of smell or taste. DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data according to Cochrane Neonatal methodology; they also assessed risk of bias, and the quality of evidence at the outcome level using the GRADE approach. We performed meta-analyses using risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, with their respective 95% confidence intervals (CIs). MAIN RESULTS: Three trials involving a total of 161 preterm infants were included in this review, but only two trials (131 infants) contributed data for meta-analysis. There was no evidence of a clear effect of exposure to the smell and taste of milk with tube feedings on time taken to reach full sucking feeds (MD -2.57 days, 95% CI -5.15 to 0.02; I2 = 17%; 2 trials, 131 infants; very low-quality evidence). One trial reported no adverse effects. There was no evidence of a clear effect of exposure to the smell and taste of milk on the following outcomes: time taken to reach full enteral feeds (MD -1.57 days, 95% CI -6.25 to 3.11; 1 trial, 51 infants; very low-quality evidence), duration of parenteral nutrition (MD -2.20 days, 95% CI -9.49 to 5.09; 1 trial, 51 infants; very low-quality evidence), incidence of necrotising enterocolitis (RR 0.62, 95% CI 0.15 to 2.48; 1 trial, 51 infants; low-quality evidence), and late infection (RR 2.46, 95% CI 0.27 to 22.13; 1 trial, 51 infants; low-quality evidence). There was very low-quality evidence demonstrating that exposure to the smell and taste of milk decreased duration of hospitalisation by almost four days (MD -3.89 days, 95% CI -7.03 to -0.75; I2 = 51%; 2 trials, 131 infants). In two trials, an increased growth velocity was noted in infants exposed to the intervention, but we were unable to combine data to perform meta-analysis. No data were available to assess feed intolerance and rates of exclusive breastfeeding at discharge. Included trials were small and had methodological limitations including lack of randomisation (one trial), lack of blinding, and different inclusion criteria and administration of the interventions. AUTHORS' CONCLUSIONS: Evidence from two trials suggests that exposure to the smell and taste of milk with tube feedings has no clear effect on time taken to reach full sucking feeds, but it may decrease length of hospitalisation. However, these results are uncertain due to the very low quality of the evidence. There is also limited evidence about the impact on other important clinical outcomes and on safety. Future research should examine the effect of exposure to the smell and taste of milk with tube feedings on clinical outcomes during hospitalisation, such as attainment of full enteral and sucking feeds, safety, feed tolerance, incidence of infection, and infant growth. Additionally, future research should be sufficiently powered to evaluate the effect of the intervention in infants of different gestational ages, on each sex separately, and on the optimal frequency and duration of exposure.


Assuntos
Recém-Nascido Prematuro/crescimento & desenvolvimento , Intubação Gastrointestinal , Olfato , Paladar , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Intubação Gastrointestinal/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Olfato/fisiologia , Comportamento de Sucção , Paladar/fisiologia , Ganho de Peso
11.
World J Surg ; 43(10): 2616-2622, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31161355

RESUMO

BACKGROUND: Evidence-based guidelines for enhanced recovery (ERAS) pathways after pancreatoduodenectomy (PD) are available. Routine use of nasogatric tube (NGT) after PD is not recommended. This study aims to evaluate the need for NGT reinsertion after PD performed within an ERAS setting. METHODS: It is a prospective observational study of all patients undergoing PD in a tertiary referral hospital within the study period from 2015 throughout 2016. Pre- and postoperative variables were collected. Patients requiring NGT reinsertion were identified. Comparative analysis of patients with and without a NGT reinsertion was performed, as well as multivariate analysis for risk factors for on-demand NGT reinsertion. RESULTS: Two-hundred and one patients were included. In total, 45 (22.4%) patients required NGT reinsertion after PD. A total of 32 (15.9%) patients underwent a relaparotomy. Reinsertion of NGT in patients not undergoing a relaparotomy occurred in 26 (15.4%) patients. The presence of a major postoperative complication was a risk factor for reinsertion of NGT, OR 5.27 (2.54-10.94, p = 0.001). Patients with the need for a NGT reinsertion had a higher frequency of major postoperative complications and relaparotomy compared to patients without the need of a NGT reinsertion, 26 (57.8%) versus 32 (20.5%), p < 0.001 and 19 (42.2%) versus 13 (8.3%), p < 0.001, respectively. CONCLUSION: Routine use of NGT after PD is not justified within an ERAS setting. Immediate removal of the NGT after the procedure can be performed safely, and reinsertion on demand is rarely necessary in uncomplicated courses.


Assuntos
Intubação Gastrointestinal , Pancreaticoduodenectomia/métodos , Adulto , Feminino , Humanos , Intubação Gastrointestinal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Adulto Jovem
12.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229975

RESUMO

Severe bleeding requiring blood transfusions following endoscopic, percutaneous gastrostomy tube placement is a rare complication. We describe a case of severe recurrent haemorrhage with bright red blood from rectum from endoscopic, percutaneous gastrostomy tube placement, which ultimately required removal of the percutaneous endoscopic gastrostomy tube.


Assuntos
Hemorragia Gastrointestinal/etiologia , Gastrostomia/instrumentação , Intubação Gastrointestinal/efeitos adversos , Pneumonia Aspirativa/terapia , Idoso de 80 Anos ou mais , Transtornos de Deglutição , Endoscopia Gastrointestinal , Humanos , Doença Iatrogênica , Masculino , Resultado do Tratamento
13.
Dis Esophagus ; 32(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31111880

RESUMO

Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4-236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Intubação Gastrointestinal/efeitos adversos , Segunda Neoplasia Primária/etiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Gástricas/etiologia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/patologia , Esofagectomia/instrumentação , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
14.
BMC Neurol ; 19(1): 83, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043159

RESUMO

BACKGROUND: In clinical practice, a large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period. However, its impact on the swallowing function remains largely unknown. This study examines the impact of prolonged placement of an NGT on the swallowing function of elderly post-stroke patients. METHODS: The participants of this study were 30 elderly post-stroke patients who had been using an NGT for more than 2 months. A videofluoroscopic swallowing study (VFSS) was performed before and 5 h after removal of the NGT. The following parameters were analyzed and compared, the functional dysphagia scale (FDS), residue in the valleculae, residue in the pyriform sinuses, and the penetration-aspiration scale (PAS). In addition, prior to the VFSS, the pharynx and larynx were examined using a fiberoptic laryngoscope. RESULTS: Significant differences were observed between the total scores of the FDS, pharyngeal transit times (PTTs), the residue in the valleculae, and the residue in the pyriform sinuses before and after the NGT removal, suggesting an improved swallowing function following the removal of the NGT. A significantly lower penetration-aspiration degree was found after removing the NGT compared with that before its removal. In addition, examinations using the fiberoptic laryngoscope showed that laryngopharyngeal edema was present in three quarters of the patients. CONCLUSIONS: Our results demonstrate that prolonged placement of the NGT had a negative impact on the swallowing function of elderly post-stroke dysphagia patients, mainly on the pharyngeal phase.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Deglutição , Intubação Gastrointestinal/efeitos adversos , Acidente Vascular Cerebral/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Acta Oncol ; 58(8): 1187-1196, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31032694

RESUMO

Background: Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function following chemoradiotherapy for oropharyngeal carcinoma in relation to the use of a prophylactic gastrostomy or nasogastric (NG) tube as required. Material and methods: The MD Anderson Dysphagia Inventory (MDADI) was posted to 204 disease-free patients at least 2 years following chemoradiotherapy for oropharyngeal carcinoma between 2010 and 2014. Results: Overall, 181/204 (89%) patients returned questionnaire at a median of 34 months post-treatment. 97/181 (54%) and 84/181 (46%) were managed with an approach of a prophylactic gastrostomy or NG tube as required, respectively. A prophylactic gastrostomy was associated with higher rates of enteral feeding (92% vs. 58%, p < .001), lower median percentage weight loss (7.0% vs. 9.4%, p < .001), increased duration of enteral feed (median 3.3 vs. 1.1 months, p < .001). There was no significant difference in patient-reported swallow function measured by MDADI summary scores and subscales for patients managed with an approach of prophylactic gastrostomy or NG as required. Duration of enteral feed correlated negatively with composite MDADI scores. A subgroup of 116/181 (64%) patients were documented as having been offered a choice of enteral feeding approach and therefore can be considered to represent clinical equipoise; there were no significant differences in MDADI scores according to route. Conclusions: Despite concern regarding the use of a prophylactic gastrostomy in prior studies, the approaches of using a prophylactic gastrostomy or an NG tube as required to support patients during/after chemoradiotherapy for oropharyngeal carcinoma were associated with similar long-term swallow outcomes.


Assuntos
Carcinoma/terapia , Quimiorradioterapia/efeitos adversos , Transtornos de Deglutição/epidemiologia , Nutrição Enteral/efeitos adversos , Intubação Gastrointestinal/efeitos adversos , Neoplasias Orofaríngeas/terapia , Adulto , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Nutrição Enteral/instrumentação , Nutrição Enteral/métodos , Feminino , Seguimentos , Gastrostomia/efeitos adversos , Humanos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
17.
J Pediatr Surg ; 54(5): 1041-1044, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30819544

RESUMO

BACKGROUND: Gastrojejunostomy tubes (GJTs) have been associated with intestinal perforation in children <6 months or <6 kg. This study evaluated the impact of an institutional practice change recommending a new soft tip GJT for children <10 kg. METHODS: We performed a single-center review of GJT placements among children <10 kg before (1/1/2010-12/31/2013) and after (7/1/2014-12/31/2016) the practice change. Intestinal perforation, nasojejunal tube (NJT) for >30 days, and GJT replacement were assessed. RESULTS: Sixty GJTs were placed in 35 children (54% male; 17.2±9.0 months old) after compared to 147 GJTs in 77 children (44% male, p=0.32; 14.1±11.8 months, p=0.08) before the practice change. Use of soft tip GJT was adhered to in 19 placements (32%). There were no intestinal perforations after the practice change (before: 6 (4.1%); p=0.11). NJT remained >30 days in 15 patients (65%) after the practice change (before: 13 (35%); p=0.02). Replacement was required for 53% with soft tip GJT and 18% with standard GJT (p=0.006). DISCUSSION: A reduction in intestinal perforation with an institutional practice change may be explained by fewer GJT placements in high-risk children and longer length of NJT placement. Future protocols may consider age and size restrictions rather than alternative tube types. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.


Assuntos
Derivação Gástrica , Perfuração Intestinal/etiologia , Intubação Gastrointestinal , Pré-Escolar , Desenho de Equipamento , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/instrumentação , Derivação Gástrica/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Estudos Retrospectivos
19.
Adv Otorhinolaryngol ; 83: 109-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30754042

RESUMO

Treatment of hypopharyngeal cancer depends on the extent and location of the tumour, patient-specific or by factors (age, performance status, co-morbidity) and the presence of psychosocial support. Options available for the treatment of hypopharyngeal cancer consist of surgery and non-surgery - radiotherapy, chemoradiation, bioradiation, or a combination of these modalities. To maintain normal functioning as much as possible, functional organ preservation is widely recommended and generally utilizes radiotherapy and/or chemoradiation. Although functional organ-sparing approaches can permit larynx preservation in patients with locoregionally advanced cancer of the hypopharynx, they do not provide a survival advantage over total laryngectomy. All available treatment modalities for patients with hypopharyngeal cancer have associated short- and long-term toxicities leading to side effects and complications.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias Hipofaríngeas/terapia , Complicações Pós-Operatórias , Radioterapia/efeitos adversos , Humanos , Hipotireoidismo/etiologia , Intubação Gastrointestinal/efeitos adversos , Linfedema/etiologia , Complicações Pós-Operatórias/prevenção & controle , Xerostomia/etiologia
20.
Am J Case Rep ; 20: 224-227, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30783075

RESUMO

BACKGROUND Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as endoscopic surgeries. Coagulation disorders increase the risk of IHE. The most common location of IHE is in the distal esophagus. The characteristic clinical triad of manifestations comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. CASE REPORT An 84-year-old male was scheduled for coil embolization for an endoleak after endovascular aneurysm repair. For this reason, he was taking aspirin and warfarin. A nasogastric tube had been inserted during surgery and subsequently removed without any problems reported. Postoperatively, he experienced chest pain and hematemesis of sudden onset. Urgent esophagogastroduodenoscopy demonstrated a large, dark red, non-pulsatile, submucosal, esophageal mass in the area of the mid-esophagus with a little oozing. He was diagnosed as having an IHE; other possible diagnoses were excluded by contrast-enhanced computed tomography and aortography. He was treated with fasting, a proton pump inhibitor, and cessation of anti-thrombotic drugs; he recovered completely. The bleeding spot in the esophagus was in the area of the mid-esophagus, which was around the second natural constriction site. It was possible that the nasogastric tube had contact with the esophageal wall at this second natural constriction, and caused intramural esophageal bleeding. CONCLUSIONS Nasogastric tubes are not generally recognized as a cause of IHE. However, they can cause them, especially when a patient is taking anti-thrombotic drugs.


Assuntos
Doenças do Esôfago/etiologia , Hematoma/etiologia , Intubação Gastrointestinal/efeitos adversos , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Humanos , Intubação Gastrointestinal/instrumentação , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Varfarina/uso terapêutico
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