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Endoscopic #submucosal dissection for suspected early #gastric cancer: absolute versus expanded criteria in a large Western cohort (with video)
https://www.giejournal.org/article/S0016-5107(19)31669-4/fulltext?mobileUi=0
Endoscopic submucosal dissection (ESD) is an effective, minimally invasive, surgery-sparing technique for the treatment of early gastric cancer (EGC). It is not well established whether EGC within the Japanese expanded criteria can be safely and effectively treated using ESD in the West. We describe the outcomes of ESD for endoscopically suspected, biopsy confirmed EGC and its adenomatous precursor lesions (pEGC) using the Vienna classification of dysplasia in a Western cohort.
Perforation occurred in 1.5% and postprocedural bleeding in 5.2%. Forty-two (31.1%) pEGCs contained LGD only. Rates of en-bloc and R0 resection were 94.8% and 86.7%, respectively. One hundred seven (79.2%) pEGCs met the absolute or expanded criteria for endoscopic cure. Two pEGC recurred during follow-up. Ten of 26 (38.5%) pEGCs outside criteria for cure underwent surgery after ESD with residual tumor detected in 3 specimens. Fifteen outside criteria pEGCs did not undergo surgery due to patient frailty or their expressed wish. Eleven of 15 have so far undergone first surveillance with 1 of 11 experiencing endoscopic and histologic recurrence.
Conclusions
ESD is a safe and effective treatment for pEGCs in a Western context. Patients who either decline or are too frail for surgery, with outside criteria resections, may benefit from ESD for local disease control. Large Western studies of ESD for pEGCs are required to define long-term patient outcomes and surveillance guidelines, particularly where pathology shows LGD or HGD only.
Endoscopic #submucosal dissection for suspected early #gastric cancer: absolute versus expanded criteria in a large Western cohort (with video)
https://www.giejournal.org/article/S0016-5107(19)31669-4/fulltext?mobileUi=0
Endoscopic submucosal dissection (ESD) is an effective, minimally invasive, surgery-sparing technique for the treatment of early gastric cancer (EGC). It is not well established whether EGC within the Japanese expanded criteria can be safely and effectively treated using ESD in the West. We describe the outcomes of ESD for endoscopically suspected, biopsy confirmed EGC and its adenomatous precursor lesions (pEGC) using the Vienna classification of dysplasia in a Western cohort.
Perforation occurred in 1.5% and postprocedural bleeding in 5.2%. Forty-two (31.1%) pEGCs contained LGD only. Rates of en-bloc and R0 resection were 94.8% and 86.7%, respectively. One hundred seven (79.2%) pEGCs met the absolute or expanded criteria for endoscopic cure. Two pEGC recurred during follow-up. Ten of 26 (38.5%) pEGCs outside criteria for cure underwent surgery after ESD with residual tumor detected in 3 specimens. Fifteen outside criteria pEGCs did not undergo surgery due to patient frailty or their expressed wish. Eleven of 15 have so far undergone first surveillance with 1 of 11 experiencing endoscopic and histologic recurrence.
Conclusions
ESD is a safe and effective treatment for pEGCs in a Western context. Patients who either decline or are too frail for surgery, with outside criteria resections, may benefit from ESD for local disease control. Large Western studies of ESD for pEGCs are required to define long-term patient outcomes and surveillance guidelines, particularly where pathology shows LGD or HGD only.
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#Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable #Gastric Banding Among Medicare Beneficiaries
https://jamanetwork.com/journals/jamasurgery/article-abstract/2733040
Roux-en-Y gastric bypass (RYGB) is associated with significant bone loss and may increase fracture risk, whereas substantial bone loss and increased fracture risk have not been reported after adjustable gastric banding (AGB). Previous studies have had little representation of patients aged 65 years or older, and it is currently unknown how age modifies fracture risk.
..Site-specific analyses demonstrated an increased fracture risk at the hip (HR, 2.81; 95% CI, 1.82-4.49), wrist (HR, 1.70; 95% CI, 1.33-2.14), and pelvis (HR, 1.48; 95% CI, 1.08-2.07) among RYGB recipients. No significant interactions of fracture risk with age, sex, diabetes status, or race were found. In particular, adults 65 years and older showed similar patterns of fracture risk to younger adults. Sensitivity analyses using propensity score matching showed similar results (nonvertebral fracture: HR 1.75; 95% CI, 1.22-2.52).
Conclusions and Relevance This study of a large, US population–based cohort including a substantial population of older adults found a 73% increased risk of nonvertebral fracture after RYGB compared with AGB, including increased risk of hip, wrist, and pelvis fractures. Fracture risk was consistently increased among RYGB patients vs AGB across different subgroups, and to a similar degree among older and younger adults. Increased fracture risk appears to be an important unintended consequence of RYGB.
#Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable #Gastric Banding Among Medicare Beneficiaries
https://jamanetwork.com/journals/jamasurgery/article-abstract/2733040
Roux-en-Y gastric bypass (RYGB) is associated with significant bone loss and may increase fracture risk, whereas substantial bone loss and increased fracture risk have not been reported after adjustable gastric banding (AGB). Previous studies have had little representation of patients aged 65 years or older, and it is currently unknown how age modifies fracture risk.
..Site-specific analyses demonstrated an increased fracture risk at the hip (HR, 2.81; 95% CI, 1.82-4.49), wrist (HR, 1.70; 95% CI, 1.33-2.14), and pelvis (HR, 1.48; 95% CI, 1.08-2.07) among RYGB recipients. No significant interactions of fracture risk with age, sex, diabetes status, or race were found. In particular, adults 65 years and older showed similar patterns of fracture risk to younger adults. Sensitivity analyses using propensity score matching showed similar results (nonvertebral fracture: HR 1.75; 95% CI, 1.22-2.52).
Conclusions and Relevance This study of a large, US population–based cohort including a substantial population of older adults found a 73% increased risk of nonvertebral fracture after RYGB compared with AGB, including increased risk of hip, wrist, and pelvis fractures. Fracture risk was consistently increased among RYGB patients vs AGB across different subgroups, and to a similar degree among older and younger adults. Increased fracture risk appears to be an important unintended consequence of RYGB.
Association of #Gastric Bypass Surgery With Risk of Developing #Diabetic #Retinopathy Among Patients With #Obesity and Type 2 Diabetes in Sweden
https://2medical.news/2021/02/21/association-of-gastric-bypass-surgery-with-risk-of-developing-diabetic-retinopathy-among-patients-with-obesity-and-type-2-diabetes-in-sweden/
Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients. Objective To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have …
https://2medical.news/2021/02/21/association-of-gastric-bypass-surgery-with-risk-of-developing-diabetic-retinopathy-among-patients-with-obesity-and-type-2-diabetes-in-sweden/
Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients. Objective To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have …
#Metabolic syndrome and #gastric cancer risk: a systematic review and meta-analysis
https://2medical.news/2021/04/15/metabolic-syndrome-and-gastric-cancer-risk-a-systematic-review-and-meta-analysis/
Gastric cancer (GC) is the fifth diagnosed cancer worldwide and the third leading cause of death for cancer. Recent reports suggest that metabolic syndrome (MetS) has a role in etiology, progression or prognosis on GC. The aim of this study is to systematically review the evidence on the association between MetS and GC risk and prognosis. Methods Literature search was performed using the electronic databases …
https://2medical.news/2021/04/15/metabolic-syndrome-and-gastric-cancer-risk-a-systematic-review-and-meta-analysis/
Gastric cancer (GC) is the fifth diagnosed cancer worldwide and the third leading cause of death for cancer. Recent reports suggest that metabolic syndrome (MetS) has a role in etiology, progression or prognosis on GC. The aim of this study is to systematically review the evidence on the association between MetS and GC risk and prognosis. Methods Literature search was performed using the electronic databases …
Risk Factors and Incidence of #Gastric #Cancer After Detection of #Helicobacter pylori Infection: A Large Cohort Study
https://2medical.news/2024/04/05/risk-factors-and-incidence-of-gastric-cancer-after-detection-of-helicobacter-pylori-infection-a-large-cohort-study/
https://2medical.news/2024/04/05/risk-factors-and-incidence-of-gastric-cancer-after-detection-of-helicobacter-pylori-infection-a-large-cohort-study/
2Medical.News
Risk Factors and Incidence of #Gastric #Cancer After Detection of #Helicobacter pylori Infection: A Large Cohort Study
Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort StudyShria KumarDavid C. MetzSusan EllenbergDavid E. KaplanDavid S. Goldberg Published:…
An ingestible device for #gastric electrophysiology
https://2medical.news/2024/07/01/an-ingestible-device-for-gastric-electrophysiology/
https://2medical.news/2024/07/01/an-ingestible-device-for-gastric-electrophysiology/
2Medical.News
An ingestible device for #gastric electrophysiology
The ability to record high-quality electrophysiology data from the gastrointestinal tract and enteric nervous system is of use in understanding a variety of disorders and improving healthcare via e…