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Fousekis FS, Tepelenis K, Stefanou SK, Stefanou CK, Pappas-Gogos G, Theopistos V, Evangelou Z, Mauri D, Christodoulou DK. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac080. [PMID: 35308257 PMCID: PMC8929746 DOI: 10.1093/jscr/rjac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Gastric metastasis from breast cancer occurs infrequently and causes non-specific symptoms, usually attributed to the underlying disease. Furthermore, endoscopic findings are almost identical to primary gastric cancer, making the immunohistochemical examination of biopsies necessary for diagnosis. We present the case of a 64-year-old woman who was diagnosed with lobular breast cancer 3 years ago and received chemotherapy with evidence of remission. The patient presented with dyspepsia and progressive dysphagia for the last 6 months, not responsive to PPI treatment. Upper endoscopy revealed partial occlusion of the cardio-esophageal junction and thickened gastric folds resembling linitis plastica. However, immunohistochemical analysis of endoscopic biopsies showed infiltration of gastric mucosa by lobular breast cancer cells, making the diagnosis of gastric metastasis. Therefore, clinicians’ awareness of possible gastric metastasis is warranted in patients with a history of advanced breast cancer and severe gastric symptoms.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina, Ioannina, Greece
| | - Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Stefanos K Stefanou
- Department of Surgery, General Hospital of Ioannina “G. Xatzikosta”, Ioannina, Greece
| | - Christos K Stefanou
- Correspondence address. Cyprus 3, Ioannina 45500, Greece. Tel: +306942071910; Fax: +302651077630; E-mail:
| | | | - Vasileios Theopistos
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina, Ioannina, Greece
| | - Zoi Evangelou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Davide Mauri
- Department of Oncology, University Hospital of Ioannina, Ioannina, Greece
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Theopistos V, Theocharis G, Konstantakis C, Kitrou P, Kehagias I, Triantos C, Thomopoulos K. Non-Operative Management of Type 2 ERCP-Related Retroperitoneal Duodenal Perforations: A 9-Year Experience From a Single Center. Gastroenterology Res 2018; 11:207-212. [PMID: 29915631 PMCID: PMC5997477 DOI: 10.14740/gr1007w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/06/2018] [Indexed: 02/06/2023] Open
Abstract
Background No consensus exists on treatment of endoscopic retrograde cholangiopancreatography (ERCP) -related, retroperitoneal duodenal perforations. The aim of this study is to determine the incidence of post-ERCP retroperitoneal periampullary (type 2) duodenal perforations and the clinical outcome of non-surgical management. Methods Patients who underwent ERCP in our institution during the period from January 1, 2009 to December 31, 2017 were included. Any cases of retroperitoneal periampullary duodenal (type 2) perforation were identified. Relevant data (patient characteristics, indications, radiographic findings, time to diagnosis and surgery, surgical procedures, hospital stay and outcome) were retrospectively collected and reviewed. Results were compared to those from the existing literature. Results There were 24 patients with retroperitoneal type 2 duodenal perforation following 4,196 ERCPs were identified (24/4196, 0.57%) over the 9-year period. ERCP indications were: choledocholithiasis, obstructive jaundice and ampullectomy (ampullary adenoma). Diagnosis (aided by CT scan) was established within the first 12 h in the majority of patients (21/24, 87.5%) and intraprocedural in 3/24, (12.5%). Twelve patients (50%) with deteriorating clinical course were managed with CT-guided percutaneous drainage. Surgical intervention was required in two (8.3%). Overall mortality was 4.2%, 1/24 (one patient died after surgery). Conclusions Retroperitoneal duodenal perforation is a rare and severe ERCP complication. However, conservative management is feasible in the majority of cases.
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Affiliation(s)
| | - Georgios Theocharis
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Kitrou
- Department of Diagnostic and Interventional Radiology, University Hospital of Patras, Patras, Greece
| | - Ioannis Kehagias
- Department of General Surgery, University Hospital of Patras, Patras, Greece
| | - Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
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Diamantopoulou G, Konstantakis C, Kottorοu A, Skroubis G, Theocharis G, Theopistos V, Triantos C, Nikolopoulou V, Thomopoulos K. Acute Lower Gastrointestinal Bleeding: Characteristics and Clinical Outcome of Patients Treated With an Intensive Protocol. Gastroenterology Res 2018; 10:352-358. [PMID: 29317943 PMCID: PMC5755637 DOI: 10.14740/gr914w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/11/2017] [Indexed: 02/06/2023] Open
Abstract
Background In recent years major advances have been made in the management of patients with acute lower gastrointestinal bleeding. The aim of this study was to investigate the characteristics and clinical outcome of patients with acute lower gastrointestinal bleeding (ALGIB) treated with an intensive protocol. Methods We analyzed the medical records of 528 patients with ALGIB. All patients after hemodynamic stabilization underwent colonoscopy during the first 24 h of hospitalization and capsule enteroscopy when needed. Patients with massive ongoing bleeding underwent computed tomography angiography (CTA), and when active bleeding was detected embolization was immediately performed. Results The mean age of the patients was 70.2 ± 14.6 years and 271 (51.3%) of them were men. At least one comorbidity was present in 464 patients (87.9%), cardiovascular disease in 266 (50.4%), while 158 (30%) patients were on antiplatelet drugs and 96 (18.2%) on anticoagulants. The most common causes of bleeding were diverticulosis (19.7%) and ischemic colitis (19.3%). Thirty-six patients (6.9%) had small intestinal bleeding. In 117 patients (22.2%) active bleeding or recent bleeding stigmata were found and in 82 of them (92.1%) endoscopic hemostasis was applied. Embolization was performed in 10 (1.9%) and was successful in seven (70%) cases, while surgical hemostasis was required in only six (1.1%) cases. Forty-four (8.3%) patients had a rebleeding episode, and 13 patients died with an overall mortality of 2.5%. Conclusions Management of ALGIB based on an intensive protocol is safe and effective. The bleeding source can be identified in most cases with a favorable outcome.
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Affiliation(s)
| | | | - Anastasia Kottorοu
- Laboratory of Molecular Oncology, University Hospital of Patras, 26504 Rio, Greece
| | - Georgios Skroubis
- Department of Surgery, University Hospital of Patras, 26504 Rio, Greece
| | - Georgios Theocharis
- Department of Gastroenterology, University Hospital of Patras, 26504 Rio, Greece
| | - Vasileios Theopistos
- Department of Gastroenterology, University Hospital of Patras, 26504 Rio, Greece
| | - Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, 26504 Rio, Greece
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Konstantakis C, Triantos C, Theopistos V, Theocharis G, Maroulis I, Diamantopoulou G, Thomopoulos K. Recurrence of choledocholithiasis following endoscopic bile duct clearance: Long term results and factors associated with recurrent bile duct stones. World J Gastrointest Endosc 2017; 9:26-33. [PMID: 28101305 PMCID: PMC5215116 DOI: 10.4253/wjge.v9.i1.26] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/17/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the rate of recurrence of symptomatic choledocholithiasis and identify factors associated with the recurrence of bile duct stones in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for bile duct stone disease.
METHODS All patients who underwent ERCP and EST for bile duct stone disease and had their bile duct cleared from 1/1/2005 until 31/12/2008 was enrolled. All symptomatic recurrences during the study period (until 31/12/2015) were recorded. Clinical and laboratory data potentially associated with common bile duct (CBD) stone recurrence were retrospectively retrieved from patients’ files.
RESULTS A total of 495 patients were included. Sixty seven (67) out of 495 patients (13.5%) presented with recurrent symptomatic choledocholithiasis after 35.28 ± 16.9 mo while twenty two (22) of these patients (32.8%) experienced a second recurrence after 35.19 ± 23.2 mo. Factors associated with recurrence were size (diameter) of the largest CBD stone found at first presentation (10.2 ± 6.9 mm vs 7.2 ± 4.1 mm, P = 0.024), diameter of the CBD at the first examination (15.5 ± 6.3 mm vs 12.0 ± 4.6 mm, P = 0.005), use of mechanical lithotripsy (ML) (P = 0.04) and presence of difficult lithiasis (P = 0.04). Periampullary diverticula showed a trend towards significance (P = 0.066). On the contrary, number of stones, angulation of the CBD, number of ERCP sessions required to clear the CBD at first presentation, more than one ERCP session needed to clear the bile duct initially and a gallbladder in situ did not influence recurrence.
CONCLUSION Bile duct stone recurrence is a possible late complication following endoscopic stone extraction and CBD clearance. It appears to be associated with anatomical parameters (CBD diameter) and stone characteristics (stone size, use of ML, difficult lithiasis) at first presentation.
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Asproudis I, Tsoumani AT, Katsanos KH, Katsanos AH, Theopistos V, Paschidis KA, Tsianos EV, Christodoulou D. Irritable bowel syndrome might be associated with dry eye disease. Ann Gastroenterol 2016; 29:487-491. [PMID: 27708515 PMCID: PMC5049556 DOI: 10.20524/aog.2016.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/05/2016] [Indexed: 12/12/2022] Open
Abstract
Background A possible association between dry eye disease (DED) and irritable bowel syndrome (IBS) has been hypothesized based on the fact that they both share an inflammatory pathogenesis. Methods Ninety-five patients with IBS and 276 healthy controls were enrolled in the study. All patients answered a questionnaire regarding DED symptoms and had a complete ophthalmic examination. DED signs were evaluated using Schirmer’s 1 and tear break-up time (tBUT) tests in both groups. Results Female IBS participants presented significantly lower Schirmer’s test and tBUT (P=0.002 and P<0.001 respectively) than controls. Both diagnostic tests in male IBS patients were also significantly lower than in controls (P<0.001). 72% of IBS patients gave at least 3 positive answers to the questionnaire compared with 42% of the control group (P<0.01). Conclusion Our results suggest a correlation between IBS and DED. DED symptoms can cause further complications in patients with IBS, and should be considered in their management. However, further research is needed to establish a possible pathophysiologic association.
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Affiliation(s)
- Ioannis Asproudis
- Department of Ophthalmology, Medical School (Ioannis Asproudis, Anthoula T. Tsoumani, Konstantinos A. Paschidis), University of Ioannina Medical School, Ioannina, Greece
| | - Anthoula T Tsoumani
- Department of Ophthalmology, Medical School (Ioannis Asproudis, Anthoula T. Tsoumani, Konstantinos A. Paschidis), University of Ioannina Medical School, Ioannina, Greece
| | - Konstantinos H Katsanos
- 1 Division of Internal Medicine and Hepato-Gastroenterology Unit (Konstantinos H. Katsanos, Vasileios Theopistos, Epameinondas V. Tsianos, Dimitrios Christodoulou), University of Ioannina Medical School, Ioannina, Greece
| | - Aristeidis H Katsanos
- Department of Neurology (Aristeidis H. Katsanos), University of Ioannina Medical School, Ioannina, Greece
| | - Vasileios Theopistos
- 1 Division of Internal Medicine and Hepato-Gastroenterology Unit (Konstantinos H. Katsanos, Vasileios Theopistos, Epameinondas V. Tsianos, Dimitrios Christodoulou), University of Ioannina Medical School, Ioannina, Greece
| | - Konstantinos A Paschidis
- Department of Ophthalmology, Medical School (Ioannis Asproudis, Anthoula T. Tsoumani, Konstantinos A. Paschidis), University of Ioannina Medical School, Ioannina, Greece
| | - Epameinondas V Tsianos
- 1 Division of Internal Medicine and Hepato-Gastroenterology Unit (Konstantinos H. Katsanos, Vasileios Theopistos, Epameinondas V. Tsianos, Dimitrios Christodoulou), University of Ioannina Medical School, Ioannina, Greece
| | - Dimitrios Christodoulou
- 1 Division of Internal Medicine and Hepato-Gastroenterology Unit (Konstantinos H. Katsanos, Vasileios Theopistos, Epameinondas V. Tsianos, Dimitrios Christodoulou), University of Ioannina Medical School, Ioannina, Greece
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Tsoumani A, Theopistos V, Katsanos K, Asproudis I, Tsianos EV. Treatment and non-treatment related ocular manifestations in patients with chronic hepatitis B or C. Eur Rev Med Pharmacol Sci 2013; 17:1123-1131. [PMID: 23661529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Worldwide, 480-520 million people are chronically infected with hepatitis B or C virus. In addition to their effects in the liver, chronic hepatitis viral infections may have serious extra hepatic manifestations. These manifestations have been more widely studied in chronic HCV infection, where they are more frequently described, but they have been also reported chronic HBV infection. AIM Among those, of great interest are the ocular manifestations caused by the HBV or HCV infection or induced by chronic hepatitis therapy. These we attempted to review. MATERIALS AND METHODS A PubMed search was conducted using the terms hepatitis, ocular, eye. RESULTS This article describes the ocular symptoms related to HBV and HCV hepatitis such as xerophthalmia, Mooren's ulcer and retinopathy as well as other rare manifestations caused by either the infection or the therapy. CONCLUSIONS The ocular manifestations of HCV infections best supported by the literature include a dry eye syndrome similar to Sjögren's syndrome, and ischemic retinopathy caused by either HCV-induced vasculitis or treatment with interferon. There are no serious ocular manifestations of HBV infection other than dry eye syndrome. Special consideration should be held for possible connection between HBV vaccine and uveitis.
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Affiliation(s)
- A Tsoumani
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece.
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Christodoulou D, Katsanos K, Zervou E, Theopistos V, Papathanasopoulos A, Christou L, Tsianos EV. Platelet IgG antibodies are significantly increased in chronic liver disease. Ann Gastroenterol 2011; 24:47-52. [PMID: 24714308 PMCID: PMC3959471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/13/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the presence of IgG antiplatelet (anti-P) IgG antibodies in patients with chronic liver disease (CLD) of diverse but well defined etiology. METHODS One-hundred fifty-six consecutive patients with CLD (65 with chronic hepatitis B, 57 with chronic hepatitis C, 23 with alcoholic liver disease and 11 with primary biliary cirrhosis), and 240 healthy blood donors were investigated for the presence of anti-P antibodies. RESULTS Anti-P antibodies were present in 36.5% (57/156) of patients with CLD, and 2.9% (7/240) of controls (P=0.0001). In detail, anti-P antibodies were detected in 35.4% (23/65) of patients with chronic hepatitis B, 26.3% (15/57) of patients with chronic hepatitis C, 47.8% (11/23) of patients with alcoholic liver disease and 72.7% (8/11) of those with primary biliary cirrhosis. The study also demonstrated the significantly higher prevalence of anti-P antibodies in patients with cirrhosis (53.0%) than in non cirrhotic patients (26.4%, P=0.0018). The association of anti-P antibodies with thrombocytopenia was inconsistent. CONCLUSIONS This study showed a high prevalence of anti-P IgG antibodies in patients with CLD compared to healthy controls.
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Affiliation(s)
- Dimitrios Christodoulou
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, School of Medicine, University of Ioannina, Greece (Dimitrios Christodoulou, Konstantinos Katsanos, Vasileios Theopistos, Athanasios Papathanasopoulos, Leonidas Christou, Epameinondas V. Tsianos)
| | - Konstantinos Katsanos
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, School of Medicine, University of Ioannina, Greece (Dimitrios Christodoulou, Konstantinos Katsanos, Vasileios Theopistos, Athanasios Papathanasopoulos, Leonidas Christou, Epameinondas V. Tsianos)
| | - Eleftheria Zervou
- Blood Bank at the University Hospital of Ioannina, Greece (Eleftheria Zervou)
| | - Vasileios Theopistos
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, School of Medicine, University of Ioannina, Greece (Dimitrios Christodoulou, Konstantinos Katsanos, Vasileios Theopistos, Athanasios Papathanasopoulos, Leonidas Christou, Epameinondas V. Tsianos)
| | - Athanasios Papathanasopoulos
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, School of Medicine, University of Ioannina, Greece (Dimitrios Christodoulou, Konstantinos Katsanos, Vasileios Theopistos, Athanasios Papathanasopoulos, Leonidas Christou, Epameinondas V. Tsianos)
| | - Leonidas Christou
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, School of Medicine, University of Ioannina, Greece (Dimitrios Christodoulou, Konstantinos Katsanos, Vasileios Theopistos, Athanasios Papathanasopoulos, Leonidas Christou, Epameinondas V. Tsianos)
| | - Epameinondas V. Tsianos
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, School of Medicine, University of Ioannina, Greece (Dimitrios Christodoulou, Konstantinos Katsanos, Vasileios Theopistos, Athanasios Papathanasopoulos, Leonidas Christou, Epameinondas V. Tsianos),
Correspondence to: Epameinondas V. Tsianos, Professor of Medicine, 1st Division of Internal Medicine, and Hepato-Gastroenterology Unit, Medical School of Ioannina-Greece University Campus 45110, Ioannina, Greece; Tel: + 30 2651007500; Fax: + 30 265107883; e-mail:
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Felekis T, Katsanos K, Kitsanou M, Trakos N, Theopistos V, Christodoulou D, Asproudis I, Tsianos EV. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single-center study. Inflamm Bowel Dis 2009; 15:29-34. [PMID: 18626979 DOI: 10.1002/ibd.20584] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The frequency and spectrum of ophthalmologic manifestations in patients with inflammatory bowel disease (IBD) has been reported to vary among studies; however, rare and silent manifestations have not been extensively studied. METHODS This was a prospective study of 60 patients diagnosed with IBD who underwent full ophthalmologic examination, including visual acuity, slit lamp examination of the anterior segments, intraocular pressure, and fundus examination accompanied by color photography. Thirty-seven (61,7%) patients were diagnosed with ulcerative colitis (UC) and 23 (38,3%) with Crohn's disease (CD). Data from 276 control individuals were used for the determination of the prevalence of dry eye in our area. RESULTS Ophthalmologic manifestations were diagnosed in 26 (43%) patients (14 UC, 12 CD; 12 males and 14 females). Conjunctivitis was diagnosed in 1 patient (CD), episcleritis in 2 patients (UC), and iridocyclitis in 3 (CD). Fundus examination showed 1 patient (CD) with unilateral choroiditis, 1 (UC) with retinal vasculitis, and 1 (CD) with optic neuritis. Retinal pigment epithelium disturbances (RPED) were present in 3 patients (1 CD, 2 UC) and 2 had serous retinal detachment. In total, 13/60 patients (22%) had dry eye compared with the 11% prevalence in controls. Eight patients developed glucocorticosteroid-induced cataracts, 2 of them treated surgically. CONCLUSIONS This study demonstrated the prevalence of the spectrum of ophthalmologic manifestations in the IBD population, including some rare and silent findings that may merit consideration and early intervention.
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Affiliation(s)
- Taxiarchis Felekis
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
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