Our Summary

This research paper examines the effectiveness of a medical treatment called endoscopic incisional therapy (EIT) in preventing the recurrence of narrowings (strictures) in the tube connecting your mouth to your stomach (esophagus) or in the stomach itself after surgery. This stricture is a common complication after removing part or all of the esophagus or stomach.

The researchers did a thorough search of previous studies about this topic. They specifically looked at studies where people had EIT after esophagus or stomach surgery, and they were older than 18. The researchers mainly wanted to find out if EIT was better than another procedure called dilation in preventing these strictures from coming back. They also looked at how long patients remained free of strictures after EIT and the rate of side effects.

After reviewing 33 studies in detail, they found five studies that met their criteria. The analysis of these five studies showed that EIT was more effective than dilation in preventing the recurrence of strictures, especially for first-time strictures. Furthermore, patients who underwent EIT remained free of strictures for a longer period compared to those who had dilation.

However, they didn’t find a significant difference in the recurrence of strictures that had previously been treated. They also noted that the data on the safety of EIT was limited, so more comprehensive studies are needed. They also want to look at the combined effect of different treatments for strictures that are hard to treat.

FAQs

  1. What is the research paper about and what treatment does it examine?
  2. How does the effectiveness of endoscopic incisional therapy (EIT) compare to dilation in preventing the recurrence of strictures after esophagus or stomach surgery?
  3. What were the findings of the researchers regarding the safety and side effects of endoscopic incisional therapy (EIT)?

Doctor’s Tip

A helpful tip a doctor might tell a patient about gastrectomy is to follow a strict post-operative diet to allow the stomach to heal properly and reduce the risk of complications. This may include starting with clear liquids and gradually progressing to soft foods as tolerated. It is also important to chew food thoroughly and eat small, frequent meals to prevent discomfort and aid digestion. Additionally, avoiding carbonated beverages, spicy foods, and alcohol can help prevent irritation to the stomach lining. Regular follow-up appointments with your healthcare team are crucial to monitor your progress and address any concerns.

Suitable For

Patients who are typically recommended gastrectomy include those with:

  1. Stomach cancer: Gastrectomy is often recommended as a treatment for stomach cancer, especially in cases where the cancer has not spread beyond the stomach.

  2. Peptic ulcers: In some cases, severe peptic ulcers that do not respond to other treatments may require gastrectomy to prevent complications such as bleeding or perforation.

  3. Gastrointestinal stromal tumors (GISTs): Gastrectomy may be recommended for the removal of GISTs that are large or causing symptoms.

  4. Severe gastroesophageal reflux disease (GERD): In cases where GERD is not controlled with medications or lifestyle changes, gastrectomy may be considered as a treatment option.

  5. Barrett’s esophagus: For patients with Barrett’s esophagus, a condition that increases the risk of esophageal cancer, gastrectomy may be recommended to reduce this risk.

  6. Obesity: In some cases of severe obesity, gastrectomy may be recommended as a weight loss surgery option.

It is important for patients to discuss the potential risks and benefits of gastrectomy with their healthcare provider to determine if it is the most appropriate treatment option for their specific condition.

Timeline

Before gastrectomy:

  1. Patient is diagnosed with a condition that requires surgery to remove part or all of the stomach (such as stomach cancer or severe ulcers).
  2. Patient undergoes preoperative tests and consultations with their healthcare team to prepare for surgery.
  3. Patient undergoes gastrectomy surgery to remove the affected part of the stomach.
  4. Patient may experience side effects such as pain, nausea, and difficulty eating in the immediate postoperative period.

After gastrectomy:

  1. Patient is monitored closely in the hospital for any complications or side effects of surgery.
  2. Patient may need to adjust their diet and lifestyle to accommodate the changes in their digestive system.
  3. Patient may undergo follow-up tests and appointments to monitor their recovery and adjust their treatment plan as needed.
  4. Patient may experience long-term side effects such as changes in eating habits, weight loss, and nutritional deficiencies.
  5. Patient may need to undergo additional procedures or treatments to manage complications such as strictures in the esophagus or stomach.

What to Ask Your Doctor

Some questions a patient should ask their doctor about gastrectomy and endoscopic incisional therapy (EIT) may include:

  1. What is the purpose of EIT in preventing strictures after gastrectomy surgery?
  2. How does EIT compare to other treatments, such as dilation, in preventing the recurrence of strictures?
  3. What are the potential risks and side effects of EIT?
  4. How long can I expect to remain free of strictures after undergoing EIT?
  5. Are there any specific criteria that make me a good candidate for EIT?
  6. What is the success rate of EIT in preventing strictures, particularly for first-time strictures?
  7. Are there any additional treatments or therapies that can be combined with EIT to improve its effectiveness?
  8. Are there any ongoing research studies or clinical trials related to EIT and its efficacy in preventing strictures after gastrectomy?
  9. How often will I need to undergo EIT treatments, and what is the long-term management plan for preventing strictures?
  10. Can you provide me with more information or resources about EIT and its role in post-gastrectomy care?

Reference

Authors: Jimoh Z, Jogiat U, Hajjar A, Verhoeff K, Turner S, Wong C, Kung JY, Bédard ELR. Journal: Surg Endosc. 2024 Jun;38(6):2995-3003. doi: 10.1007/s00464-024-10817-8. Epub 2024 Apr 22. PMID: 38649492