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Failure of second-generation tyrosine kinase inhibitors (2GTKI) is a challenging situation in patients with chronic myeloid leukemia (CML). Asciminib, recently approved by the US Federal Drug Administration, has demonstrated in clinical trials a good efficacy and safety profile after failure of 2GTKI. However, no study has specifically addressed response rates to asciminib in ponatinib pretreated patients (PPT). Here, we present data on responses to asciminib from 52 patients in clinical practice, 20 of them (38%) with prior ponatinib exposure. We analyzed retrospectively responses and toxicities under asciminib and compared results between PPT and non-PPT patients.After a median follow-up of 30 months, 34 patients (65%) switched to asciminib due to intolerance and 18 (35%) due to resistance to prior TKIs. Forty-six patients (88%) had received at least 3 prior TKIs. Regarding responses, complete cytogenetic response was achieved or maintained in 74% and 53% for non-PPT and PPT patients, respectively. Deeper responses such as major molecular response and molecular response 4.5 were achieved in 65% and 19% in non-PPT versus 32% and 11% in PPT, respectively. Two patients (4%) harbored the T315I mutation, both PPT.In terms of toxicities, non-PPT displayed 22% grade 3–4 TEAE versus 20% in PPT. Four patients (20% of PPT) suffered from cross-intolerance with asciminib as they did under ponatinib.Our data supports asciminib as a promising alternative in resistant and intolerant non-PPT patients, as well as in intolerant PPT patients; the resistant PPT subset remains as a challenging group in need of further therapeutic options.

Background: Children with autoimmune hepatitis (AIH) often exhibit particular features. Accordingly, seven pediatric-specific criteria have been proposed. Aim: To develop a prediction model based on them, transform it into a scoring system and study its accuracy. Methods: A cohort of children under study for liver disease was consecutively selected. AIH diagnosis was based on classical criteria. Already proposed pediatric criteria were recorded. The best possible regression model was selected, and the beta coefficient of each criterion was translated into a whole number (points). Total scores were obtained following the points system and the best cut-off was calculated. Subsequently, accuracy of the diagnostic score was studied in the validation set. Results: Among 212 included patients, 100 had AIH. The score included 5 criteria: autoantibodies (0-2 points), hypergammaglobulinemia, exclusion of viral hepatitis, exclusion of Wilson's disease (1 point each) and liver histology (3 points). In addition, a normal cholangiogram is mandatory. The validation set was formed of 70 patients (24 with AIH). In this subsample, a score of >= 6 renders a sensitivity/specificity of 95.8%/100%. The area under the receiver operating characteristic curve was 97.1%. Conclusion: Pediatric-specific criteria for the diagnosis of AIH can be reliably used as a scoring system. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Este documento es una recopilación de los materiales que he preparado en los últimos años para la asignatura “Econometría básica” de la Universidad de Navarra. Los alumnos de esta asignatura han estudiado antes Cálculo, Álgebra, Probabilidad y Estadística. El manual en el que nos apoyamos es “Introducción a la Econometría” de James Stock y Mark Watson, un libro excelente y que se encuentra disponible tanto en inglés como en castellano. Este curso básico abarca los 8 o 9 primeros temas. Los autores facilitan esquemas en inglés para su presentación: yo los resumí, adapté y traduje al castellano.

Introducción: Se ha comunicado recientemente que la reducción de peso previa a cirugía bariátrica mediante dieta muy baja en calorías (VLCD) durante 2 semanas supone menor tasa de complicaciones postoperatorias. Es debatido, sin embargo, si la pérdida de peso preoperatoria con VLCD puede favorecer pérdida de peso postoperatoria. Objetivos: Valorar la eficacia de una VLCD, seguida durante 6 semanas preoperatorias, en el descenso de peso conseguido al año de la cirugía bariátrica. Evaluar los cambios en parámetros antropométricos y bioquímicos conseguidos con dicha dieta. Metodología: Estudio prospectivo no controlado en los pacientes obesos sometidos a derivación biliopancréatica en la Unidad de Obesidad de referencia en el periodo 2008-2010. Los pacientes recibieron durante 6 semanas previas a la intervención una VLCD que aportaba diariamente 840 kcal y 60 g de proteínas (Optisource®). Los datos descriptivos se presentan como media y desviación estándar (DS), y tras comprobar su distribución normal, fueron analizados mediante prueba t de Student, ANOVA o correlación de Pearson. Resultados: Fueron valorados 107 pacientes obesos, de 43,5 (10,2) años, el 72 % fueron mujeres con peso inicial 122,4 (18,6) Kg e IMC de 46,8 (5,5) kg/m². Un 24,5% perdieron más de 10 % de su peso inicial y un 73,5% más de 5% tras VLCD. La media de porcentaje pérdida de exceso de peso (% PSP) a los 12 meses de la intervención fue 59,6 (13,4)%, y aunque fue mayor en los pacientes que habían perdido peso con VLCD, no se asoció de forma significativa: aquellos pacientes con pérdida mayor de 5% perdieron a los 12 meses 59,5 (13,8)% de PSP y 68,4 and 71 (16,2) % de exceso de IMC (%PEIMC), frente a 57,9 (13,1) % y 68,5 (16,6) % si no conseguían esa pérdida. El grupo de pacientes con pérdida mayor de 10 % consiguió %PSP de 63,3 (13,7) y %PEIMC de 70,9 (14,7) vs 58,2 (14,0) y 67,7 (16,7) si no perdieron >10% del peso inicial. No se encontró correlación entre la pérdida preoperatoria con VLCD y %PSP ni de exceso de IMC (%PEIMC) a 3,6,9 y 12 meses, sólo el %PSP a 1 mes se correlacionó con %PSP con VLCD (r = 0,454, p = 0,003). Conclusiones: La pérdida de peso preoperatoria mediante VLCD en pacientes obesos mórbidos no ha demostrado favorecer la pérdida de exceso de peso ni de exceso de IMC al año de la cirugía bariátrica. Background: Weight loss before bariatric surgery, achieved by means of a very low calorie diet (VLCD) has been recently reported to be related to a lower rate of postoperative complications. However, it is controversial if preoperative weight loss after VLCD could improve postoperative weight loss. Aims: To assess the effectiveness of a preoperative VLCD for 6 weeks in weight loss one year after bariatric surgery. To evaluate the changes obtained in anthropometric measures and biochemical parameters after VLCD. Methods: Prospective uncontrolled study including severely obese patients undergoing biliopancreatic diversión in our Obesity Unit in 2008-2010. Patients included followed a VLCD providing 840 kcal and 60 g of protein (Optisource®). Descriptive data are presented as mean (standard deviation) and after checking a normal distribution is followed, they were analyzed by Student s T test, ANOVA or Pearson correlation. Results: We evaluted 107 obese patients, 43.5 (10.2) years-old, 72% women, with initial weight 122.4 (18.6) Kg and BMI 46.8 (5.5) kg/m². 24.5% of them lost more than 10 % of initial weight and 73.5% more than 5% after following VLCD. Mean percentage of excess weight loss (% PSP) one year after surgery was 59.6 (13.4)%, and although it was higher for those patients losing more weight after VLCD, a significant correlation was not found: those who lost more than 5% showed %PSP 59.5 (13.8) % after twelve months and 68.4 (16.2) % of percentage of excess BMI loss (%PEIMC), vs 57,9 (13,1) % and 68.5 (16.6) % if they didn t lose that amount of weight. Those patients losing more than 10% achieved %PSP 63.3 (13.7) and %PEIMC 70.9 (14.7) vs 58.2 (14.0) y 67.7 (16.7) vs those not losing that amount. Significant correlations between preoperative loss with VLCD and %PSP or %PEIMC at 3,6,9 and 12 months were not found, only %PSP 1 month after surgery correlated with %PSP after VLCD (r = 0.454, p = 0.003). Conclusions: Preoperative weight loss with VLCD in severely obese patients did not show to improve either %PSP or %PEIMC one year after bariatric surgery.

Background: Relapsing-remitting dynamics are a hallmark of autoimmune diseases such as Multiple Sclerosis (MS). A clinical relapse in MS reflects an acute focal inflammatory event in the central nervous system that affects signal conduction by damaging myelinated axons. Those events are evident in T1-weighted post-contrast magnetic resonance imaging (MRI) as contrast enhancing lesions (CEL). CEL dynamics are considered unpredictable and are characterized by high intra- and inter-patient variability. Here, a population approach (nonlinear mixed-effects models) was applied to analyse of CEL progression, aiming to propose a model that adequately captures CEL dynamics. Methods and Findings: We explored several discrete distribution models to CEL counts observed in nine MS patients undergoing a monthly MRI for 48 months. All patients were enrolled in the study free of immunosuppressive drugs, except for intravenous methylprednisolone or oral prednisone taper for a clinical relapse. Analyses were performed with the nonlinear mixed-effect modelling software NONMEM 7.2. Although several models were able to adequately characterize the observed CEL dynamics, the negative binomial distribution model had the best predictive ability. Significant improvements in fitting were observed when the CEL counts from previous months were incorporated to predict the current month's CEL count. The predictive capacity of the model was validated using a second cohort of fourteen patients who underwent monthly MRIs during 6-months. This analysis also identified and quantified the effect of steroids for the relapse treatment. Conclusions: The model was able to characterize the observed relapsing-remitting CEL dynamic and to quantify the inter-patient variability. Moreover, the nature of the effect of steroid treatment suggested that this therapy helps resolve older CELs yet does not affect newly appearing active lesions in that month. This model could be used for design of future longitudinal studies and clinical trials, as well as for the evaluation of new therapies.

Aims: The uncertainty around the EQ-5D-3L value set is commonly ignored in economic evaluation. This study evaluates the impact of including parameter uncertainty around the original UK EQ-5D-3L value set (or “tariff”) within standard errors as well as sampling uncertainty around the trial population. Methods: First, we re-estimated the N3 model of the EQ-5D-3L value set with original data from the Measurement and Valuation of Health (MVH) study to replicate the published coefficients. Second, we estimated standard errors around the predicted utility of each EQ-5D-3L health state to evaluate the impact of parameter uncertainty on these estimated utilities. Third, we used a two-stage bootstrap approach to combine the resulting MVH parameter uncertainty with trial sampling uncertainty for a large randomised trial population. In the first step, we generated 1,000 sets of coefficients for the UK EQ-5D-3L tariff using bootstrap resampling from the original MVH sample. In the second step, we used bootstrap resampling from the clinical trial data 10,000 times for each of the 1,000 sets of EQ-5D tariff coefficients. The standard error including MVH parameter uncertainty was then estimated as the standard deviation across the resulting vector of results from the 10 million bootstrap replicates. This figure was compared against a one-stage bootstrap from the clinical trial sample to assess the impact of including parameter uncertainty. Data: The EQ-5D N3 model was estimated using the original MVH data. The randomised control trial used as a case study was the International Subarachnoid Aneurysm Trial (ISAT), a large clinical trial comparing endovascular coiling and neurosurgery for the treatment of ruptured aneurysms. EQ-5D-3L data to calculate mean utilities at 2 and 12 months’ follow-up and the quality-adjusted life years (QALYs) accrued over the trial period were available for 1633 patients. Findings: Including MVH parameter uncertainty around the original EQ-5D N3 model increased the standard errors around mean between-group differences in utility only very slightly from 0.01542 (ignoring parameter uncertainty) to 0.01550 at 2 months follow-up, from 0.01490 to 0.01493 at 12 months follow-up and from 0.01149 to 0.01155 for QALYs. Sensitivity analysis suggests parameter uncertainty has a larger impact when the N3 model is re-estimated using much smaller valuation samples: estimates based on a 1% sub-sample of MVH respondents increases the variance by 5.60% at 2 months follow-up, 4.87% at 12 months follow-up and 4.59% for QALYs. The standard errors around with the original time trade-off valuations in the MVH study suggests a substantial amount of between respondent variation affecting most health states, which the original N3 model did not fully account for. Therefore, the standard errors around N3 model predictions are likely to be biased, and do not reflect the true uncertainty around the valuations. Conclusions/implications: Our results suggest that parameter uncertainty around the EQ-5D value set has little impact on the estimated confidence intervals around utility differences in this example. This result is driven by the precision of the original estimated coefficients, given the large dataset used in the original MVH study. However, parameter uncertainty may have more influence on value sets estimated using different estimation methods or smaller valuation samples. Our results suggest that other types of uncertainty around health state valuations, such as model uncertainty, may have more important implications than parameter uncertainty: further research is required to clarify this.

Decision making can be regarded as the outcome of cognitive processes leading to the selection of a course of action among several alternatives. Borrowing a central measurement from information theory, Shannon entropy, we quantified the uncertainties produced by decisions of participants within an economic decision task under different configurations of reward probability and time. These descriptors were used to obtain blood oxygen level-dependent (BOLD) signal correlates of uncertainty and two clusters codifying the Shannon entropy of task configurations were identified: a large cluster including parts of the right middle cingulate cortex (MCC) and left and right pre-supplementary motor areas (pre-SMA) and a small cluster at the left anterior thalamus. Subsequent functional connectivity analyses using the psycho-physiological interactions model identified areas involved in the functional integration of uncertainty. Results indicate that clusters mostly located at frontal and temporal cortices experienced an increased connectivity with the right MCC and left and right pre-SMA as the uncertainty was higher. Furthermore, pre-SMA was also functionally connected to a rich set of areas, most of them associative areas located at occipital and parietal lobes. This study provides a map of the human brain segregation and integration (i.e., neural substrate and functional connectivity respectively) of the uncertainty associated to an economic decision making paradigm.

Semantic memory organization and retrieval is a cutting edge topic that is being studied from different fields such as Linguistics, Psychology, Computer Science and Neuroscience. The aim of this thesis is to improve the understanding of conceptual organization and retrieval by means of network theory and the use of semantic verbal fluency tests (animals) in an unsupervised fashion. Conceptual organization will be studied here as a complex network attached to a dual-mechanism of information retrieval, i.e. switching and clustering. The chapters are organized as follows: 1. An introduction to the concepts of human brain, memory and network theory. 2. A study of the frequency patterns obtained from the verbal fluency tests. 3. Development of a statistical method for the unsupervised generation of a conceptual network and the insilico evaluation of switching and clustering. Such evaluation together with the definition of accessibility and diffusivity measurements allowed the decoupling of switching and clustering functioning. 4. Study of switcher random walks (by means of finite Markov chains) as an exploration-propagation paradigm in a number of insilico network models. 5. Modelization of the switching-clustering retrieval on the conceptual network obtained in chapter 3. 6. Amodel of concept acquisition and semantic growth based on frequency of concepts. 7. Study of the lexical access impairment in three different neurodegenerative conditions: Multiple Sclerosis, Mild Cognitive Impairment and Alzheimer’s disease. 8. General conclusions and outlook of this work.

Objective: to evaluate the usefulness of a non-invasive clinical score to predict liver fibrosis in the steatosis associated with morbid obesity. Patients and methods: we included 88 patients, who underwent bariatric surgery in the Sanitary Area of León, Spain, and who showed a liver biopsy with steatosis greater than 5%. This is a retrospective study in which the rate of fibrosis is calculated from tests performed during the preoperative period, and is then compared to data from intraoperative hepatic biopsies. The analysis population was grouped according to the presence of advanced fibrosis in the liver biopsy (grade 3-4) or its absence (grade 0-2). The cutoff used for diagnosing advanced fibrosis was 0.676 (high cutoff point), and the cutoff point to exclude advanced fibrosis was -1.455 (low cutoff). Results: the prevalence of advanced fibrosis in the histological samples was 5.5%, and 65.9% of patients had no fibrosis. The cutoff for a low negative predictive value was 100%, and sensitivity was 100%. The cutoff point for a high positive predictive value was 1.7%, and specificity was 31.3%. Conclusions: this scoring system for morbidly obese patients eligible for bariatric surgery allows to identify those without advanced fibrosis, but cannot predict who may have advanced fibrosis. Objetivo: evaluar la utilidad de un índice de puntuación clínica no invasivo para predecir fibrosis hepática en la esteatosis asociada a la obesidad mórbida. Pacientes y métodos: se incluyeron 88 pacientes, intervenidos de cirugía bariátrica en el área sanitaria de León, que presentaron en la biopsia hepática una esteatosis mayor del 5%. Se trata de un estudio retrospectivo en el que se calculó el índice de fibrosis a partir de los datos analíticos del preoperatorio, y se comparó su resultado con los datos de la biopsia hepática intraoperatoria realizada. Para el análisis los pacientes fueron agrupados según presentaban en la biopsia hepática fibrosis avanzada (grado 3-4) o no (grado 0-2). El punto de corte usado para diagnosticar fibrosis avanzada fue 0,676 (punto de corte alto), y el punto de corte para excluir fibrosis avanzada fue -1,455 (punto de corte bajo). Resultados: la prevalencia de fibrosis avanzada en las muestras histológicas fue del 5,5% y el 65,9% de los pacientes no presentaban fibrosis. Para el punto de corte bajo el valor predictivo negativo fue del 100% y la sensibilidad del 100%. Para el punto de corte alto el valor predictivo positivo fue del 1,7% y la especificidad del 31,3%. Conclusiones: el sistema de puntuación analizado permite, en los pacientes con obesidad mórbida candidatos a cirugía bariátrica, detectar aquellos sin fibrosis avanzada, pero no permite predecir aquellos que pueden tener una fibrosis avanzada.

This study reveals the occurrence of Phalaris coerulescens communities both in Portugal and the south of Andalusia (Spain). These grasslands present a variable cover ratio and have an average dominant vegetation size of about 100 cm. They tend to occur in river beds and in places which are sometimes water-logged, with a certain amount of organic matter inducing the occurrence of nitrophilous companion species. The soils are always siliceous, very poor in carbonates, but with a high proportion of sand. Consequently, flooding never lasts for long. The grasslands of Portugal are located in the Marianic-Monchiquensean unit, within the series of Pyro bourgaeanae-Queceto rotundifoliae s. and Poterio agrimonioidis-Querceto suberis s. The new Senecio foliosi-Phalaridetum coerulescentis is characterized by Senecio jacobaea var foliosus, meanwhile, in the the south of Andalusia, the Hedysaro coronarii-Phalaridetum coerulescentis is described for the Aljibic and Gaditan-Onubensean Sectors, and, in the Rondean and Bermejensean areas, the Elymo repentis-Phalaridetum coerulescentis. These associations are included in the Gaudinio fragilis-Hordeion bulbosi alliance.

The fractal dimension (FD) is a quantitative parameter that characterizes the morphometric variability of a complex object. Among other applications, FD has been used to identify abnormalities of the human brain in conventional magnetic resonance imaging (MRI), including white matter abnormalities in patients with Multiple Sclerosis (MS). Extensive grey matter (GM) pathology has been recently identified in MS and it appears to be a key factor in long-term disability. The aim of the present work was to assess whether FD measurement of GM in T1 MRI sequences can identify GM abnormalities in patients with MS in the early phase of the disease. A voxel-based morphometry approach optimized for MS was used to obtain the segmented brain, where we later calculated the three-dimensional FD of the GM in MS patients and healthy controls.We found that patients with MS had a significant increase in the FD of the GM compared to controls. Such differences were present even in patients with short disease durations, including patients with first attacks of MS. In addition, the FD of the GM correlated with T1 and T2 lesion load, but not with GM atrophy or disability. The FD abnormalities of the GM here detected differed from the previously published FD of the white matter in MS, suggesting that different pathological processes were taking place in each structure. These results indicate that GM morphology is abnormal in patients with MS and that this alteration appears early in the course of the disease.

This paper describes the participation of the MIRACLE consortium at the ImageCLEF Photographic Retrieval task of ImageCLEF 2008. In this is new participation of the group, our first purpose is to evaluate our own tools for text-based retrieval and for content-based retrieval using different similarity metrics and the aggregation OWA operator to fuse the three topic images. From the MIRACLE last year experience, we implemented a new merging module combining the text-based and the content-based information in three different ways: FILTER-N, ENRICH and TEXT-FILTER. The former approaches try to improve the text-based baseline results using the content-based results lists. The last one was used to select the relevant images to the content-based module. No clustering strategies were analyzed. Finally, 41 runs were submitted: 1 for the text-based baseline, 10 content-based runs, and 30 mixed experiments merging text and content-based results. Results in general can be considered nearly acceptable comparing with the best results of other groups. Obtained results from textbased retrieval are better than content-based. Merging both textual and visual retrieval we improve the text-based baseline when applying the ENRICH merging algorithm although visual results are lower than textual ones. From these results we were going to try to improve merged results by clustering methods applied to this image collection.

Objectives: we analyzed the characteristics of patients with gastric tumors diagnosed with multiple malignant primary neoplasm (MMPN) in the Health District of León. Material and methods: using the information in the Tumor Registry at León Hospital patients selected were those with gastric neoplasms diagnosed between 1993 and 2002. A follow-up was performed until December 31, 2004, and the characteristics of patients diagnosed with a second neoplasm were analyzed. Results: MMPN prevalence was 1,96%; 56% of patients had a history of cancer in first-degree relatives. The most frequent second neoplasms were digestive (26%) and urologic (21%); 87% of patients were diagnosed with a second neoplasm within the first two years. No significative differences in survival were observed among patients with synchronous or metachronous MMPN. Conclusions: MMPN in patients with gastric neoplasms is a relevant problem. While external carcinogenic agents could act as promoters in the development of second neoplasms, these patients seem to have a genetic background favoring the development of MMPN. Secondary prevention is the best measure to avoid MMPN development. Objetivos: analizar las características de los pacientes con tumores gástricos diagnosticados de una neoplasia primaria maligna múltiple (NPMM) en el área sanitaria de León. Pacientes y método: utilizando los datos del Registro de Tumores del Hospital de León se han seleccionado aquellos pacientes con tumores gástricos diagnosticados entre 1993 y 2002. Se realizó un seguimiento hasta el 31 de diciembre de 2004 analizando las características de los pacientes diagnosticados de una segunda neoplasia durante el periodo de seguimiento. Resultados: la prevalencia de NPMM fue del 1,96%. El 56% de los pacientes tenían antecedentes oncológicos en familiares de primer grado. Las segundas neoplasias más frecuentes fueron las digestivas (26%) y las urológicas (21%). El 87% de los pacientes fueron diagnosticados del segundo tumor en los primeros dos años. No se observaron diferencias respecto a la supervivencia entre los pacientes con NPMM sincrónicas y metacrónicas. Conclusiones: las NPMM en los pacientes con cáncer gástrico son un problema relevante. Aunque los agentes carcinógenos externos puedan actuar como promotores en el desarrollo de una segunda neoplasia, en estos pacientes parece existir una base genética que favorece el desarrollo del una NPMM. La prevención secundaria es la mejor medida para evitar el desarrollo de una NPMM.

La Universidad está viviendo un proceso de construcción o reconstrucción de su identidad a partir de cambios internos y externos buscando transformarse y adaptarse a las necesidades de la sociedad actual. Esta búsqueda de identidad, de prestigio y consideración social es una constante que está presente en las reformas universitarias, en las directrices de la UNESCO y en las normativas europeas de los últimos años. Hay que tener en cuenta que la misión de la universidad ha ido transformándose en un proceso de cambio que está influido y condicionado por los cambios políticos, sociales, económicos y del mundo del trabajo. Esta transformación es necesaria si no quiere convertirse en anacrónica o sobrevivir de espaldas a la sociedad que es quien le da sentido. Aunque hay que advertir que a menudo se confunde sociedad con poderes fácticos, políticos y económicos, que sólo en parte la representan. Desde nuestra perspectiva la universidad debe ser el «templo» de la cultura y de la ciencia, de la reflexión intelectual y de la formación humana en su plenitud. Aunque también es cierto, que cada vez más se va decantando hacia la profesionalización, hacia la formación de «trabajadores especializados » que puedan acceder a profesiones y puestos de trabajo al terminar sus estudios...

La obstrucción gastroduodenal neoplásica puede causar una significativa morbilidad. La inserción de prótesis enterales como tratamiento paliativo es una aceptable opción para conseguir un adecuado vaciamiento gástrico sin la morbilidad asociada a la cirugía paliativa, con menor mortalidad relacionada con el procedimiento y menor coste, proporcionando una mejor calidad de vida. Es importante unificar y consolidar la técnica endoscópica de colocación de las prótesis enterales evitando variaciones que impidan un adecuado análisis de los resultados de esta técnica. Malignant gastroduodenal obstruction may cause significant morbidity. Insertion of enteral prostheses as a palliative treatment is an acceptable option to achieve an appropriate gastric voiding without the morbidity associated to palliative surgery, with a lesser procedure-related mortality and a lower cost, while providing a better quality of life. Its is important to unify and consolidate the endoscopic procedure for the placement of enteral prostheses, avoiding variations that may preclude an adequate analysis of this procedure outcome.

La obstrucción gastroduodenal neoplásica puede causar una significativa morbilidad. La inserción de prótesis enterales como tratamiento paliativo es una aceptable opción para conseguir un adecuado vaciamiento gástrico sin la morbilidad asociada a la cirugía paliativa, con menor mortalidad relacionada con el procedimiento y menor coste, proporcionando una mejor calidad de vida. Es importante unificar y consolidar la técnica endoscópica de colocación de las prótesis enterales evitando variaciones que impidan un adecuado análisis de los resultados de esta técnica.