Presentation of Gastric Carcinoma on a Radionuclide Gastric-Emptying Study

Schraml, Frank V.; Krueger, W.

doi:10.1097/01.rlu.0000171686.59672.9c

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…Gastroparesis is one of the most under-diagnosed problems in patients with cancer and is often overlooked as a potential etiology of chronic nausea and vomiting. The exact prevalence of DGE is unknown; however, it is generally recognized that gastroparesis is common among patients with upper gastrointestinal tract tumors [ 50 , 51 ] and after surgical treatment. A diagnosis of DGE is important in cancer and postoperative patients because the consequences of malignancy-associated gastroparesis can be serious, particularly in the context of other common problems that affect nutrition and fluid-electrolyte balance.…”

Section: Discussionmentioning

confidence: 99%

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD)

Busquets

Martín

Secanella

et al. 2022

Langenbecks Arch Surg

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Purpose Pylorus-preserving pancreatoduodenectomy (PPPD) has been the gold standard for pancreatic head lesion resection for several years. Some studies have noted that it involves more delayed gastric emptying (DGE) than classical Whipple (i.e., pancreatoduodenectomy with antrectomy). Our working hypothesis was that the classical Whipple has a lower incidence of DGE. We aimed to compare the incidence of DGE among pancreatoduodenectomy techniques. Methods This pragmatic, randomized, open-label, single-center clinical trial involved patients who underwent classical Whipple (study group) or PPPD (control group). Gastric emptying was clinically evaluated using scintigraphy. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. The secondary endpoints were postoperative morbidity, length of hospital stay, anthropometric measurements, and nutritional status. Results A total of 84 patients were randomized (42 per group). DGE incidence was 50% (20/40, 95% confidence interval (95% CI): 35–65%) in the study group and 62% (24/39, 95% CI: 46–75%) in the control group (p = 0.260). No differences were observed between both groups regarding postoperative morbidity or length of hospital stay. Anthropometric measurements at 6 months post-surgery: triceps fold measurements were 12 mm and 16 mm (p = 0.021). At 5 weeks post-surgery, triceps fold measurements were 13 mm and 16 mm (p = 0.020) and upper arm circumferences were 26 cm and 28 cm (p = 0.030). No significant differences were observed in nutritional status. Conclusion DGE incidence and severity did not differ between classical Whipple and PPPD. Some anthropometric measurements may indicate a better recovery with PPPD. Trial registration ClinicalTrials.gov Identifier: NCT03984734.

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Section: Discussionmentioning

confidence: 99%

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD)

Busquets

Martín

Secanella

et al. 2022

Langenbecks Arch Surg

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“…While the exact prevalence is not known, gastroparesis is common among patients with upper gastrointestinal tract and pancreatic malignancy. [ 10 11 12 13 ] Management options of gastroparesis in malignancy are limited as most of the patients with advanced malignancy are not ideal candidates for long-term erythromycin therapy or invasive management of gastroparesis.…”

Section: Discussionmentioning

confidence: 99%

Effect of mirtazapine on gastric emptying in patients with cancer-associated anorexia

Kumar

Barai

Gambhir

et al. 2017

Indian J Palliat Care

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Background/Aims:The tetracyclic antidepressant mirtazapine is widely used in cancer patients suffering from anorexia. Although it is known to restore appetite, the exact mechanism remains unknown. The aim of the study was to evaluate if mirtazapine has any effect on gastric emptying in patients suffering from cancer-related anorexia.Materials and Methods:Solid-meal gastric-emptying study using radiolabeled meal was performed in 28 patients suffering from cancer anorexia once at baseline and repeated after 15 days of mirtazapine therapy.Results:At baseline, only 7 (25%) patients had normal gastric motility (emptying >70% at 3 h postingestion) whereas after treatment, 18 (64.2%) patients achieved this limit. Mean % gastric emptying increased from 55.2% ±21.0% to 68.9% ±21.3% (P < 0.001). Mean gastric emptying time (t1/2) before intervention was 314.7 ± 421.0 min which decreased to 116.0 ± 106.7 min after intervention. Results were further analyzed by dividing the patients into two groups based on baseline gastric-emptying study. Group A (normal gastric emptying) consisted of seven patients, mean % gastric emptying at baseline and postintervention was 75.0% ±5.25% and 87.57% ±5.94%, respectively (P < 0.018). Group B (delayed gastric emptying) consisted of 21 patients, mean % gastric emptying at baseline and postintervention was 48.71% ±18.82% and 62.76% ±16.86%, respectively (P < 0.001).Conclusion:Mirtazapine significantly improves gastric emptying in patients of prostate and breast cancer suffering from cancer-associated anorexia.

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“…The aetiology is often multifactorial and can depend on the type of cancer. For example, pathogenesis in gastric cancer may include a mass effect from the tumour, infiltration into the myenteric plexus and vagotomy postgastric surgery 3. Important mechanisms overall include paraneoplastic phenomena, direct tumour infiltration of the coeliac plexus or vagus nerve, past GI surgery, viral infection and the toxic effects of chemotherapy and radiotherapy 4…”

Section: Discussionmentioning

confidence: 99%

Malignancy-associated gastroparesis: an important and overlooked cause of chronic nausea and vomiting

Kelly¹,

Moran

Maher

et al. 2014

BMJ Case Reports

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A 69-year-old woman was referred to a gastroenterology clinic with a 1-year history of protracted nausea and postprandial vomiting. She had a background of gastro-oesophageal reflux disease, irritable bowel syndrome and chronic obstructive pulmonary disease with a significant smoking history. Her laboratory work-up including autoimmune screen, coeliac serology and synacthen test were unremarkable. Upper gastrointestinalendoscopy and CT imaging ruled out mucosal and obstructive causes. Gastric emptying studies demonstrated a delayed gastric emptying consistent with diagnosis of gastroparesis. Concurrently, she underwent a CT of the thorax for unresolved consolidation on her chest X-ray. This revealed a locally advanced primary lung carcinoma. In this context, with all other causes excluded, her gastroparesis was deemed to represent a paraneoplastic phenomenon. Gastroparesis is a frequent, under-recognised and important complication of cancer.

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Presentation of Gastric Carcinoma on a Radionuclide Gastric-Emptying Study

Cited by 5 publications

References 4 publications

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD)

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD)

Effect of mirtazapine on gastric emptying in patients with cancer-associated anorexia

Malignancy-associated gastroparesis: an important and overlooked cause of chronic nausea and vomiting

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