Juozas Stanaitis - Academia.edu (original) (raw)
Papers by Juozas Stanaitis
World Journal of Clinical Cases
Visceral Medicine
Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the uppe... more Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.
Lietuvos chirurgija
Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevariko... more Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijos diagnostika ir gydymas labai svarbus skubiosios pagalbos, intensyviosios terapijos skyrių gydytojų, endoskopuotojų, gastroenterologų ir chirurgų kasdieniame darbe. Straipsnyje pateikiamos Lietuvos gastroenterologų draugijos ekspertų posėdyje apsvarstytos tarptautiniu mastu priimtos rekomendacijos, stengiantis jas pritaikyti prie Lietuvos medicinos įstaigų situacijos. Recommendations for managing patients with nonvariceal gastrointestinal bleeding Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijo...
Lietuvos chirurgija
Įvadas / tikslasOTSC (Over-The-Scope Clip, Ovesco Endoscopy GmbH, Tuebingen, Vokietija) – tai nau... more Įvadas / tikslasOTSC (Over-The-Scope Clip, Ovesco Endoscopy GmbH, Tuebingen, Vokietija) – tai naujas endoskopinis virškinamojo trakto vientisumo atkūrimo būdas, naudojant endoskopinę kabutę, stipriau ir plačiau suspaudžiančią defekto kraštus, palyginti su įprastine per endoskopo kanalą uždedama kabute. OTSC naudojama su lanksčiais endoskopais šiais atvejais: 1) ūminiam kraujavimui stabdyti, 2) kiauriniam virškinamojo trakto defektui užverti, 3) audiniams suspausti ir suartinti, 4) endoskopinių ir chirurginių intervencijų komplikacijoms gydyti. Publikacijos tikslas – retrospektyvioji OTSC naudojimo virškinamojo trakto vientisumui atkurti analizė.RezultataiNuo 2013 m. kovo iki 2014 m. vasario Vilniaus universiteto Onkologijos institute ir Vilniaus universiteto Santariškių klinikose naudojant OTSC kabutes gydyti 9 ligoniai, iš jų 6 vyrai ir 3 moterys. Ligonių amžius – 35–86 metai. Indikacijos atlikti procedūrą: anastomozių nepakankamumas po stemplės rezekcijos, skrandžio rezekcijos ir ...
Lietuvos chirurgija
Įvadas / tikslasPagrindinis stemplės venų varikozės gydymo metodas yra endoskopinis jų perrišimas... more Įvadas / tikslasPagrindinis stemplės venų varikozės gydymo metodas yra endoskopinis jų perrišimas guminiais žiedais (toliau – endoskopinis perrišimas). Stemplės venų varikozės atsinaujinimas po endoskopinio gydymo yra dažnas ir jam būdingas didelis kraujavimo pavojus. Sergant kepenų ciroze su portine hipertenzija, aplink stemplę išsiplečia kolateralinės venos, kurias galima matyti ir įvertinti atliekant endoskopinį ultragarsinį tyrimą. Šio darbo tikslas – nustatyti, ar endoskopinio ultragarsinio tyrimo metu matomas kolateralinių venų tipas ir dydis gali padėti prognozuoti ankstyvą stemplės venų varikozės atsinaujinimą po endoskopinio perrišimo.Ligoniai ir metodaiĮ prospektyvųjį tyrimą įtraukti ligoniai, kuriems buvo atliktas stemplės varikozinių venų endoskopinis perrišimas. Prieš perrišimą visiems pacientams buvo atliktas endoskopinis ultragarsinis tyrimas ir įvertintas aplink stemplę esančių venų tipas ir dydis. Po endoskopinio stemplės varikozinių venų perrišimo ligoniai buvo ...
Videosurgery and Other Miniinvasive Techniques
Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth mo... more Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas. Aim: To overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure. Material and methods: A retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee. Results: Twenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0-Is, 0-Ip, and 0-IIa, except one, which belonged to 0-III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication-bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery. Conclusions: The LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.
United European Gastroenterology Journal
Background Accurate risk evaluation of choledocholithiasis prior to laparoscopic cholecystectomy ... more Background Accurate risk evaluation of choledocholithiasis prior to laparoscopic cholecystectomy is essential to determine optimal management strategy. Objective Our study aimed to evaluate the accuracy of separate predictors and Vilnius University Hospital Index (VUHI = A/30 + 0.4 × B; A = total bilirubin concentration (µmol/l), B = common bile duct (CBD) diameter (mm) measured by ultrasound) diagnosing choledocholithiasis and to assess different management strategies (cholecystectomy with intraoperative cholangiography and endoscopic retrograde cholangiopancreatography (ERCP)). Methods The retrospective study included 350 patients admitted to a tertiary care centre for laparoscopic cholecystectomy for cholecystolithiasis who were investigated for concomitant choledocholithiasis. Results Choledocholithiasis was diagnosed in 182 (76.2%) cases in the high-risk group (VUHI value ≥4.7) and 44 (39.6%) in the low, odds ratio is 4.86 (95% CI: 3.00–7.88). Its sensitivity was 80.5%, specifi...
Lietuvos chirurgija, 2017
Įvadas Prevencinių kolonoskopijų kokybė vertinama apskaičiuojant adenomų radimo dažį (ARD). Mūsų ... more Įvadas Prevencinių kolonoskopijų kokybė vertinama apskaičiuojant adenomų radimo dažį (ARD). Mūsų tyrimo tikslas – apskaičiuoti prevencinių kolonoskopijų (storosios žarnos vėžio ankstyvosios diagnostikos programa) ARD ir kitus išvestinius kokybės rodiklius bei palyginti jų skirtumus tarp Vilniaus universiteto ligoninės Santariškių klinikų endoskopuotojų (VUL SK).Metodai Retrospektyvusis 2009–2012 metais VUL SK (Vilnius, Lietuva) atliktų prevencinių kolonoskopijų duomenų tyrimas.Rezultatai Į analizę buvo įtrauktos 1633 kolonoskopijos, kurias atliko 5 endoskopuotojai. Bendras aklosios žarnos intubacijos dažnis buvo 96,8%. Žarnynas tyrimui buvo paruoštas gerai 65,2% atvejų, vidutiniškai 28,1 % atvejų ir blogai 6,7 % atvejų. Polipai dažniau rasti vyrams nei moterims: adenomos 40,4 % vs. 24 % (p<0,001), hiperplaziniai polipai 11,1 % vs. 6,6 % (p=0,001), daugybinės adenomos 6,4 % vs. 1,9 % (p<0,001). Storosios žarnos vėžys buvo rastas 76 pacientams (4,6 %) ir statistiškai reikšminga...
Videosurgery and Other Miniinvasive Techniques, 2016
The aim of our study was to evaluate the efficacy of deep biopsy via the endoscopic submucosal di... more The aim of our study was to evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD) technique for SELs in the upper gastrointestinal tract. Material and methods It was a case series study. Deep biopsy via the endoscopic submucosal dissection technique in upper
BMJ Case Reports, 2016
An 83-year-old woman under intravenous anaesthesia underwent endoscopic submucosal dissection due... more An 83-year-old woman under intravenous anaesthesia underwent endoscopic submucosal dissection due to early well-differentiated colon cancer with no deep invasion (pT1). Wide perforation in the deep site of excision of the descending colon was identified and an Ovesco clip placed to close the defect. The patient was discharged from the hospital on day 4 after the procedure, with no abdominal pain and no peritoneal signs of inflammation. Follow-up CT and colonoscopy were performed after 6 months, and no recurrence was observed.
Background The primary goal of this hospital-based retrospective multicenter case series study wa... more Background The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study. Methods The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey. Results A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management,
Scandinavian Journal of Gastroenterology, 2015
Variceal recurrence following endoscopic band ligation (EBL) is common. Esophageal collateral vei... more Variceal recurrence following endoscopic band ligation (EBL) is common. Esophageal collateral veins (ECV) are observed by endoscopic ultrasound (EUS) in patients with portal hypertension. The aim of the present study was to assess the role of EUS in predicting the recurrence of esophageal varices following EBL. Forty patients who had undergone EBL for eradication of varices were examined over a 12-month period to detect variceal recurrence. EUS was performed before ligation to detect and describe the type, grade, and the number of ECV. EUS findings obtained prior to EBL were compared in the variceal recurrence and non-recurrence groups. Of the 40 patients, 19 (47.5%) had variceal recurrence within 12 months of EBL. Univariate logistic regression analysis showed that severe peri-ECV (p &amp;amp;amp;amp;amp;lt; 0.001), multiple peri-ECV (p &amp;amp;amp;amp;amp;lt; 0.001), and the presence of perforating veins (p &amp;amp;amp;amp;amp;lt; 0.014) were statistically significantly related to the variceal recurrence after EBL. Multivariate logistic regression model found that only severe peri-ECV (odds ratio [OR] = 24.39; 95% confidence interval [CI]: 2.34-253.78) and multiple peri-ECV (OR = 24.39; 95% CI: 2.34-253.78) remained as independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence was 89.2% and 90.5%, respectively (prognostic value (AUC) = 0.946). Recurrence rate of esophageal varices after EBL is high (47.5%). EUS can clearly depict ECV and has a value in predicting variceal recurrence after EBL; severe peri-ECV and multiple peri-ECV were significant and independent prognostic factors associated with variceal recurrence risk.
Hepatology International, 2014
Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of... more Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of varices is still common following endoscopic treatment. The aim was to identify predictive factors for variceal recurrence detected by endosonography. We performed a systematic review of studies published prior to June 2013. Studies analyzing gastroesophageal collateral veins as risk factors for variceal recurrence after endoscopic treatment were included. The primary outcome was to identify predictive factors for variceal recurrence investigated by endosonography. After a full-text review, 13 studies were included in our analysis. Analysis of risk factors was not possible for all studies included. Perforating veins and periesophageal collateral veins were related to a higher risk of variceal recurrence (OR = 3.93; 95 % CI 1.06-14.51; I (2) = 96 %; OR = 2.29; 95 % CI 1.58-3.33; I (2) = 55 %). Analysis of cardiac intramural veins and paragastric/cardiac collateral veins showed the same trend, but without reaching statistical significance because of the small group size and wide CI (OR = 3.72; 95 % CI 0.14-101.53; I (2) = 91 %; OR = 1.85; 95 % CI 0.84-4.07; I (2) = 0 %). Analysis of other collateral veins as risk factors for variceal recurrence and analysis of risk factors with regard to the endoscopic treatment method was not possible because of the limited number of cases and different methodologies. A positive association between variceal recurrence and type and grade of collateral veins, investigated by endosonography, was demonstrated. Endosonography is a promising tool for predicting recurrence of esophageal varices following endoscopic treatment. These findings should be interpreted with caution because of the heterogeneity of the studies.
Acta medica Lituanica, 2012
Background and objective. Endoscopic band ligation is the main endoscopic treatment for esophagea... more Background and objective. Endoscopic band ligation is the main endoscopic treatment for esophageal varices, but the main problem after endoscopic treatment is variceal recurrence. The aim of this study was to evaluate and determine the esophageal varices recurrence rate and the time interval after endoscopic band ligation and to investigate possible risk factors affecting recurrence. Material and methods. The retrospective analysis of endoscopic band ligation procedures, performed in Vilnius University Hospital Santariskiu Clinics during the period 2006–2010, was made. 133 endoscopic band ligation procedures were included in the study. Results. After endoscopic band ligation, esophageal varices recurred in 45% of cases. The early recurrence of esophageal varices occurred in 46.7% of cases. Extrahepatic portal hypertension and a greater size of varices lead to the statistically significant early recurrence of esophageal varices after endoscopic band ligation. Conclusions. Endoscopic ...
Acta medica Lituanica, 2013
Gastrinomas are rare neuroendocrine tumors characterized by the secretion of gastrin, which cause... more Gastrinomas are rare neuroendocrine tumors characterized by the secretion of gastrin, which causes hyperchlorhydria, thereby producing the Zollinger-Ellison syndrome. In most cases this syndrome manifests as severe peptic ulcer disease. We are presenting an extremely rare clinical case of sporadic duodenal macrogastrinoma. The patient underwent investigation due to six-year history of epigastric pain, heartburn and episodic diarrhea. Endoscopy, endosonoscopy and histologic examination of biopsy specimens indicated the presence of duodenal gastrinoma with no signs of peptic ulcers. Pyloroduodenal segment including 3.5 cm macrogastrinoma was resected. This case is unique as duodenal gastrinomas are usually very small, up to 1 cm. During the follow up period we observed slowly decreasing hypergastrinemia. Somatostatin receptor scintigraphy, CT and upper GI endoscopy were performed to reveal the reasons, though did not find any abnormalities. 8 months of follow-up did not reveal any pro...
Videosurgery and Other Miniinvasive Techniques, 2014
Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of t... more Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection. Aim: To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs. Material and methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed. Results: Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively. Conclusions: Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.
Surgical Endoscopy, 2013
The primary goal of this hospital-based retrospective multicenter case series study was to determ... more The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study. The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey. A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management, either primary repair (70.0 %) or bowel resection (30.0 %). Postoperative complications were diagnosed in 15 patients. Immediate treatment resulted in fewer intestinal resections and shorter hospital stays (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Smoking [odds ratio (OR) 14.4, 95 % confidence interval (CI) 1.16-179.8] and a large size perforation site (15 ± 10 vs. 8 ± 5 mm; OR 1.19, 95 % CI 1.03-1.38) were risk factors for developing a postoperative complication after curative surgery. Six patients died. All deaths were related to diagnostic colonoscopy. Total incidence of large bowel full-thickness injury in Lithuanian hospitals is 0.07 %. Incidence of this complication after diagnostic and therapeutic colonoscopies is 0.056 and 0.169 %, respectively. The most common site of perforation is sigmoid colon and rectosigmoid junction, at 70 %. Risk rises when colonoscopy is performed in low-volume practice centers. Urgent surgical management resulted in overall mortality rate of 15.0 % and morbidity of 37.5 %.
Pancreatology, 2005
Delayed gastric emptying (DGE) is frequently reported in patients following pancreatoduodenectomy... more Delayed gastric emptying (DGE) is frequently reported in patients following pancreatoduodenectomy (PD). The present study tested the hypothesis that gastrointestinal hormones known to effect gastric emptying contribute to DGE in patients after PD. Patients with (delayed, n = 9) or without clinical signs of DGE (non-delayed, n = 22) after PD were investigated. Plasma concentrations of motilin, glucagon-like peptide-1 (GLP-1), neurotensin, and peptide YY (PYY) and the gastric emptying rate (GER), assessed by the paracetamol absorption method were measured after a liquid meal on postoperative day 11. Days with a nasogastric tube (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), days until solid food was tolerated (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), and hospital stay (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) were increased in delayed compared to non-delayed patients. The total and incremental integrated peptide responses of motilin and GLP-1 were similar, but the responses of neurotensin and PYY were reduced, in delayed compared to non-delayed patients, whether considered on clinical grounds or by measured GER (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05-0.005). Neurotensin and PYY slow the rate of gastric emptying in humans. Therefore, our findings suggest that reduced hormone responses were the consequence of DGE arising from delayed delivery of nutrients to the distal intestine where the endocrine cells secrete neurotensin and PYY reside.
World Journal of Clinical Cases
Visceral Medicine
Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the uppe... more Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.
Lietuvos chirurgija
Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevariko... more Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijos diagnostika ir gydymas labai svarbus skubiosios pagalbos, intensyviosios terapijos skyrių gydytojų, endoskopuotojų, gastroenterologų ir chirurgų kasdieniame darbe. Straipsnyje pateikiamos Lietuvos gastroenterologų draugijos ekspertų posėdyje apsvarstytos tarptautiniu mastu priimtos rekomendacijos, stengiantis jas pritaikyti prie Lietuvos medicinos įstaigų situacijos. Recommendations for managing patients with nonvariceal gastrointestinal bleeding Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijo...
Lietuvos chirurgija
Įvadas / tikslasOTSC (Over-The-Scope Clip, Ovesco Endoscopy GmbH, Tuebingen, Vokietija) – tai nau... more Įvadas / tikslasOTSC (Over-The-Scope Clip, Ovesco Endoscopy GmbH, Tuebingen, Vokietija) – tai naujas endoskopinis virškinamojo trakto vientisumo atkūrimo būdas, naudojant endoskopinę kabutę, stipriau ir plačiau suspaudžiančią defekto kraštus, palyginti su įprastine per endoskopo kanalą uždedama kabute. OTSC naudojama su lanksčiais endoskopais šiais atvejais: 1) ūminiam kraujavimui stabdyti, 2) kiauriniam virškinamojo trakto defektui užverti, 3) audiniams suspausti ir suartinti, 4) endoskopinių ir chirurginių intervencijų komplikacijoms gydyti. Publikacijos tikslas – retrospektyvioji OTSC naudojimo virškinamojo trakto vientisumui atkurti analizė.RezultataiNuo 2013 m. kovo iki 2014 m. vasario Vilniaus universiteto Onkologijos institute ir Vilniaus universiteto Santariškių klinikose naudojant OTSC kabutes gydyti 9 ligoniai, iš jų 6 vyrai ir 3 moterys. Ligonių amžius – 35–86 metai. Indikacijos atlikti procedūrą: anastomozių nepakankamumas po stemplės rezekcijos, skrandžio rezekcijos ir ...
Lietuvos chirurgija
Įvadas / tikslasPagrindinis stemplės venų varikozės gydymo metodas yra endoskopinis jų perrišimas... more Įvadas / tikslasPagrindinis stemplės venų varikozės gydymo metodas yra endoskopinis jų perrišimas guminiais žiedais (toliau – endoskopinis perrišimas). Stemplės venų varikozės atsinaujinimas po endoskopinio gydymo yra dažnas ir jam būdingas didelis kraujavimo pavojus. Sergant kepenų ciroze su portine hipertenzija, aplink stemplę išsiplečia kolateralinės venos, kurias galima matyti ir įvertinti atliekant endoskopinį ultragarsinį tyrimą. Šio darbo tikslas – nustatyti, ar endoskopinio ultragarsinio tyrimo metu matomas kolateralinių venų tipas ir dydis gali padėti prognozuoti ankstyvą stemplės venų varikozės atsinaujinimą po endoskopinio perrišimo.Ligoniai ir metodaiĮ prospektyvųjį tyrimą įtraukti ligoniai, kuriems buvo atliktas stemplės varikozinių venų endoskopinis perrišimas. Prieš perrišimą visiems pacientams buvo atliktas endoskopinis ultragarsinis tyrimas ir įvertintas aplink stemplę esančių venų tipas ir dydis. Po endoskopinio stemplės varikozinių venų perrišimo ligoniai buvo ...
Videosurgery and Other Miniinvasive Techniques
Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth mo... more Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas. Aim: To overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure. Material and methods: A retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee. Results: Twenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0-Is, 0-Ip, and 0-IIa, except one, which belonged to 0-III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication-bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery. Conclusions: The LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.
United European Gastroenterology Journal
Background Accurate risk evaluation of choledocholithiasis prior to laparoscopic cholecystectomy ... more Background Accurate risk evaluation of choledocholithiasis prior to laparoscopic cholecystectomy is essential to determine optimal management strategy. Objective Our study aimed to evaluate the accuracy of separate predictors and Vilnius University Hospital Index (VUHI = A/30 + 0.4 × B; A = total bilirubin concentration (µmol/l), B = common bile duct (CBD) diameter (mm) measured by ultrasound) diagnosing choledocholithiasis and to assess different management strategies (cholecystectomy with intraoperative cholangiography and endoscopic retrograde cholangiopancreatography (ERCP)). Methods The retrospective study included 350 patients admitted to a tertiary care centre for laparoscopic cholecystectomy for cholecystolithiasis who were investigated for concomitant choledocholithiasis. Results Choledocholithiasis was diagnosed in 182 (76.2%) cases in the high-risk group (VUHI value ≥4.7) and 44 (39.6%) in the low, odds ratio is 4.86 (95% CI: 3.00–7.88). Its sensitivity was 80.5%, specifi...
Lietuvos chirurgija, 2017
Įvadas Prevencinių kolonoskopijų kokybė vertinama apskaičiuojant adenomų radimo dažį (ARD). Mūsų ... more Įvadas Prevencinių kolonoskopijų kokybė vertinama apskaičiuojant adenomų radimo dažį (ARD). Mūsų tyrimo tikslas – apskaičiuoti prevencinių kolonoskopijų (storosios žarnos vėžio ankstyvosios diagnostikos programa) ARD ir kitus išvestinius kokybės rodiklius bei palyginti jų skirtumus tarp Vilniaus universiteto ligoninės Santariškių klinikų endoskopuotojų (VUL SK).Metodai Retrospektyvusis 2009–2012 metais VUL SK (Vilnius, Lietuva) atliktų prevencinių kolonoskopijų duomenų tyrimas.Rezultatai Į analizę buvo įtrauktos 1633 kolonoskopijos, kurias atliko 5 endoskopuotojai. Bendras aklosios žarnos intubacijos dažnis buvo 96,8%. Žarnynas tyrimui buvo paruoštas gerai 65,2% atvejų, vidutiniškai 28,1 % atvejų ir blogai 6,7 % atvejų. Polipai dažniau rasti vyrams nei moterims: adenomos 40,4 % vs. 24 % (p<0,001), hiperplaziniai polipai 11,1 % vs. 6,6 % (p=0,001), daugybinės adenomos 6,4 % vs. 1,9 % (p<0,001). Storosios žarnos vėžys buvo rastas 76 pacientams (4,6 %) ir statistiškai reikšminga...
Videosurgery and Other Miniinvasive Techniques, 2016
The aim of our study was to evaluate the efficacy of deep biopsy via the endoscopic submucosal di... more The aim of our study was to evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD) technique for SELs in the upper gastrointestinal tract. Material and methods It was a case series study. Deep biopsy via the endoscopic submucosal dissection technique in upper
BMJ Case Reports, 2016
An 83-year-old woman under intravenous anaesthesia underwent endoscopic submucosal dissection due... more An 83-year-old woman under intravenous anaesthesia underwent endoscopic submucosal dissection due to early well-differentiated colon cancer with no deep invasion (pT1). Wide perforation in the deep site of excision of the descending colon was identified and an Ovesco clip placed to close the defect. The patient was discharged from the hospital on day 4 after the procedure, with no abdominal pain and no peritoneal signs of inflammation. Follow-up CT and colonoscopy were performed after 6 months, and no recurrence was observed.
Background The primary goal of this hospital-based retrospective multicenter case series study wa... more Background The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study. Methods The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey. Results A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management,
Scandinavian Journal of Gastroenterology, 2015
Variceal recurrence following endoscopic band ligation (EBL) is common. Esophageal collateral vei... more Variceal recurrence following endoscopic band ligation (EBL) is common. Esophageal collateral veins (ECV) are observed by endoscopic ultrasound (EUS) in patients with portal hypertension. The aim of the present study was to assess the role of EUS in predicting the recurrence of esophageal varices following EBL. Forty patients who had undergone EBL for eradication of varices were examined over a 12-month period to detect variceal recurrence. EUS was performed before ligation to detect and describe the type, grade, and the number of ECV. EUS findings obtained prior to EBL were compared in the variceal recurrence and non-recurrence groups. Of the 40 patients, 19 (47.5%) had variceal recurrence within 12 months of EBL. Univariate logistic regression analysis showed that severe peri-ECV (p &amp;amp;amp;amp;amp;lt; 0.001), multiple peri-ECV (p &amp;amp;amp;amp;amp;lt; 0.001), and the presence of perforating veins (p &amp;amp;amp;amp;amp;lt; 0.014) were statistically significantly related to the variceal recurrence after EBL. Multivariate logistic regression model found that only severe peri-ECV (odds ratio [OR] = 24.39; 95% confidence interval [CI]: 2.34-253.78) and multiple peri-ECV (OR = 24.39; 95% CI: 2.34-253.78) remained as independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence was 89.2% and 90.5%, respectively (prognostic value (AUC) = 0.946). Recurrence rate of esophageal varices after EBL is high (47.5%). EUS can clearly depict ECV and has a value in predicting variceal recurrence after EBL; severe peri-ECV and multiple peri-ECV were significant and independent prognostic factors associated with variceal recurrence risk.
Hepatology International, 2014
Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of... more Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of varices is still common following endoscopic treatment. The aim was to identify predictive factors for variceal recurrence detected by endosonography. We performed a systematic review of studies published prior to June 2013. Studies analyzing gastroesophageal collateral veins as risk factors for variceal recurrence after endoscopic treatment were included. The primary outcome was to identify predictive factors for variceal recurrence investigated by endosonography. After a full-text review, 13 studies were included in our analysis. Analysis of risk factors was not possible for all studies included. Perforating veins and periesophageal collateral veins were related to a higher risk of variceal recurrence (OR = 3.93; 95 % CI 1.06-14.51; I (2) = 96 %; OR = 2.29; 95 % CI 1.58-3.33; I (2) = 55 %). Analysis of cardiac intramural veins and paragastric/cardiac collateral veins showed the same trend, but without reaching statistical significance because of the small group size and wide CI (OR = 3.72; 95 % CI 0.14-101.53; I (2) = 91 %; OR = 1.85; 95 % CI 0.84-4.07; I (2) = 0 %). Analysis of other collateral veins as risk factors for variceal recurrence and analysis of risk factors with regard to the endoscopic treatment method was not possible because of the limited number of cases and different methodologies. A positive association between variceal recurrence and type and grade of collateral veins, investigated by endosonography, was demonstrated. Endosonography is a promising tool for predicting recurrence of esophageal varices following endoscopic treatment. These findings should be interpreted with caution because of the heterogeneity of the studies.
Acta medica Lituanica, 2012
Background and objective. Endoscopic band ligation is the main endoscopic treatment for esophagea... more Background and objective. Endoscopic band ligation is the main endoscopic treatment for esophageal varices, but the main problem after endoscopic treatment is variceal recurrence. The aim of this study was to evaluate and determine the esophageal varices recurrence rate and the time interval after endoscopic band ligation and to investigate possible risk factors affecting recurrence. Material and methods. The retrospective analysis of endoscopic band ligation procedures, performed in Vilnius University Hospital Santariskiu Clinics during the period 2006–2010, was made. 133 endoscopic band ligation procedures were included in the study. Results. After endoscopic band ligation, esophageal varices recurred in 45% of cases. The early recurrence of esophageal varices occurred in 46.7% of cases. Extrahepatic portal hypertension and a greater size of varices lead to the statistically significant early recurrence of esophageal varices after endoscopic band ligation. Conclusions. Endoscopic ...
Acta medica Lituanica, 2013
Gastrinomas are rare neuroendocrine tumors characterized by the secretion of gastrin, which cause... more Gastrinomas are rare neuroendocrine tumors characterized by the secretion of gastrin, which causes hyperchlorhydria, thereby producing the Zollinger-Ellison syndrome. In most cases this syndrome manifests as severe peptic ulcer disease. We are presenting an extremely rare clinical case of sporadic duodenal macrogastrinoma. The patient underwent investigation due to six-year history of epigastric pain, heartburn and episodic diarrhea. Endoscopy, endosonoscopy and histologic examination of biopsy specimens indicated the presence of duodenal gastrinoma with no signs of peptic ulcers. Pyloroduodenal segment including 3.5 cm macrogastrinoma was resected. This case is unique as duodenal gastrinomas are usually very small, up to 1 cm. During the follow up period we observed slowly decreasing hypergastrinemia. Somatostatin receptor scintigraphy, CT and upper GI endoscopy were performed to reveal the reasons, though did not find any abnormalities. 8 months of follow-up did not reveal any pro...
Videosurgery and Other Miniinvasive Techniques, 2014
Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of t... more Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although the therapy targeted at inhibiting tyrosine kinases has shown dramatic results in metastatic and inoperable GISTs, the mainstay of treatment in primary localized forms remains surgical resection. Aim: To provide an overview of our experience of GIST diagnosis and management, with emphasis on comparison of minimally invasive and open surgical resection for primary GISTs. Material and methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2008 to 2012. Patient demographics, clinical data, surgery, complications, histopathological data and clinical course were analyzed. Results: Forty-four patients were identified. Average age at diagnosis was 63 years. Minimally invasive (MIS) and open surgery (OS) were each attempted in 22 (50.0%) patients. Laparoscopic removal was performed in 20, laparoendoscopic in 1, and laparoscopy-assisted endoscopic removal in 1. Conversion to an open procedure was performed in 4 (18.2%). We found significant differences in postoperative length of stay (8.5 days vs. 10.1 days, p < 0.001) and tumor size (2.93 cm vs. 5.78 cm, p = 0.018) between MIS and OS groups, respectively. Conclusions: Laparoscopic removal is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to remove safely. We recommend avoiding laparoscopic removal of these tumors due to the high rate of conversion (100.0%) to an open procedure. Laparoendoscopic surgical approach is an appropriate technique for removal of small-sized intraluminal benign GISTs not involving the muscularis propria layer.
Surgical Endoscopy, 2013
The primary goal of this hospital-based retrospective multicenter case series study was to determ... more The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study. The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey. A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management, either primary repair (70.0 %) or bowel resection (30.0 %). Postoperative complications were diagnosed in 15 patients. Immediate treatment resulted in fewer intestinal resections and shorter hospital stays (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Smoking [odds ratio (OR) 14.4, 95 % confidence interval (CI) 1.16-179.8] and a large size perforation site (15 ± 10 vs. 8 ± 5 mm; OR 1.19, 95 % CI 1.03-1.38) were risk factors for developing a postoperative complication after curative surgery. Six patients died. All deaths were related to diagnostic colonoscopy. Total incidence of large bowel full-thickness injury in Lithuanian hospitals is 0.07 %. Incidence of this complication after diagnostic and therapeutic colonoscopies is 0.056 and 0.169 %, respectively. The most common site of perforation is sigmoid colon and rectosigmoid junction, at 70 %. Risk rises when colonoscopy is performed in low-volume practice centers. Urgent surgical management resulted in overall mortality rate of 15.0 % and morbidity of 37.5 %.
Pancreatology, 2005
Delayed gastric emptying (DGE) is frequently reported in patients following pancreatoduodenectomy... more Delayed gastric emptying (DGE) is frequently reported in patients following pancreatoduodenectomy (PD). The present study tested the hypothesis that gastrointestinal hormones known to effect gastric emptying contribute to DGE in patients after PD. Patients with (delayed, n = 9) or without clinical signs of DGE (non-delayed, n = 22) after PD were investigated. Plasma concentrations of motilin, glucagon-like peptide-1 (GLP-1), neurotensin, and peptide YY (PYY) and the gastric emptying rate (GER), assessed by the paracetamol absorption method were measured after a liquid meal on postoperative day 11. Days with a nasogastric tube (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), days until solid food was tolerated (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), and hospital stay (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) were increased in delayed compared to non-delayed patients. The total and incremental integrated peptide responses of motilin and GLP-1 were similar, but the responses of neurotensin and PYY were reduced, in delayed compared to non-delayed patients, whether considered on clinical grounds or by measured GER (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05-0.005). Neurotensin and PYY slow the rate of gastric emptying in humans. Therefore, our findings suggest that reduced hormone responses were the consequence of DGE arising from delayed delivery of nutrients to the distal intestine where the endocrine cells secrete neurotensin and PYY reside.