Feasibility, safety and outcome of endoscopic gastrostomy in patients with esophageal cancer

Abstract

Introduction: Disease related malnutrition (DRM) affects at least one in four inpatients, increasing both morbidity and mortality during admission and after discharge. Nevertheless, its repercussion on hospital activity is not properly quantified. Objective: To determine the impact of an adequate coding of DRM and procedures employed to reverse it in the hospital average weight and other hospital indicators. Methods: Comparative study carried out in every patients requiring nutritional support and followed up by the Clinical Nutrition and Dietetics Unit of the Endocrinology and Nutrition Department in Complejo Asistencial Universitario de León (Spain) in 2008 and 2013. A nutritional coding report at discharge including diagnosis, nutritional treatment and access was performed following ICD-9-MC.Average weight, average length of stay adjusted by case-mix and case-mix index were compared before and after coding. Results: Hospital average weight increased after coding, both in 2008 (+4.1%) and 2013 (+1.7%) and especially in those departments in which nutritional screening is performed (Hematology, +10.5%). Average length of stay adjusted by case-mix was reduced under 1 (-5.7% and -0.2% in 2008 y 2013), pointing out to better functioning, and functioning index also decreased (-5.6% y -0.4% in 2008 and 2013), what means a higher efficiency. Conclusion: Adequate coding of nutritional diagnosis and treatment of patients with DRM increases the average weight of our hospital and improves average length of stay adjusted by case-mix and functioning index.Impacto de una adecuada codificación de la desnutrición relacionada con la enfermedad en los índices hospitalarios Influence of an appropriate coding of disease-related malnutrition in clinical indexes

Laparogastroscopy—A Transgastric Laparoscopic Approach for Malignant Esophageal Stenosis

“…Several studies reported that the mean survival in the surgical gastrostomy group was 3–4 months; in the bypass group, it was 3–9.7 months; in the endoscopic gastrostomy group, it was 4–7 months; in palliative resection, it was 7.8–13 months; in (NdYaG) laser treatment, it was 7.2 months; and in the stent group, it was 2.9–6 months [ 24 , 25 , 27 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Regarding survival time, our results with laparogastroscopic procedure are encouraging and comparable to the above-mentioned methods.…”

“…(2) It is a technique with a medium learning curve, requiring competence in thoracic and abdominal surgery. (3) It avoids disabling surgical procedures used in open surgery or endoscopy (PEG (percutaneous endoscopic gastrostomy)) [ 38 , 44 , 45 , 46 , 47 ]. (4) Laparogastroscopy allows the assessment of the cancer stage to be performed with endoperitoneal visualization (during transtumoral drilling, biopsy material can be taken).…”

Radiological gastrostomy: A comparative analysis of different image-guided methods

“…Enteral nutrition is recognized as the first choice for longterm nutritional support treatment. 10 For more than 30 days of nutritional support, the American Gastroenterology Association recommends percutaneous gastrostomy. 11 Most doctors support enteral nutrition therapy for elderly patients, and percutaneous gastrostomy should be considered if there are no contraindications.…”