Text A 78-year-old male, late fistula after Ivor-Lewis esophagectomy, communication between gastroplasty-right bronchus. Refractory to several endoscopic therapies (clips, tissue adhesive, stents). Fistula closure after combination of submucosal dissection assisted by clip-with-line traction technique of the mucosal flap (to allow deep dissection) plus over-the-scope-clip; and ablative technique (argon plasma coagulation) with single loop-and-clips technique (KING-Closure) In two consecutive endoscopic procedures. Comments: Successful treatment of a chronic persistent fistula between the digestive tract and the trachea-bronquial tree, by combination of various endoscopic closure techniques. [1]

Purpose Molecular analysis of peritoneal fluid in staging laparoscopy of gastric cancer is performed to improve the detection of free intraperitoneal tumor cells. Nevertheless, its significance is controversial, especially in patients with negative cytology but positive molecular analysis. The aim of this study was to analyze the sensitivity of molecular analysis and its prognostic value. Methods A retrospective analysis from April 2011 to October 2019 was performed. Cytology (Cyt) and molecular analysis were analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) of the carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) tumor makers. Results During the study period, 138 staging laparoscopies were performed. Macroscopic carcinomatosis was found in 12.3%. Of the remaining 87.7%, 9.9% were Cyt + and 11.6% were Cyt- RT-PCR + . Of the latter, 9 responded to chemotherapy and underwent radical surgery. The sensitivity of cytology and molecular analysis was 0.70 and 0.76, respectively (p = 0.67). The 2-year overall survival (OS) of Cyt- RT-PCR + vs. Cyt + was similar (p = 0.1). The 2-year OS of Cyt-RT-PCR + subgroup who underwent radical surgery vs. Cyt-RT-PCR- patients was similar (p = 0.69), but disease-free survival was shorter in the first group (p = 0.005). Conclusion Our results show that the sensitivity of molecular analysis is similar to that of cytology. The prognostic value of positive molecular analysis was similar to positive cytology in terms of 2-year overall survival, except in the subgroup of operated patients in whom the overall survival was similar to that of those with a negative molecular analysis, albeit with a shorter disease-free survival.

Gastric and small intestine are the most common gastrointestinal stromal tumors (GISTs). There are few studies of patients who underwent surgical treatment with disparate findings. We aimed to evaluate the differences between groups and the risk factors for recurrence and mortality. A retrospective study of 96 gastric and 60 small intestine GIST was performed between 1995 and 2015. Both groups were compared in terms of clinicopathologic features, morbidity, recurrence, and mortality. Statistical analysis was performed with SPSS®. Eighty-one gastric GISTs and 56 small intestine GISTs underwent surgical treatment. Gastrointestinal bleeding was the most common cause of emergency surgery being more frequent in gastric GIST (P = 0.009); however, emergency surgery was indicated more frequently in the small intestinal GIST (P = 0.004) and was mostly due to perforation (P = 0.009). With a median follow-up of 66.9 (39.7–94.8) months, 28 (20.4%) patients had recurrence. A mitotic index > 5 (P ≤ 0.001) and the intestinal location (P = 0.012) were significantly associated to recurrence. Tumor size > 15 cm (P = 0.001) and an age of ≥ 75 years (P = 0.014) were associated to mortality. On univariate analysis, higher mean values of Ki-67 were associated to higher mortality (P = 0.0032). Small intestine GIST presented lower disease-free survival (DFS) than that of gastric GIST (65.7% vs 90.8%) with P = 0.003. The overall survival (OS) of gastric and small intestine GIST was 74.7% and 71.6%, respectively (P = 0.68). Small intestine GIST received emergency surgery more frequently showing lower DFS and same OS than that of gastric GIST. We found that Ki-67 could be a prognostic factor. Further studies are necessary to assess whether Ki-67 is a prognostic risk factor for GISTs.

Introduction: Patients (pts) with locally advanced esophageal carcinoma (LAEC) benefit from preoperative chemo-radiotherapy (NA CRT) followed by surgery. However, half of them will relapse within the first 2 years, having limited treatment options. Moreover, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) are thought to represent two different diseases which might differ in terms of recurrence. Our aim is to analyze the characteristics and outcome of pts who relapse. Methods: We retrospectively reviewed pts with LAEC treated at the Gastroesophageal Tumors Functional Unit of Catalan Institute of Oncology, Bellvitge University Hospital and integrated centers who underwent NA CRT followed by surgery from 2000 to 2014. We analyzed recurrence rate (RR), median time to relapse (mTTR) and pattern of recurrence (PR): locoregional recurrence (LRR), distant recurrence (DR) or synchronic LR and DR (SR); results were stratified by histology. Clinical data and salvage therapy (ST) were also collected, including surgery, radiotherapy and palliative chemotherapy (PCT). Kaplan Meier for median overall survival (mOS) and median time to progression (mTTP) were performed. Results: 83/100(83%) pts receiving NA CRT underwent surgery: ADC 33(40%), SCC 44(53%), undifferentiated 6(7%). 88% R0, pathologic complete response (ypT0N0): 20 (24%): ADC 18,2 %, SCC 33,3%, p0,22. After a median follow-up of 26 months (m) (1-126) 1-year and 3-year RR were 36 (ADC 40,9%, SCC 27,3%) and 43% (ADC 47,7%, SCC 36,4%) respectively. mTTR 6 m (4,1-7,8), PR (%) of the 36 (43%) pts who relapse: LRR 31% (ADC 18%,SCC 55%, 37% ND) DR 50 % (ADC 72, SCC 28) SR 19 % (ADC 86, SCC 14), logRank for histology 0,032.median OS was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). Median number of metastatic sites at relapse: 2. Data of 26/36 pts who relapse was available: 13/26 (50%) received ST: radical radiotherapy1 (7%), salvage surgery 1(7%). 11 (86%) receivedPCT. 90% had performance status ≤1, 100% had albumin serum levels ≥34g/l and Hemoglobin > 12g/L. PCT schedule: Docetaxel (46%), Cisplatin plus 5-fluoracyl (23%), Carboplatin plus 5-fluoracyl (15%). Median time on treatment was 10.7m (1-22). 5/13 (38%) pts received subsequent lines of PCT. Median OS was 11m (6,3-16,5): 26m (12,2-41,5) for patients who received ST versus 6,5m (1,3-11,4) for those who received best supportive care (p < 0,026). Conclusion: ADC and SCC differ significantly in their pattern of recurrence, being ADC more frequent in distant recurrence which confers a poor prognosis. A lower rate of pathologic complete response and a higher RR was observed for the group of ADC compared to SCC, although those differences were not statistical significant. Pts who relapse and maintain favorable prognostic clinical factors clearly benefit from salvage therapy if feasible and PCT.

Introduction: The standard treatment for patients (pts) with locally advanced esophageal carcinoma (LAEC) and good performance status is preoperative chemoradiotherapy followed by surgery. The two main histologic subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) present different epidemiology and might differ in prognosis. Our aim is to analyze the outcomes of a cohort of patients treated in our center and compare both histologies.Methods: We reviewed 100 patients (pts) diagnosed with primary LAEC that were treated with concurrent CRT followed by surgery at the Catalan Institute of Oncology, Bellvitge Hospital and integrated centers between 2000-2014. All pts were discussed at the multidisciplinary Gastroesophageal Tumors Functional Unit (UTEG). We described clinical characteristics, recurrence rates and survival curves using Kaplan Meier. A multivariate Cox regression was performed to identify prognostic factors.Results: 100 pts were studied: mean age 61 (34-78); 93% male; 96% PS ≤ 1; 18% Barrett esophagus; 42/43/15% Active/Former/Never smokers; Histology: 50% ADC/ 42% SCC, 2% undifferentiated. Location: 82% esophagus (7/35/40% upper, middle, lower) and 18% esophagogastric junction (Siewert I and II). Clinical stage included cT2N + , cT3-4a-b N0/+. 88% were node positive (cN+). 96% pts received a median of 2 cycles of NA CT, being the most used regimen CDDP-5FU (83%). Total RT dose received was 45 Gy (76%) and 50,4Gy (18%), depending on the centre protocol. G3/G4 toxicity occurred in 18% pts. Radiological response was assessed by PET: 19% complete response (CR), 55% partial response (PR), 16% stable disease (SD), 7% progression (PD), 3% not determined (ND). 83 pts (83%) underwent surgery: ADC 53%, SCC 40%. 83% R0. Pathologic complete response (ypT0N0-ypCR) was achieved in 20 pts (24%): 39% ADC/61% SCC. Downstaging of cN+ to ypN0 was 61% (44/72 pts). Deaths due to post-operative complications (within 30 days) occurred in 2 patients (2,8%). After a median follow-up of 26 months (m), overall recurrence rate (ORR) of pts who underwent surgery was 43% (36 pts): 58% of resected ADC, 33% of resected SCC. Median time to recurrence disease (mTRD) for ADC was 16,5m vs SCC, not reached (p < 0,24). 1 and 3 years RR was 36% and 43%, respectively. Median overall survival (OS) was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). 1 and 3 years OS rate were 66% and 53%, respectively. In the multivariate Cox regression, two independent factors influenced in OS: ypCR HR 0,5 (0,19-1,25) (p< 0,016) and ypN+ HR 2,3 (1,1-4,8) (p< 0,001).Conclusion: ADC and SCC represent two different diseases with different prognosis in locally advanced esophageal carcinoma. These results might be considered when developing novel therapies and follow up strategies in this setting. Introduction: The standard treatment for patients (pts) with locally advanced esophageal carcinoma (LAEC) and good performance status is preoperative chemoradiotherapy followed by surgery. The two main histologic subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) present different epidemiology and might differ in prognosis. Our aim is to analyze the outcomes of a cohort of patients treated in our center and compare both histologies. Methods: We reviewed 100 patients (pts) diagnosed with primary LAEC that were treated with concurrent CRT followed by surgery at the Catalan Institute of Oncology, Bellvitge Hospital and integrated centers between 2000-2014. All pts were discussed at the multidisciplinary Gastroesophageal Tumors Functional Unit (UTEG). We described clinical characteristics, recurrence rates and survival curves using Kaplan Meier. A multivariate Cox regression was performed to identify prognostic factors. Results: 100 pts were studied: mean age 61 (34-78); 93% male; 96% PS ≤ 1; 18% Barrett esophagus; 42/43/15% Active/Former/Never smokers; Histology: 50% ADC/ 42% SCC, 2% undifferentiated. Location: 82% esophagus (7/35/40% upper, middle, lower) and 18% esophagogastric junction (Siewert I and II). Clinical stage included cT2N + , cT3-4a-b N0/+. 88% were node positive (cN+). 96% pts received a median of 2 cycles of NA CT, being the most used regimen CDDP-5FU (83%). Total RT dose received was 45 Gy (76%) and 50,4Gy (18%), depending on the centre protocol. G3/G4 toxicity occurred in 18% pts. Radiological response was assessed by PET: 19% complete response (CR), 55% partial response (PR), 16% stable disease (SD), 7% progression (PD), 3% not determined (ND). 83 pts (83%) underwent surgery: ADC 53%, SCC 40%. 83% R0. Pathologic complete response (ypT0N0-ypCR) was achieved in 20 pts (24%): 39% ADC/61% SCC. Downstaging of cN+ to ypN0 was 61% (44/72 pts). Deaths due to post-operative complications (within 30 days) occurred in 2 patients (2,8%). After a median follow-up of 26 months (m), overall recurrence rate (ORR) of pts who underwent surgery was 43% (36 pts): 58% of resected ADC, 33% of resected SCC. Median time to recurrence disease (mTRD) for ADC was 16,5m vs SCC, not reached (p < 0,24). 1 and 3 years RR was 36% and 43%, respectively. Median overall survival (OS) was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). 1 and 3 years OS rate were 66% and 53%, respectively. In the multivariate Cox regression, two independent factors influenced in OS: ypCR HR 0,5 (0,19-1,25) (p< 0,016) and ypN+ HR 2,3 (1,1-4,8) (p< 0,001). Conclusion: ADC and SCC represent two different diseases with different prognosis in locally advanced esophageal carcinoma. These results might be considered when developing novel therapies and follow up strategies in this setting.

e15111 Background: Modern management of Oesophageal and oesophagogastric junction (OGJ) cancers requires a multidisciplinary approach, which was implemented at our health centre in 2005. This study aimed to assess the impact of this change on clinical outcomes. Methods: A retrospective cohort study was conducted, covering all patients treated for oesophageal and OGJ cancer at the cancer centre established by the Bellvitge University Hospital and Catalonian Institute of Oncology, over two time periods, i.e., 2000-2004 and 2005-2008. Descriptive and multivariate analyses were performed using survival at 1 and 3 years as dependent variables. Results: Between 1 January 2000 and 31 December 2008, 586 patients were included. Number of patients with unknown stage at diagnosis was significantly reduced. Neoadjuvant strategies at the oesophageal location clearly increased in the recent period. A multidisciplinary approach resulted in a significant reduction in surgical mortality (11.8% vs. 2%) in the period 2005-2008. Analysis restricted to patients undergoing surgery with curative intent indicated a significant increase in 1- and 3-year survival in the latter period (68.4% vs. 89.8% and 38.2% vs. 57.1% respectively). Multivariate analysis showed that variables associated with improved survival were: age; tumour stage; radical intent of treatment (surgery and radical combined chemoradiotherapy); and therapeutic strategy. Conclusions: Better selection of patients for therapy together with improved staging resulted in a significant improvement in 1- and 3-year survival in cases undergoing surgery with curative intent. These changes would support the adoption of a multidisciplinary approach to clinical decision-making in cases of oesophageal and OGJ cancer.

Introduction: Neoadjuvant chemoradiotherapy (NA CRT) has shown benefit in overall survival (OS) in patients with locally advanced esophageal carcinoma. However, toxicity and postoperative morbidity are not negligible.Methods: We retrospectively reviewed patients with locally advanced esophageal carcinoma treated at Catalan Institute of Oncology and integrated centers who underwent NA CRT from 2009 to 2013. G3/4 toxicity and postoperative complications were recorded. OS and disease free survival (DFS) curves and medians were performed by using Kaplan Meier method as well as identification of prognostic factors using multivariate Cox regression.Results: 61 pts were studied: median age 61 (34-75); 90% male; 97% PS ≤ 1, 3% PS2; 20% Barrett esophagus; 51% adenocarcinoma (ADC)/ 49% squamous cell carcinoma (SCC). Location: 82% esophagus, 18% esophagogastric junction (Siewert I or II). Clinical stage included cT2N + , cT3-4a N0/+. 95% were node positive (cN+). 90% pts received 2 cycles of NA CT, being the most used regimen CDDP-5FU (87%). Total RT dose received was 45 Gy (75%) and 50,4 Gy (25%), depending on the centre protocol. G3/G4 toxicity occurred in 9% pts (5% nonhematologic, 4% hematologic). Treatment radiological response was assessed by PET: 16% complete response, 56% partial response, 20% stable disease, 8% progression. 51 pts (84%) underwent surgery, 88% R0. Pathologic complete response (ypT0N0) was achieved in 12 pts (24%): 15% of resected ADC, 30% of SCC, ypN+ 38%. Deaths due to post-operative complications (within 30 days) occurred in 2 patients (4%). Overall recurrence rate (ORR) of pts who underwent surgery was 43% (54% of resected ADC, 32% of SCC). 25% pts had distant recurrence (DR), 8% locoregional recurrence (LR), and 10% synchronic DR and LR. After a median follow-up of 18 months (m), median OS was 31,2 m (IC 95% 20,9-41,5): 22,4m ADC vs 39,7m SCC (p < .38). 1 and 2 years overall survival rate were 76,9% and 53,7%, respectively. mDFS was 17m (IC 95% 12-22): ADC 13m vs SCC 18m (p <.29). In the multivariate Cox regression, two independent factors influenced positively in OS: R0 (p< .001) and PS ≤ 1 (p< .012).Conclusion: NA CRT is a safe strategy for locally advanced esophageal carcinoma in selected pts, who have been treated with multidisciplinary approach. It improves R0 rate and tumor downstaging with similar results than previous reports. ADC and SCC represent two distinct diseases with different epidemiology and prognosis. However, no significant differences were achieved in our cohort probably due to small number of pts. Introduction: Neoadjuvant chemoradiotherapy (NA CRT) has shown benefit in overall survival (OS) in patients with locally advanced esophageal carcinoma. However, toxicity and postoperative morbidity are not negligible. Methods: We retrospectively reviewed patients with locally advanced esophageal carcinoma treated at Catalan Institute of Oncology and integrated centers who underwent NA CRT from 2009 to 2013. G3/4 toxicity and postoperative complications were recorded. OS and disease free survival (DFS) curves and medians were performed by using Kaplan Meier method as well as identification of prognostic factors using multivariate Cox regression. Results: 61 pts were studied: median age 61 (34-75); 90% male; 97% PS ≤ 1, 3% PS2; 20% Barrett esophagus; 51% adenocarcinoma (ADC)/ 49% squamous cell carcinoma (SCC). Location: 82% esophagus, 18% esophagogastric junction (Siewert I or II). Clinical stage included cT2N + , cT3-4a N0/+. 95% were node positive (cN+). 90% pts received 2 cycles of NA CT, being the most used regimen CDDP-5FU (87%). Total RT dose received was 45 Gy (75%) and 50,4 Gy (25%), depending on the centre protocol. G3/G4 toxicity occurred in 9% pts (5% nonhematologic, 4% hematologic). Treatment radiological response was assessed by PET: 16% complete response, 56% partial response, 20% stable disease, 8% progression. 51 pts (84%) underwent surgery, 88% R0. Pathologic complete response (ypT0N0) was achieved in 12 pts (24%): 15% of resected ADC, 30% of SCC, ypN+ 38%. Deaths due to post-operative complications (within 30 days) occurred in 2 patients (4%). Overall recurrence rate (ORR) of pts who underwent surgery was 43% (54% of resected ADC, 32% of SCC). 25% pts had distant recurrence (DR), 8% locoregional recurrence (LR), and 10% synchronic DR and LR. After a median follow-up of 18 months (m), median OS was 31,2 m (IC 95% 20,9-41,5): 22,4m ADC vs 39,7m SCC (p < .38). 1 and 2 years overall survival rate were 76,9% and 53,7%, respectively. mDFS was 17m (IC 95% 12-22): ADC 13m vs SCC 18m (p <.29). In the multivariate Cox regression, two independent factors influenced positively in OS: R0 (p< .001) and PS ≤ 1 (p< .012). Conclusion: NA CRT is a safe strategy for locally advanced esophageal carcinoma in selected pts, who have been treated with multidisciplinary approach. It improves R0 rate and tumor downstaging with similar results than previous reports. ADC and SCC represent two distinct diseases with different epidemiology and prognosis. However, no significant differences were achieved in our cohort probably due to small number of pts.

Introduction: Among the different factors described, nutritional support has been associated to prevention and management of enterocutaneous fistulae (ECF).Objectives: To assess the influence that the parameters related to nutritional, clinical status, and surgical variables have on the occurrence of ECF.Methods: An observational case/control retrospective study was performed on patients admitted to the General and Digestive Surgery Department. The parameters analyzed were: diagnosis, body mass index (BMI), pathologic personal history, number of surgical interventions (SI) and complications (previous infection, bleeding, and ischemia). In patients with SI, we analyzed: number and type of SI, time until onset of nutritional support, and type of nutritional support. We performed a multiple logistic uni- and multivariate regression analysis by using the SPSSv.19.0 software.Results: The primary diagnoses related to the occurrence of ECF were pancreatic pathology (OR = 5.346) and inflammatory bowel disease (IBD) (OR = 9.329). The surgical variables associated to higher prevalence of ECF emergency SI (OR = 5.79) and multiple SI (OR = 4.52). Regarding the nutritional variables, the late onset of nutrition (more than three days after SI) was associated to the occurrence of ECF (OR = 3.82).Conclusions: In surgical patients, early nutritional support, independently of the route of administration, decreases the occurrence of fistulae. Pancreatic pathology, IBD, emergency SI, and multiple SI were associated to higher prevalence of ECF. The variable hyponutrition appears as a risk factor that should be confirmed in further studies.

Introducción: el uso de las prótesis esofágicas más habitual y extendido es en la paliación de disfagia en pacientes con cáncer de esófago. Su utilización en patología esofágica benigna, estenosis o fístulas, es más reciente y con poca experiencia.

To determine if ischemic conditioning of the stomach improves the morbidity, mortality, and the anastomotic failure in gastroplasties with cervical anastomosis. Analysis of all patients with indication for cervical gastroplasty during the period of study. In all cases, ischemic conditioning was performed by selective embolization. Anastomotic failure, morbidity, and mortality rates were studied. Thirty-nine consecutive patients were included. Angiography and selective embolization of the left gastric, right gastric, and splenic arteries were performed. Surgery was performed 2 weeks later. Four patients did not have a complete embolization; median hospital stay after conditioning was 1.24 ± 0.6 days. In two patients, surgery could not be completed. Of the 33 remaining, 29 had a posterior mediastinic gastroplasty and four through the anterior mediastinum. The most common morbidity was respiratory. Five patients had a reoperation and the mortality was 6%. One case of anastomotic leak was found (3%). The mean hospital stay was 17.5 days. Preoperative embolization is a technique with acceptable morbidity and a short hospital stay. In our experience it can reduce the incidence of the morbidity, mortality, and anastomotic leak in gastroplasties with cervical anastomosis. Prospective studies will be necessary to demonstrate the validity of this approach.

We sought to determine the safety and feasibility of esophagectomy after neoadjuvant immunotherapy and chemoradiotherapy in clinical trial patients with locally advanced esophageal cancer.We retrospectively identified patients who were treated with neoadjuvant immunotherapy and chemoradiotherapy (n = 25) or chemoradiotherapy alone (n = 143) at our institution between 2017 and 2020. The primary end point was risk of 30-day major complications (Clavien-Dindo classification system grade ≥ 3), which was assessed between groups using a multivariable log-binomial regression model to obtain adjusted relative risk ratios. Secondary end points were interval to surgery, 30-day readmission rate, and 30-day mortality.All included patients successfully completed neoadjuvant therapy and underwent esophagectomy with negative margins. Age, sex, performance status, clinical stage, histologic subtype, procedure type, and operative approach were similar between groups. Neoadjuvant immunotherapy was not associated with a statistically significantly increased risk of developing a major pulmonary (relative risk, 1.43; 95% confidence interval, 0.53-3.84; P = .5), anastomotic (relative risk, 1.34; 95% confidence interval, 0.45-3.94; P = .6), or other complication (relative risk, 1.29; 95% confidence interval, 0.26-6.28; P = .8). Median (interquartile range) interval to surgery was 54 days (47-61 days) in the immune checkpoint inhibitor group versus 53 days (47-66 days) in the control group (P = .6). Minimally invasive approaches were successful in 72% of cases, with only 1 conversion. Thirty-day mortality and readmission rates were 0% and 17%, respectively, in the immune checkpoint inhibitor group and 1.4% and 13%, respectively, in the control group.On the basis of our preliminary experience, esophagectomy appears to be safe and feasible following combined neoadjuvant immunotherapy and standard chemoradiotherapy for locally advanced esophageal cancer.

Apoptosis, necrosis and neovascularization are three processes that occur during ischemic preconditioning in a range of organs. In the stomach, the effect of this preconditioning (the delay phenomenon) has helped to improve gastric vascularization prior to esophagogastric anastomosis after esophagectomy. Here we present a sequential study of the histological recovery of the gastric fundus and the phenomena of apoptosis, necrosis and neovascularization in an experimental model of partial gastric ischemia. Partial gastric devascularization was performed by ligature of the left gastric vessels in Sprague-Dawley rats. Rats were assigned to groups in accordance with their evaluation period: control, 1, 3, 6, 10, 15 and 21 days. Histological analysis, caspase-3 activity, DNA fragmentation and vascular endothelial cell proliferation (Ki-67) were measured in tissue samples after sacrifice. After 24 h of partial gastric ischemia, rates of apoptosis and necrosis were higher in the experimental groups than in controls. Tissue injury was higher 3 and 6 days post-ischemia. From day 10 after partial gastric ischemia, apoptosis and necrosis started to decrease, and on days 15 and 21 showed no differences in relation to controls. Neovascularization began between days 1 and 3, reaching its peak at 15 days after ischemia and coinciding with complete histological recovery. Both necrosis and apoptosis play a role in tissue injury during the first days after partial gastric ischemia. After 15 days, the evolution of both the histology and the neovascularization suggested that this is the optimal time for performing gastric transposition.

Our aim in this study is to evaluate the efficacy of decontamination of the high digestive tract in reducing the incidence of anastomotic dehiscence, pulmonary infection and mortality after resective gastro-esophageal surgery. A prospective randomized and double-blinded study was conducted in patients undergoing total gastrectomy for gastric cancer and esophagectomy for esophageal cancer. Two groups were studied: group A patients were given erythromycin + gentamicine + nistatine sulfate orally; group B patients were given placebo. Mortality, incidence of anastomotic dehiscence and incidence of pulmonary infection were the end points evaluated. One hundred and nine consecutive patients were randomized. Eighteen (16.5%) were excluded. From the 91 patients who were evaluated, 42 (46.2%) received an esophagectomy and 49 (53.8%) had a total gastrectomy. Esophagectomies showed: a 0% rate of anastomotic dehiscence in group A and 12.5% in group B, P = 0.176; a pulmonary infection rate of 22.2% in group A and 29.1% in group B, P = 0.443; and mortality rate was 0% in group A and 12.5% in group B, P = 0.176. After gastrectomy, anastomotic dehiscence rate was 4.5% in group A and 0% in group B, P = 0.449; pulmonary infection rate was 4.5% in group A and 11.1% in group B, P = 0.387 and mortality was 9% in group A and 0% in group B, P = 0.196. Decontamination protocol does not help in decreasing the incidence of anastomotic dehiscence, pulmonary infection and mortality in the present study. Nevertheless, there seems to be a tendency to low pulmonary infection after gastrectomy and esophagectomy and to improve the incidence of anastomotic dehiscence after esophagectomy. Further studies are needed to re-evaluate these findings.