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BACKGROUND AND OBJECTIVES: At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions. METHODS: From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on. RESULTS: Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts. CONCLUSIONS: There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the safest method; unilateral and bilateral injection techniques are equivalent for EUS-guided celiac neurolysis, and in patients with visible ganglia, celiac ganglia neurolysis appears to lead to better results. There is a moderate level of evidence for: yield of tissue sampling of pancreatic solid lesions is not influenced by the needle shape, gauge, or employed aspiration technique; EUS-guided and percutaneous biliary drainage present similar clinical success and adverse event rates; plastic and metallic stents are equivalent in the EUS-guided treatment of pancreatic pseudocyst. There is a low level of evidence in the routine use of EUS-guided treatment of gastric varices.
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BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients is associated with higher complication and mortality rates when compared to a general patient population. The pull technique is still the preferred technique worldwide but it has some limitations. The aim of this study is to compare the pull and introducer PEG techniques in patients with HNC. PATIENTS AND METHODS: This study is based on a retrospective analysis of a prospectively collected database of 309 patients with HNC who underwent PEG in the Cancer Institute of São Paulo. RESULTS: The procedure was performed with the standard endoscope in 205 patients and the introducer technique was used in 137 patients. There was one procedure-related mortality. Age, sex and albumin level were similar in both groups. However in the introducer technique group, patients had a higher tumor stage, a lower Karnofsky status, and presented more frequently with tracheostomy and trismus. Overall, major, minor, immediate and late complications and 30-day mortality rates were similar but the introducer technique group presented more minor bleeding and tube dysfunctions. CONCLUSION: The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.
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BACKGROUND AND AIMS: Variceal recurrence after endoscopic band ligation (EBL) for secondary prophylaxis is a frequent event. Some studies have reported a correlation between variceal recurrence and variceal rebleeding with the EUS features of paraesophageal vessels. A prospective observational study was conducted to correlate EUS evaluation of paraesophageal varices, azygos vein, and thoracic duct with variceal recurrence after EBL variceal eradication in patients with cirrhosis. METHODS: EUS was performed before and 1 month after EBL variceal eradication. Paraesophageal varices, azygos vein, and thoracic duct maximum diameters were evaluated in predetermined anatomic stations. After EBL variceal eradication, patients were submitted to endoscopic examinations every 3 months for 1 year. We looked for EUS features that could predict variceal recurrence. RESULTS: Thirty patients completed a 1-year endoscopic follow-up. Seventeen patients (57%) presented variceal recurrence. There was no correlation between azygos vein and thoracic duct diameter with variceal recurrence. Larger paraesophageal varices predicted variceal recurrence in both evaluation periods. Paraesophageal varices diameters that best correlated with variceal recurrence were 6.3 mm before EBL (52.9% sensitivity, 92.3% specificity, and .749 area under the receiver operating characteristic curve [AUROC]) and 4 mm after EBL (70.6% sensitivity, 84.6% specificity, and .801 AUROC). CONCLUSIONS: We conclude that paraesophageal varices diameter measured by EUS predicts variceal recurrence within 1 year after EBL variceal eradication. Paraesophageal diameter after variceal eradication is a better recurrence predictor, because it has a lower cut-off parameter, higher sensitivity, and higher AUROC.
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Vena Ácigos/diagnóstico por imagen , Várices Esofágicas y Gástricas/diagnóstico por imagen , Esófago/irrigación sanguínea , Conducto Torácico/diagnóstico por imagen , Área Bajo la Curva , Endosonografía , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/cirugía , Esofagoscopía , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Ligadura , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Curva ROC , Recurrencia , Prevención SecundariaRESUMEN
Strongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.
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Duodenitis/patología , Strongyloides stercoralis , Estrongiloidiasis/patología , Anciano , Animales , Duodenitis/complicaciones , Resultado Fatal , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Estrongiloidiasis/complicacionesRESUMEN
SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.
ResumoHiperinfecção por Strongyloides stercoralis: uma causa incomum de hemorragia digestiva A estrongiloidíase é uma parasitose que pode evoluir para uma forma disseminada, denominada síndrome de hiperinfecção, nos pacientes em estados de imunossupressão. A síndrome de hiperinfecção é ocasionada pela grande multiplicação e migração de larvas infectantes, com envolvimento gastrointestinal e/ou pulmonar característico. Essa doença pode representar um desafio diagnóstico, pois apresenta- se em achados inespecíficos à endoscopia.
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Anciano , Animales , Humanos , Masculino , Duodenitis/patología , Strongyloides stercoralis , Estrongiloidiasis/patología , Duodenitis/complicaciones , Resultado Fatal , Hemorragia Gastrointestinal/etiología , Estrongiloidiasis/complicacionesAsunto(s)
Humanos , Anticolesterolemiantes/uso terapéutico , Apolipoproteínas B/genética , Atrofia Muscular Espinal/tratamiento farmacológico , Oligonucleótidos Antisentido/uso terapéutico , Empalme del ARN/genética , Proteínas del Complejo SMN/genética , Exones/genética , Modelos Biológicos , Atrofia Muscular Espinal/genética , Oligonucleótidos Antisentido/genéticaRESUMEN
BACKGROUND: The source and outcomes of upper gastrointestinal bleeding (UGIB) in oncologic patients are poorly investigated. OBJECTIVE: The study aimed to investigate these issues in a tertiary academic referral center specialized in cancer treatment. METHODS: This was a retrospective study including all patients with cancer referred to endoscopy due to UGIB in 2010. RESULTS: UGIB was confirmed in 147 (of 324 patients) referred to endoscopy for a suspected episode of GI bleeding. Tumor was the most common cause of bleeding (N = 35, 23.8%), followed by varices (N = 30, 19.7%), peptic ulcer (N = 29, 16.3%) and gastroduodenal erosions (N = 16, 10.9%). Among the 32 patients with cancer of the upper GI tract, the main causes of bleeding were cancer (N = 27, 84.4%) and peptic ulcer (N = 5, 6.3%). Forty-one patients (27.9%) presented with bleeding from the primary tumor or from a metastatic lesion, and seven received endoscopic therapy, with successful initial hemostasis in six (85.7%). Rebleeding and mortality rates were not different between endoscopically treated (N = 7) and non-treated (N = 34) patients (28.6% vs. 14.7%, p = 0.342; 43.9% vs. 44.1%, p = 0.677). Median survival was 20 days, and the overall 30-day mortality rate was 44.9%. There was no predictive factor of mortality or rebleeding. CONCLUSION: Tumor bleeding is the most common cause of UGIB in cancer patients. UGIB in cancer patients correlates with a high mortality rate regardless of the bleeding source. Current endoscopic treatments may not be effective in preventing rebleeding or improving survival.
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CONTEXT: Endosonography-guided biliary drainage has been used over the last few years as a salvage procedure when endoscopic retrograde cholangiopancreatography fails. Malignant gastric outlet obstruction may also be present in these patients. We report the results of both procedures during the same session in patients with duodenal and biliary obstruction due to malignant disease. METHODS: A retrospective review from a prospective collected database. RESULTS: Technical success was achieved in all five patients; however, only three patients experienced relief of jaundice and gastric outlet obstruction. CONCLUSIONS: Endosonography-guided biliary drainage and duodenal stenting in the same session is feasible. However, severe complications may limit the procedure. This is a challenging procedure and should be done by experts with special attention to patient's selection.
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Colangiopancreatografia Retrógrada Endoscópica/métodos , Obstrucción Intestinal/cirugía , Ictericia Obstructiva/cirugía , Cuidados Paliativos/métodos , Stents , Adenocarcinoma/complicaciones , Anciano , Anciano de 80 o más Años , Sistema Biliar/diagnóstico por imagen , Drenaje/métodos , Duodeno/diagnóstico por imagen , Femenino , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Ictericia Obstructiva/diagnóstico por imagen , Ictericia Obstructiva/etiología , Masculino , Persona de Mediana Edad , Neoplasias de Células Escamosas/complicaciones , Neoplasias Pancreáticas/complicaciones , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias del Cuello Uterino/complicacionesRESUMEN
BACKGROUND: Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. In this series the outcome of a 4-year experience in a tertiary hospital school in Brazil is reported. METHODS: A total of 457 consecutive DBE were performed in 418 patients from August 2004 to August 2008. 93 patients with several indications, whose aim was not the evaluation of suspected diseases of the small bowel mucosa, were excluded, therefore leaving 364 DBE in 325 patients for analysis. Data were retrospectively collected with regard to clinical, endoscopic findings, therapy and complications. RESULTS: Among the 364 DBE performed in 325 patients, 143/325 were males (44%) and 182/325 females (56%) with a mean age of 48.6 +/- 15.7 years (range 17-89). Mean investigation time was 64 +/- 22 min (range 35-135). The depth of insertion beyond the ligament of Treitz was 230 +/- 85 cm (range 30-500) by the antegrade approach and 140 +/- 75 cm (range 0-320) by the retrograde approach. Total enteroscopy was achieved in 41.66% of the attempts (30 of 72 patients). Overall diagnostic yield was 54.95% (200 of 364 procedures) ranging from 0 to 100% in this series, depending on the indication. Angiodysplasia was the main diagnosis in 24.5% (49 of 200 procedures) and endoscopic treatment, including biopsies, hemostasis, tattooing and polypectomy were performed in 65.38% (238 of 364 procedures). No major complications were reported. CONCLUSIONS: DBE is a feasible, safe and well-tolerated procedure allowing endoscopic therapy. Selection of indications increases its diagnostic yield.
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Cateterismo/métodos , Endoscopía , Enfermedades Gastrointestinales/terapia , Hospitales , Intestino Delgado/patología , Derivación y Consulta , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiodisplasia/complicaciones , Brasil , Femenino , Enfermedades Gastrointestinales/complicaciones , Enfermedades Gastrointestinales/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Sporadic lymphangiectasias are commonly found throughout the small bowel and are considered to be normal. Not uncommonly, lymphangiectasias are pathologic and can lead to mid-gastrointestinal bleeding, abdominal pain and protein-losing enteropathy. Pathologic lymphangiectasias of the small bowel include primary lymphangiectasia, secondary lymphangiectasia and lymphaticovenous malformations. In this report we present three different cases of small bowel lymphangiectasia detected by double balloon enteroscopy. The patients were diagnosed with South American blastomycosis, tuberculosis and primary small bowel lymphangioma.
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Cateterismo/métodos , Endoscopía Gastrointestinal/métodos , Linfangiectasia/diagnóstico , Linfangiectasia/terapia , Adulto , Anciano , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/patología , Humanos , Neoplasias Intestinales/patología , Intestino Delgado/patología , Linfangiectasia/complicaciones , Linfangioma/complicaciones , Linfangioma/patología , MasculinoRESUMEN
Relata-se um caso pouco freqüente, no qual os autores identificam osteofitose de coluna torácica mimetizando lesões esofágicas submucosas. O ultra-som endoscópico evidenciou imagens hiperecóicas comprimindo a parede posterior do terço médio do esôfago, que correspondem a osteófitos, os quais foram confirmados na radiografia em perfil do tórax.