BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of b...BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.展开更多
AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen b...AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.展开更多
Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy(SG) has emerged over the last few years to be an ideal bariatric procedure because it has several adv...Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy(SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures,including avoiding an intestinal bypass. However,several published follow-up studies report an increased rate of gastroesophageal reflux(GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However,the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.展开更多
A 67-year-old man diagnosed with HER2 overexpression advanced gastric adenocarcinoma and metastasis to liver and lungs was admitted for tertiary care. He received a third line chemotherapy that consists of trastuzumab...A 67-year-old man diagnosed with HER2 overexpression advanced gastric adenocarcinoma and metastasis to liver and lungs was admitted for tertiary care. He received a third line chemotherapy that consists of trastuzumab combined with FOLFIRI regimen (irinotecan plus 5-FU/LV) following a disease relapse after an initial successful response to a combination of 5FU + oxaliplatin and trastuzumab. The patient showed a favorable and prolonged response to it. In addition the chemotherapy was well tolerated and devoid of remarkable side effects. The response to trastuzumab + FOLFIRI was assessed clinically and through CT scan imaging and upper gastrointestinal endoscopy. This case report shows that firstly the combination of FOLFIRI and trastuzumab could be tested as another regimen in metastatic gastric cancer, and, secondly, that in this disease, like in metastatic breast cancer, the continuation of trastuzumab after an initial progression under this antibody could be tested in order to improve the efficacy of the treatment Trastuzumab re-introduction with FOLFIRI for treatment of HER2 overexpression-advanced gastric adenocarcinoma following failure of other trastuzumab-based chemotherapy regimens.展开更多
文摘BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.
文摘AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.
文摘Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy(SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures,including avoiding an intestinal bypass. However,several published follow-up studies report an increased rate of gastroesophageal reflux(GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However,the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.
文摘A 67-year-old man diagnosed with HER2 overexpression advanced gastric adenocarcinoma and metastasis to liver and lungs was admitted for tertiary care. He received a third line chemotherapy that consists of trastuzumab combined with FOLFIRI regimen (irinotecan plus 5-FU/LV) following a disease relapse after an initial successful response to a combination of 5FU + oxaliplatin and trastuzumab. The patient showed a favorable and prolonged response to it. In addition the chemotherapy was well tolerated and devoid of remarkable side effects. The response to trastuzumab + FOLFIRI was assessed clinically and through CT scan imaging and upper gastrointestinal endoscopy. This case report shows that firstly the combination of FOLFIRI and trastuzumab could be tested as another regimen in metastatic gastric cancer, and, secondly, that in this disease, like in metastatic breast cancer, the continuation of trastuzumab after an initial progression under this antibody could be tested in order to improve the efficacy of the treatment Trastuzumab re-introduction with FOLFIRI for treatment of HER2 overexpression-advanced gastric adenocarcinoma following failure of other trastuzumab-based chemotherapy regimens.
