Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 8 Articles
Background: Laparoscopic cholecystectomy (LC) has become the ââ?¬Ë?gold standardââ?¬â?¢ for the treatment of symptomatic\ngallstones. Innovative methods are being introduced, and these procedures include transgastric or transcolonic\nendoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more\nconvenient treatment is still needed. Moreover, some gallbladders still have good functionality and cholecystectomy\nmay be associated with various complications. The aim of this study was to evaluate the trans-gastrointestinal tract\ncholecystoscopy technique in the treatment of gallbladder disease without cholecystectomy.\nMethod: Endoscopic ultrasound (EUS)-guided cholecystoduodenostomy or cholecystogastrostomy with the placement\nof a double-flanged fully covered metal stent was performed and endoscopic sphincterotomy (EST) was also performed\nduring this procedure for those patients with accompanying common bile duct stones. One or two weeks later the stent\nwas removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy or polyp\nresection was performed. Four weeks later gallbladder was assessed by abdominal ultrasound.\nResults: EUS guided cholecystoduodenostomy (n = 3) or cholecysto gastrostomy (n = 4) with double flanged mental stent\ndeployment was successfully performed in all of 7 patients. After the procedure, fistulas had formed in each of the\npatients and the stents were removed. Endoscopic cholecystolithotomy(7) and polyps resection(2) were successfully\nperformed through the fistulas. Common bile duct stones were also successfully removed in 5 patients. The ultrasound\nexamination of the gallbladder 4 weeks later showed no stones remaining and also showed satisfactory functioning of\nthe gallbladder.\nConclusion: The EUS-guided placement of a novel metal stent is a safe and simple approach for performing an\nendoscopic cholecystoduodenostomy or cholecysto gastrostomy, which can subsequently allow procedures to\nbe performed for treating biliary disease, including cholecystolithotomy....
The ingestion of foreign bodies is a worldwide pediatric pathology.We assessed the clinical, endoscopic, and therapeutic aspects of\nthis condition in a pediatric gastroenterology unit. We reviewed 61 patients (median age of 3.25 Ã?± 4.7 years). The most frequently\ningested objects were coins (26.23%), unidentified metal objects (13.11%), bones (8.19%), batteries, and buttons (6.55%). The clinical\nfeatures we encountered included abdominal pain (55.73%), vomiting (34.42%), and asymptomatic children (29.5%). Routine Xray\nexamination enabled finding the foreign body in 42 of the cases. An esophagogastroduodenoscopy was performed within\n24ââ?¬â??72 hours. 25 cases resulted in a negative endoscopy (40.98%), 19 objects (31.14%) were removed using a polypectomy snare, and\nextraction failure occurred in 17 patients (27.86%). 28 foreign bodies were passed without incidents; in 14 cases, the swallowed\nobjects were never found. In one case, a battery was stuck in the esophageal folds and led to tracheal-esophageal fistula and\nbronchopneumonia and later to esophageal stenosis.We report a large proportion of foreign bodies that could not be identified or\nremoved due to lack of early endoscopy and poor technical settings. Batteries and sharp objects lead to severe complications and\npreschool-age children are at high risk for such events....
Background: The surveillance of subjects at risk of pancreatic cancer is restricted to clinical research; the incidence\nof familial pancreatic cancer needs to be better established. Thus, we aimed to evaluate the frequency of familial\npancreatic cancer in a population of hospitalized patients with pancreatic cancer.\nMethods: A retrospective study based on the hospital charts of patients discharged with a diagnosis of pancreatic\ncancer. One hundred and eighty-seven patients or their relatives were called for a phone interview.\nResults: There were 97 males (51.9 %) and 90 (48.1 %) females. The overall mean Ã?± SD age was 67.3 Ã?± 11.8 years;\nthe age of males was similar to that of females (P = 0140). The mean size of the tumors found was 36.3 Ã?± 17.4 mm\n(range of 5ââ?¬â??110 mm); it was related to gender but was not related to the site of the tumor or the age of the\npatient. Regarding genetic diseases, three females (1.6 %) had familial adenomatous polyposis; three patients\n(1 male and two females) (1.6 %) had at least one relative with pancreatic cancer whereas only one 80-year old\nmale patient (0.5 %) had two relatives affected by pancreatic cancer (the mother had died at the 65 years of age\nand the brother had died at 75 years of age).\nConclusions: The frequency of familial pancreatic ductal adenocarcinoma is small, but its importance, from the\npoint of view of early diagnosis, is not negligible and patients with a risk of familial cancer merit an appropriate\nclinical follow-up....
Background: The association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy\n(SE) provides high resolution and modulation of images that may improve minimal change lesion (MCL) detection.\nWe aimed to assess the efficacy of SE in detecting MCL in dyspeptic patients with GERD compared with patients\nwithout GERD by GerdQ or by endoscopy with 24-h pH monitoring (PHM) and in normal volunteers.\nMethods: This is a cohort study conducted at a tertiary center. All dyspeptic patients were prospectively recruited.\nAll patients completed a validated Thai version of GerdQ and then underwent endoscopy. Forty normal volunteers\nas a control group were recruited for endoscopy. The distal esophagus was examined by high definition endoscopy\nand SE sequentially. All had PHM done. GERD was diagnosed by Los Angeles classification A-D and/or by a positive\nPHM. MCE was diagnosed when MCL or combination of MCL was present.\nResults: Of 174 patients, 144 completed the study protocol. After the exclusion of 6 patients, 138 remained for\nanalysis. Overlapping GERD symptoms were found in 44.2 % and 26.8 % had confirmed GERD. Group A was\ncomprised of 61 patients with a positive GerdQ and 77 patients in group B had a negative GerdQ. Twenty-four in\ngroup A, 28 in group B and 7 in the control group had MCE that was not significantly different. MCE in GERD was\nsignificantly higher (51.45 %) than in non-GERD (32.7 %) (p = 0.047) and in the control group (20.58 %) (p = 0.007).\nThe sensitivity, specificity, positive predictive value, and negative predictive value of SE were 51.35 %, 67.33 %,\n36.54 % and 79.06 %, respectively.\nConclusion: In dyspeptic patients, SE detected more MCE in GERD than in non-GERD patients and in the control\ngroup....
Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for\nthe 40% of the newdiagnoses.Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques\nseem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible\nElectroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the use\nof these techniques have already demonstrated encouraging results in terms of safety and feasibility. Unfortunately, few studies on\ntheir efficacy are currently available. Even though some reports on the overall survival are encouraging, randomized studies are\nstill required to corroborate these findings. This study provides an up-to-date overview and a thematic summary of the current\navailable evidence on the application of RFA and IRE on PDAC, together with a comparison of the two procedures....
White light colonoscopy is the current gold standard for early detection and treatment of colorectal cancer, but emerging data\nsuggest that this approach is inherently limited. Even the most experienced colonoscopists, under optimal conditions, miss at least\n15ââ?¬â??25% of adenomas. There is an unmet clinical need for an adjunctive modality to white light colonoscopy with improved lesion\ndetection and characterization. Optical molecular imaging with exogenously administered organic fluorochromes is a burgeoning\nimaging modality poised to advance the capabilities of colonoscopy. In this proof-of-principle clinical trial, we investigated the\nability of a custom-designed fluorescent colonoscope and indocyanine green, a clinically approved fluorescent blood pool imaging\nagent, to visualize polyps in high risk patients with polyposis syndromes or known distal colonic masses. We demonstrate (1) the\nsuccessful performance of real-time, wide-field fluorescence endoscopy using off-the-shelf equipment, (2) the ability of this system\nto identify polyps as small as 1 mm, and (3) the potential for fluorescence imaging signal intensity to differentiate between neoplastic\nand benign polyps....
We analysed trends over time in palliative first-line chemotherapy in patients with locally advanced or metastatic esophagogastric\ncancer. Special focus was on frequency and quality of HER2-testing and trends in drug use in combination with trastuzumab.\nEarlier published data about patients treated outside clinical studies showed a relatively low rate of HER2-testing and insufficient\ntest quality. A total of 2,808 patients retrospectively documented in The rapiemonitorââ??â?¡ from 2006 to 2013 were analysed regarding\ntreatment intensity and trends in used drugs. Data on HER2-testing and therapies were analysed in two cohorts documented in\n2010 and 2011 (1) compared to 2012 and 2013 (2). Treatment intensity increased: 49.3% of patients received at least a triplet in 2013\ncompared to 10.1% in 2006. In cohort 2 HER2 expression was tested in 79.1% of the cases. Still, in 26.9% testing was not done\nas requested by guidelines. Good performance status, multiple metastases, age ââ?°Â¤ 65 years, the objective ââ?¬Å?to prevent progression,ââ?¬Â\ngood cognitive capabilities, estimated good compliance, and social integration positively influenced the probability of HER2-testing;\ncomorbidities negatively affected it. Usage of the combination of fluoropyrimidines and cisplatin with trastuzumab declined from\n67% in cohort 1 to 50% in cohort 2....
Background. Assessment of endoscopic activity of Crohn�s disease (CD) is of growing importance both in clinical practice and in\nclinical trials. The study aimed to assess which of the endoscopic indices used for evaluation ofmucosal changes correlates with the\ncurrently used clinical indices for determination of disease activity and with the results of histopathological examination. Study.\nA group of 71 patients with CD and 52 individuals without a diagnosis of GI tract disease as a control group were investigated,\nconsidering clinical and histological severity of the disease and the severity of inflammatory changes in the bowel. Evaluation was\nconducted with the use of clinical, endoscopic, and histopathological indices. Endoscopic indices were then correlated with different\nclinical and histopathological indices with the aim of finding the strongest correlations. Results and Conclusions. Correlation\nbetween the clinical disease activity and the severity of endoscopic lesions in CD was shown in this study to be poor. The results\nalso indicate that the optimal endoscopic index used in the diagnostic stage and in the assessment of treatment effects in CD is\nSimple Endoscopic Score for Crohn�s Disease (SES-CD)....
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