Background
A simplified report of gastric retention values at select times is now recommended for scintigraphic gastric emptying test (GET).
Aims
The purpose of this study was to assess correlation ...between severity of gastroparetic symptoms and all variables of GET, compared to select variables in clinical use.
Methods
This was a prospective study of patients referred for scintigraphic GET. The Gastroparesis Cardinal Symptom Index questionnaire was obtained prior to the scintigraphy. Variables determined were lag time, half emptying time (T1/2), retention at 30 min, 1, 2 and 4 h. Statistical analysis was by Spearman rank correlation and Wilcoxon rank test with a significance set at
p
≤ 0.05.
Results
Seven hundred seventeen patients had GET from 03/09 to 03/11. Results are from 325 patients who did not take medications known to affect GET were analyzed (64.9 % females, mean age 47 ± 18.9 years, 21.8 % diabetics, 78.2 % non-diabetic, of which 7.6 % were post-surgical, primarily post-fundoplication). Combined gastric retention at 2 and 4 h detected delayed GET in 83.5 % non-diabetics and 76.6 % of diabetics. Rapid GET was present in 11 % of patients at 30 min and 4 % at 1 h. Significant positive correlation was observed between nausea, vomiting, loss of appetite and variables of GET, but not with the half-time of emptying (T1/2). Bloating negatively correlated with retention at 2 h. There was no association between duration of symptoms and GET variables.
Conclusions
Gastroparetic symptoms correlate with different retention times of GET, but not with T1/2. However, symptoms poorly distinguish between categories of gastroparesis or status of gastric emptying. Delayed GE is best detected by 2 and 4 h retention times, while 30 min and 1 h retention times detect rapid GE.
To establish the efficacy and safety of antroduodenal metal stents for the treatment of pyloric syndrome in patients with distal gastric cancer.
Data were obtained from 31 patients older than 18 ...years who had a diagnosis of distal gastric cancer between 2009 and 2017, who presented pyloric syndrome associated with antroduodenal stenosis documented by endoscopy or X-ray of upper digestive tract, being managed with an antroduodenal auto-expandable metal stent in the gastroenterology unit of the San Ignacio University Hospital (HUSI) in Bogotá DC, Colombia.
The main documented symptom that led to consultation was the presence of vomiting in 45.1%, followed by weight loss 16.13% and upper digestive tract bleeding 19.35%, the diagnosis being made in 74.19 % of cases with endoscopy of upper digestive tract. 96.7% of the patients presented metastases at the time of diagnosis of pyloric syndrome. 100% of patients had technical success in relation to stenting with subsequent resolution of symptoms in 96.77%, the most frequent complication being displacement in 16.13%.
Auto-expandable metal stents for the management of gastric outlet tract obstruction secondary to distal gastric cancer is a safe and effective method as a palliative treatment, improving morbidity and mortality compared to surgical management.
Achalasia in pregnancy is an infrequent, poorly understood condition and its treatment is not clearly defined. The repercussions on the patients nutritional status are serious and in a pregnant woman ...have serious implications for the course of gestation, with high risk of intrauterine growth restriction, preterm delivery and even fetal loss; there are symptoms that can be confused with hyperemesis gravidarum delaying the diagnosis. The therapeutic options are medical treatment, endoscopic and surgical interventions; to decide what is the best treatment, we should be taken into account the severity, gestational age and patient conditions. Within the spectrum mentioned in the management include calcium antagonists and nitrates, however these have restrictions in pregnancy, another options are botulinum toxin, endoscopic pneumatic dilation, laparoscopic Heller myotomy and recently POEM. In pregnancy there is a few evidence in the literature and in this moment there are about 40 reported cases, some with complications such as fetal loss and maternal death. We present our experience at the San Ignacio University Hospital in Bogotá, Colombia, with a 26-year-old woman with a novo diagnosis of achalasia type II during the first trimester of pregnancy, with a clinical history of severe dysphagia associated with malnutrition. She was management with enteral nutrition support with nasogastric tube to achieve repletion of the body mass index (BMI) and after that, she had a endoscopic management with Rigiflex balloon dilation. It allowed to successfully carry out pregnancy without adverse effects on the mother or the fetus, with adequate evolution and oral tolerance without dysphagia. We consider that nutritional support is important prior to taking a desicion with this type of patient, in addition that endoscopic management with balloon dilation can be safe and effective for the management of achalasia in pregnancy.
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