Background: dilatation of the intercellular spaces by electron microscopy has been considered as an early morphological marker of tissue injury in gastroesophageal reflux disease. The degree of dilatation in Barrett's esophagus is currently unknown.Objectives: to determine the frequency of dilated intercellular spaces in Barrett's esophagus.Material and methods: cross-sectional and prospective analysis of consecutive patients with gastroesophageal reflux disease. We selected symptomatic patients > 18 years and both sexes. Patients with recent PPI use (< 14 days), H-2 antagonists, NSAID's or previous upper GI tract surgery were excluded. Variables included: clinical-demographic data, Carlsson-Dent score, conventional endoscopy findings, pH-metry results (in non-erosive) and normal mucosal biopsies at 2 and 5 cm above the squamocolumnar junction. Dilation of intercellular spaces was measured by electron microscopy. Statistics: Chi square test with a significance level 0.05 was calculated. The following four groups were compared: a) non-erosive reflux disease (n = 14); b) erosive esophagitis (n = 5); c) Barrett's esophagus (n = 13); and d) healthy controls (n = 5).Results: the dilation of intercellular spaces was increasingly greater from non-erosive reflux to Barret´s esophagus and higher in biopsies taken at 5 cm than at 2 cm of the squamous columnar junction (2.72 ± 1.35 vs. 1.71 ± 0.48 µm) (p = 0.001). There was no difference between biopsies at 2 and 5 cm in the other groups.Conclusion: dilation of intercellular spaces was greater in Barrett's esophagus than in the other groups and higher at 5 cm from the squamocolumnar junction. RESUMENIntroducción: la dilatación de los espacios intercelulares mediante microscopia electrónica se considera un marcador morfológico temprano de daño tisular en la enfermedad por reflujo gastroesofágico. El grado de dilatación en el esófago de Barrett se desconoce actualmente.Objetivos: determinar la frecuencia y grado de la dilatación de los espacios intercelulares en el esófago de Barrett.Material y métodos: series de casos consecutivos con análisis transversal y prospectivo de pacientes con reflujo gastroesofágico. Criterios de selección: > 18 años, sintomáticos, ambos sexos. Se excluyeron aquellos con ingesta de IBP, antagonistas H-2, AINE y cirugía previa. Tomamos datos clínicos, cuestionario de Carlsson-Dent, endoscopia, pH-metría (no erosivos), y biopsias de la mucosa normal a 2 y 5 cm por encima de la unión escamo-columnar. La medición de la dilatación de los espacios intercelulares fue por microscopia electrónica. Estadística: descriptiva. Prueba de Chi-cuadrado con nivel de significancia de 0,05. Se compararon 4 grupos: a) enfermedad por reflujo no erosiva (n = 14); b) esofagitis erosiva (n = 5); c) esófago de Barrett (n = 13); y d) controles sanos (n = 5).Resultados: hubo mayor dilatación de los espacios intercelulares en el esófago de Barrett (5 cm, 2,72 ± 1,3 µm vs. 2 cm, 1,7 ± 0,48 µm) (p = 0,001). Los otros grupos mostraron menor dilatación y sin diferencias entre los...

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Background: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum.Methods: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected data included: age, gender, performance status (Karnofsky's score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival.Results: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky's score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival.Conclusions: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter inhospital stay and lower rate of complications.Key words: Self-expanding metal stents. Antrectomy. Gastric cancer. INTRODUCTIONGastric cancer patients present with an unresectable tumor in up to 40% of cases (1,2). Gastric outlet obstruction (GOO) is a frequent complications and presents as nausea, vomiting, dehydration and eventually malnutrition. Most patients at this stage have a short life expectancy if left without treatment (3-5). Open gastrojejunostomy (OGJ) has been considered the preferred treatment for relieving malignant GOO with good results and adequate symptom relief in most cases. Early major complications of OGJ can be seen in 6% of patients and late complications in up to 17%, and are similar to those of self-expanding metal stents (SEMS) (6% for early and 18% for late complications) (6). However, OGJ has a higher overall mortality when compared to SEMS (29 vs. 17%; p < 0.001) (7).Patients with OGJ have delayed gastric emptying, which can decrease oral intake for up to 8 days (8). While laparoscopic gastrojejunostomy is less invasive, adequate gastrointestinal function can also be delayed for a similar period, with this approach (9). Gastric stents are less invasive than surge...

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