11251
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Kambadakone A, Thabet A, Gervais DA, Mueller PR, Arellano RS. CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics 2012; 31:1599-621. [PMID: 21997984 DOI: 10.1148/rg.316115526] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The celiac plexus is the largest visceral plexus and is located deep in the retroperitoneum, over the anterolateral surface of the aorta and around the origin of the celiac trunk. It serves as a relay center for nociceptive impulses that originate from the upper abdominal viscera, from the stomach to the proximal transverse colon. Celiac plexus neurolysis, with agents such as ethanol, is an effective means of diminishing pain that arises from these structures. Percutaneous imaging-guided celiac plexus neurolysis has been established as an invaluable therapeutic option in the management of intractable abdominal pain in patients with upper abdominal malignancy. The use of multidetector computed tomography (CT) for imaging guidance has superseded other modalities and allows direct visualization of the spread of the neurolytic agent in the antecrural space. Accurate depiction of the retroperitoneal anatomy and the position of the needle tip helps avoid crucial anatomic structures such as the pancreas, aorta, celiac artery, and superior mesenteric artery. Proper patient education, meticulous preprocedure planning, use of optimal multidetector CT techniques, adjunctive CT maneuvers, and postprocedure care are integral to successful celiac plexus neurolysis. Celiac plexus neurolysis does not completely abolish pain; rather, it diminishes pain, helping to reduce opioid requirements and their related side effects and improving survival in patients with upper abdominal malignancy.
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Affiliation(s)
- Avinash Kambadakone
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA
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11252
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[The Alliance for the Prevention of Colorectal Cancer in Spain. A civil commitment to society]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:109-28. [PMID: 22365571 DOI: 10.1016/j.gastrohep.2012.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 01/20/2012] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) is the most common malignant tumor in Spain, when men and women are considered together, and the second leading cause of cancer death. Every week in Spain over 500 cases of CRC are diagnosed, and nearly 260 people die from the disease. Epidemiologic estimations for the coming years show a significant increase in the number of annual cases. CRC is a perfectly preventable tumor and can be cured in 90% of cases if detected in the early stages. Population-based screening programs have been shown to reduce the incidence of CRC and mortality from the disease. Unless early detection programs are established in Spain, it is estimated that in the coming years, 1 out of 20 men and 1 out of 30 women will develop CRC before the age of 75. The Alliance for the Prevention of Colorectal Cancer in Spain is an independent and non-profit organization created in 2008 that integrates patients' associations, altruistic non-governmental organizations and scientific societies. Its main objective is to raise awareness and disseminate information on the social and healthcare importance of CRC in Spain and to promote screening measures, early detection and prevention programs. Health professionals, scientific societies, healthcare institutions and civil society should be sensitized to this highly important health problem that requires the participation of all sectors of society. The early detection of CRC is an issue that affects the whole of society and therefore it is imperative for all sectors to work together.
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11253
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Unruh BT, Nejad SH, Stern TW, Stern TA. Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies. Prim Care Companion CNS Disord 2012; 14:11f01192. [PMID: 22690353 DOI: 10.4088/pcc.11f01192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/18/2011] [Indexed: 12/17/2022] Open
Abstract
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts.Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article.
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11254
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Koulaouzidis A, Douglas S, Plevris JN. Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy. World J Gastrointest Endosc 2012; 4:33-7. [PMID: 22347530 PMCID: PMC3280353 DOI: 10.4253/wjge.v4.i2.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/16/2012] [Accepted: 02/06/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To check the usefulness of blue mode (BM) review in lewis score (LS) calculation, by comparing it with respective LS results obtained by white light (WL) small-bowel capsule endoscopy (SBCE) review and mucosal inflammation as reflected by faecal calprotectin (FC) levels, considered as ‘gold standard’ for this study.
METHODS: Computational analysis of our SBCE database to identify patients who underwent SBCE with PillCam® and had FC measured within a 30-day period from their test. Only patients with prior colonoscopy were included, to exclude any colon pathology-associated FC rise. Each small bowel tertile was reviewed (viewing speed 8 fps) with WL and BM, in a back-to-back mode, by a single experienced reviewer. LS were calculated after each WL and BM reviews. Pearson rank correlation (rho, r) statistic was applied.
RESULTS: Twenty-seven (n = 27, 20F/7M) patients were included. Thirteen (n = 13) had SBCE with PillCam®SB1, and the remainder (n = 14) with PillCam®SB2. The median level of FC in this cohort was 125 μg/g. LS (calculated in WL SBCE review) correlation with FC levels was r = 0.490 (P = 0.01), while for BM review and LS correlation with FC was r = 0.472 (P = 0.013).
CONCLUSION: Although BM is believed to enhance mucosal details i.e., small mucosal breaks, it did not perform better than WL in the calculation of LS in our cohort.
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Affiliation(s)
- Anastasios Koulaouzidis
- Anastasios Koulaouzidis, Sarah Douglas, John N Plevris, Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland, United Kingdom
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11255
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Nicolás-Pérez D. [Endoscopic submucosal dissection: only for expert endoscopists?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:344-67. [PMID: 22341600 DOI: 10.1016/j.gastrohep.2011.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 12/29/2011] [Indexed: 12/16/2022]
Abstract
Endoscopic submucosal dissection (ESD) can be applied to early gastrointestinal cancers. This technique was developed to achieve radical curative resection and to reduce unnecessary surgical interventions. ESD was designed in eastern countries and is not widely used in the West. Although ESD represents a major therapeutic advance in endoscopy and is performed with curative intent, the complication rate (hemorrhage, perforation) is higher than reported in other techniques, requiring from endoscopists the acquirement of technical skill and experience through a structured and progressive training program to reduce the morbidity associated with this technique and increase its potential benefits. Although there is substantial published evidence on the applications and results of ESD, there are few publications on training in this technique and a standardized training program is lacking. The current article aims to describe the various proposals for training, as well as the basic principles of the technique, its indications, and the results obtained, since theoretical knowledge that would guide endoscopists during the clinical application of ESD is advisable before training begins. Training in an endoscopic technique has a little value without knowledge of the technique's aims, the situations in which it should be applied, and the results that can be expected.
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Affiliation(s)
- David Nicolás-Pérez
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
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11256
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Abstract
The frequency of endoscopic complications is likely to rise owing to the increased number of indications for therapeutic procedures and also to the increased complexity of endoscopic techniques. Informed patient consent should be obtained as part of the procedure. Prevention of endoscopic adverse events is based on knowledge of the relevant risk factors and their mechanisms of occurrence. Thus, suitable training of future gastroenterologists and endoscopists is required for these complex procedures. When facing a complication, appropriate management is generally provided by an early diagnosis followed by prompt therapeutic care tailored to the situation. The most common complications of diagnostic and therapeutic upper gastrointestinal endoscopy, retrograde cholangiopancreatography, small bowel endoscopy and colonoscopy are reviewed here. Different modalities of medical, endoscopic or surgical management are also considered.
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Affiliation(s)
- Daniel Blero
- ISPPC, 1 Boulevard Zoé Drion, 6000 Charleroi, Belgium.
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11257
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Testerman GM, Osborne JB, Easparam SA. Endoscopic Clipping of Bleeding Ascending Colon Dieulafoy Lesion. Am Surg 2012. [DOI: 10.1177/000313481207800207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George M. Testerman
- Holston Valley Hospital Trauma Center ETSU Department of Surgery Kingsport, Tennessee
| | - James B. Osborne
- Holston Valley Hospital Trauma Center ETSU Department of Surgery Kingsport, Tennessee
| | - Sarah A. Easparam
- Holston Valley Hospital Trauma Center ETSU Department of Surgery Kingsport, Tennessee
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11258
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Kawakami H, Maguchi H, Mukai T, Hayashi T, Sasaki T, Isayama H, Nakai Y, Yasuda I, Irisawa A, Niido T, Okabe Y, Ryozawa S, Itoi T, Hanada K, Kikuyama M, Arisaka Y, Kikuchi S. A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study. Gastrointest Endosc 2012; 75:362-72, 372.e1. [PMID: 22248605 DOI: 10.1016/j.gie.2011.10.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 10/10/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Wire-guided cannulation (WGC) with a sphincterotome (S) for selective bile duct cannulation (SBDC) has been reported to have a higher success rate and lower incidence of post-ERCP pancreatitis (PEP) than conventional methods in some randomized, controlled trials (RCTs) that were both single center and limited to only a few endoscopists. OBJECTIVE To estimate the difference in SBDC according to the method and catheter used in a multicenter and multiendoscopist study. DESIGN A prospective, multicenter RCT with a 2 × 2 factorial design. SETTING Fifteen referral endoscopy units. PATIENTS In total, 400 consecutive patients with naive papillae who were candidates for ERCP were enrolled and randomized. INTERVENTIONS Patients were assigned to 4 groups according to combined catheter (S or catheter [C]) and method (with/without guidewire [GW]). MAIN OUTCOME MEASUREMENTS Success rate of SBDC performed in 10 minutes, SBDC time, fluoroscopy time, and incidence of complications. RESULTS There was no significant difference in the SBDC success rate between the groups with and without GW, between C and S, or among the 4 groups (C+GW, C, S+GW, S). WGC had a tendency to significantly shorten cannulation and fluoroscopy times only in approximately 70% of patients in this study in whom SBDC was achieved in 10 minutes or less (P = .036 and .00004, respectively). All 4 groups resulted in similar outcomes in PEP (4%, 5.9%, 2%, and 2.1%, respectively). LIMITATIONS Non-double-blind study. CONCLUSIONS WGC appears to significantly shorten cannulation and fluoroscopy times. However, neither the method nor type of catheter used resulted in significant differences in either SBDC success rate or incidence of PEP in this RCT. ( CLINICAL TRIAL REGISTRATION NUMBER UMIN000002572.).
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Affiliation(s)
- Hiroshi Kawakami
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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11259
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Fottner C, Weber MM. [Neuroendocrine neoplasms of the gastrointestinal tract. Classification, clinical presentation and diagnosis]. Internist (Berl) 2012; 53:131-44. [PMID: 22290317 DOI: 10.1007/s00108-011-2916-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Neuroendocrine neoplasms of the digestive system represent a rare and heterogeneous group of malignancies with various clinical presentations and prognoses. The WHO classification for the year 2000 was updated in 2010 to take the histopathology and tumor biology of these tumors into account. Together with proliferation-based grading and the recently established staging system using the ENETS TNM classification, it forms the basis for the further diagnostic and therapeutic approach. Clinical presentation depends mainly on the primary site of the tumor and its functionality. Characteristic symptoms are seen only rarely, this being the reason these tumors are usually detected at an advanced stage. Approximately 30% of GEP-NEN are hormonally active and can cause a specific clinical syndrome. In addition to these specific hormones, chromogranin A is considered the most accurate general marker for the biochemical follow-up of these patients. In addition to commonly used radiological and endoscopic imaging modalities, somatostatin receptor-based functional imaging using either octreotide scintigraphy or novel PET-based techniques with specific isotopes such as Ga68-DOTA-octreotate play a crucial role in the detection of the primary tumor as well as in the evaluation of tumor extent and the selection of patients for receptor-based radionuclide therapy.
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Affiliation(s)
- C Fottner
- Schwerpunkt Endokrinologie und Stoffwechselerkrankungen, I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstrasse 1, Mainz
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11260
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Abstract
Osseous metaplasia within the gastrointestinal tract is rare and occurs in benign, premalignant, and malignant neoplasms. Here, we report the youngest case of an adenomatous polyp with the presence of ossification and a concomitant review of the literature with regard to ossification of colonic polyps. A 28-year-old man underwent colonoscopy for 8 months of rectal bleeding. A 4.5-cm pedunculated polyp was found in the descending colon and excised. Histological examination showed adenomatous change with an area of calcification and osteoid formation. Ossification of colonic polyps is mainly associated with the clinical symptom of bleeding and may warrant consideration as a high-risk feature.
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11261
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Confocal endomicroscopy of colorectal polyps. Gastroenterol Res Pract 2012; 2012:545679. [PMID: 22319524 PMCID: PMC3272798 DOI: 10.1155/2012/545679] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/21/2011] [Indexed: 01/04/2023] Open
Abstract
Confocal laser endomicroscopy (CLE) is one of several novel methods that provide real-time, high-resolution imaging at a micron scale via endoscopes. CLE has the potential to be a disruptive technology in that it can change the current algorithms that depend on biopsy to perform surveillance of high-risk conditions. Furthermore, it allows on-table decision making that has the potential to guide therapy in real time and reduce the need for repeated procedures. CLE and related technologies are often termed “virtual biopsy” as they simulate the images seen in traditional histology. However, the imaging of living tissue allows more than just pragmatic convenience; it also allows imaging of living tissue such as active capillary circulation, cellular death, and vascular and endothelial translocation, thus extending beyond what is capable in traditional biopsy. Immediate potential applications of CLE are to guide biopsy sampling in Barrett's esophagus and inflammatory bowel disease surveillance, evaluation of colorectal polyps, and intraductal imaging of the pancreas and bile duct. Data on these applications is rapidly emerging, and more is needed to clearly demonstrate the optimal applications of CLE. In this paper, we will focus on the role of CLE as applied to colorectal polyps detected during colonoscopy.
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11262
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Muraki Y, Enomoto S, Iguchi M, Fujishiro M, Yahagi N, Ichinose M. Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection. World J Gastrointest Endosc 2012; 4:1-8. [PMID: 22267977 PMCID: PMC3262173 DOI: 10.4253/wjge.v4.i1.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 11/06/2011] [Accepted: 01/12/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharmacotherapy during the healing process are essential.
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Affiliation(s)
- Yosuke Muraki
- Yosuke Muraki, Shotaro Enomoto, Mikitaka Iguchi, Masao Ichinose, Second Department of Internal Medicine, Wakayama Medical University, Wakayama-city, Wakayama 641-0012, Japan
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11263
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Hussain A, Obaid S, El-Hasani S. Bouveret's syndrome: endoscopic or surgical treatment. Updates Surg 2012; 65:63-5. [PMID: 22238074 DOI: 10.1007/s13304-011-0131-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 12/28/2011] [Indexed: 12/22/2022]
Affiliation(s)
- A Hussain
- General Surgery Department, Princess Royal University Hospital, Greater London, UK.
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11264
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Temiz A, Oguzkurt P, Ezer SS, Ince E, Gezer HO, Hicsonmez A. Management of pyloric stricture in children: endoscopic balloon dilatation and surgery. Surg Endosc 2012; 26:1903-8. [PMID: 22234589 DOI: 10.1007/s00464-011-2124-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/05/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical correction is the most preferred treatment modality in pyloric stricture (PS). Recently a few studies reported the experience of balloon dilation in children with PS. This study was designed to present our experiences of the management of the patients with PS with balloon dilation and corrective surgery. METHODS The records of 14 patients who were treated with the diagnosis of PS between August 2003 and August 2011 were reviewed retrospectively. RESULTS There were nine boys and five girls (mean age, 3.4 ± 1.7 years). The history of caustic ingestion was detected in eight patients; six of them were admitted on the day of ingestion. Two patients were admitted with nonbilious vomiting more than 2 weeks after ingestion. Four patients did not have a remarkable medical history, including caustic ingestion. They admitted with the complaint of nonbilious vomiting. PS was detected during endoscopy in two patients who had a diagnosis of peptic ulcer disease. PS was shown by barium meal study in all patients. Endoscopy was performed in all patients. Endoscopic balloon dilation was tried in 12 patients. Overall eight patients required surgical procedures for PS. The complaints were resolved by endoscopic balloon dilation of pylorus in the remaining six patients. CONCLUSIONS Although endoscopic balloon dilatation for benign PS in adults is a generally accepted method of treatment, there is less experience with endoscopic balloon dilatation for PS in children. PS due to benign disorders can be effectively and successfully treated through endoscopic balloon dilatation in suitable patients. In patients with successful pyloric balloon dilatation, surgery can be avoided.
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Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
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11265
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Bravo G, Arcand M, Blanchette D, Boire-Lavigne AM, Dubois MF, Guay M, Hottin P, Lane J, Lauzon J, Bellemare S. Promoting advance planning for health care and research among older adults: a randomized controlled trial. BMC Med Ethics 2012; 13:1. [PMID: 22221980 PMCID: PMC3328256 DOI: 10.1186/1472-6939-13-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 01/05/2012] [Indexed: 01/25/2023] Open
Abstract
Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. Discussion This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial Registration ISRCTN89993391
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Affiliation(s)
- Gina Bravo
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.
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11266
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Leung FW, Aljebreen A. Health care providers' acceptance of unsedated colonoscopy before and after a state-of-the-art lecture on the feasibility of the option. Saudi J Gastroenterol 2012; 18:50-4. [PMID: 22249093 PMCID: PMC3271695 DOI: 10.4103/1319-3767.91736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/AIM The impact of education on acceptance of unsedated colonoscopy by health care providers is unknown. To test the hypothesis that knowledge imparted by a lecture on unsedated colonoscopy is associated with its enhanced acceptance. SETTINGS AND DESIGN At the State-of-the-Art Lecture on "Unsedated colonoscopy: Is it feasible?" presented at the 8 th Pan-Arab Conference on Gastroenterology, February, 2011, Riyadh, Saudi Arabia, a questionnaire survey of the audience was undertaken. MATERIALS AND METHODS An expectation questionnaire was administered before and after the lecture. Attendees responded anonymously. STATISTICAL ANALYSIS USED The responses of a convenient sample of 49 attendees who provided completed responses to the questionnaire both before and after the lecture were analyzed. Data are expressed as frequency counts and means±SEM. Repeated measures analysis of variance (ANOVA), ANOVA with contrasts and Chi-square analysis (Statview II Program for Macintosh computers) were used to assess the data. A P value of <0.05 is considered significant. RESULTS AND CONCLUSIONS The mean±SEM credibility score (maximum possible score=50) was 25.8 ± 1.8 before and 33.3 ± 2.1 after the lecture, with a significant improvement in mean score of 7.5 ± 1.3 (P=0.001, paired t test). Nineteen (39%) respondents were not willing to consider unsedated colonoscopy for themselves before the lecture. This number decreased to 13 (27%) after the lecture. Before the lecture only 4 (8%) respondents were willing to consider unsedated colonoscopy for themselves. After the lecture this number increased to 8 (16%). The data suggest education of healthcare professionals regarding the feasibility of unsedated colonoscopy appears to enhance its acceptance as a credible patient care option at a Pan-Arab Gastroenterology Conference.
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Affiliation(s)
- Felix W. Leung
- The Research and Medical Services, Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, CA,David Geffen School of Medicine at UCLA, Los Angeles, CA,Address for correspondence: Prof. Felix W. Leung, 111G, Sepulveda Ambulatory Care Center, VAGLAHS, 16111 Plummer Street, North Hills, CA 91343. E-mail:
| | - Abdulrahman Aljebreen
- King Khalid University Hospital, KSU, Internal Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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11267
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Moreels TG. Small bowel enteroscopy in Crohn's disease. Ann Gastroenterol 2012; 25:14-20. [PMID: 24713796 PMCID: PMC3959356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/10/2011] [Indexed: 11/24/2022] Open
Abstract
Endoscopic assessment of the small bowel is difficult because of its long and tortuous anatomy. However, recent developments have greatly improved the insertion depth and diagnostic yield, by means of device-assisted enteroscopy (DAE). Therefore, DAE may be of specific interest in the diagnostic and therapeutic approach of patients with inflammatory bowel disease. It may be of help in the diagnostic assessment of intestinal disease extent and severity and complications, with an impact on the therapeutic management. Moreover, local treatment within the small bowel is also feasible with DAE. This review aims to provide an overview of the currently available literature data on the use of enteroscopy in inflammatory bowel disease, and Crohn's disease in particular.
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Affiliation(s)
- Tom G. Moreels
- Division of Gastroenterology & Hepatology, Antwerp University Hospital, Belgium,
Correspondence to: Tom G. Moreels, Antwerp University Hospital, Division of Gastroenterology & Hepatology, Wilrijkstraat 10, B-2650 Antwerp, Belgium, Tel: +32-3-821 4974, Fax: +32-3-821 4478, e-mail:
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11268
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Katsinelos P, Gatopoulou A, Gkagkalis S, Fasoulas K, Beltsis A, Zavos C, Terzoudis S, Lazaraki G, Chatzimavroudis G, Vasiliadis I, Kountouras J. A prospective analysis of factors influencing fluoroscopy time during therapeutic ERCP. Ann Gastroenterol 2012; 25:338-344. [PMID: 24714062 PMCID: PMC3959413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/25/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fluoroscopy time (FT) in endoscopic retrograde cholangiopancreatography (ERCP) has a linear relationship with radiation exposure to endoscopist, personnel and patients. The aim of this prospective study was to investigate the factors influencing the FT during ERCP. PATIENTS AND METHODS Between January 2010 and August 2011, patients with naïve papilla undergoing therapeutic ERCP were included in the study. Patient and procedural factors affecting fluoroscopy duration were investigated. RESULTS During the study period 549 ERCP records were included in the final analysis. The mean procedural time and FT were 19.53±7.61 min and 48.82±26.43 sec, respectively. There was no effect of age or gender on FT. Univariate analysis showed choledocholithiasis (+17.92 sec; 95%CI: 12.73-23.11, p<0.001), multiple stones (+21.21 sec; 95%CI: 14.31-30.35, p<0.001), stone size >10 mm (+27.514 sec; 95%CI: 16.62-35.71; p<0.001), precut technique (+12.46 sec; 95%CI: 6.32-18.60; p<0.001), periampullary diverticulum (+33.36 sec; 95%CI: 28.49-38.23; p<0.001), mechanical lithotripsy (+31.14 sec; 95%CI: 24.67-37.61; p<0.001) and mechanical lithotripsy plus stent placement (+42.41 sec; 95%CI: 31.93-52.89; p<0.001) to be associated with longer FT. Multivariate analysis identified choledocholithiasis (+13.24 sec; 95%CI: 4.44-22.04; p=0.003), multiple stones (+19.51 sec; 95%CI: 11.72-26.78; p<0.001), stone size >10 mm (+23.95 sec; 95%CI: 14.35-29.45; p<0.001), needle-knife papillotomy (+17.26 sec; 95%CI: 7.77-26.75; p<0.001), periampullary diverticulum (+21.99 sec; 95%CI: 17.81-26.16; p<0.001) and mechanical lithotripsy plus stent placement (+20.39 sec; 95%CI: 7.38-33.40; p=0.002) to prolong FT. CONCLUSIONS The identified factors influencing the FT may help endoscopists take appropriate precautions during ERCP to significantly decrease FTs.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Anthi Gatopoulou
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Stergios Gkagkalis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Athanasios Beltsis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Christos Zavos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras)
| | - Sotiris Terzoudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Ioannis Vasiliadis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras)
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11269
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Albert JG. Interventional balloon-enteroscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:42-50. [PMID: 22586550 DOI: 10.4161/jig.20134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 12/16/2011] [Accepted: 12/18/2011] [Indexed: 12/20/2022]
Abstract
Balloon assisted enteroscopy (BE) expands greatly the therapeutic options in interventional endoscopy; bleeding sites, strictures, polyps, and other small bowel lesions are increasingly been treated by use of BE in the last 10 years. Treatment options for small bowel bleeding include Argon plasma coagulation (APC), injection therapy, and application of TTS metal clips, and thereby bleeding is stopped in most cases. Dilating symptomatic strictures, resecting polyps as seen in Peutz-Jeghers syndrome (PJS), and removing foreign bodies, BE carries most endoscopic treatment techniques to the small bowel. Another new indication field for BE are interventions at the biliary system in patients with surgically modified anatomy such as Roux-Y anastomosis. This review offers a full overview on indications of BE and refers to the practical use of the method for all endoscopic interventions.
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Affiliation(s)
- Jörg G Albert
- Department of Medicine I, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
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11270
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Chibishev A, Pereska Z, Chibisheva V, Simonovska N. Corrosive poisonings in adults. Mater Sociomed 2012; 24:125-30. [PMID: 23678319 PMCID: PMC3633385 DOI: 10.5455/msm.2012.24.125-130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/15/2012] [Indexed: 12/23/2022] Open
Abstract
Ingestion of corrosive substances may cause severe to serious injuries of the upper gastrointestinal tract and the poisoning can even result in death. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. The golden standard for determination of the grade and extent of the lesion is esophagogastroduodenoscopy performed in the first 12-24 hours following corrosive ingestion. The most common late complications are esophageal stenosis, gastric stenosis of the antrum and pyloris, and rarely carcinoma of the upper gastrointestinal tract. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery.
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Affiliation(s)
- Andon Chibishev
- University Clinic of Toxicology, Clinical Center Skopje, Republic of Macedonia
| | - Zanina Pereska
- University Clinic of Toxicology, Clinical Center Skopje, Republic of Macedonia
| | - Vesna Chibisheva
- University “Ss Cyril and Metodius”, Medical faculty, Skopje, Republic of Macedonia
| | - Natasa Simonovska
- University Clinic of Toxicology, Clinical Center Skopje, Republic of Macedonia
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11271
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Xouris D, Vafiadis-Zoumbulis I, Papaxoinis K, Bamias G, Karamanolis G, Vlachogiannakos J, Ladas SD. Possible Strongyloides stercoralis infection diagnosed by videocapsule endoscopy in an immunocompetent patient with devastating diarrhea. Ann Gastroenterol 2012; 25:268-270. [PMID: 24713813 PMCID: PMC3959373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 03/19/2012] [Indexed: 11/02/2022] Open
Abstract
Strongyloides stercoralis is an endemic parasitic infection of tropical areas, but it is rare in Europe. Most infected immunocompetent patients are asymptomatic, but may present with abdominal pain and diarrhea even several years after acquiring the infection. However, in immunocompromized patients, hyperinfection syndrome has a high mortality rate. Risk factors for the hyperinfection syndrome are corticosteroids and infection with human T lymphotropic virus type 1. Diagnosis of strongyloidiasis is usually made by identifying the larvae in the stool or in duodenal biopsies. There are only four published cases of strongyloidiasis in Greek patients, three of them were immunocompromized. In our patient videocapsule endoscopy identified rhabditiform larvae suggestive of strongyloidiasis. This case report illustrates the difficulty in establishing a diagnosis of the disease in immunocompetent patients.
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Affiliation(s)
- Dimitrios Xouris
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Irene Vafiadis-Zoumbulis
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Kostis Papaxoinis
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Giorgos Bamias
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - George Karamanolis
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Janis Vlachogiannakos
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Spiros D. Ladas
- Gastroenterology Division, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece,
Correspondence to: Prof. Spiros D. Ladas, 1st Department of Medicine-Propaedeutic, National & Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, 17 Ag. Thoma Street, Athens 115 27, Greece, Tel: 0030 213 2061061, 0030 213 2061307, Fax: 0030 210 7791839,e-mail:
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11272
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Reversal of Jaundice in Two Patients with Inoperable Cholangiocarcinoma Treated with Cisplatin and Gemcitabine Combination. Case Reports Hepatol 2012; 2012:138381. [PMID: 25954551 PMCID: PMC4412096 DOI: 10.1155/2012/138381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 01/17/2012] [Indexed: 11/23/2022] Open
Abstract
Two patients are presented with severe jaundice, due to inoperable cholangiocarcinoma. The chemotherapeutic approach in patients with severe jaundice is discussed. Many schedules of chemotherapy were developed in this tumor type with normal serum bilirubin. We report here the first successful use of cisplatin and gemcitabine combination chemotherapy in these patients. Tolerability was good and liver function tests gradually improved.
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11273
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Rana SS, Bhasin DK, Rao C, Singh K. Role of endoscopic ultrasound in idiopathic acute pancreatitis with negative ultrasound, computed tomography, and magnetic resonance cholangiopancreatography. Ann Gastroenterol 2012; 25:133-137. [PMID: 24714266 PMCID: PMC3959389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 01/31/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Idiopathic acute pancreatitis (IAP) is a diagnostic challenge. Finding a treatable cause after appropriate investigation may help to prevent recurrent pancreatitis and further management. The aim of our study was to retrospectively report our experience with endoscopic ultrasound (EUS) in investigating patients with IAP. METHODS Forty patients (26 males; age range: 17-72 years) of IAP with no underlying cause identified on transabdominal ultrasound, computed tomography and magnetic resonance cholangiopancreatography were studied. In 23 patients (57.5%), it was the first attack of acute pancreatitis whereas in 17 patients (42.5%) there was at least one previous attack of documented acute pancreatitis. EUS examination was done using a radial echoendoscope. RESULTS Twenty (50%) of the patients had biliary tract disease (cholelithiasis in 3, gallbladder sludge in 13, choledocholithiasis in 1 and common bile duct sludge in 3 patients). One each had an 8 mm tumor in the head of pancreas and pancreas divisum. No underlying cause could be found in 18 (45%) patients. Nine patients had features of chronic pancreatitis (CP) and the remaining had a normal pancreas. CONCLUSIONS Occult biliary pathology is the predominant cause of IAP. Half of the cases without identified etiology already had an underlying CP. EUS is a very important tool in evaluating IAP especially after an initial negative diagnostic workup.
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Affiliation(s)
- Surinder Singh Rana
- Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India,
Correspondence to: Dr Surinder S. Rana, MD, DM, FASGE, Ass. Prof., Department of Gastroenterology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012 India, Tel: +91 172 2749123, Fax: +91 172 2744401, e-mail: ,
| | - Deepak Kumar Bhasin
- Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Chalapathi Rao
- Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kartar Singh
- Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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11274
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Removal of a sewing needle penetrating the wall of the third portion of the duodenum by double-balloon endoscopy. Clin J Gastroenterol 2011; 5:79-81. [PMID: 26181881 DOI: 10.1007/s12328-011-0274-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/27/2011] [Indexed: 11/27/2022]
Abstract
We describe successful removal a sewing needle penetrating the wall of the third portion of the duodenum by means of double-balloon endoscopy (DBE). The patient was a 47-year-old woman who accidentally swallowed a sewing needle and was admitted to our hospital. Abdominal radiography and abdominal computed tomography revealed a metallic object in the third portion of the duodenum. DBE performed by the antegrade approach, revealed that the sewing needle had penetrated the duodenal wall. The sewing needle was retrieved with biopsy forceps and pulled out together with the endoscope through the flexible overtube that remained positioned in the duodenum. There was no injury to the patient's esophagus or gastrointestinal wall. Our experience in this case suggests that sharp foreign bodies in the gastrointestinal tract can be safely removed by means of DBE.
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11275
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A Gastrointestinal Stromal Tumor Presenting as an Emergency: a Case Report. J Gastrointest Cancer 2011; 43 Suppl 1:S178-80. [PMID: 22200966 DOI: 10.1007/s12029-011-9358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11276
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Li J, Wu LH, Shi Y, Jiao YF, Pathology DO, University TSACHOHM, 150081 H, Province H, China. Expression patterns of MUC1, MUC2 and MUC3 in gastric hyperplastic polyps Juan Li, Li-Hua Wu, Yan Shi, Yu-Fei Jiao. Shijie Huaren Xiaohua Zazhi 2011; 19:3591-3596. [DOI: 10.11569/wcjd.v19.i35.3591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the expression patterns of MUC1, MUC2 and MUC3 in gastric hyperplastic polyps (GHP) and to analyze their value as markers for judging the malignant potential of GHP.
METHODS: A total of 238 GHP biopsy or surgical specimens, including 188 cases without dysplasia, 35 cases with low grade dysplasia (LGD), 8 cases with high grade dysplasia(HGD), and 7 cases with carcinoma (Ca), were used in this study. Thirty normal gastric mucosal specimens were used as controls. Immunohistochemistry was performed to detect the expression patterns of mucin proteins (MUC1, MUC2 and MUC3) in these specimens.
RESULTS: Cytoplasmic and membranous expression of MUC1 was observed in 85.60% of GHP cases without dysplasia or carcinoma. Glandular luminal expression of MUC1 was observed in 80.0% of GHP cases with LGD and 100% of GHP cases with HGD/Ca. The positive rate of MUC2 expression was 8.11% in GHP, 21.93% in GHP with LGD, and 31.42% in GHP with HGD/Ca. MUC3 expression was detected in one case of GHP with LGD and three cases of GHP with HGD/Ca but not in GHP without dysplasia.
CONCLUSION: MUC1 and MUC2 may be useful markers for judging the malignant potential of GHP.
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11277
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Kubota K, Okada A, Kuroda J, Yoshida M, Ohta K, Adachi M, Itabashi M, Osamura Y, Kitajima M. Neuroendocrine carcinoma of the stomach: a case study. Case Rep Med 2011; 2011:948328. [PMID: 22216035 PMCID: PMC3246717 DOI: 10.1155/2011/948328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/22/2011] [Indexed: 11/24/2022] Open
Abstract
Gastric neuroendocrine carcinomas are rare and have a poor prognosis, and the diagnostic criteria for this disease have recently changed. We herein report a case of sporadic gastric neuroendocrine carcinoma. A 75-year-old man was referred to our hospital with epigastric pain. Endoscopic examination revealed a localized ulcerative lesion (diameter, 4 cm) at the upper stomach. The diagnosis on biopsy was neuroendocrine carcinoma. Total gastrectomy with D2 lymphadenectomy, splenectomy, and cholecystectomy was performed. Pathologically, the tumor infiltrated the subserosal layer, and 6/49 lymph nodes were involved. The tumor was uniform in shape and arranged in a rosette-like structure to form solid nests, with medium-sized, round-to-cuboid-shaped tumor cells and intense mitosis 46/10 HPF. It was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 70-80%. The diagnosis of neuroendocrine carcinoma was made according to the WHO 2010 criteria. The patient was followed up for three years without recurrence.
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Affiliation(s)
- Keisuke Kubota
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Akihiro Okada
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Junko Kuroda
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Masashi Yoshida
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Keiichiro Ohta
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Miki Adachi
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Masayuki Itabashi
- Department of Pathology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yoshiyuki Osamura
- Department of Pathology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Masaki Kitajima
- Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
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11278
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Apendicitis aguda tras colonoscopia. Med Clin (Barc) 2011; 137:710. [PMID: 21592536 DOI: 10.1016/j.medcli.2011.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 03/17/2011] [Accepted: 03/17/2011] [Indexed: 11/18/2022]
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11279
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Pant C, Sferra TJ, Deshpande A, Minocha A. Clinical approach to severe Clostridium difficile infection: update for the hospital practitioner. Eur J Intern Med 2011; 22:561-8. [PMID: 22075280 DOI: 10.1016/j.ejim.2011.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 04/17/2011] [Accepted: 04/26/2011] [Indexed: 12/18/2022]
Abstract
The rising incidence of Clostridium difficile (C. difficile) infection or CDI is now a problem of pandemic proportions. The NAP1 hypervirulent strain of C. difficile is responsible for a majority of recent epidemics and the widespread use of fluoroquinolone antibiotics may have facilitated the selective proliferation of this strain. The NAP1 strain also is more likely to cause severe and fulminant colitis characterized by marked leukocytosis, renal failure, hemodynamic instability, and toxic megacolon. No single test suffices to diagnose severe CDI, instead; the clinician must rely on a combination of clinical acumen, laboratory testing, and radiologic and endoscopic modalities. Although oral vancomycin and metronidazole are considered standard therapies in the medical management of CDI, recently it has been demonstrated that vancomycin is the more effective antibiotic in cases of severe disease. Moreover, early surgical consultation is necessary in patients who do not respond to medical therapy or who demonstrate rising white blood cell counts or hemodynamic instability indicative of fulminant colitis. Subtotal colectomy with end ileostomy is the procedure of choice for fulminant colitis. When applied to select patients in a judicious and timely fashion, surgery can be a life-saving intervention. In addition to these therapeutic approaches, several investigational treatments including novel antibiotics, fecal bacteriotherapy and immunotherapy have shown promise in the care of patients with severe CDI.
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Affiliation(s)
- Chaitanya Pant
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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11280
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Han JP, Hong SJ, Moon JH, Lee GH, Byun JM, Kim HJ, Choi HJ, Ko BM, Lee MS. Benefit of pronase in image quality during EUS. Gastrointest Endosc 2011; 74:1230-7. [PMID: 21963063 DOI: 10.1016/j.gie.2011.07.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 07/18/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS is useful for diagnosis of GI disease. However, artifacts caused by gastric mucus may worsen visibility during EUS. OBJECTIVE To investigate the efficacy of premedication with pronase, the proteolytic enzyme, for improving imaging during EUS. DESIGN Blinded, randomized, prospective study. SETTING Tertiary-care referral center. PATIENTS This study involved 183 patients scheduled for EUS. INTERVENTION Patients were assigned to oral premedication with saline solution (group A), pronase and bicarbonate (group B), or pronase, bicarbonate, and simethicone (group C). Either conventional EUS or high-frequency catheter EUS (HFUS) was selected. Gastric cavity and gastric mucosal surface obscurity grades were assessed by using visibility scores from ultrasonographic images of each patient. MAIN OUTCOME MEASUREMENTS Means of visibility scores and proportion of images with better visibility scores of the gastric cavity and gastric mucosal surface. Lower scores indicate better visibility of the gastric mucosal surface and fewer artifacts within the gastric cavity on conventional EUS and HFUS. RESULTS Group B had significantly lower mean gastric cavity and gastric mucosal surface visibility scores than did groups A and C in both conventional EUS and HFUS. Group B also had a high proportion of images that had better gastric cavity and gastric mucosal surface visibility scores than did the other two groups in conventional EUS and HFUS. LIMITATIONS Small number of patients and no assessment of the amount of mucus before oral premedication. CONCLUSION Premedication for conventional EUS and HFUS by using a mixture of pronase and bicarbonate seems to decrease the number of gastric wall and lumen hyperechoic artifacts observed in patients given either saline solution or pronase/bicarbonate/simethicone.
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Affiliation(s)
- Jae Pil Han
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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11281
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Abstract
Esophageal strictures are a common problem in gastroenterological practice. In general, the management of malignant or benign esophageal strictures is different and requires a different treatment approach. In daily clinical practice, stent placement is a commonly used modality for the palliation of incurable malignant strictures causing dysphagia, whereas, if available, intraluminal brachytherapy can be considered in patients with a good performance status. Recurrent dysphagia frequently occurs in malignant cases. In case of tissue in- or overgrowth, a second stent is placed. If stent migration occurs, the stent can be repositioned or a second (preferably partially covered) stent can be placed. Food obstruction of the stent lumen can be resolved by endoscopic cleansing. The cornerstone of the management of benign strictures is still dilation therapy (Savary-Gilliard bougie or balloon). There are a subgroup of strictures that are refractory or recur and an alternative approach is required. In order to prevent stricture recurrence, steroid injections into the stricture followed by dilation can be considered. In case of anastomotic strictures or Schatzki rings, incisional therapy is a safe method in experienced hands. Temporary stent placement is a third option before considering self-bougienage or surgery as a salvage treatment. In this review, the most frequently used endoscopic treatment modalities for malignant and benign stricture management will be discussed based on the available literature, and some practical information for the management in daily clinical practice will be provided.
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11282
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Rodríguez-D'Jesús A, Fernández-Esparrach G, Saperas E. [Endoscopic treatment of pancreatic pseudocyst. Practical features]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:711-6. [PMID: 22112632 DOI: 10.1016/j.gastrohep.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/09/2011] [Indexed: 11/24/2022]
Abstract
The initial treatment of most cases of pancreatic pseudocyst is endoscopic while surgery has been relegated to patients who cannot undergo this procedure for technical reasons, such as roux-en-Y roux reconstruction, or to those in whom other procedures have been unsuccessful. This change in the management of this entity is due to advances in therapeutic endoscopy (as a result of the development of guidelines, dilatation balloons, prostheses, safer techniques) as well as to better knowledge of the pathogenesis of pancreatic pseudocyst. The present study aims to describe endoscopic procedures for the drainage of pancreatic pseudocysts, particularly key technical features to ensure the maximum safety and effectiveness of this therapeutic technique.
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11283
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Mönkemüller K, Jovanovic I. Endoscopic and retrograde cholangiographic appearance of hepaticojejunostomy strictures: A practical classification. World J Gastrointest Endosc 2011; 3:213-9. [PMID: 22110837 PMCID: PMC3221953 DOI: 10.4253/wjge.v3.i11.213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 09/04/2011] [Accepted: 09/11/2011] [Indexed: 02/05/2023] Open
Abstract
AIM: To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy (HJ) and propose a practical HJ stricture classification.
METHODS: In a retrospective observational study, a balloon-assisted enteroscopy (BAE)-endoscopic retrograde cholangiography was performed 44 times in 32 patients with surgically-altered gastrointestinal (GI) anatomy. BAE-endoscopic retrograde cholangio pancreatography (ERCP) was performed 23 times in 18 patients with HJ. The HJ was carefully studied with the endoscope and using cholangiography.
RESULTS: The authors observed that the hepaticojejunostomies have characteristics that may allow these to be classified based on endoscopic and cholangiographic appearances: the HJ orifice aspect may appear as small (type A) or large (type B) and the stricture may be short (type 1), long (type 2) and type 3, intrahepatic biliary strictures not associated with anastomotic stenosis. In total, 7 patients had type A1, 4 patients A2, one patient had B1, one patient had B (large orifice without stenosis) and one patient had type B3.
CONCLUSION: This practical classification allows for an accurate initial assessment of the HJ, thus potentially allowing for adequate therapeutic planning, as the shape, length and complexity of the HJ and biliary tree choice may mandate the type of diagnostic and therapeutic accessories to be used. Of additional importance, a standardized classification may allow for better comparison of studies of patients undergoing BAE-ERCP in the setting of altered upper GI anatomy.
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Affiliation(s)
- Klaus Mönkemüller
- Klaus Mönkemüller, Department of Internal Medicine, Gastroenterology and Infectious Diseases, Marienhospital Bottrop, Bottrop 46236, Germany
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11284
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Oh TG, Chung JW, Kim HM, Han SJ, Lee JS, Park JY, Song SY. Primary intestinal lymphangiectasia diagnosed by capsule endoscopy and double balloon enteroscopy. World J Gastrointest Endosc 2011; 3:235-40. [PMID: 22110841 PMCID: PMC3221958 DOI: 10.4253/wjge.v3.i11.235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 10/19/2011] [Accepted: 10/28/2011] [Indexed: 02/05/2023] Open
Abstract
Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lymphatics and the development of protein-losing enteropathy. Patients with PIL develop hypoalbuminemia, hypocalcemia, lymphopenia and hypogammaglobulinemia, and present with bilateral lower limb edema, fatigue, abdominal pain and diarrhea. Endoscopy reveals diffusely elongated, circumferential and polypoid mucosae covered with whitish enlarged villi, all of which indicate intestinal lymphangiectasia. Diagnosis is confirmed by characteristic tissue pathology, which includes dilated intestinal lymphatics with diffusely swollen mucosa and enlarged villi. The prevalence of PIL has increased since the introduction of capsule endoscopy. The etiology and prevalence of PIL remain unknown. Some studies have reported that several genes and regulatory molecules for lymphangiogenesis are related to PIL. We report the case of a patient with PIL involving the entire small bowel that was confirmed by capsule endoscopy and double-balloon enteroscopy-guided tissue pathology who carried a deletion on chromosome 4q25. The relationship between this deletion on chromosome 4 and PIL remains to be investigated.
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Affiliation(s)
- Tak Geun Oh
- Tak Geun Oh, Joo Won Chung, Hee Man Kim, Jung Yeob Park, Si Young Song, Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
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11285
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Richards RJ. Management of abdominal and pelvic abscess in Crohn's disease. World J Gastrointest Endosc 2011; 3:209-12. [PMID: 22110836 PMCID: PMC3221952 DOI: 10.4253/wjge.v3.i11.209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 09/07/2011] [Accepted: 10/26/2011] [Indexed: 02/05/2023] Open
Abstract
Patients with Crohn's disease may develop an abdominal or pelvic abscess during the course of their illness. This process results from transmural inflammation and penetration of the bowel wall, which in turn leads to a contained perforation and subsequent abscess formation. Management of patients with Crohn's related intra-abdominal and pelvic abscesses is challenging and requires the expertise of multiple specialties working in concert. Treatment usually consists of percutaneous abscess drainage (PAD) under guidance of computed tomography in addition to antibiotics. PAD allows for drainage of infection and avoidance of a two-stage surgical procedure in most cases. It is unclear if PAD can be considered a definitive treatment without the need for future surgery. The use of immune suppressive agents such as anti-tumor necrosis factor-α in this setting may be hazardous and their appropriate use is controversial. This article discusses the management of spontaneous abdominal and pelvic abscesses in Crohn's disease.
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Affiliation(s)
- Robert J Richards
- Robert J Richards, Department of Gastroenterology and Hepatology, Stony Brook University, Stony Brook, NY 11793-8173, United States
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11286
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Clostridium difficile Infection and Proton Pump Inhibitor Use in Hospitalized Pediatric Cystic Fibrosis Patients. Gastroenterol Res Pract 2011; 2011:345012. [PMID: 22144994 PMCID: PMC3226314 DOI: 10.1155/2011/345012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 01/03/2023] Open
Abstract
Children with cystic fibrosis (CF) often take proton pump inhibitors (PPIs), which helps improve efficacy of fat absorption with pancreatic enzyme replacement therapy. However, PPI use is known to be associated with Clostridium difficile-(C. diff-) associated diarrhea (CDAD). We retrospectively evaluated the incidence of C. diff infection from all pediatric hospital admissions over a 5-year period at a single tertiary children's hospital. We found significantly more C. diff-positive stool tests in hospitalized patients with CF compared to patients with no diagnosis of CF. However, use of a PPI was not associated with an increased risk of CDAD in hospitalized CF patients. In summary, C. diff infection is more common in hospitalized pediatric CF patients although PPI use may not be a risk factor for CDAD development in this patient population.
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11287
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Al-Saeed O, Kombar O, Morsy M, Sheikh M. Sixty-four multi-detector computerised tomography in the detection of lower gastrointestinal bleeding: A prospective study. J Med Imaging Radiat Oncol 2011; 55:252-8. [PMID: 21696557 DOI: 10.1111/j.1754-9485.2011.02261.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Acute gastrointestinal bleeding (AGIB) is a serious and life-threatening condition. Many diagnostic procedures and tests are being used to detect the site of bleeding with different success rates. The aim of our study is to prospectively evaluate accuracy of 64-slice multi-detector computerised tomography (MDCT) in the diagnosis of lower AGIB. METHODS Between September 2007 and January 2009, patients with presumed lower AGIB were referred to the radiology department of our institution for 64-slice MDCT examination as part of the investigation for the lower AGIB. Any abnormalities to account for bleeding, such as tumours, bowel wall enhancement and increased intraluminal density, were recorded. RESULTS Out of 139 patients with AGIB that were admitted to our casualty department, 27 patients (19 men and 8 women) in the age range of 24-88 years (mean age, 56 years) were suspected to have lower AGIB. Sixty-four-slice MDCT was performed and considered positive for bleeding in 19 (70%) cases, and in all the cases, the bleeding source was indentified in the arterial phase, showing a focal dense wall enhancement in 8 (42%) cases, circumferential wall enhancement in 4 (22%) cases and progressive increasing intraluminal density in 7 (36%) cases. The venous phase scan showed increased dispersion of the contrast within the lumen as an additional clue for active extravasation in 15 (79%) out of the 19 cases. Delayed 5-min scanning showed the same findings as venous phase in all the 19 positive cases and failed to depict any additional findings in the eight cases that were negative on arterial or venous phases. CONCLUSION The study supports the high accuracy of 64-slice MDCT in locating the site of AGIB in patients thought to have a distal source of bleeding. Its accuracy in clinically proximal bleeding is not clear from this study, but MDCT is capable of showing such sources.
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Affiliation(s)
- Osama Al-Saeed
- Department of Radiology, Kuwait UniversityDepartments of Radiology Surgery, Amiri Hospital, Kuwait City, Kuwait.
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11288
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Gastric antral vascular ectasia in systemic sclerosis. Int J Rheumatol 2011; 2011:305238. [PMID: 22121374 PMCID: PMC3216371 DOI: 10.1155/2011/305238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/26/2011] [Indexed: 12/13/2022] Open
Abstract
Gastric antral vascular ectasia is a not so well-understood, and more rare, gastrointestinal manifestation of Systemic Sclerosis which can lead to chronic anemia. A high suspicion and better understanding of this rare manifestation is needed for early detection and treatment. Therapeutic regiments include iron supplementation with acid suppressive therapy, while endoscopic intervention has been shown to be successful in most cases, with gastrectomy or antrectomy rarely needed.
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11289
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Datta S, Williams N, Suortamo S, Mahmood A, Oliver C, Hedley N, Ray P. Carcinoid syndrome from small bowel endocrine carcinoma in the absence of hepatic metastasis. Age Ageing 2011; 40:760-2. [PMID: 21903639 DOI: 10.1093/ageing/afr122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
An 80-year-old male patient presented with abdominal pain, paroxysmal diaphoresis, diarrhoea and vomiting. CT scan revealed a small bowel endocrine carcinoma (or 'carcinoid' tumour), but the absence of hepatic disease. The lesion was excised 'en-bloc'. Intra-operatively, there was wide fluctuation in blood pressure associated with tumour manipulation, with hyper- and hypotension. Carcinoid syndrome usually occurs from gastrointestinal tumours when hepatic metastases occur, causing flushing, diarrhoea, bronchoconstriction and murmurs from cardiac valvular lesions. This patient did not have radiological evidence of hepatic metastasis, but the syndrome could still occur with midgut tumours via local invasion of the retroperitoneal circulation, or by action of substances other than serotonin that do not undergo hepatic metabolism.
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Affiliation(s)
- Sayan Datta
- University Hospitals Coventry and Warwickshire, UK.
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11290
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Girelli CM, Porta P, Colombo E, Lesinigo E, Bernasconi G. Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy. Gastrointest Endosc 2011; 74:1067-74; quiz 1115.e1-5. [PMID: 21907982 DOI: 10.1016/j.gie.2011.07.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/01/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Submucosal malignant masses (SMMs) and innocent bulges look similar on small-bowel capsule endoscopy (SBCE). In a previous observational study, 4 criteria associated with innocent bulges were recognized. OBJECTIVE To devise and validate an index based on these criteria (smooth, protruding lesion index on capsule endoscopy [SPICE]) to discriminate SMMs from innocent bulges. DESIGN Single-center, prospective study. SETTING General hospital in Busto Arsizio, Italy. PATIENTS This study involved 25 of 424 consecutive SBCEs performed on as many patients having SBCE findings of smooth, round, protruding lesions. INTERVENTION Patients' evaluation up to the final diagnosis. At study entry, a short video clip of the lesion was obtained and deidentified for blind SPICE calculation. MAIN OUTCOME MEASUREMENTS SPICE accuracy, using the final diagnosis of each patient as the criterion standard. RESULTS Six patients had SMMs (4 GI stromal tumors, 2 neuroendocrine tumors), and 19 had innocent bulges. SPICE scores ranged from 0 to 4; they discriminated SMMs from innocent bulges (P = .002). A SPICE value >2 had 83.3% sensitivity and 89.4% specificity, and the area under the curve was 0.90 (95% confidence interval, 0.72-0.98; P < .001) for the detection of SMMs. LIMITATIONS Single-center study; small sample size; no invasive ascertainment in 36% of patients. CONCLUSION SPICE is easy to calculate and useful for distinguishing SMMs from innocent bulges. An index >2 is predictive of SMM.
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Affiliation(s)
- Carlo M Girelli
- First Division of Internal Medicine, Service of Gastroenterology and Digestive Endoscopy, Hospital of Busto Arsizio, Busto Arsizio (VA), Italy.
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11291
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Abstract
PURPOSE OF REVIEW Gastric cancer remains a prevalent disease with a 5-year mortality rate of less than 25%. This review focuses on the endoscopic detection, staging, and management of gastric adenocarcinoma. RECENT FINDINGS Confocal laser endomicroscopy and narrow band imaging have a 77-99.4% sensitivity for early cancer detection, a significant improvement when compared with white light endoscopy. Proper staging can be accomplished through endoscopic ultrasound and multidetector row-computed tomography, with accuracy as high as 90.1%. Endoscopic management of early gastric cancer is minimally invasive and can be preferable to surgery. In properly selected patients, endoscopic submucosal dissection has been found to have 100% 5-year survival. SUMMARY The recent advances in gastric cancer have greatly improved the care we can offer our patients in gastric oncology. The emerging technologies will hopefully continue to promote this trend.
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11292
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Fluorescence in situ hybridization and K-ras analyses improve diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses. Pancreas 2011; 40:1057-62. [PMID: 21705950 DOI: 10.1097/mpa.0b013e3182200201] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is the main diagnostic modality for pancreatic mass lesions. However, cytology is often indeterminate, leading to repeat FNAs and delay in care. Here, we evaluate whether combining routine cytology with fluorescence in situ hybridization (FISH) and K-ras/p53 analyses improves diagnostic yield of pancreatic EUS-FNA. METHODS Fifty EUS-FNAs of pancreatic masses in 46 patients were retrospectively analyzed. Mean follow-up was 68 months. Thirteen initial cytologic samples (26%) were benign, 23 malignant (46%), and 14 atypical (28%). We performed FISH for p16, p53, LPL, c-Myc, MALT1, topoisomerase 2/human epidermal growth factor receptor 2, and EGFR, as well as K-ras/p53 mutational analyses. RESULTS On final diagnosis, 11 (79%) of atypical FNAs were malignant, and 3 benign (21%). Fluorescence in situ hybridization was negative in all benign and all atypical samples with final benign diagnosis. Fluorescence in situ hybridization plus K-ras analysis correctly identified 60% of atypical FNAs with final malignant diagnosis. Combination of routine cytology with positive FISH and K-ras analyses yielded 87.9% sensitivity, 93.8% specificity, 96.7% positive predictive value, 78.9% negative predictive value, and 89.8% accuracy. CONCLUSIONS Combining routine cytology with FISH and K-ras analyses improves diagnostic yield of EUS-FNA of solid pancreatic masses. We propose to include these ancillary tests in the workup of atypical cytology from pancreatic EUS-FNA.
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11293
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Leung FW, Mann SK, Leung JW, Siao-Salera RM, Guy J. The water method is effective in difficult colonoscopy - it enhances cecal intubation in unsedated patients with a history of abdominal surgery. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:172-176. [PMID: 22586531 DOI: 10.4161/jig.19960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 01/18/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND: Colonoscopy in unsedated patients in the US is considered to be difficult. Success rate of cecal intubation is limited by discomfort. Colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. OBJECTIVE: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. DESIGN: The data bases of two parallel RCT were combined and analyzed. SETTING: Two Veterans Affairs endoscopy units. PATIENT AND METHODS: The water and air methods were compared in these two parallel RCT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. MAIN OUTCOME MEASUREMENTS: Completion of unsedated colonoscopy. RESULTS: Among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). LIMITATIONS: Small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. CONCLUSION: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.
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Affiliation(s)
- Felix W Leung
- Gastroenterology, Sepulveda ACC, VAGLAHS, North Hill
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11294
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Kozarek RA. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting: should it be routine? Clin Gastroenterol Hepatol 2011; 9:810-2. [PMID: 21723233 DOI: 10.1016/j.cgh.2011.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 02/07/2023]
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11295
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Psarras K, Baltatzis ME, Pavlidis ET, Lalountas MA, Pavlidis TE, Sakantamis AK. Autoimmune pancreatitis versus pancreatic cancer: a comprehensive review with emphasis on differential diagnosis. Hepatobiliary Pancreat Dis Int 2011; 10:465-73. [PMID: 21947719 DOI: 10.1016/s1499-3872(11)60080-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis with a discrete pathophysiology, occasional diagnostic radiological findings, and characteristic histological features. Its etiology and pathogenesis are still under investigation, especially during the last decade. Another aspect of interest is the attempt to establish specific criteria for the differential diagnosis between autoimmune pancreatitis and pancreatic cancer, entities that are frequently indistinguishable. DATA SOURCES An extensive search of the PubMed database was performed with emphasis on articles about the differential diagnosis between autoimmune pancreatitis and pancreatic cancer up to the present. RESULTS The most interesting outcome of recent research is the theory that autoimmune pancreatitis and its various extra-pancreatic manifestations represent a systemic fibro-inflammatory process called IgG4-related systemic disease. The diagnostic criteria proposed by the Japanese Pancreatic Society, the more expanded HISORt criteria, the new definitions of histological types, and the new guidelines of the International Association of Pancreatology help to establish the diagnosis of the disease types. CONCLUSION The valuable help of the proposed criteria for the differential diagnosis between autoimmune pancreatitis and pancreatic cancer may lead to avoidance of pointless surgical treatments and increased patient morbidity.
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Affiliation(s)
- Kyriakos Psarras
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
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11296
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Kim MS, Choi SR, Roh MH, Lee JH, Jang JS, Kim BG, Kim SO, Han JS, Hsing CT. Efficacy of I-scan endoscopy in the diagnosis of gastroesophageal reflux disease with minimal change. Clin Endosc 2011; 44:27-32. [PMID: 22741109 PMCID: PMC3363044 DOI: 10.5946/ce.2011.44.1.27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 08/20/2011] [Accepted: 08/26/2011] [Indexed: 12/12/2022] Open
Abstract
Background/Aims The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved. Methods The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change. Results A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25). Conclusions The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely
the type of minimal change.
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Affiliation(s)
- Min Sik Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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11297
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Kondo M, Kawamoto M, Hasuoka A, Kajino M, Inatomi N, Tarui N. High-throughput screening of potassium-competitive acid blockers. ACTA ACUST UNITED AC 2011; 17:177-82. [PMID: 21940711 DOI: 10.1177/1087057111421004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
H(+),K(+)-ATPase is a key enzyme in the process of gastric acid secretion, and proton pump inhibitors (PPIs) have been accepted as one of the most effective treatments for peptic ulcer and gastroesophageal reflux disease. To discover a novel class of PPIs, the authors screened a low-molecular-weight compound library and identified two prospective acid blockers that were pyrrole derivatives. Both compounds inhibited H(+),K(+)-ATPase in a reversible and potassium-competitive manner. These compounds led to the development of TAK-438 (1-[5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate), which is currently undergoing clinical trials as a novel potassium-competitive acid blocker for the treatment of acid-related diseases.
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Affiliation(s)
- Mitsuyo Kondo
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
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11298
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Ciaccio EJ, Tennyson CA, Bhagat G, Lewis SK, Green PHR. Robust spectral analysis of videocapsule images acquired from celiac disease patients. Biomed Eng Online 2011; 10:78. [PMID: 21906318 PMCID: PMC3203259 DOI: 10.1186/1475-925x-10-78] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 09/09/2011] [Indexed: 12/17/2022] Open
Abstract
Background Dominant frequency (DF) analysis of videocapsule endoscopy images is a new method to detect small intestinal periodicities that may result from mechanical rhythms such as peristalsis. Longer periodicity is related to greater image texture at areas of villous atrophy in celiac disease. However, extraneous features and spatiotemporal phase shift may mask DF rhythms. Method The robustness of Fourier and ensemble averaging spectral analysis to compute DF was tested. Videocapsule images from the distal duodenum of 11 celiac patients (frame rate 2/s and pixel resolution 576 × 576) were analyzed. For patients 1, 2, ... 11, respectively, a total of 10, 11, ..., 20 sequential images were extracted from a randomly selected time epoch. Each image sequence was artificially repeated to 200 frames, simulating periodicities of 0.2, 0.18, ..., 0.1Hz, respectively. Random white noise at four different levels, spatiotemporal phase shift, and frames with air bubbles were added. Power spectra were constructed pixel-wise over 200 frames, and an average spectrum was computed from the 576 × 576 individual spectra. The largest spectral peak in the average spectrum was the estimated DF. Error was defined as the absolute difference between actual DF and estimated DF. Results For Fourier analysis, the mean absolute error between estimated and actual DF was 0.032 ± 0.052Hz. Error increased with greater degree of random noise imposed. In contrast, all ensemble average estimates precisely predicted the simulated DF. Conclusions The ensemble average DF estimate of videocapsule images with simulated periodicity is robust to noise and spatiotemporal phase shift as compared with Fourier analysis. Accurate estimation of DF eliminates the need to impose complex masking, extraction, and/or corrective preprocessing measures.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Celiac Disease Center, Columbia University, New York, USA.
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11299
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Li DY, Wang ZY, Qin MF. EUS for diagnosis of malignant biliary stricture: an analysis of 13 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:2693-2695. [DOI: 10.11569/wcjd.v19.i25.2693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the clinical value of endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of malignant biliary stricture.
METHODS: The imaging data for 76 patients with malignant biliary stricture who underwent EUS, ERCP or MRCP from January 2008 to May 2010 were retrospectively analyzed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each test were compared.
RESULTS: EUS had significantly higher sensitivity (94.2% vs 78.5%), specificity (84.6% vs 57.1%), positive predictive value (89.1% vs 64.5%), negative predictive value (73.3% vs 41.3%) and accuracy (91.6% vs 71.6%) than MRCP in the diagnosis of malignant biliary stricture. EUS had significantly higher sensitivity (94.2% vs 80.5%), specificity (84.6% vs 68.4%) and accuracy (91.6% vs 71.6%) than ERCP in the diagnosis of malignant biliary stricture.
CONCLUSION: EUS has higher sensitivity, specificity and accuracy than MRCP and ERCP in the diagnosis of malignant biliary stricture.
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Abstract
The echoendoscopic biliary drainage is an option to treat obstructive jaundices when ERCP drainage fails. These procedures compose alternative methods to the side of surgery and percutaneous transhepatic biliary drainage, and it was only possible by the continuous development and improvement of echoendoscopes and accessories. The development of linear setorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeutic dimenion on echoendoscopy capabilities, opening the possibility to perform punction over direct ultrasonographic view. Despite of the high success rate and low morbidity of biliary drainage obtained by ERCP, difficulty could be found at the presence of stent tumor ingrown, tumor gut compression, periampulary diverticula, and anatomic variation. The echoendoscopic technique starts performing punction and contrast of the left biliary tree. When performed from gastric wall, the access is made through hepatic segment III. From duodenum, direct common bile duct punction. Dilatation is required before stent introduction, and a plastic or metallic stent is introduced. This phrase should be replaced by: diathermic dilatation of the puncturing tract is required using a 6F cystostome. The technical success of hepaticogastrostomy is near 98%, and complications are present in 36%: pneumoperitoneum, choleperitoneum, infection, and stent disfunction. To prevent bile leakage, we have used the 2 stent techniques, the first stent introduced was a long uncovered metallic stent (8 or 10 cm), and inside this first stent a second fully covered stent of 6 cm was delivered to bridge the bile duct and the stomach. Choledochoduodenostomy overall success rate is 92% and described complications include, in frequency order, pneumoperitoneum and focal bile peritonitis, present in 19%. By the last 10 years, the technique was especially performed in reference centers, by ERCP experienced groups, and this seems to be a general guideline to safer procedure execution.
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