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1.
Efficacy of Early Enteral Immunonutrition on Immune Function and Clinical Outcome for Postoperative Patients With Gastrointestinal Cancer.
Luo, Z, Wang, J, Zhang, Z, Li, H, Huang, L, Qiao, Y, Wang, D, Huang, J, Guo, L, Liu, J, et al
JPEN. Journal of parenteral and enteral nutrition. 2018;(4):758-765
Abstract
BACKGROUND Nutrition support is crucial for patients with gastrointestinal (GI) cancer after the operation. However, the controversy over the application of parenteral nutrition (PN) and early enteral immunonutrition (EEIN) has no determinate conclusion. MATERIALS AND METHODS We compared the effects of PN and EEIN on the postoperative nutrition condition, immune status, inflammation level, long-term survival, and quality of life of the patients with GI cancer. Seventy-eight patients were randomly divided into the PN group (n = 44) or EEIN group (n = 34). After an 8-day nutrition treatment, clinical and immunological parameters were evaluated. RESULTS The EEIN group had a significantly shorter hospital stay and higher body mass index level on postoperative day 30 than those in the PN group (P < .05). However, total hospital cost and incidences of short-term postoperative complications had no significant difference (P > .05). The percentages of CD4+ , natural killer, and natural killer T lymphocyte cells and the ratio of CD4+ /CD8+ in peripheral blood were significantly increased. Compared with the PN group, the EEIN group had a higher expression of activated cell surface markers such as CD27 and CD28. In addition, the secretion of interleukin (IL)-2 and interferon-γ was significantly higher, and the secretion of tumor necrosis factor-α and IL-10 was lower. Complication-free survival in the EEIN group were longer than those in the PN group (P = .04). CONCLUSION EEIN is superior to PN in improving nutrition status, enhancing immune function, and elevating quality of life.
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2.
[A 35-year report of the study of group on gastrointestinal cancer in Mexico City: variations in frequency of different digestive tract neoplasms among different socioeconomic statuses].
Villalobos Pérez, JJ, Bourlon, MT, Loaeza Del Castillo, A, Torres Villalobos, G
Gaceta medica de Mexico. 2014;(1):49-57
Abstract
BACKGROUND Since the middle of the last century, North America and occidental countries have reported variations in the frequency of gastrointestinal neoplasms. Several environmental factors, mainly nutritional and dietary exposure, as well as habits have contributed to these changes. We have documented these changes in Mexico during the last 35 years. AIMS To define the epidemiologic changes of gastrointestinal neoplasms during the last three decades in our population. METHODS We summarized the evidence of an observational study, registering the frequency of different gastrointestinal malignancies from four institutions of socioeconomically different populations in Mexico City during 35 years. The Mexican National Academy of Medicine supported this effort. During this period, two nutritional surveys took place, letting us define the relationship between dietary changes and cancer occurrence. RESULTS Replacement of gastric cancer by colorectal cancer as the leading gastrointestinal malignancy. Relationship between cancer and diet changes. Increase of esophageal adenocarcinoma in relation to epidermoid carcinoma secondary to gastroesophageal reflux and Barrett's esophagus rising incidence. Gall bladder cancer had a high frequency in one institution, probably related to genetic and racial factors. CONCLUSIONS This epidemiologic data should lead us to implement sanitary measures for the prevention, early diagnosis, and appropriate treatment of gastrointestinal neoplasms.
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3.
Comparison of the effect of positive and negative oral contrast agents on (18)F-FDG PET/CT scan.
Sun, XG, Huang, G, Liu, JJ, Wan, LR
Hellenic journal of nuclear medicine. 2009;(2):115-8
Abstract
UNLABELLED Our aim was to compare the effect of orally taken 1% diatrizoate meglumine, 5% mannitol and water before positron emission tomography/computerized tomography (PET/CT) scan on gastrointestinal tract delineation and fluorine-18-fluorodeoxyglucose ((18)F-FDG) uptake. Our methods were as follows: Sixty-one patients referred for PET/CT scan without gastrointestinal diseases were divided into three groups. One thousand mL of 1% diatrizoate meglumine was orally taken 50 min before PET/CT scan in Group 1 (n=25), 1000 mL 2.5% mannitol was orally taken before scan in Group 2 (n=20) and 1000 mL water was orally taken before scan in Group 3 (n=16). Serum glucose and insulin were tested before and 45 min after taking mannitol in Group 2 patients. Paired t test was used to compare the glucose and insulin changes. The degree of gastrointestinal filling and (18)F-FDG uptake were evaluated by three nuclear medicine physicians using a 4 grade classification standard. Kruskal-Wallis and Mann- Whitney none parametric test was used to compare the filling condition and (18)F-FDG uptake difference among the three groups and between each group. RESULTS the differences of serum glucose and insulin levels were not significant before and after contrast taken, in Group 2 patients. Group 2 patients had better gastrointestinal filling than patients of Group 1. Also, Group 2 patients' gastrointestinal filling was better than in Group 3 except in rectum. The jejunum, ascending, transverse and descending colon were better filled in Group 1 patients than in Group 3 patients. The degree of (18)FFDG uptake in stomach, jejunum and ileum, in Group 2 were significantly lower than those of Group 3 (P<0.05). (18)F-FDG uptake in jejunum, in Group 1 was also lower than in Group 3 (P<0.05). (18)F-FDG uptake in ascending colon in Group 1 was higher than in Group 3 (P<0.05). (18)F-FDG uptake in transverse and descending colon, in both Group 1 and Group 2 was significantly higher than in Group 3 (P<0.05). (18)F-FDG uptake in rectum, in Group 2 was significantly higher than in Group 3 (P<0.01). The average maximum CT values in stomach, jejunum, ileum and ascending colon in Group 1 patients were: 132+/-23, 191+/-31, 313+/-47 and 374+/-53 Hounsfield units respectively (Mean+/-SD, P<0.01 between every two groups). In conclusion, patients who take iso-osmia mannitol have good gastrointestinal filling, less physiological (18)F-FDG uptake and may thus have better (18)F-FDG images displaying gastrointestinal abnormalities and differentiating pathological from physiological lesions.
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4.
Detection of hepatic metastases from carcinoid tumor: prospective evaluation of contrast-enhanced ultrasonography.
Hoeffel, C, Job, L, Ladam-Marcus, V, Vitry, F, Cadiot, G, Marcus, C
Digestive diseases and sciences. 2009;(9):2040-6
Abstract
The purpose of our study was to prospectively compare unenhanced ultrasonography (US) to contrast-enhanced US (CEUS) in the detection of hepatic metastases from carcinoid tumor. Thirty patients with carcinoid tumor prospectively underwent US, CEUS, and magnetic resonance imaging (MRI). Differences in sensitivity at US and CEUS were compared using a combination of the results of MR imaging, fine-needle biopsy, and follow-up imaging. Lesion conspicuity was assessed subjectively for US and CEUS. Seventeen patients had a total of 69 hepatic metastases. The addition of CEUS improved the detection of individual metastases from 47 (Se 68%; 95% CI: 57.0, 79.0) to 68 (Se 99%; 99% CI: 96.7, 100.0). Contrast enhancement improved the subjective conspicuity of metastases in 85% of patients. CEUS showed one more metastasis than did MRI in one patient, and MRI showed one more than did CEUS in one patient. CEUS is more sensitive than US in the detection of carcinoid liver metastases.
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5.
Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients.
Jeurnink, SM, Steyerberg, EW, Hof, Gv, van Eijck, CH, Kuipers, EJ, Siersema, PD
Journal of surgical oncology. 2007;(5):389-96
Abstract
AIM: Gastrojejunostomy (GJJ) and duodenal stent placement are the most commonly used palliative treatment modalities for gastric outlet obstruction (GOO). In this retrospective study, we compared GJJ and stent placement with regard to medical effects. METHODS Medical records of 95 patients who had undergone palliative treatment between 1994 and 2006 in a Dutch university hospital, were reviewed. Study outcomes were improvement of food intake, complications, persistent and recurrent symptoms, re-interventions, hospital stay, and survival. RESULTS Fifty-three patients were referred for duodenal stent placement and 42 patients underwent GJJ. There were no differences in technical and clinical success and the incidence of minor and early major complications and survival. Food intake improved more rapidly after stent placement than GJJ (P = 0.01). The time to late major complications, recurrent obstructive symptoms and re-intervention was significantly shorter after stent placement than GJJ (P = 0.004, 0.002, and 0.004, respectively). Hospital stay was also shorter after stent placement than GJJ (P < 0.001). CONCLUSION These findings suggest that stent placement is associated with better short-term outcomes and GJJ with better long-term outcomes. A large randomized controlled trial is however needed to systematically compare stent placement with GJJ with regard to medical effects, quality of life and costs.
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6.
A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer.
Gianotti, L, Braga, M, Nespoli, L, Radaelli, G, Beneduce, A, Di Carlo, V
Gastroenterology. 2002;(7):1763-70
Abstract
BACKGROUND & AIMS Perioperative nutrition with specialized enteral diets improves outcome when compared with standard formulas. A post-hoc analysis suggested preoperative administration as the most important period. Thus, we designed a study to understand prospectively whether preoperative supplementation could be as efficacious as the perioperative approach and superior to a conventional treatment (no artificial nutrition) in reducing postoperative infections and length of hospital stay. METHODS A total of 305 patients with preoperative weight loss <10% and cancer of the gastrointestinal tract were randomized to receive the following: (1) oral supplementation for 5 days before surgery with 1 L/day of a formula enriched with arginine, omega-3 fatty acids, and RNA, with no nutritional support given after surgery (preoperative group, n = 102); (2) the same preoperative treatment plus postoperative jejunal infusion with the same enriched formula (perioperative group, n = 101); and (3) no artificial nutrition before and after surgery (conventional group; n = 102). RESULTS The 3 groups were comparable for all baseline and surgical characteristics. Intention-to-treat analysis showed a 13.7% incidence of postoperative infections in the preoperative group, 15.8% in the perioperative group, and 30.4% in the conventional group (P = 0.006 vs. preoperative; P = 0.02 vs. perioperative). Length of hospital stay was 11.6 +/- 4.7 days in the preoperative group, 12.2 +/- 4.1 days in the perioperative group, and 14.0 +/- 7.7 days in the conventional group (P = 0.008 vs. preoperative and P = 0.03 vs. perioperative). CONCLUSIONS Preoperative supplementation is as effective as perioperative administration in improving outcome. Both strategies seem superior to the conventional approach.
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7.
[Tumour anorexia--tumour cachexia in case of gastrointestinal tumours: standards and visions].
Ockenga, J, Pirlich, M, Gastell, S, Lochs, H
Zeitschrift fur Gastroenterologie. 2002;(11):929-36
Abstract
The development of progressive malnutrition or cachexia is frequent in patients with gastrointestinal cancer - especially in patients with a carcinoma of the pancreas. The cachexia syndrome which is characterised by loss of body weight, negative nitrogen balance and fatigue significantly affects patients' quality of life, morbidity and survival. Because the currently established therapeutical strategies are often disappointing many physicians tended to develop a therapeutical nihilism. Cancer anorexia and cachexia are two distinct syndromes which may have synergistic effects in a patient. This review highlights the growing understanding of the multidimensional pathophysiological background. An algorithm of the current treatment strategies is given. In addition, we discuss new anabolic and anticatabolic agents (e.g. eicosapentanoic acid) and the results from first clinical trials.
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8.
Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial.
Bozzetti, F, Braga, M, Gianotti, L, Gavazzi, C, Mariani, L
Lancet (London, England). 2001;(9292):1487-92
Abstract
BACKGROUND Although current opinion favours the use of enteral over parenteral nutrition, the clinical benefits of early postoperative nutrition in patients undergoing elective surgery have never been clearly shown. We aimed to test the hypothesis that postoperative enteral nutrition is better (fewer postoperative complications) than parenteral nutrition containing similar energy and nitrogen amounts (112 kJ kg(-1) day(-1) and 1.4 g aminoacid kg(-1) day(-1)). METHODS We did a randomised multicentre clinical trial in patients with gastrointestinal cancer who were malnourished and candidates for major elective surgery. 159 patients were assigned to enteral nutrition and 158 to parenteral nutrition. The primary endpoint was the occurrence of postoperative complications, and secondary endpoints were length of postoperative hospital stay, adverse effects, and treatment crossover. Analysis was by intention to treat. FINDINGS Postoperative complications occurred in 54 (34%) patients fed enterally versus 78 (49%) fed parenterally (relative risk 0.69, 95% CI 0.53-0.90, p=0.005). Length of postoperative stay was 13.4 days and 15.0 days in the enteral nutrition and parenteral nutrition groups, respectively (p=0.009). Adverse effects occurred in 56 (35%) patients fed enterally versus 22 (14%) patients fed parenterally (2.50, 1.61-3.86, p<0.0001). 14 (9%) patients on enteral nutrition had to switch to parenteral nutrition, whereas none of those fed parenterally crossed over to enteral feeding. INTERPRETATION We conclude that early enteral nutrition significantly reduces the complication rate and duration of postoperative stay compared with parenteral nutrition, although parenteral nutrition is better tolerated than enteral nutrition.
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9.
Health care resources consumed to treat postoperative infections: cost saving by perioperative immunonutrition.
Gianotti, L, Braga, M, Frei, A, Greiner, R, Di Carlo, V
Shock (Augusta, Ga.). 2000;(3):325-30
Abstract
The objectives of the study were to calculate the costs of postoperative complications and to evaluate whether the use of perioperative enteral immunonutrition, may lead to a saving in health care resources consumed. The economic analysis was based on data from a randomized double-blind trial that include 206 cancer patients who received perioperatively either enteral immunonutrition (treatment group, n = 102) or a standard enteral diet (control group, n = 104). Estimates of costs were based on resource use for treatment of complications, which were valued according to the National List of Sanitary Costs of the Italian Ministry of Health and on the medical Diagnosis-Related-Group (DRG) reimbursement rates. Costs of nutrition were also calculated. Cost comparison and cost effectiveness analyses were then carried out. Intent-to-treat analysis showed that the total costs of 52 postoperative complications were 322,218 euros, with a consumption of the DRG reimbursement rate of 15.4%. The costs of nutrition were 35,437 euros in the treatment group versus 10,768 euros in the control group. The total costs (nutrition plus treating complications) amounted to 113,778 euros in the treatment group versus 254,450 euros in the control group. The mean total costs per patient were 1,115 euros in the treatment group versus 2,447 euros in the control group (P = 0.04). Effectiveness was 83.3% in the treatment group versus 68.3% in the control group (P = 0.009). Cost effectiveness analysis showed a net saving of 2,386 euros per complication-free patient in favor of the treatment group. In conclusion, the perioperative use of immunonutrition appears cost effective due to a substantial saving of resources used to treat postoperative complications.