OBJECTIVE: To assess the technical success, ability to eat, complications and clinical outcomes of patients with self-expandable metal stent (SEMS) placed for malignant upper gastrointestinal (GI) obstruction. MATERIALS AND METHODS: Data was collected retrospectively on patients who underwent SEMS placement for palliation of malignant upper GI obstruction by reviewing hospital charts from June 1998 to May 2011. Main outcome measurements were technical success, gastric outlet obstruction scoring system (GOOSS) score before and after treatment, complications, and survival. RESULTS: A total of 82 patients underwent SEMS placement with malignant upper GI obstruction. The initial SEMS placement was successful in 77 patients (93.9%). The mean GOOSS score was 0.56 before stenting and 1.92 (p < 0.001) after treatment. Complications arose in 12 patients (14.6%): stent migration in 1 patient (1.2%), perforation in 1 (1.2%), and obstruction of stent due to tumor ingrowth in 10 (12.2%). The median survival time after stenting was 52 days (6-445). CONCLUSION: SEMS placement is an effective and safe treatment for palliation of malignant upper GI obstruction. It provides lasting relief in dysphagia and improves the QOL of patients.
Adult ; Aged ; Aged, 80 and over ; Deglutition Disorders/physiopathology/prevention & control ; Equipment Design ; Female ; Humans ; Intestinal Neoplasms/physiopathology/*surgery ; Intestinal Obstruction/physiopathology/*surgery ; Male ; Metals ; Middle Aged ; *Palliative Care ; Postoperative Complications ; Retrospective Studies ; *Stents ; Survival Rate ; Treatment Outcome ; *Upper Gastrointestinal Tract

In Akita Prefecture, there are nine hospitals established by the Akita Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Koseiren). Half of the stroke patients in the prefecture were treated in these Koseiren hospitals, and half of the mass screening projects for the prevention of cardio vascular diseases were undertaken by these hospitals. A retrospective cohort study was done using mass-screening data (age, sex, past history of diabetes mellitus, blood pressure, body mass index, smoking and drinking habits) of 175,033 cases stored at these hospitals from 1988 to 1999, and the prefecture-wide stroke data of 2,520 initial stroke events registered from 1988 to 2003. The number of stroke cases was broken down into 1,428 cases of cerebral infarction (57%, CI), 693 cases of cerebral hemorrhage (27%, CH) and 399 cases of subarachnoid hemorrhage (16%, SAH). The subjects were also divided into five age groups:30-49, 50-59, 60-69, 70-79 and 80-89. Blood pressure (BP) was classified into six categories according to the JNC 6 criteria. Risk factors were determined using the Cox analysis. The hazard ratio for CI and CH was increasing with advancing age. CI showed a higher hazard ratio in men than women (hazard ratio for men was 1.8). The hazard ratio was increasing as BP became higher in any of three stroke subtypes, and especially CH showed the strongest correlation with BP. Uncontrollable risk factors were very closely associated with the attack of CI. On the other hand, BP (controllable risk) was closely linked with the attack of CH. Our results showed the prevention of CI was not easy. Controlling BP may be the most effective strategy for preventing hemorrhagic stroke (CH and SAH).
Cerebrovascular accident ; Cephalic index ; Blood pressure determination ; hazard ; Risk Factors

BACKGROUND/AIMS: There are controversies for the management of esophageal neoplasia due to its variety among countries. In this study, we tried to uncover the different managements on esophageal neoplasia between Korea, Singapore, and Japan. MATERIALS AND METHODS: We administered ten questionnaires to Korean, Japanese, and Singaporean endoscopists. The questionnaire consisted of endoscopic images from ten different esophageal neoplasms. RESULTS: For Barrett esophagus (BE) with adenocarcinoma (P=0.013) and well-differentiated- type squamous cell carcinoma (P=0.007), all (100%) of the Japanese endoscopists selected endoscopic resection as treatment, whereas 25~40% of the Korean and Singaporean endoscopists selected surgical resection. For BE with low grade dysplasia (P=0.002) and flat-type squamous dysplasia (P<0.001), observation without endoscopic treatment was preferred in Japan, whereas endoscopic treatment was preferred in Korea and Singapore. Similar findings between three countries were; (i) medication for BE, (ii) endoscopic treatment for BE with high grade dysplasia and elevated-type squamous dysplasia, and (iii) operation for moderately-differentiated or poorly-differentiated typed SCC. CONCLUSIONS: Our survey addresses different managements on esophageal neoplasia between Korea, Singapore, and Japan. More advanced or aggressive treatments are preferred in Korea and Singapore than in Japan for the management of BE with LGD, flat-type squamous dysplasia, BE with adenocarcinoma, and WD-typed SCC.
Adenocarcinoma ; Asian Continental Ancestry Group ; Barrett Esophagus ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Humans ; Japan ; Korea ; Neoplasms, Glandular and Epithelial ; Singapore ; Surveys and Questionnaires