A Prospective, Randomized, Controlled Trial of Covered Expandable Metal Stents in The Palliation of Malignant Esophageal Obstruction at The Gastroesophageal Junction
Palliation of malignant esophageal obstruction is an important clinical problem. Expandable metal stents are a major advance in therapy, but many stents become obstructed because of tumor ingrowth. The aim of this study was to compare a new, membrane-covered expandable metal stent to conventional pr...
Gespeichert in:
| Veröffentlicht in: | The American journal of gastroenterology 2001-06, Vol.96 (6), p.1791-1796 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1796 |
|---|---|
| container_issue | 6 |
| container_start_page | 1791 |
| container_title | The American journal of gastroenterology |
| container_volume | 96 |
| creator | Vakil, Nimish Morris, Anthony I Marcon, Norman Segalin, Andrea Peracchia, Alberto Bethge, Norbert Zuccaro, Gregory Bosco, John J Jones, Whitney F |
| description | Palliation of malignant esophageal obstruction is an important clinical problem. Expandable metal stents are a major advance in therapy, but many stents become obstructed because of tumor ingrowth. The aim of this study was to compare a new, membrane-covered expandable metal stent to conventional prostheses in a randomized controlled trial. Sixty-two patients with malignant inoperable esophageal obstruction at the gastroesophageal junction participated in the study. Patients were randomly assigned to covered or uncovered stents. The principal outcome measure was the need for reintervention because of recurrent dysphagia or migration. Secondary endpoints were relief of dysphagia measured by a dysphagia score (grade 0 = no dysphagia, grade 1 = able to eat solid food, grade 2 = semisolids only, grade 3 = liquids only, grade 4 = complete dysphagia) and the rate of complications and functional status. All patients were observed at monthly intervals until death or for 6 months. One week after stenting the dysphagia score improved significantly in both the uncovered (n = 32, 3 ± 0.1 to 1 ± 0.1 [means ± SEMs], p < 0.001) and covered (n = 30, 3 ± 0.1 to 1 ± 0.2 [means ± SEMs], p < 0.001) stents. Obstructing tumor ingrowth was significantly more likely in the uncovered stent group (9/30) than in the covered group (1/32) (p = 0.005). Significant stent migration occurred in 2/30 patients with uncovered stents, as compared with 4/32 patients in the covered group (p = 0.44). Reinterventions for tumor ingrowth were significantly greater in the uncovered stent group (27%), as compared with 0% in the covered group (p = 0.002). Life table analysis showed similar survival in both groups. Membrane-covered stents have significantly better palliation than conventional bare metal stents because of decreased rates of tumor ingrowth that necessitate endoscopic reintervention for dysphagia. |
| doi_str_mv | 10.1111/j.1572-0241.2001.03923.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70939982</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70939982</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3965-56dcfbc5db0f48029b99bde103457a15f79a9580445d5dbb03a9464a6c7655053</originalsourceid><addsrcrecordid>eNpdkt1u1DAQhS0EokvhFZAlEFdN8G8SX1arpYBatYLl2nISp5vFawfbabd9H94TJ7uiiLmxPPMdz2iOAYAY5TjFx22OeUkyRBjOCUI4R1QQmu-fgcXfwnOwQAiRTJASnYBXIWwTyEnJX4ITjBkWFcUL8Psc3ngXBt3E_k6fwW_Ktm7XP-r2DC6djd4Zo1u49r0y0HUpd6d9Sqz2QyJVbTS80jHVvkdtY4C9heuNhjfKmF7F3tlJdKVMf2uVjXAV3LBRtzoJrusQ_djMjIqz6kKllNNPzNfRzsBr8KJTJug3x_MU_Pi0Wi8_Z5fXF1-W55dZQ0XBM160TVc3vK1RxypERC1E3WqMKOOlwrwrhRK8QozxNkE1okqwgqmiKQvOEaen4MPh3cG7X6MOUe760GhjlNVuDLJEggpRkQS--w_cutHbNJvEZcXS4imeqOpANWnFwetODr7fKf8gMZKTkXIrJ7_k5JecjJSzkXKfpG-PDcZ6p9sn4dG5BLw_Aio0ynRe2aYP_zQghZhHYAfs3pmoffhpxnvt5SZtN24kmoJRlk29UZEu2fRnOP0D6n23NA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1784000312</pqid></control><display><type>article</type><title>A Prospective, Randomized, Controlled Trial of Covered Expandable Metal Stents in The Palliation of Malignant Esophageal Obstruction at The Gastroesophageal Junction</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Vakil, Nimish ; Morris, Anthony I ; Marcon, Norman ; Segalin, Andrea ; Peracchia, Alberto ; Bethge, Norbert ; Zuccaro, Gregory ; Bosco, John J ; Jones, Whitney F</creator><creatorcontrib>Vakil, Nimish ; Morris, Anthony I ; Marcon, Norman ; Segalin, Andrea ; Peracchia, Alberto ; Bethge, Norbert ; Zuccaro, Gregory ; Bosco, John J ; Jones, Whitney F</creatorcontrib><description>Palliation of malignant esophageal obstruction is an important clinical problem. Expandable metal stents are a major advance in therapy, but many stents become obstructed because of tumor ingrowth. The aim of this study was to compare a new, membrane-covered expandable metal stent to conventional prostheses in a randomized controlled trial. Sixty-two patients with malignant inoperable esophageal obstruction at the gastroesophageal junction participated in the study. Patients were randomly assigned to covered or uncovered stents. The principal outcome measure was the need for reintervention because of recurrent dysphagia or migration. Secondary endpoints were relief of dysphagia measured by a dysphagia score (grade 0 = no dysphagia, grade 1 = able to eat solid food, grade 2 = semisolids only, grade 3 = liquids only, grade 4 = complete dysphagia) and the rate of complications and functional status. All patients were observed at monthly intervals until death or for 6 months. One week after stenting the dysphagia score improved significantly in both the uncovered (n = 32, 3 ± 0.1 to 1 ± 0.1 [means ± SEMs], p < 0.001) and covered (n = 30, 3 ± 0.1 to 1 ± 0.2 [means ± SEMs], p < 0.001) stents. Obstructing tumor ingrowth was significantly more likely in the uncovered stent group (9/30) than in the covered group (1/32) (p = 0.005). Significant stent migration occurred in 2/30 patients with uncovered stents, as compared with 4/32 patients in the covered group (p = 0.44). Reinterventions for tumor ingrowth were significantly greater in the uncovered stent group (27%), as compared with 0% in the covered group (p = 0.002). Life table analysis showed similar survival in both groups. Membrane-covered stents have significantly better palliation than conventional bare metal stents because of decreased rates of tumor ingrowth that necessitate endoscopic reintervention for dysphagia.</description><identifier>ISSN: 0002-9270</identifier><identifier>EISSN: 1572-0241</identifier><identifier>DOI: 10.1111/j.1572-0241.2001.03923.x</identifier><identifier>PMID: 11419831</identifier><language>eng</language><publisher>Oxford: .</publisher><subject>Adenocarcinoma - complications ; Aged ; Biological and medical sciences ; Deglutition Disorders - etiology ; Deglutition Disorders - mortality ; Deglutition Disorders - surgery ; Esophageal Neoplasms - complications ; Esophagogastric Junction - surgery ; Gastroenterology ; Humans ; Intestinal Obstruction - etiology ; Intestinal Obstruction - mortality ; Intestinal Obstruction - surgery ; Karnofsky Performance Status ; Medical sciences ; Palliative Care ; Stents - adverse effects ; Stomach, duodenum, intestine, rectum, anus ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Survival Rate ; Treatment Outcome</subject><ispartof>The American journal of gastroenterology, 2001-06, Vol.96 (6), p.1791-1796</ispartof><rights>All Rights Reserved.</rights><rights>2001 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Jun 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3965-56dcfbc5db0f48029b99bde103457a15f79a9580445d5dbb03a9464a6c7655053</citedby><cites>FETCH-LOGICAL-c3965-56dcfbc5db0f48029b99bde103457a15f79a9580445d5dbb03a9464a6c7655053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1026912$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11419831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vakil, Nimish</creatorcontrib><creatorcontrib>Morris, Anthony I</creatorcontrib><creatorcontrib>Marcon, Norman</creatorcontrib><creatorcontrib>Segalin, Andrea</creatorcontrib><creatorcontrib>Peracchia, Alberto</creatorcontrib><creatorcontrib>Bethge, Norbert</creatorcontrib><creatorcontrib>Zuccaro, Gregory</creatorcontrib><creatorcontrib>Bosco, John J</creatorcontrib><creatorcontrib>Jones, Whitney F</creatorcontrib><title>A Prospective, Randomized, Controlled Trial of Covered Expandable Metal Stents in The Palliation of Malignant Esophageal Obstruction at The Gastroesophageal Junction</title><title>The American journal of gastroenterology</title><addtitle>Am J Gastroenterol</addtitle><description>Palliation of malignant esophageal obstruction is an important clinical problem. Expandable metal stents are a major advance in therapy, but many stents become obstructed because of tumor ingrowth. The aim of this study was to compare a new, membrane-covered expandable metal stent to conventional prostheses in a randomized controlled trial. Sixty-two patients with malignant inoperable esophageal obstruction at the gastroesophageal junction participated in the study. Patients were randomly assigned to covered or uncovered stents. The principal outcome measure was the need for reintervention because of recurrent dysphagia or migration. Secondary endpoints were relief of dysphagia measured by a dysphagia score (grade 0 = no dysphagia, grade 1 = able to eat solid food, grade 2 = semisolids only, grade 3 = liquids only, grade 4 = complete dysphagia) and the rate of complications and functional status. All patients were observed at monthly intervals until death or for 6 months. One week after stenting the dysphagia score improved significantly in both the uncovered (n = 32, 3 ± 0.1 to 1 ± 0.1 [means ± SEMs], p < 0.001) and covered (n = 30, 3 ± 0.1 to 1 ± 0.2 [means ± SEMs], p < 0.001) stents. Obstructing tumor ingrowth was significantly more likely in the uncovered stent group (9/30) than in the covered group (1/32) (p = 0.005). Significant stent migration occurred in 2/30 patients with uncovered stents, as compared with 4/32 patients in the covered group (p = 0.44). Reinterventions for tumor ingrowth were significantly greater in the uncovered stent group (27%), as compared with 0% in the covered group (p = 0.002). Life table analysis showed similar survival in both groups. Membrane-covered stents have significantly better palliation than conventional bare metal stents because of decreased rates of tumor ingrowth that necessitate endoscopic reintervention for dysphagia.</description><subject>Adenocarcinoma - complications</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Deglutition Disorders - etiology</subject><subject>Deglutition Disorders - mortality</subject><subject>Deglutition Disorders - surgery</subject><subject>Esophageal Neoplasms - complications</subject><subject>Esophagogastric Junction - surgery</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Intestinal Obstruction - etiology</subject><subject>Intestinal Obstruction - mortality</subject><subject>Intestinal Obstruction - surgery</subject><subject>Karnofsky Performance Status</subject><subject>Medical sciences</subject><subject>Palliative Care</subject><subject>Stents - adverse effects</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0002-9270</issn><issn>1572-0241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkt1u1DAQhS0EokvhFZAlEFdN8G8SX1arpYBatYLl2nISp5vFawfbabd9H94TJ7uiiLmxPPMdz2iOAYAY5TjFx22OeUkyRBjOCUI4R1QQmu-fgcXfwnOwQAiRTJASnYBXIWwTyEnJX4ITjBkWFcUL8Psc3ngXBt3E_k6fwW_Ktm7XP-r2DC6djd4Zo1u49r0y0HUpd6d9Sqz2QyJVbTS80jHVvkdtY4C9heuNhjfKmF7F3tlJdKVMf2uVjXAV3LBRtzoJrusQ_djMjIqz6kKllNNPzNfRzsBr8KJTJug3x_MU_Pi0Wi8_Z5fXF1-W55dZQ0XBM160TVc3vK1RxypERC1E3WqMKOOlwrwrhRK8QozxNkE1okqwgqmiKQvOEaen4MPh3cG7X6MOUe760GhjlNVuDLJEggpRkQS--w_cutHbNJvEZcXS4imeqOpANWnFwetODr7fKf8gMZKTkXIrJ7_k5JecjJSzkXKfpG-PDcZ6p9sn4dG5BLw_Aio0ynRe2aYP_zQghZhHYAfs3pmoffhpxnvt5SZtN24kmoJRlk29UZEu2fRnOP0D6n23NA</recordid><startdate>20010601</startdate><enddate>20010601</enddate><creator>Vakil, Nimish</creator><creator>Morris, Anthony I</creator><creator>Marcon, Norman</creator><creator>Segalin, Andrea</creator><creator>Peracchia, Alberto</creator><creator>Bethge, Norbert</creator><creator>Zuccaro, Gregory</creator><creator>Bosco, John J</creator><creator>Jones, Whitney F</creator><general>.</general><general>Blackwell Publishing</general><general>Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>20010601</creationdate><title>A Prospective, Randomized, Controlled Trial of Covered Expandable Metal Stents in The Palliation of Malignant Esophageal Obstruction at The Gastroesophageal Junction</title><author>Vakil, Nimish ; Morris, Anthony I ; Marcon, Norman ; Segalin, Andrea ; Peracchia, Alberto ; Bethge, Norbert ; Zuccaro, Gregory ; Bosco, John J ; Jones, Whitney F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3965-56dcfbc5db0f48029b99bde103457a15f79a9580445d5dbb03a9464a6c7655053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adenocarcinoma - complications</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Deglutition Disorders - etiology</topic><topic>Deglutition Disorders - mortality</topic><topic>Deglutition Disorders - surgery</topic><topic>Esophageal Neoplasms - complications</topic><topic>Esophagogastric Junction - surgery</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Intestinal Obstruction - etiology</topic><topic>Intestinal Obstruction - mortality</topic><topic>Intestinal Obstruction - surgery</topic><topic>Karnofsky Performance Status</topic><topic>Medical sciences</topic><topic>Palliative Care</topic><topic>Stents - adverse effects</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vakil, Nimish</creatorcontrib><creatorcontrib>Morris, Anthony I</creatorcontrib><creatorcontrib>Marcon, Norman</creatorcontrib><creatorcontrib>Segalin, Andrea</creatorcontrib><creatorcontrib>Peracchia, Alberto</creatorcontrib><creatorcontrib>Bethge, Norbert</creatorcontrib><creatorcontrib>Zuccaro, Gregory</creatorcontrib><creatorcontrib>Bosco, John J</creatorcontrib><creatorcontrib>Jones, Whitney F</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>The American journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vakil, Nimish</au><au>Morris, Anthony I</au><au>Marcon, Norman</au><au>Segalin, Andrea</au><au>Peracchia, Alberto</au><au>Bethge, Norbert</au><au>Zuccaro, Gregory</au><au>Bosco, John J</au><au>Jones, Whitney F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Prospective, Randomized, Controlled Trial of Covered Expandable Metal Stents in The Palliation of Malignant Esophageal Obstruction at The Gastroesophageal Junction</atitle><jtitle>The American journal of gastroenterology</jtitle><addtitle>Am J Gastroenterol</addtitle><date>2001-06-01</date><risdate>2001</risdate><volume>96</volume><issue>6</issue><spage>1791</spage><epage>1796</epage><pages>1791-1796</pages><issn>0002-9270</issn><eissn>1572-0241</eissn><abstract>Palliation of malignant esophageal obstruction is an important clinical problem. Expandable metal stents are a major advance in therapy, but many stents become obstructed because of tumor ingrowth. The aim of this study was to compare a new, membrane-covered expandable metal stent to conventional prostheses in a randomized controlled trial. Sixty-two patients with malignant inoperable esophageal obstruction at the gastroesophageal junction participated in the study. Patients were randomly assigned to covered or uncovered stents. The principal outcome measure was the need for reintervention because of recurrent dysphagia or migration. Secondary endpoints were relief of dysphagia measured by a dysphagia score (grade 0 = no dysphagia, grade 1 = able to eat solid food, grade 2 = semisolids only, grade 3 = liquids only, grade 4 = complete dysphagia) and the rate of complications and functional status. All patients were observed at monthly intervals until death or for 6 months. One week after stenting the dysphagia score improved significantly in both the uncovered (n = 32, 3 ± 0.1 to 1 ± 0.1 [means ± SEMs], p < 0.001) and covered (n = 30, 3 ± 0.1 to 1 ± 0.2 [means ± SEMs], p < 0.001) stents. Obstructing tumor ingrowth was significantly more likely in the uncovered stent group (9/30) than in the covered group (1/32) (p = 0.005). Significant stent migration occurred in 2/30 patients with uncovered stents, as compared with 4/32 patients in the covered group (p = 0.44). Reinterventions for tumor ingrowth were significantly greater in the uncovered stent group (27%), as compared with 0% in the covered group (p = 0.002). Life table analysis showed similar survival in both groups. Membrane-covered stents have significantly better palliation than conventional bare metal stents because of decreased rates of tumor ingrowth that necessitate endoscopic reintervention for dysphagia.</abstract><cop>Oxford</cop><pub>.</pub><pmid>11419831</pmid><doi>10.1111/j.1572-0241.2001.03923.x</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9270 |
| ispartof | The American journal of gastroenterology, 2001-06, Vol.96 (6), p.1791-1796 |
| issn | 0002-9270 1572-0241 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70939982 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adenocarcinoma - complications Aged Biological and medical sciences Deglutition Disorders - etiology Deglutition Disorders - mortality Deglutition Disorders - surgery Esophageal Neoplasms - complications Esophagogastric Junction - surgery Gastroenterology Humans Intestinal Obstruction - etiology Intestinal Obstruction - mortality Intestinal Obstruction - surgery Karnofsky Performance Status Medical sciences Palliative Care Stents - adverse effects Stomach, duodenum, intestine, rectum, anus Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Survival Rate Treatment Outcome |
| title | A Prospective, Randomized, Controlled Trial of Covered Expandable Metal Stents in The Palliation of Malignant Esophageal Obstruction at The Gastroesophageal Junction |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T02%3A07%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Prospective,%20Randomized,%20Controlled%20Trial%20of%20Covered%20Expandable%20Metal%20Stents%20in%20The%20Palliation%20of%20Malignant%20Esophageal%20Obstruction%20at%20The%20Gastroesophageal%20Junction&rft.jtitle=The%20American%20journal%20of%20gastroenterology&rft.au=Vakil,%20Nimish&rft.date=2001-06-01&rft.volume=96&rft.issue=6&rft.spage=1791&rft.epage=1796&rft.pages=1791-1796&rft.issn=0002-9270&rft.eissn=1572-0241&rft_id=info:doi/10.1111/j.1572-0241.2001.03923.x&rft_dat=%3Cproquest_cross%3E70939982%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1784000312&rft_id=info:pmid/11419831&rfr_iscdi=true |