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1.
Comparison of efficacy of pharmacological therapies for gastric endoscopic submucosal dissection-induced ulcers: a systematic review and network meta-analysis.
Gao, H, Li, L, Zhang, C, Tu, J, Geng, X, Wang, J, Zhou, X, Jing, J, Pan, W
Expert review of gastroenterology & hepatology. 2020;(3):207-220
Abstract
Objectives: This study aimed to compare the efficacy of various anti-ulcer medications in preventing delayed bleeding and promoting ulcer healing after ESD.Methods: Asystematic search was conducted for articles up to August2019. The treatments of iatrogenic ulcer were analyzed by Bayesian network meta-analysis.Results: The analysis included 28 studies. Six treatments were compared. For the prevention of delayed bleeding, potassium-competitive acid blocker (P-CAB) alone was superior to proton-pump inhibitor (PPI) alone [RR = 1.02, 95%CI (1.00, 1.05)]. Treatments based on P-CAB tended to be better than the non-P-CAB groups [RR = 1.05, 95%CI (1.03, 1.07)]. Concerning the ulcer healing rate at 4 weeks, the combined treatment of PPI and mucoprotective agent (MP) was superior to PPI alone [RR = 1.81, 95%CI (1.19, 2.76)] and P-CAB alone [RR = 2.75, 95%CI (1.02, 7.44)]. At 8 weeks, PPI+MP and P-CAB+MP tend to be superior to than the other four groups. The healing effect of MP-based therapies was better than that of non-MP groups at 4 weeks [RR = 1.63, 95%CI (1.32, 2.01)] and 8 weeks [RR = 1.06, 95%CI (1.02, 1.11)].Conclusion: P-CAB may prevent delayed bleeding, but not significantly. MP agents have the potential to heal post-ESD ulcers.
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FOLFIRINOX for the Treatment of Advanced Gastroesophageal Cancers: A Phase 2 Nonrandomized Clinical Trial.
Park, H, Jin, RU, Wang-Gillam, A, Suresh, R, Rigden, C, Amin, M, Tan, BR, Pedersen, KS, Lim, KH, Trikalinos, NA, et al
JAMA oncology. 2020;(8):1231-1240
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Abstract
IMPORTANCE Standard first-line regimens for patients with metastatic gastroesophageal adenocarcinomas have an approximate 40% objective response rate (ORR). The combination of leucovorin, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) has been efficacious as first-line therapy for other gastrointestinal cancers, such as pancreatic and colon cancers. OBJECTIVE To evaluate the clinical activity and safety of FOLFIRINOX as first-line treatment for patients with advanced gastroesophageal adenocarcinoma. DESIGN, SETTING, AND PARTICIPANTS This is an open-label, single-arm phase 2 study of first-line FOLFIRINOX in patients with advanced gastroesophageal adenocarcinoma. Estimated sample size included 41 patients with ERBB2-negative disease with 90% power to detect an ORR of 60% or greater with α of .10. No enrollment goal was planned for ERBB2-positive patients, but they were allowed to receive trastuzumab in combination with FOLFIRINOX. INTERVENTIONS Starting doses were fluorouracil, 400 mg/m2 bolus, followed by 2400 mg/m2 over 46 hours; leucovorin, 400 mg/m2; irinotecan, 180 mg/m2; and oxaliplatin, 85 mg/m2. Trastuzumab was administered as a 6 mg/kg loading dose, followed by 4 mg/kg every 14 days in patients with ERBB2-positive disease. MAIN OUTCOMES AND MEASURES The primary end point was ORR by the Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary end points included safety profile, progression-free survival (PFS), overall survival (OS), and duration of response. RESULTS From November 2013 to May 2018, 67 patients were enrolled (median [range] age, 59.0 [34-78] years; including 56 [84%] men), and 26 of 67 (39%) had ERBB2-positive disease. Median follow-up was 17.4 months. The ORR was 61%(95% CI, 44.5%-75.8%) (25 of 41) in the ERBB2-negative group and 85% (95% CI, 65.1%-95.6%) (22 of 26) in the ERBB2-positive group, including 1 patient with complete response. For ERBB2-negative patients, median PFS was 8.4 months and median OS was 15.5 months; for ERBB2-positive patients, median PFS was 13.8 months and median OS was 19.6 months. Fifty-six patients (84%) had dose modifications or treatment delays. The most common toxic effects were neutropenia (91%, n = 61), diarrhea (63%, n = 42), peripheral sensory neuropathy (61%, n = 41), and nausea (48%, n = 32), with no unexpected toxic effects. CONCLUSIONS AND RELEVANCE The FOLFIRINOX regimen with or without trastuzumab was associated with improved ORR and PFS in patients with advanced gastroesophageal adenocarcinoma in the first-line setting. This regimen may be a reasonable therapeutic option for patients with preserved performance status. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01928290.
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Robotic versus laparoscopic surgery for gastric cancer: an overview of systematic reviews with quality assessment of current evidence.
Hoshino, N, Murakami, K, Hida, K, Hisamori, S, Tsunoda, S, Obama, K, Sakai, Y
Updates in surgery. 2020;(3):573-582
Abstract
Many systematic reviews have been published to evaluate the clinical benefits of robotic surgery for gastric cancer. However, these reviews have investigated various outcomes and differ considerably in quality. In this overview, we summarize the findings and quality of these reviews. A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials to identify systematic reviews and meta-analyses that compared robotic surgery with laparoscopic surgery for gastric cancer. We summarized the results of the meta-analyses and evaluated the quality of the reviews using the AMSTAR-2 tool. The literature search identified 14 eligible reviews. The reviews showed that estimated blood loss was significantly less and time to resumption of oral intake was significantly shorter in patients who underwent robotic surgery than in those who underwent laparoscopic surgery. However, no significant differences in other outcomes were found between the two types of surgery. The quality of the included reviews was judged to be critically low. In conclusion, the available evidence, albeit of critically low quality, suggests that robotic surgery decreases estimated blood loss and shortens the time to resumption of oral intake in patients with gastric cancer. There is currently no high-quality evidence that robotic surgery has clinical benefits for gastric cancer patients.
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Are depression and anxiety disorders associated with adductor pollicis muscle thickness, sleep duration, and protein intake in cancer patients?
de Sousa, DE, de Carli, MN, Fernandes, RC, Trindade, DB, Laviano, A, Pichard, C, Pimentel, GD
Experimental gerontology. 2020;:110803
Abstract
INTRODUCTION Psychological disturbances may be associated with compromised body composition and food intake. However, this has not been elucidated totally. Thus, this study aimed to evaluate the prevalence of anxiety and depression, and whether there is an association between these disorders and adductor pollicis muscle thickness (APMT), protein intake and sleep duration, in gastrointestinal cancer patients. METHODS A cross-sectional study evaluated 117 patients of both genders diagnosed with gastrointestinal cancer. Protein intake was assessed by the USDA food database; sleep duration by self-administered questionnaire; and APMT using the skinfold. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety (HADS-A) and depression (HADS-D). RESULTS A total of 117 (65% male) patients were assessed, of which 40 (34%) had anxiety and 39 (33%) depression. There was a negative correlation between APMT and anxiety (r = -0.20, p = .020) and depression (r = -0.19, p = .03), and between anxiety and sleep duration (r = -0.30, p = .001). Although there was an inverse association between anxiety and APMT (OR: 0.88, 95%CI: 0.79-0.99, p = .032) and sleep duration (OR: 0.71, 95%CI: 0.58-0.87, p = .001), when adjusted for gender and age, the association remained only between anxiety and sleep duration (OR: 0.71, 95%CI: 0.58-0.87, p = .001). CONCLUSION One-third of gastrointestinal cancer patients were classified as expressing anxiety and depression. Additionally, only sleep duration is associated with anxiety.
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Grain consumption and risk of gastric cancer: a meta-analysis.
Wang, T, Zhan, R, Lu, J, Zhong, L, Peng, X, Wang, M, Tang, S
International journal of food sciences and nutrition. 2020;(2):164-175
Abstract
This study evaluated the relationship between grain consumption and the risk of gastric cancer. A total of 19 studies met the inclusion criteria. For whole grain consumption, there was a 13% reduction in the risk of gastric cancer (p = .003), and a subgroup analysis showed that a large amount of whole grain consumption reduced the risk of gastric cancer by 44% (p < .001). For refined grain consumption, there was a 36% increase in the risk of gastric cancer (p < .001); a subgroup analysis showed that a large and a moderate amount of refined grain consumption increased the risk of gastric cancer by 63% (p < .001) and 28% (p < .001), respectively. A large intake of whole grains might be protective against gastric cancer, whereas the ingestion of refined cereals may be a risk factor for gastric cancer. Moreover, the risk of cancer increases with the increase of refined grain intake.
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Does early postoperative enteral ecoimmunonutrition enhance intestinal function in gastric cancer?
Xu, R, Xiao, S, Ding, Z, Zhao, P
Asia Pacific journal of clinical nutrition. 2020;(3):469-475
Abstract
BACKGROUND AND OBJECTIVES We assessed the effect of enteral ecoimmunonutrition (enteral nutrition involving probiotics and immune nutrients) on gastric cancer in the postoperative period. METHODS AND STUDY DESIGN In total, 60 patients with gastric cancer were randomized into an enteral ecoimmunonutrition group or an enteral nutrition group. Information on postoperative complications; hospitalization length; time to first bowel movement and first flatus; and differences between preoperative and postoperative nutritional status, inflammatory reactions, and immune function was collected. RESULTS No significant between-group differences in nutritional status and complications were observed. C-reactive protein concentrations were lower in the enteral ecoimmunonutrition group than in the enteral nutrition group on postoperative day 7 (p<0.001) and CD4+ concentrations were significantly higher (p=0.01). The enteral ecoimmunonutrition group had a significantly shorter time to first flatus than the enteral nutrition group (p=0.03). CONCLUSIONS Early postoperative enteral ecoimmunonutrition significantly improved immune function, reduced inflammatory responses, and promoted intestinal function recovery in patients with gastric cancer undergoing gastrectomy.
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A systematic review of the effect of preoperative nutrition support on nutritional status and treatment outcomes in upper gastrointestinal cancer resection.
Deftereos, I, Kiss, N, Isenring, E, Carter, VM, Yeung, JM
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2020;(8):1423-1434
Abstract
BACKGROUND Malnutrition is highly prevalent in patients with Upper Gastrointestinal (UGI) cancer and is associated with poor outcomes. However, there are no evidence-based guidelines for nutrition support specific to UGI cancer surgery. METHODS Databases including MEDLINE, PUBMED, CINAHL, Web of Science, Cochrane Central and Clinicaltrials.gov were systematically searched. Abstracts of studies investigating the effect of preoperative nutrition support on nutritional status, functional status, body composition, quality of life and treatment outcomes in adult patients undergoing oesophageal, gastric or pancreatic cancer resection were identified. Screening of studies, quality assessment using the Downs and Black checklist, data extraction, and appraisal of evidence using GRADE were performed by two reviewers. Due to heterogeneity of the studies, results were synthesised narratively. The protocol was registered in PROSPERO (CRD42018111930). RESULTS Nine studies with a total of 442 oesophageal and 418 gastric patients were included. Individualised dietary counselling, and enteral feeding in neoadjuvant therapy for oesophageal cancer demonstrated positive effects for weight maintenance and surgical complications, however the GRADE evidence quality was very low. Preoperative nutrition support in gastric cancer decreased the incidence of surgical site infections, length of stay and hospital costs, but GRADE assessment was unable to be completed due to only one study reporting on each outcome measure. CONCLUSIONS This review demonstrates the lack of strong evidence to determine the most optimal methods of nutrition support prior to UGI cancer resection. Current surgical oncology guidelines should be utilised until further research from high quality trials enable the development of specific clinical practice guidelines.
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In Search of the Optimal Reconstruction Method after Total Gastrectomy. Is Roux-en-Y the Best? A Review of the Randomized Clinical Trials.
Naum, C, Bîrlă, R, Marica, DC, Constantinoiu, S
Chirurgia (Bucharest, Romania : 1990). 2020;(1):12-22
Abstract
Background: Numerous procedures for reconstruction after total gastrectomy have been proposed in order to achieve the lowest postoperative morbidity. Roux-en-Y esojejunostomy is widely accepted as a standard reconstruction technique due to its simplicity and its satisfactory nutritional outcomes. The construction of a gastric pouch and the maintenance of the duodenal transit have been proposed to ameliorate the quality of life of patients with gastric cancer. The aim of this study is to assess the quality of life of patients with different types of reconstruction after total gastrectomy. Material and Method: A systematic literature search was performed in PubMed, Science Direct, Wiley Online, Springer Link, up to December 1, 2019. Only original articles published in English were included. Quality of life was measured using different instruments. Postoperative aspects of reflux oesophagitis, dumping syndrome, food intake and weight status were evaluated. Results: 15 studies were included in this research. Three techniques for restoring the digestive tract continuity were compared: Roux-en-Y eso-jejunostomy, jejunal interposition and gastric pouch construction. The statistical results of the included studies were evaluated in terms of quality of life or weight status. Conclusions: The length of the alimentary limb for prophylaxis of eso-jejunal reflux should be at least 50 cm, but not more than 60 cm for the prevention of malabsorption. The quality of life was significantly better in patients with gastric pouch. Maintaining the duodenal transit does not seem to bring any benefit in quality of life or weight status, even if this is a physiological way.
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Postoperative nutritional outcomes and quality of life-related complications of proximal versus total gastrectomy for upper-third early gastric cancer: a meta-analysis.
Lee, I, Oh, Y, Park, SH, Kwon, Y, Park, S
Scientific reports. 2020;(1):21460
Abstract
Although proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform PG due to the high rate of postoperative reflux. This meta-analysis aimed to comprehensively compare operative outcomes, nutritional outcomes, and quality of life-related complications between TG and PG performed with esophagogastrostomy (EG), jejunal interposition, or double-tract reconstruction (DTR) to reduce reflux after PG. After searching PubMed, Embase, Medline, and Web of Science databases, 25 studies comparing PG with TG in upper-third EGC published up to October 2020 were identified. PG with DTR was similar to TG regarding operative outcomes. Patients who underwent PG with DTR had less weight reduction (weighted mean difference [WMD] 4.29; 95% confidence interval [0.51-8.07]), reduced hemoglobin loss (WMD 5.74; [2.56-8.93]), and reduced vitamin B12 supplementation requirement (odds ratio [OR] 0.06; [0.00-0.89]) compared to patients who underwent TG. PG with EG caused more reflux (OR 5.18; [2.03-13.24]) and anastomotic stenosis (OR 3.94; [2.40-6.46]) than TG. However, PG with DTR was similar to TG regarding quality of life-related complications including reflux, anastomotic stenosis, and leakage. Hence, PG with DTR can be recommended for patients with upper-third EGC considering its superior postoperative nutritional outcomes.
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AGA Technical Review on Gastric Intestinal Metaplasia-Epidemiology and Risk Factors.
Altayar, O, Davitkov, P, Shah, SC, Gawron, AJ, Morgan, DR, Turner, K, Mustafa, RA
Gastroenterology. 2020;(3):732-744.e16