Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer.

Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil.

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

Evaluation of five parasitological techniques for diagnosing phylum Ciliophora cysts in fecal samples from free-living wild artiodactyls / Avaliação de cinco técnicas parasitológicas para o diagnóstico de cistos do filo Ciliophora em amostras fecais de artiodáctilos silvestres em vida livre

A variety of laboratory techniques are used in parasitological diagnosis. However, studies that analyze their laboratory efficiency are very scarce, especially with regard to biological samples from wild animals that are little known, with little popular attachment, such as artiodactyls. These can be infected by different parasites, including protozoa of the phylum Ciliophora, which includes the parasites Balantioides coli and Buxtonella sulcata. In this light, the aim of this study was to compare the efficiency of five coproparasitological techniques for diagnosing protozoan cysts of the phylum Ciliophora in the feces of free-living artiodactyls. To this end, 101 fecal samples were collected from trails in Pedra Selada State Park, Rio de Janeiro state, from 2020 to 2021. All the samples were analyzed using the qualitative techniques of modified Sheather floatation, modified Ritchie sedimentation and Lutz, as well as the quantitative techniques of Mini-FLOTAC and McMaster. Cyst recovery was best achieved using the modified Ritchie technique, in which 62.5% positivity was detected, followed by Lutz (47.5%), modified Sheather (37.5%) and the quantitative techniques of Mini-FLOTAC (30%) and McMaster (17.5%). In most of the comparisons between the techniques, reasonable agreement regarding the diagnosis was observed (Kappa 0.21 to 0.40), which was statistically significant (p≤0.05). McMaster showed higher mean and standard deviation values for counts of cysts per gram of feces than Mini-FLOTAC. However, there was no significant difference in the estimates for cyst counts (Wilcoxon p>0.05). Sedimentation qualitative techniques were more indicated for diagnosing cysts of protozoa of the phylum Ciliophora in the feces of free-living wild artiodactyls. These techniques can therefore be used as laboratory tools for environmental parasite monitoring. In addition, between the two quantitative techniques, Mini-FLOTAC presented better performance, thus showing its potential as a tool for estimating the abundance of cystic forms of the phylum Ciliophora in environmental samples.

Diversas são as técnicas laboratoriais utilizadas no diagnóstico parasitológico. No entanto, estudos que analisam a eficiência laboratorial das mesmas são muito escassos, principalmente quando se trata de amostras biológicas de animais silvestres, que possuem pouca divulgação e apego popular, como os artiodáctilos. Estes podem se infectar por diferentes parasitos, incluindo os protozoários do Filo Ciliophora, no qual se inclui Balantioides coli, bem como Buxtonella sulcata. Mediante o exposto, este estudo objetivou comparar a eficiência entre cinco técnicas coproparasitológicas para o diagnóstico de cistos de protozoário do Filo Ciliophora em fezes de artiodáctilos em vida livre. Entre 2020 e 2021 foram coletadas 101 amostras fecais em trilhas do Parque Estadual da Pedra Selada localizado no estado do Rio de Janeiro. Todas as amostras foram analisadas pelas técnicas qualitativas de flutuação de Sheather modificada, sedimentação de Ritchie modificada e Lutz, bem como por meio das técnicas quantitativas de Mini-FLOTAC e McMaster. Pode-se verificar uma superioridade na recuperação dos cistos por meio da técnica de Ritchie modificada, no qual foi detectado 62,5% de positividade, seguida pelo Lutz (47,5%), Sheather modificada (37,5%) e pelas técnicas quantitativas de Mini-FLOTAC (30%) e McMaster (17,5%). Na maioria das comparações entre as técnicas foi possível verificar uma concordância razoável (Kappa 0,21 a 0,40) em relação ao diagnóstico entre as mesmas, sendo este estatisticamente significativo (p≤0,05). McMaster em comparação com o Mini-FLOTAC foi a que apresentou os maiores valores médio e de desvio padrão na contagem dos cistos por grama de fezes. No entanto, não foi evidenciado diferença significativa na estimativa de contagem dos cistos (Wilcoxon=p>0,05). Pode-se verificar que as técnicas qualitativas de sedimentação foram consideradas as mais indicadas para o diagnóstico de cistos do protozoário do Filo Ciliophora em fezes de artiodáctilos silvestres em vida livre, podendo ser utilizadas como ferramentas laboratoriais de monitoramento parasitário ambiental. Além disso, dentre as técnicas quantitativas, o Mini-FLOTAC foi a que apresentou a melhor performance, denotando o seu potencial como uma ferramenta para se estimar a abundância de formas císticas do Filo Ciliophora em amostra ambiental.

Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients is associated with higher complication and mortality rates when compared to a general patient population. The pull technique is still the preferred technique worldwide but it has some limitations. The aim of this study is to compare the pull and introducer PEG techniques in patients with HNC. PATIENTS AND METHODS: This study is based on a retrospective analysis of a prospectively collected database of 309 patients with HNC who underwent PEG in the Cancer Institute of São Paulo. RESULTS: The procedure was performed with the standard endoscope in 205 patients and the introducer technique was used in 137 patients. There was one procedure-related mortality. Age, sex and albumin level were similar in both groups. However in the introducer technique group, patients had a higher tumor stage, a lower Karnofsky status, and presented more frequently with tracheostomy and trismus. Overall, major, minor, immediate and late complications and 30-day mortality rates were similar but the introducer technique group presented more minor bleeding and tube dysfunctions. CONCLUSION: The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.