RESUMEN
BACKGROUND AND STUDY AIMS: endoscopic retrograde cholangiopancreatography (ERCP) is essential when dealing in patients with choledocholithiasis. However, the proper extraction device selection is, often, a matter of the endoscopists' preference. We conducted a single center prospective randomized controlled study to access success rates for basket versus balloon catheters for small stones. PATIENT AND METHODS: in our non-inferiority study, 180 patients with bile duct stones were randomized in a basket and a balloon catheter group. Inclusion criteria were fluoroscopically bile duct stones ≤10mm in diameter and a common bile duct diameter ≤15mm. The primary endpoint was the rate of complete bile duct clearance for each method. Secondary endpoints included time completed and amount of radiation dose recorded in each ERCP session, as well as any reported adverse events. RESULTS: balloon was non-inferior to basket stone extraction (OR 3.35, 95% CI 1.12-10.05, p=0.031). Complete clearance was achieved in 69 out of 82 patients (84.1%) in the basket catheter group versus 79 out of 84 patients (94%) in the balloon catheter group (p=0.047) ; this seems to be especially true for patients with few stones and of small size (≤2 stones, p=0.043 and stone diameter ≤5mm, p=0.032). Complete stone clearance in the basket group patients took longer than that in the balloon group (4.52 and 4.06 min, respectively, p=0.015). Higher median radiation doses for stone clearance were recorded in the basket versus the balloon catheter group (1534.43 Gy versus 1245.45 Gy, p=0.023). CONCLUSIONS: our study showed that balloon was non-inferior to basket stone extraction.
Asunto(s)
Coledocolitiasis , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitiasis/cirugía , Humanos , Estudios Prospectivos , Método Simple Ciego , Esfinterotomía Endoscópica , Resultado del TratamientoRESUMEN
A variant of bile duct carcinoma, intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease mainly found in Eastern Asia which encompasses a spectrum of intraductal papillary growth occurring anywhere along the intrahepatic and/or extrahepatic biliary tree that carries a high potential for malignancy. We report the case of a patient with episodes of recurrent cholangitis that was diagnosed with IPNB, our clinical and diagnostic approach, the radiographic and endoscopic findings, the interventions used, while discussing the therapeutic options.
Asunto(s)
Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/terapia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/terapia , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Neoplasias de los Conductos Biliares/patología , Biomarcadores de Tumor/análisis , Carcinoma Papilar/patología , Terapia Combinada , Diagnóstico Diferencial , Humanos , Masculino , StentsRESUMEN
Cancer of the gastroesophageal junction (GEJ), although rare, is now considered a separate entity with a distinct pathophysiological and molecular profile. Although much progress has been made over the past decades in delineating the multiple environmental and genetic pathways involved GEJ carcinoma, the exact molecular mechanisms underlying disease initiation and progression are still poorly understood. This is of paramount importance for the treating physician as the disease bears a poor therapeutic response. This review defines the GEJ and types of GEJ carcinoma, and provides useful insight in its pathophysiology. Future aspects include better understanding of GEJ oncogenesis, early detection of precursor lesions, the use of biomarkers and targeted therapy (through molecular profiling) so as to increase overall survival. (Acta gastroenterol. belg., 2016, 79, 471-479).
Asunto(s)
Adenocarcinoma , Neoplasias Esofágicas , Unión Esofagogástrica/patología , Neoplasias Gástricas , Adenocarcinoma/genética , Adenocarcinoma/patología , Biomarcadores de Tumor/análisis , Carcinogénesis/genética , Diagnóstico Diferencial , Progresión de la Enfermedad , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/patología , Humanos , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologíaRESUMEN
Giant condyloma acuminatum (GCA), or Buschke-Löwenstein tumour (BLT), is a rare large tumour of the anogenital area. It is caused by human papillomavirus genotypes 6 and 11, and it is characterized by aggressive local invasion and frequent recurrences after treatment. Treatment of choice is radical excision, although chemotherapy and radiation are also used in special cases. We report a case of a young man with anogenital GCA, presenting with a large perianal mass and pain during defaecation. The patient was treated by surgical removal of almost the entirety of the mass, using radiofrequency surgical dissection. The concurrent use of oral acitretin for the treatment of erythrodermic psoriasis led to elimination of the remaining disease. The patient remains free of disease 26 months after the end of treatment.
Asunto(s)
Acitretina/administración & dosificación , Neoplasias del Ano/tratamiento farmacológico , Neoplasias del Ano/cirugía , Condiloma Acuminado/tratamiento farmacológico , Condiloma Acuminado/cirugía , Queratolíticos/administración & dosificación , Neoplasias del Pene/tratamiento farmacológico , Neoplasias del Pene/cirugía , Radiocirugia/métodos , Administración Oral , Tumor de Buschke-Lowenstein , Humanos , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND STUDY AIMS: The Capsule Endoscopy Crohn's Disease Activity Index (CECDAI or Niv score) was devised to measure mucosal disease activity using video capsule endoscopy (VCE). The aim of the current study was to prospectively validate the use of the scoring system in daily practice. METHODS: This was a multicenter, double-blind, prospective, controlled study of VCE videos from 62 consecutive patients with isolated small-bowel Crohn's disease. The CECDAI was designed to evaluate three main parameters of Crohn's disease: inflammation (A), extent of disease (B), and stricture (C), in both the proximal and distal segments of the small bowel. The final score was calculated by adding the two segmental scores: CECDAI =â([A1â×âB1] +âC1) +â([A2â×âB2] +âC2). Each examiner in every site interpreted 6â-â10 videos and calculated the CECDAI. The de-identified CD-ROMs were then coded and sent to the principal investigator for CECDAI calculation. RESULTS: The cecum was reached in 72â% and 86â% of examinations, and proximal small-bowel involvement was found in 56â% and 62â% of the patients, according to the site investigators and principal investigator, respectively. Significant correlation was demonstrated between the calculation of the CECDAI by the individual site investigators and that performed by the principal investigator. Overall correlation between endoscopists from the different study centers was good, with râ=â0.767 (range 0.717â-â0.985; Kappa 0.66; Pâ<â0.001). There was no correlation between the CECDAI and the Crohn's Disease Activity Index or the Inflammatory Bowel Disease Quality of Life Questionnaire or any of their components. CONCLUSION: A new scoring system of mucosal injury in Crohn's disease of the small intestine, the CECDAI, was validated. Its use in controlled trials and/or regular follow-up of these patients is advocated.
Asunto(s)
Endoscopía Capsular , Enfermedad de Crohn/patología , Mucosa Intestinal/patología , Índice de Severidad de la Enfermedad , Adulto , Constricción Patológica/patología , Método Doble Ciego , Femenino , Humanos , Intestino Delgado/patología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Adulto JovenAsunto(s)
Endoscopía Capsular , Enfermedades Intestinales/diagnóstico , Sarcoidosis/diagnóstico , Colonoscopía/métodos , Duodenoscopía/métodos , Gastroscopía/métodos , Glucocorticoides/administración & dosificación , Humanos , Enfermedades Intestinales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prednisolona/administración & dosificación , Sarcoidosis/tratamiento farmacológicoRESUMEN
BACKGROUND: Capsule endoscopy (CE) fails to reach the caecum in approximately 20% of patients. Data suggest that chewing-gum, simulating sham feeding, provokes the cephalic phase of gastrointestinal (GI) motor response and may increase GI motility. AIM: To determine whether chewing-gum increases the ability of CE reaching the caecum. METHODS: Prospective, randomized, single-blinded controlled trial. Ninety-three consecutive patients were randomized either to use chewing-gum (n = 47) or not (n = 46). All patients received the identical bowel preparation. Patients chewed one piece of gum for approximately 30 min every 2 h. Two blinded gastroenterologists examined all studies. The number of CE that reached the caecum within 8-h, gastric transit time (GTT) and small bowel transit time (SBTT) were evaluated in all patients. RESULTS: The CE percentage passed into the caecum was higher in the chewing-gum group compared with those in the other (83.0% vs. 71.7% respectively, P = 0.19). Both GTT and SBTT were significantly shorter in the chewing-gum vs. control group [40.8 min (interquartile range: 21-61 min) vs. 56.1 min (interquartile range: 22-78 min) (P = 0.045) and 229.1 min (interquartile range: 158-282 min) vs. 266.2 min (interquartile range: 204-307 min) (P = 0.032) respectively]. Chewing-gum did not adversely affect CE image quality. CONCLUSIONS: Chewing-gum significantly reduces GTT and SBTT during CE. Its use may improve the likelihood of the capsule reaching the caecum without affecting CE image quality.
Asunto(s)
Endoscopía Capsular/métodos , Ciego/fisiopatología , Goma de Mascar , Tránsito Gastrointestinal/fisiología , Catárticos/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Small intestine video-capsule endoscopy examination in patients with diabetes mellitus may be incomplete due to delayed gastric emptying. AIM: To measure video-capsule endoscopy gastric and small bowel transit time and to assess the completeness of the examination in diabetes mellitus patients. METHODS: In this retrospective, case-control study, we examined capsule endoscopy videos from 29 consecutive diabetes mellitus patients. Fifty-eight matched for sex, type of preparation, age and reason for referral non-diabetic controls were selected from our video-capsule endoscopy database. Two independent experienced investigators measured transit times and assessed examinations' completeness. RESULTS: Video-capsule endoscopy gastric transit time was significantly longer in diabetes mellitus (87, 1-478 min) compared to non-diabetic patients (24, 4-108 min, p<0.001). The caecum was visualized in 20/29 (69%) diabetes mellitus and 52/58 (89.6%) non-diabetic controls (p=0.02). In 16 diabetes mellitus patients that video-capsule endoscopy reached the caecum, small bowel transit time was significantly shorter (261.2+/-55.5 min) compared to their 32 non-diabetic matched controls (302+/-62.7 min, p=0.03). CONCLUSIONS: Patients with type 2 diabetes mellitus have prolonged video-capsule endoscopy gastric transit time compared to non-diabetic patients. Prospective studies are required to complete our understanding of video-capsule endoscopy transit times in the setting of diabetes mellitus.
Asunto(s)
Endoscopía Capsular , Diabetes Mellitus/fisiopatología , Tránsito Gastrointestinal/fisiología , Intestino Delgado/fisiopatología , Examen Físico , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del ObservadorRESUMEN
INTRODUCTION: Despite undergoing standard endoscopic diagnostic evaluation with eosophagogastroduodenoscopy and ileocolonoscopy, up to 30% of patients with iron deficiency anemia (IDA) have no definitive diagnosis. The aim of this study was to prospectively investigate the role of wireless capsule endoscopy (WCE) in detecting lesions of the small bowel in patients with unexplained IDA after a negative endoscopic work-up. PATIENTS AND METHODS: Between 1 December 2003 and 31 December 2004, 253 consecutive patients who had been referred because of unexplained IDA underwent eosophagogastroduodenoscopy with small-bowel biopsies and ileocolonoscopy. Endoscopic and histological investigations were negative in 51 of these patients (20.2%) and WCE was performed. Air double-contrast enteroclysis was performed following WCE in all these patients. RESULTS: Wireless capsule endoscopy revealed one or more small-bowel lesions that were considered to be a likely cause of the IDA in 29/51 patients (57%): angiodysplasias in twelve patients (23.5%), multiple jejunal and/or ileal ulcers in six patients (11.7%), multiple erosions in four patients (7.8%), a solitary ulcer in three patients (5.9%), polyps in two patients (3.9%), and tumors in two patients (3.9%). Enteroclysis revealed abnormal findings likely to cause IDA in only 6/51 patients (11.8%): multiple ileal ulcers in three patients (5.9%), tumors in two patients (3.9%), and polyps in one patient (1.9%) (enteroclysis VS. WCE, P < 0.0001). WCE revealed all of the radiographic findings and no adverse events were observed. CONCLUSIONS: This study demonstrates the importance of investigating the small bowel with WCE in patients with unexplained IDA after negative standard endoscopic evaluation. Wireless capsule endoscopy is superior to enteroclysis for detecting lesions of the small bowel in patients with unexplained IDA and should be the next diagnostic test of choice after unremarkable standard endoscopic evaluation.
Asunto(s)
Anemia Ferropénica/etiología , Endoscopía Capsular , Enfermedades Intestinales/complicaciones , Enfermedades Intestinales/patología , Intestino Delgado , Adulto , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/patología , Anemia Ferropénica/terapia , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Intestinales/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND/AIMS: This study presents our cumulative clinical experience from the use of wireless capsule endoscopy (WCE) in a large series of Greek patients with suspected small bowel (SB) diseases. METHODOLOGY: Over an 18-month period, 193 patients were evaluated with WCE for suspected SB diseases [108 obscure gastrointestinal (GI) bleeding, 32 chronic diarrhea, 22 suspected and 6 diagnosed Crohn's disease, 16 abdominal pain, 4 refractory celiac disease, 3 polyposis syndromes, 1 Rendu-Osler-Weber disease and 1 Behcet disease]. All patients had undergone upper GI endoscopy and total colonoscopy. WCE findings were characterized as specific or non-specific, depending on whether the patient's signs and symptoms could be sufficiently attributed to them or not. RESULTS: One or more abnormal findings were detected in 161/193 (83%) patients; these were classified as specific in 91/193 (47%). The diagnostic yield of WCE (in terms of specific findings) was significantly higher when evaluating patients with obscure GI bleeding, compared to chronic diarrhea (52% vs. 25%, respectively, p=0.013, 95% CI: 1.33-7.83). Among obscure GI bleeders, specific findings were significantly more in the group of overt rather than occult bleeders (66% vs. 42% respectively, p=0.026, 95% CI: 1.19-5.88). In patients referred for diagnosed or suspected Crohn's disease, WCE findings were compatible with the diagnosis in 5/6 cases (83%) and in 8/22 cases (36%), respectively. In 9 more patients from other groups with a negative previous diagnostic work-up, WCE helped in diagnosing Crohn's disease. Among 16 patients evaluated for abdominal pain, specific findings were identified only in 1 (6%). CONCLUSIONS: WCE seems to be a very useful diagnostic tool in the evaluation of GI bleeding of obscure origin (in both overt and occult bleeders), as well as suspected Crohn's disease. In other indications, such as unexplained chronic diarrhea and abdominal pain, it completes the traditional work-up, but abnormal findings need to be better delineated before WCE can be widely recommended in these cases.
Asunto(s)
Endoscopía del Sistema Digestivo , Enfermedades Intestinales/patología , Intestino Delgado , Dolor Abdominal/patología , Enfermedad Crónica , Enfermedad de Crohn/patología , Diarrea/patología , Endoscopía del Sistema Digestivo/normas , Hemorragia Gastrointestinal/patología , Humanos , Estudios RetrospectivosAsunto(s)
Cápsulas , Enfermedad Celíaca/complicaciones , Endoscopía del Sistema Digestivo/métodos , Enteritis/diagnóstico , Anciano , Antiinflamatorios/uso terapéutico , Enteritis/tratamiento farmacológico , Enteritis/etiología , Humanos , Masculino , Prednisolona/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: The validity of the rapid urease (CLO) test to diagnose Helicobacter pylori infection in patients with bleeding ulcers has been questioned. The aim of this paper is to evaluate the validity of the CLO test in comparison with histology in diagnosing H. pylori infection in patients with acute upper gastrointestinal bleeding (UGB), irrespective of non-steroidal anti-inflammatory drug (NSAID) use. METHODS: Upper gastrointestinal endoscopy was performed within 24 h of admission for all patients with UGB admitted to the Department of Pathophysiology, Medical School, Athens, for a period of 12 months. Patients with variceal bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication therapy were excluded from the study. At least four biopsies (two from the antrum and two from the body) were obtained for the CLO test and histology (modified Giemsa). RESULTS: Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 women) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, while 44 patients (61%) were found to be positive on histology (P<0.045, 95% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 68 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not influence results of either the CLO or histology. CONCLUSIONS: The CLO test, performed within 24 h of hospital admission in patients with UGB, irrespective of NSAID use, is unreliable for the detection of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results.
Asunto(s)
Biopsia , Mucosa Gástrica/patología , Hemorragia Gastrointestinal/diagnóstico , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/enzimología , Ureasa/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Diagnóstico Diferencial , Úlcera Duodenal/complicaciones , Úlcera Duodenal/diagnóstico , Endoscopía del Sistema Digestivo , Femenino , Mucosa Gástrica/microbiología , Hemorragia Gastrointestinal/etiología , Infecciones por Helicobacter/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/etiología , Estudios Prospectivos , Recurrencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Úlcera Gástrica/complicaciones , Úlcera Gástrica/diagnósticoRESUMEN
AIM: To evaluate the validity of the CLO test in detecting Helicobacter pylori in patients with gastric operation and to investigate the relationship of H. pylori with peptic ulcer recurrence in these patients. METHODS: In this prospective study, 110 consecutive patients, the majority of whom had undergone gastric operation for benign disease (n = 102), were included. Eighty patients (62 males), aged 38-87 years, had had a gastrectomy (10 Billroth I, 70 Billroth II), and 30 patients (27 males), aged 36-73 years, had had a vagotomy (13 vagotomy plus gastroenterostomy, 17 vagotomy plus pyloroplasty). H. pylori was sought on multiple biopsy specimens, using CLO test and histology (modified Giemsa stain). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the CLO test were estimated using histology as 'gold standard'. RESULTS: Overall, 21 gastrectomy patients (26%) were H. pylori-positive by CLO and 25 (31 %) were H. pylori-positive by histology. The estimated sensitivity, specificity, PPV and NPV of the CLO test, using histology as 'gold standard', were 68%, 91%, 77% and 86%, respectively. The CLO test was positive in 67% of vagotomy patients (20 of 30), while 50% (15 of 30) were H. pylori-positive by histology. The estimated sensitivity, specificity, PPV and NPV of the CLO test were 87%, 53%, 65% and 80%, respectively. H. pylori prevalence by histology was 50% in patients with vagotomy and 31% in those with gastrectomy (P = 0.0787). Recurrent ulcers were observed in 8/30 patients (27%) after vagotomy and in 10/72 patients (14%) after gastrectomy. Recurrent ulcer was documented in 6/15 H. pylori-positive patients with vagotomy (40%), and in one of 25 H. pylori-positive patients with gastrectomy (4%). This difference was significant (Fisher's exact test, P = 0.007, relative risk 5.091, 95% CI 0.819-31.64). CONCLUSION: The CLO test seems to be unreliable in diagnosing H. pylori in post-surgical stomach. The H. pylori prevalence is higher, although not significantly, in vagotomized patients compared with gastrectomized patients, and in this group is closely related to the presence of recurrent ulcer. So, at least in this group of patients, it is strongly recommended to look for and eradicate H. pylori.