RESUMEN
Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.
Asunto(s)
Coristoma , Quistes , Enfermedades Duodenales , Pancreatitis Crónica , Masculino , Persona de Mediana Edad , Humanos , Enfermedad Aguda , Páncreas/cirugía , Pancreaticoduodenectomía/métodos , Pancreatitis Crónica/cirugía , Quistes/complicaciones , Enfermedades Duodenales/cirugía , Coristoma/complicaciones , Coristoma/patología , Coristoma/cirugíaRESUMEN
BACKGROUND: It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS: Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS: A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS: EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
Asunto(s)
Ascitis/complicaciones , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colestasis/cirugía , Drenaje/métodos , Endosonografía/métodos , Neoplasias Pancreáticas/complicaciones , Cirugía Asistida por Computador/métodos , Anciano , Ascitis/cirugía , Colestasis/etiología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Proyectos Piloto , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias PancreáticasRESUMEN
BACKGROUND: Obesity has become a disease of global public health concern in both developing and developed countries. We investigated the influence of socio-demographic, dietary habits and physical activity levels on general and abdominal obesity among a sample of university students in Ghana. METHODS: This cross-sectional study was carried out among a sample of 552 students attending the University for Development Studies, School of Medicine and Health Sciences, Tamale, Ghana. Demographic characteristics were assessed using questionnaire. Dietary habits were measured by means of food frequency questionnaires. Anthropometric measurements were done using appropriate methods. Physical activity levels were measured using the World Health Organization (WHO) global physical activity questionnaire. Spearman's nonparametric correlation coefficient and multinomial logistic regression analysis were used to investigate the determinants of general and abdominal obesity. RESULTS: The prevalence of general overweight/obesity (25.8 % vs. 5.9 %) and abdominal obesity (40.9 % vs. 0.8 %) was higher in female students than in male students. General overweight/obesity was less likely in students who engaged in vigorous physical activity (Adjusted Odds Ratio (AOR) = 0.3, 95 % CI = 0.1 - 0.7, p = 0.004), but more likely in students who consumed fruits and vegetables > 3 days per week (AOR = 2.6, 95 % CI = 1.2 - 5.4, p = 0.015). Abdominal obesity was also less likely in male students (AOR = 0.0, 95 % CI = 0.0 - 0.5, p = 0.017) but more likely in students who consumed roots and tubers > 3 times per week (AOR = 8.0, 95 % CI = 2.2 - 10.1, p = 0.017) and in those who consumed alcoholic and non-alcoholic beverages > 3 times per week (AOR = 8.2, 95 % CI = 2.2 - 31.1, p = 0.002). CONCLUSION: Demographic factors, dietary habits and physical activity levels were found to be associated to general overweight/obesity and abdominal obesity. General overweight/obesity was associated to the consumption of fruits and vegetables > 3 times a week. The consumption of roots and tubers > 3 times per week and alcoholic and non-alcohol beverages > 3 times a week was associated to abdominal obesity. Engagement in vigorous physical activity and being male were negatively associated to general overweight/obesity and abdominal obesity respectively. Promotion of active lifestyles in young adults should be encouraged.
RESUMEN
With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two tables are included for quick reference.
Asunto(s)
Endoscopía , Atención Perioperativa , Inhibidores de Agregación Plaquetaria/administración & dosificación , Pérdida de Sangre Quirúrgica/prevención & control , Humanos , Hemorragia Posoperatoria/prevención & control , Trombosis/prevención & controlRESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is a technique for "en bloc" resection of superficial tumors of the gastrointestinal tract. In France, experience with this technique is still limited. We wanted to assess the development of ESD in France, with special attention to short term outcomes. PATIENTS AND METHODS: Members of the Société Française d'Endoscopie Digestive (SFED) who declared performing ESD reported their cases prospectively on a voluntary basis. Demographic, clinical, and technical data, and the results of immediate complications were collected. Case reports were completed prospectively by each investigator before pooled analysis. RESULTS: A total of 188 consecutive case reports were collected from 16 centers. The median case mix per center was 6 patients (range 1-43). The lesion sites treated by ESD were the stomach (n = 75), esophagus (n = 27), duodenum (n = 1), cecum (n = 2), right colon (n = 3), transverse colon (n = 5), sigmoid (n = 3), and rectum (n = 72). The median size of the lesions was 26 mm (range 2-150 mm). En bloc resection was achieved in 77.1% of cases, with complete R0 resection in 72.9%. Histopathology results showed high grade dysplasia or superficial cancer in 71.2%. The median duration of ESD was 105 minutes (range 20-450 minutes). The short term morbidity was 29.2% including 34 cases of perforation (18.1%), and 21 hemorrhages (11.2%) during the 24 hours following ESD, 89% of which were managed conservatively or endoscopically. CONCLUSION: In this early experience, the feasibility of ESD appeared to be good but R0 resection and complication rates did not match those reported by Japanese authors and must be improved by an extended practice.
Asunto(s)
Disección/métodos , Endoscopía Gastrointestinal/métodos , Mucosa Gástrica/cirugía , Neoplasias Gastrointestinales/cirugía , Mucosa Intestinal/cirugía , Perforación Intestinal/etiología , Hemorragia Posoperatoria/etiología , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Disección/efectos adversos , Endoscopía Gastrointestinal/efectos adversos , Femenino , Francia , Neoplasias Gastrointestinales/patología , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
BACKGROUND AND STUDY AIMS: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope. PATIENTS AND METHODS: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months. RESULTS: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89 %, 88 %, 88 %, 89 %, and 88.5 %, compared with corresponding values of 72 %, 100 %, 77 %, 100 %, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS. CONCLUSIONS: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses.
Asunto(s)
Carcinoma Ductal Pancreático/diagnóstico por imagen , Endosonografía/métodos , Páncreas/diagnóstico por imagen , Enfermedades Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Carcinoma Ductal Pancreático/patología , Carcinoma Ductal Pancreático/cirugía , Medios de Contraste , Femenino , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugía , Páncreas/irrigación sanguínea , Páncreas/patología , Enfermedades Pancreáticas/patología , Enfermedades Pancreáticas/cirugía , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Proyectos Piloto , Estudios ProspectivosAsunto(s)
Dióxido de Carbono/administración & dosificación , Colangiopancreatografia Retrógrada Endoscópica , Hipercapnia/etiología , Insuflación/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica/métodos , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Conductos Pancreáticos/patología , Pancreatitis/etiología , Enfermedad Aguda , Adenocarcinoma/secundario , Biopsia/efectos adversos , Pancreatocolangiografía por Resonancia Magnética , Neoplasias del Colon/patología , Resultado Fatal , Femenino , Humanos , Neoplasias Hepáticas/secundario , Persona de Mediana Edad , Seudoquiste Pancreático/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Data on endoscopic resection of sporadic duodenal adenoma (SDA) are sparse; we present our results concerning safety and efficacy in a retrospective analysis of saline-assisted endoscopic resection of SDA. PATIENTS AND METHODS: The cases of all patients who underwent endoscopic resection for SDA between May 1998 and May 2006 were analyzed. Endoscopic resection was carried out using standard injection and cut methods. In some patients hemoclips and argon plasma coagulation were used, either for prophylaxis or for the treatment of procedure-related bleeding. RESULTS: Thirty-six patients with a total of 37 lesions (mean size 19 mm, range 4 - 50 mm) were analyzed. Lesions larger than 20 mm were more frequently resected piecemeal ( P = 0.022). Intraprocedural bleeding occurred in 14 % of cases, without any significant association with lesion size or the resection technique. One fatal perforation occurred. Macroscopically complete resection was achieved in 97 % of cases, as confirmed by at least one negative control endoscopy with biopsies after a mean follow-up of 15 months. Although clipping and argon plasma coagulation were not applied in any systematic way, it was noticeable that in the 20 cases in which they were used for hemostasis or prevention, no delayed bleeding was observed after the procedures. In contrast, bleeding occurred in 22 % of the 23 procedures performed without these additional techniques. CONCLUSION: Endoscopic resection is an efficient and acceptably safe technique for treating SDA. Further studies need to assess whether systematic bleeding prophylaxis will reduce the incidence of delayed hemorrhage after endoscopic resection.
Asunto(s)
Adenoma/cirugía , Neoplasias Duodenales/cirugía , Endoscopía/efectos adversos , Hemorragia Posoperatoria/epidemiología , Adenoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Neoplasias Duodenales/patología , Femenino , Hemostasis Quirúrgica , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/prevención & control , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Várices Esofágicas y Gástricas/cirugía , Esofagoscopía/métodos , Anciano , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidad , Endoscopía/métodos , Endoscopía/mortalidad , Endosonografía/métodos , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidad , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/mortalidad , Estudios de Seguimiento , Humanos , Cirrosis Hepática Alcohólica/complicaciones , Cirrosis Hepática Alcohólica/diagnóstico , Masculino , Persona de Mediana Edad , Membrana Mucosa/patología , Membrana Mucosa/cirugía , Estadificación de Neoplasias , Medición de Riesgo , Muestreo , Sensibilidad y Especificidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Autoimmune pancreatitis is a rare disease characterized by inflammation of the pancreatic parenchyma, irregular narrowing of the pancreatic duct, periductal lymphoplasmacytic infiltration and fibrosis at histological examination, the presence of autoantibodies and hypergammaglobulinemia, as well as the possible association of cholangitis and other autoimmune diseases. There is a favorable response to steroid therapy. We report the case of a patient with autoimmune pancreatitis with bile duct involvement and peripheral eosinophilia, requiring long-term immunosuppressant treatment. The diagnosis of a diffuse form of AIP was made without direct histological evidence and based on indirect imaging, clinical and laboratory findings in an autoimmune context. The histological and imaging studies of bile duct involvement and the favourable response to steroids were additional arguments.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Enfermedades de los Conductos Biliares/etiología , Pancreatitis/complicaciones , Enfermedades de los Conductos Biliares/clasificación , Enfermedades de los Conductos Biliares/tratamiento farmacológico , HumanosRESUMEN
BACKGROUND AND STUDY AIMS: The high-frequency endosonography miniprobe has been advocated prior to endoscopic treatment of superficial esophageal neoplasm. We conducted a retrospective study, which summarized our clinical experience with various miniprobe techniques in the assessment of early squamous cell carcinoma (SCC) and superficial adenocarcinoma on Barrett's mucosa (SAB). PATIENTS AND METHODS: A total of 106 superficial and naive esophageal lesions were included in this series (52 SAB, 54 SCC). The results of the miniprobe staging were compared with pathology in order to determine the accuracy of this technique in differentiating mucosal from submucosal infiltration. Secondary aims were a comparison between the frequencies (20- vs. 30-MHz) and coupling methods (water-filled lumen vs. balloon-sheathed catheter) used. RESULTS: Overall accuracy, sensitivity, and specificity to differentiate T1sm from T1 m tumors were 73.5 %, 62 %, and 76.5 %, respectively. Overdiagnosis occurred in 18.6 % of the lesions. No statistically significant difference was found in the accuracy of the miniprobe staging between the two lesion types (SCC and SAB) ( P = 0.65), and results were significantly poorer in the distal part of the esophagus ( P = 0.00039). No significant difference was found between the two frequencies ( P = 0.51). Water-filled lumen proved to be superior to the balloon-sheathed catheter ( P = 0.015). CONCLUSION: High-frequency miniprobe examination has a limited accuracy in the detection of submucosal invasion in early esophageal cancer. Further improvements in acoustic coupling and ultrasound technique are required to improve the miniprobe accuracy before its implementation into clinical routine.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Esófago de Barrett/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico por imagen , Endosonografía/instrumentación , Neoplasias Esofágicas/diagnóstico por imagen , Invasividad Neoplásica/patología , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Esófago de Barrett/patología , Esófago de Barrett/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Distribución de Chi-Cuadrado , Endosonografía/métodos , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND STUDY AIMS: Duodenal stenting has become a popular treatment in cases of malignant stenosis. However, a prospective evaluation of the efficacy and morbidity of this procedure has not been performed. A prospective multicenter study of duodenal stenting was conducted by the Société Française d'Endoscopie Digestive (SFED). PATIENTS AND METHODS: A total of 51 patients were selected (mean age 72), the majority (69%) having pancreatic adenocarcinoma. Palliative treatment was chosen because of irresectability (61.2%), inoperability (18.4%), or both (20.4 %). Enteral Wallstent prostheses were used, and the patients were followed up on day 3, after 1 month, and then every month, with weight measurement, and symptomatic and laboratory evaluation. RESULTS: One prosthesis was sufficient in 46 patients. Stent positioning and deployment were correct in 50/51 patients (98%). Twenty patients also underwent biliary stenting in addition to the duodenal stenting. On day 3, 43 patients (84%) were able to tolerate soft solids or a full diet. Six complications were attributed to stenting: three intestinal hemorrhages, two cases of peritonitis due to bowel perforation, and one case of septicemia, and these led to five deaths (mortality 9.8%). Stent dysfunction was observed in 12 cases (23.5%) after a mean delay of 75 days, comprising 11-malignant obstructions and one migration: a new stent was inserted inside the first one and was effective in eight cases; and no treatment was given in the other four patients because of their clinical state. The median survival was 71.5 days. CONCLUSIONS: Palliative endoscopic treatment of malignant duodenal stenosis using metallic prostheses is highly feasible, even with associated biliary stenting. Symptomatic improvement is fast. However, the mortality and the obstruction rate are high, suggesting that a prospective trial comparing this treatment with surgery is still required.
Asunto(s)
Adenocarcinoma/complicaciones , Obstrucción Duodenal/terapia , Cuidados Paliativos , Neoplasias Pancreáticas/complicaciones , Implantación de Prótesis , Stents , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco/complicaciones , Constricción Patológica , Obstrucción Duodenal/etiología , Duodenoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Estudios Prospectivos , Resultado del TratamientoRESUMEN
UNLABELLED: BACK AND STUDY AIMS: Endoscopic mucosal resection (EMR) is used to treat premalignant and malignant digestive tract lesions. This report presents the efficacy and safety of EMR for squamous superficial neoplastic esophageal lesions. PATIENTS AND METHODS: A retrospective cohort study presented data from 51 patients with 54 lesions over an 8-year period, between November 1997 and September 2005. Dysplasas or mucosal (m) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas or more advanced stage were offered surgery or chemoradiotherapy. RESULTS: There was no mortality, perforation, or major hemorrhage, and there were three easily dilated stenoses. Of the patients, 16 had lesions graded as T1sm or more advanced and one patient was found to have normal tissue post EMR. Complete local remission was achieved in 31 of the 34 patients with dysplasia or T1 m cancers (91%). There was no distant relapse and there was local disease recurrence in eight of the 31 patients (26%). The 5-year survival rate was 95%. CONCLUSIONS: EMR for squamous superficial neoplastic lesions of the esophagus is safe and provides satisfactory survival results.