Browsing by Author "Lacy, Antonio"
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Item Endoscopic full-thickness resection of esophagogastric junction gastrointestinal stromal tumor assisted by laparoscopy after neoadjuvant therapy(Georg Thieme Verlag KG Stuttgart · New York, 2016) Navarrete, Andrés; Momblan, Dulce; Fernández, Gloria; Delgado, Salvadora; Jiménez, Marta; Hessheimer, Amelia; Lacy, AntonioGastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive tract [1]. Surgery is the only potentially curative therapy. However, some tumors are locally advanced, and therefore R0 resection cannot be guaranteed. In this situation, imatinib can allow organ-preserving surgery and optimal oncological outcome GISTs located at the esophagogastric junction (EGJ) are challenging because wedge resection is difficult to achieve, and gastrectomy and/or esophagectomy are associated with morbidity and mortality. Consequently, endoscopic resection could be an ideal alternative to surgery, with comparable oncological outcomes. We present the case of an 82-year-old woman with a 1-month history of progressive dysphagia. An upper endoscopy showed a 6-cm pedunculated polypoid lesion at the EGJ, with a short and wide pedicle that protruded into the gastric fundus. The biopsy demonstrated a high-risk GIST with 20 mitoses per 50 high-power fields (HPF). Abdominal double-contrast radiography and computed tomography (CT) scan ruled out metastasis. It was decided to treat the tumor with imatinib to decrease its size. A 6-month course of therapy was started.Item Giant Gastric Gastrointestinal Stromal Tumor (GIST)(Springer, 2016) Navarrete, Andres; Momblan, Dulce; Almenara, Raul; Lacy, AntonioGastrointestinal stromal tumors (GIST) represent 0.1–3 % of gastrointestinal malignancy. Surgery is the mainstay of treatment, but in high-risk tumors, imatinib can help to achieve better oncological outcomes. We present a rare case of a patient with gastric GIST with very aggressive evolution in a short period of time despite the use of neoadjuvant therapy with imatinib.Item Sleeve Gastrectomy in the Elderly: A case-control study with Long Term Follow-up of 3 years(Elsevier, 2016) Navarrete, Andres; Corcelles, Ricard; Diaz del Gobbo, Gabriel; Perez, Sofia; Vidal, Josep; Lacy, AntonioBACKGROUND: Advanced age is considered to be a relative contraindication to bariatric surgery because of increased perioperative risk and suboptimal excess weight loss. OBJECTIVES: The aim of this study was to analyze the safety and effectiveness of the sleeve gastrectomy (SG) procedure in a cohort of elderly patients (aged≥60 yr) compared with younger patients (aged<60 yr). SETTING: Hospital clinic, Barcelona, Spain. METHODS: A retrospective analysis of all cases of SG in patients≥60 years old between January 2006 and December 2012 was performed. RESULTS: The study included 206 patients, 103 in each group. The mean age was 63.3±2.8 years, and the body mass index was 45.8±22.8 kg/m2. The overall complication rate within the elderly group was 9.7% versus 15.5% in the younger group (P = .2). After SG, there was no statistical difference in body mass index between the groups until 24 (33.4 versus 31.5 kg/m2, P = .01) and 36 (34.6 versus 32.8 kg/m2, P = .01) months of follow-up, favoring the younger cohort. Mean percent excess weight loss was similar between the groups during all periods of follow-up. The mean percent total weight loss change was statistically higher in the younger group at 3 (15.1% versus 17.1%, P = .03); 6 (25.2% versus 27.5%, P = .04); 12 (32.4% versus 35.2%, P = .03); 24 (26.7% versus 32.4%, P<.01); and 36 months (24.9% versus 29.1%, P<.01). Neither groups revealed a statistical difference in resolution of all co-morbidities, except for obstructive sleep apnea (P = .02) in the younger group. CONCLUSIONS: SG is a safe and feasible procedure in the elderly with results comparable to those in the standard bariatric population.