Elsevier BV

The relationship between fat distribution and lymph node metastasis has not been well studied. The goal of this study was to determine the impact of visceral obesity on lymph node metastasis in gastric cancer. Metastatic lymph node ratio (MLR) was defined as the number of involved nodes by tumor divided by the total number of resected lymph nodes. Visceral (VFA) and subcutaneous fat areas (SFA) were determined by measuring abdominal fat volume distribution via CT scan, and visceral obesity was defined as a VFA to total fat area ratio (V/T) >0.29. With lymph node metastasis as a dependent variable, the following factors were significant in multivariate analysis among 495 patients: pathologic T stage (P < 0.001), lympho-vascular invasion (P < 0.001), and V/T (hazard ratio (HR) = 0.455, 95 % confidence interval (CI) = 0.263–0.786, P = 0.005). Similarly, when MLR was the dependent variable in multivariate analysis, MLR was significantly associated with lympho-vascular invasion (HR = 2.222, 95 % CI = 1.149–4.296, P = 0.018), and V/T (HR = 0.247, 95 % CI = 0.133–0.458, P < 0.001). Visceral obesity defined by higher visceral to total fat area ratio was significantly associated with decreased MLR.

The emerging gastric per-oral endoscopic myotomy (G-POEM) is becoming an alternative treatment method for gastroparesis. This study aimed to evaluate the feasibility and safety of G-POEM for gastroparesis. Relevant publications were identified through searching PubMed, EMBASE, Cochrane Library, and Web of Science before April 1, 2019. Studies presenting the clinical data of G-POEM for the treatment of gastroparesis were included. Data about effectiveness and safety were extracted, pooled, and analyzed. Forest plots were graphed based on random effects models. A total of 272 patients representing 8 studies were eligible for analysis. The pooled rates of GCSI at preprocedure, 1–3 months, 6 months, and 12 months, were 3.25 (95% CI, 2.75–3.75), 1.80 (95% CI, 1.10–2.49), 1.56 (95% CI, 0.45–2.68), and 1.10 (95% CI, 0.75–1.45), respectively. The pooled results of 4-h GES pre- and post-G-POEM were 41.89% (95% CI, 32.75–51.03%) and 16.48% (95% CI, 9.83–23.14%), respectively. Furthermore, the pooled clinical response rate was 84% (95% CI, 77–89%). The GES improvement rate and GES normal rate were also analyzed, and the results were 84% (95% CI, 77–90%) and 53% (95% CI, 39–66%), respectively. Finally, the pooled adverse events rate was 12% (95% CI, 6–19%). G-POEM was shown to be feasible and safe for the treatment of gastroparesis with various etiologies, which could be a potential first-line therapy for certain patients. Future studies are needed to investigate the appropriate patients for G-POEM to explore the “most beneficial” subgroup of patients.