Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Compuestos Ferrosos/efectos adversos , Melanosis/inducido químicamente , Melanosis/patología , Gastropatías/inducido químicamente , Gastropatías/patología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Administración Oral , Anciano , Anemia Ferropénica/diagnóstico , Biopsia con Aguja , Femenino , Compuestos Ferrosos/uso terapéutico , Estudios de Seguimiento , Mucosa Gástrica/efectos de los fármacos , Mucosa Gástrica/patología , Gastroscopía/métodos , Humanos , Inmunohistoquímica , Enfermedades Raras , Medición de RiesgoRESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) is considered to be the most accurate modality for T staging of esophageal cancer. This study attempted to determine whether endoscopic features such as the length and degree of luminal stenosis in esophageal cancer can predict the T stage on EUS. PATIENTS AND METHODS: Thirty-five patients with newly diagnosed esophageal adenocarcinoma or squamous-cell carcinoma undergoing EUS prior to initiation of any treatment were included in the study. The length of the tumor was assessed prospectively during esophagogastroduodenoscopy (EGD) before EUS in 22 patients. Radial EUS was then performed in these patients. The other 13 patients had sufficient luminal stenosis to prevent complete advancement of the echo endoscope through the tumor. In these 13 patients, the length of the esophageal cancer was not examined, but the T and N stage up to the level of maximum advancement of the echo endoscope through the tumor were noted. RESULTS: All 13 patients with luminal stenosis had at least a T3 (n = 12) or T4 (n = 1) lesion up to the level of maximum advancement of the echo endoscope. Among the 22 patients in whom the length of the esophageal cancer was measured, the mean length in the 13 patients with a T1 or T2 lesion on EUS was 2.6 cm. The mean length in the nine patients with T3 esophageal cancer was 7.1 cm. The difference in the mean length of T1 or T2 lesions (2.6 cm) was significantly different ( P < 0.001) from the mean length of T3 lesions (7.1 cm). Using a clinical diagnostic testing approach, when > or = 5 cm length was used as a criteria for diagnosing T3 lesions, the sensitivity was 89 %, specificity 92 %, positive predictive value 89 %, and negative predictive value 92 %. There was also a suggestion of increased chances of lymph-node metastases with increasing length of esophageal cancer. CONCLUSIONS: In esophageal carcinoma, endoscopic features such as the length of the cancer and the degree of luminal stenosis correlate with T staging on EUS. Esophageal cancers that are > or = 5 cm in length, or are sufficiently stenotic to prevent passage of an endoscope, are much more likely to be T3 or higher-stage lesions, while those that are < 5 cm in length have a greater chance (92 %) of being T1 or T2.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Estenosis Esofágica/diagnóstico por imagen , Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Endosonografía , Neoplasias Esofágicas/patología , Estenosis Esofágica/patología , Femenino , Humanos , Masculino , Estadificación de Neoplasias , Sensibilidad y EspecificidadRESUMEN
We have reviewed the risks of various nonshunt intra-abdominal operations in cirrhotic patients. Most of these studies are retrospective reviews with limitations. Among various risk stratifications in cirrhosis, Child-Pugh classification is sufficiently informative. Elective surgery can be done safely in patients with Child's A or B class. Operations in Child's C patients and emergent surgery carry formidably high mortality. Limiting the extent of surgery, controlling ascites, correcting coagulation abnormality and malnutrition and aggressively treating infection, might reduce mortality. Laparoscopic cholecystectomy and endoscopic sphincterotomy in cirrhotics seem to be promising in reducing mortality and morbidity.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Cirrosis Hepática , Humanos , Medición de RiesgoRESUMEN
BACKGROUND: Accurate measurement of polyp size during colonoscopy is important because of the direct correlation of size with colon cancer. Major studies of colorectal neoplasms have measured polyp size differently. It is also well documented that endoscopists underestimate polyp size frequently. The goal of this prospective study was to determine which one of the five methods of estimating polyp size during colonoscopy is most accurate. METHODS: One hundred colon polyps were measured by means of visual estimation, open biopsy forceps methods, linear probe, a ruler immediately after excision, and after fixation in formalin. The size of the polyps measured outside the body immediately after excision was considered the "gold standard" against which all measurements were compared. RESULTS: Forty-seven polyps were 5 mm or less in diameter, 33 polyps were 5.01 mm to 10 mm, and 20 polyps were more than 10 mm in size. For all polyps the mean difference versus the actual size of the polyps was 3.4% for linear probe, 6.4% for visual estimation, and 12.3% for the forceps. CONCLUSION: Measurement of polyp size by linear probe agreed best with the actual polyp size, followed closely by visual estimation. The open biopsy forceps method was the least accurate.
Asunto(s)
Adenoma Velloso/patología , Adenoma/patología , Pólipos Adenomatosos/patología , Pólipos del Colon/patología , Adenoma/cirugía , Adenoma Velloso/cirugía , Pólipos Adenomatosos/cirugía , Biopsia/estadística & datos numéricos , Colon/patología , Neoplasias del Colon/epidemiología , Pólipos del Colon/cirugía , Colonoscopía/estadística & datos numéricos , Humanos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
In a 46-year-old man with Zollinger-Ellison syndrome, multiple imaging studies were negative for a primary gastrinoma. Preoperative endoscopic ultrasonography (EUS) revealed a 3.3-cm mass which appeared to be in the pancreatic head. During surgery, a celiac lymph node of the size of the mass seen by EUS was found, but the pancreatic head also felt firm and was suspicious for a mass. After resection of the celiac node, intraoperative EUS revealed no mass in the pancreatic head. Based upon intraoperative EUS findings, the pancreatic head was not resected. Histologic evidence of gastrinoma was found in the celiac lymph node and a 4 to 5 mm nodule in the duodenal wall. Postoperatively serum gastrin levels returned to normal.
Asunto(s)
Endosonografía , Ganglios Linfáticos/diagnóstico por imagen , Monitoreo Intraoperatorio , Síndrome de Zollinger-Ellison/diagnóstico por imagen , Humanos , Ganglios Linfáticos/cirugía , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Síndrome de Zollinger-Ellison/cirugíaRESUMEN
Local injection of corticosteroids into refractory esophageal strictures to decrease the restenosis rate has been reported. Here we report our efforts in three patients to render the delivery of steroids more precise, by injecting them in the thickest segment of the stricture with the guidance of a high frequency ultrasound miniprobe passed through a regular upper endoscope. Steroid injection under ultrasound miniprobe guidance may be indicated for patients who do not respond to a "blind" steroid injection without miniprobe guidance.
Asunto(s)
Antiinflamatorios/administración & dosificación , Endosonografía/métodos , Estenosis Esofágica/tratamiento farmacológico , Triamcinolona Acetonida/administración & dosificación , Anciano , Humanos , Inyecciones Intralesiones , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
BACKGROUND: It has been customary to initiate feeding through percutaneous endoscopic gastrostomy (PEG) tubes 24 hours or more after placement of these tubes. Recent changes in practice environment and emphasis on early discharge of hospitalized patients prompted us to evaluate early PEG feeding in a randomized prospective manner. METHODS: Forty-one patients were included in the study. After an informed consent, the patients were randomly assigned to two groups. Groups I (21 patients) received tube feedings 3 hours and Group II (20 patients) received feedings 24 hours after PEG placement. All patients received an Iso-osmolar formula by continuous infusion at 30 ml/hour for the first 24 hours of feeding. The rates were then increased to 70 ml/hour. Residual volumes, tube length, peristomal leakage, and vital signs were checked, and a global assessment was done every 4 hours. Evaluation by a physician was done every 24 hours for 72 hours. If the residual volume was more than 60 ml (significant residual volume), the tube feedings were held for 2 hours. Patients exited the study at 72 hours from the time of procedure. All deaths were recorded to calculate 30-day mortality. RESULTS: One patient (Group 2) died during the study period. Three patients (two in Group 1 and one in Group 2) had a significant residual volume. One patient (Group 1) had local skin infection requiring treatment. None of the patients had any signs of peritonitis or systemic infection. CONCLUSION: Early PEG tube feeding (3 hours after tube placement) is as safe as next day feeding in elderly patients.
Asunto(s)
Endoscopía/métodos , Nutrición Enteral , Gastrostomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía/mortalidad , Nutrición Enteral/métodos , Estudios de Seguimiento , Gastrostomía/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: In view of controversy about the association of aortic stenosis and angiodysplasia of the gut, we performed a prospective, controlled study to evaluate the relationship between aortic valve disease and gastrointestinal angiodysplasia. METHODS: Forty patients who had endoscopy for clinical indications such as gastrointestinal bleeding, anemia, polyps, colon cancer, and dyspepsia, and who were found to have angiodysplasia of the gastrointestinal tract, underwent two-dimensional and Doppler echocardiography. Thirty-seven controls matched for age, sex, indication, and nature of endoscopic examination, but without angiodysplasia, underwent similar echocardiographic examination. RESULTS: None of the patients in either group had aortic stenosis. The prevalence of aortic sclerosis, aortic insufficiency, and low left ventricular ejection fraction was similar in patients with and without angiodysplasia. CONCLUSIONS: This study does not support the role of aortic valve disease as the cause of angiodysplasia of the gastrointestinal tract. A subgroup of patients with angiodysplasia with aortic sclerosis, with or without other valvular disease (but none with aortic stenosis), had increased prevalence of gastrointestinal bleeding when compared with controls. When aortic valve disease or decreased left ventricular ejection fraction were analyzed as independent predictors, none of them in and of itself appeared to be a factor in bleeding from these gastrointestinal lesions.
Asunto(s)
Angiodisplasia/epidemiología , Insuficiencia de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/epidemiología , Válvula Aórtica/patología , Enfermedades Gastrointestinales/epidemiología , Anciano , Anciano de 80 o más Años , Angiodisplasia/diagnóstico , Angiodisplasia/etiología , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estudios de Casos y Controles , Ecocardiografía Doppler , Endoscopía Gastrointestinal , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Esclerosis , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiologíaRESUMEN
The incidence of transient bacteremia following endoscopic injection sclerotherapy of esophageal varices was evaluated in 18 patients subjected to 40 sessions of injection sclerotherapy. Blood cultures were obtained before sclerotherapy and at five minutes, 30 minutes, and 24 hours after sclerotherapy. The injectors as well as the endoscope were cultured before and after the procedure. Blood cultures were positive in two patients after injection sclerotherapy (Enterobacter cloacae and Staphylococcus species, coagulase-negative, respectively) for an incidence of 5% of transient bacteremia. Pseudomonas aeruginosa was the most frequent bacteria isolated from the injector after sclerotherapy. We conclude that the incidence of transient bacteremia after sclerotherapy is no higher than routine upper-intestinal endoscopy.