RESUMO
BACKGROUND AND AIMS: Although sporadic duodenal and/or ampullary adenomas (DAs) are uncommon, they are increasingly diagnosed during upper endoscopy. These patients have a 3- to 7-fold increased risk of colonic neoplasia compared with the normal population. It is unknown, however, whether they also have an increased risk of additional small-bowel (SB) polyps. Our aim was to establish the prevalence of SB polyps in patients with DA. METHODS: In a single-center, prospective study, we used video capsule endoscopy (VCE) to investigate the prevalence of SB polyps in patients with a DA compared with patients undergoing VCE for obscure GI bleeding or iron deficiency anemia. RESULTS: Over 25 months, 201 patients were enrolled in the study; the mean age was 65 years and 47% were male. There were 101 control patients and 100 cases of DA cases (mean size, 30 mm (range, 10-80 mm)). We did not identify any SB polyps in either group. Colonic polyps were found more frequently in the DA group compared with controls (61% versus 37%, respectively (P =.002)). Advanced colonic adenoma (high-grade dysplasia, >10 mm, villous histology) were found in 18% of the DA group and 5% of the control group (P =.018). CONCLUSION: Our data suggest that patients with a DA are not at risk for additional SB polyps and hence do not support screening with VCE. However, colonoscopy is mandatory due to the significantly higher risk of colonic polyps including advanced adenomas. (Clinical trial registration number: NCT02470416.).
Assuntos
Adenoma , Endoscopia por Cápsula , Pólipos do Colo , Adenoma/diagnóstico , Adenoma/epidemiologia , Idoso , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/epidemiologia , Colonoscopia , Feminino , Humanos , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/epidemiologia , Masculino , Prevalência , Estudos ProspectivosRESUMO
Wide-field endoscopic mucosal resection (EMR) is the primary management option for noninvasive laterally spreading colorectal lesions. It has been proved to be safe, highly effective, efficient, and cost-effective. Careful lesion interrogation before resection is essential because it provides essential information, including the risk of submucosal invasive disease. Adjuvant thermal ablation to the post-EMR defect margin has recently been shown to substantially reduce adenoma recurrence. Adenoma recurrence is predictable using the Sydney EMR Recurrence Tool. Adenoma recurrence can be accurately detected using standardized imaging of the post-EMR scar, and can be effectively treated.
Assuntos
Adenoma/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Recidiva Local de Neoplasia/cirurgia , Adenoma/patologia , Idoso , Perda Sanguínea Cirúrgica/fisiopatologia , Neoplasias Colorretais/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Duração da Cirurgia , Prognóstico , Medição de Risco , Resultado do TratamentoRESUMO
Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients.
Assuntos
Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/epidemiologia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Biópsia , Imunodeficiência de Variável Comum/etiologia , Detecção Precoce de Câncer , Feminino , Gastrite Atrófica/complicações , Gastroscopia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Programas de Rastreamento , Metaplasia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Lesões Pré-Cancerosas , Prevalência , Vigilância em Saúde Pública , Medição de Risco , Fatores de Risco , Neoplasias Gástricas/diagnóstico , Inquéritos e Questionários , Adulto JovemAssuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Sigmoidoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sangue OcultoRESUMO
AIM: To determine the prevalence of esophageal squamous papillomas (ESPs) in a tertiary teaching hospital and to assess for any clinical associations, including relations with esophageal squamous cell carcinomas (SCCs). METHODS: Data from a total of 6962 upper gastrointestinal endoscopies over a five year period were retrospectively obtained and analysed. RESULTS: ESP was found in sixteen patients (0.23%). Eight (50%) patients had a high body mass index, seven (44%) had history of cigarette smoking. Reflux esophagitis was found in four (25%) patients. All ESPs were solitary with a mean endoscopic size of 3.8 mm and located in the mid to lower esophagus. Human papilloma virus (HPV) was tested in three (19%) patients and was negative. Esophageal SCC was found in seven patients (0.10%) during the same period. None of the specimens were tested for HPV, and none had associated papillomatous changes. CONCLUSION: ESP is an uncommon tumour with unclear clinical associations and malignant potential.
Assuntos
Colo Transverso/patologia , Neoplasias do Colo/patologia , Leiomiossarcoma/patologia , Adulto , Colectomia , Colo Transverso/diagnóstico por imagem , Colo Transverso/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Colonoscopia , Hemorragia Gastrointestinal/etiologia , Humanos , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Masculino , Reto , Tomografia Computadorizada por Raios XRESUMO
Lymphocytic esophagitis (LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema ("spongiosis"). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn's disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. LyE has been reported to run a benign course; however there has been a case of esophageal perforation associated with LyE. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature.
Assuntos
Carcinoma de Células Renais/secundário , Neoplasias Duodenais/secundário , Neoplasias Renais/patologia , Ampola Hepatopancreática , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colangite/etiologia , Neoplasias Duodenais/complicações , Neoplasias Duodenais/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Infliximab is recommended to be infused over 2 h, but accelerated infusion rates of 30 min may improve efficiency, patient satisfaction and reduce nursing time and cost. The safety of this approach is not established. This study aims to assess the safety of accelerated infliximab infusion and determine the direct cost savings. METHODS: The primary endpoint of the study was adverse events and the secondary endpoints were cost, time saving per infusion and patient satisfaction associated with an accelerated infusion protocol. RESULTS: One hundred and thirty-six and 342 infusions were administered to 23 and 39 patients in the standard and accelerated protocols, respectively (mean infusion times 150 and 73.4 min, respectively, p < 0.0001). The adverse reaction rate of the standard protocol was 2.2% (95% confidence interval: 0.46 - 6.57) and accelerated protocol was 3.2% (95% CI: 1.74 - 5.73; p = 0.77). The odds ratio of adverse reaction for the 30-min infusion was 0.40 (95% CI: 0.09 - 1.82). The relative direct cost of nursing was decreased by 51.1% per infusion. Patient satisfaction score of the accelerated protocol was 9.2/10 (95% CI: 8.55 - 9.76) compared to 8.5/10 (95% CI: 7.83 - 9.17) in the initiation phase (p = 0.018). CONCLUSIONS: Accelerated 30-min infliximab infusions significantly reduced nursing time, cost and increased patient satisfaction without increasing infusion reactions. Increased patient freedom and improved efficiency in healthcare delivery can be expected.