Outpatient percutaneous endoscopic gastrostomy in selected head and neck cancer patients.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a relatively simple and safe method of providing access for enteral feeding. The procedure is usually performed in hospitalized patients. The feasibility of PEG as an outpatient procedure has not been well estabilished in the medical literature. The main objective of this study was to investigate the feasibility and safety of PEG as an outpatient procedure in a selected group of head and neck cancer patients. PATIENTS AND METHODS: In this prospective cohort study, head and neck cancer subjects in good clinical condition were selected and enrolled in a close follow-up protocol of outpatient PEG. The clinical and demographic variables evaluated were age, gender, early complications, and timing of PEG. RESULTS: Of a total of 136 PEG patients, 129 (94.8%) were discharged 3 h after the procedure. Three were excluded from the study and four were hospitalized because of moderate abdominal pain. The rate of minor complications was 17.6% (local pain, 7.4%; wound infection, 6.6%; abdominal pain, 2.9%; hematoma, 0.7%). Major complications occurred in 2.2% of the procedures (buried bumper syndrome, 1.5%; early tube displacement, 0.7%). There was no mortality. CONCLUSION: Ambulatory placement of gastrostomy tubes is viable and safe in head and neck cancer patients in good clinical condition. The early complication rates are similar to those described for hospitalized patients. Unnecessary admissions are avoided and costs of hospitalization are reduced.

Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis.

AIM: To evaluate the clinical impact of confocal laser endomicroscopy (CLE) in the diagnosis and management of patients with an uncertain diagnosis. METHODS: A retrospective chart review was performed. Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included. Baseline characteristics, indications, previous diagnostic studies, findings at the time of CLE, clinical management and histological results were analyzed. Interventions based on CLE findings were also analyzed. We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens. RESULTS: A total of 144 patients were included. Of these, 51% (74/144) were female. The mean age was 51 years old. In all, 41/144 (28.4%) lesions were neoplastic (13 bile duct, 10 gastric, 8 esophageal, 6 colonic, 1 duodenal, 1 rectal, 1 ampulloma and 1 pancreatic). The sensitivity, specificity, positive predictive value, negative predictive value, and observed agreement when CLE was used to detect N-lesions were 85.37%, 87.38%, 72.92%, 93.75% and 86.81%, respectively. Cohen's Kappa was 69.20%, thus indicating good agreement. Changes in management were observed in 54% of the cases. CONCLUSION: CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.

Role of endoscopic ultrasonography in intramural bronchogenic cysts: case reports and review of the literature.

The differentiation between a solid and cystic lesion is not always easy. EUS has provided a minimally invasive approach to the diagnosis of benign mediastinal cysts. Our report describes two cases of intramural bronchogenic cysts and reviews the role of EUS in dealing with such cases. We conclude that the bronchogenic cysts are still a challenge despite evolution of the imaging studies.

Intramural esophageal hematoma after elective injection sclerotherapy.

CONTEXT: Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. OBJECTIVE: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. METHODS: This is a retrospective observational study made at the 'Hospital Universitário Clementino Fraga Filho', Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. RESULTS: A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%). Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. CONCLUSION: Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa.

Intramural esophageal hematoma after elective injection sclerotherapy / Hematoma intramural esofágico após escleroterapia eletiva de varizes

Context: Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. Objective: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. Methods - This is a retrospective observational study made at the "Hospital Universitário Clementino Fraga Filho", Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. Results: A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28 percent). Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. Conclusion: Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa.

Contexto: Apesar do fato de que a escleroterapia endoscópica de varizes esofágicas vem sendo largamente substituída pela técnica de ligadura elástica, a escleroterapia é ainda rotineiramente utilizada em muitas instituições, especialmente em países em desenvolvimento. O hematoma intramural esofágico é uma complicação rara da escleroterapia e os fatores de risco para seu desenvolvimento ainda não estão completamente estabelecidos. Objetivo - Demonstrar a incidência do hematoma intramural esofágico pós-escleroterapia no Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, e discutir os possíveis fatores envolvidos. Métodos: Este é um estudo retrospectivo observacional realizado no Hospital Universitário Clementino Fraga Filho, através da revisão dos prontuários médicos de todos os pacientes submetidos a escleroterapia endoscópica de varizes esofágicas entre abril de 2000 e novembro de 2005. Uma avaliação das características clínicas, laboratoriais e endoscópicas desses pacientes e dos descritos na literatura foi realizada. A revisão da literatura foi feita através de pesquisa no MEDLINE. Resultados: Foram realizados 1.433 procedimentos de escleroterapia endoscópica de varizes esofágicas em 397 pacientes, com incidência de hematoma intramural esofágico de 4 casos (0,28 por cento). Três dos quatro pacientes desenvolveram complicações adicionais e um falecimento foi consequência direta do hematoma intramural esofágico. Dezenove casos bem documentados de hematoma intramural esofágico foram descritos na literatura. Na maioria dos casos o hematoma intramural esofágico ocorreu a partir da quarta sessão de escleroterapia endoscópica de varizes esofágicas e distúrbios de coagulação estavam presentes. Conclusão: O hematoma intramural esofágico é complicação rara da escleroterapia e a incidência no hospital onde foi realizada esta pesquisa foi similar à observada na literatura. Este estudo sugere que essa complicação resulta de mucosa...

Immunohistochemical study of intestinal eosinophils in inflammatory bowel disease.

BACKGROUND: Eosinophil accumulation and activation are characteristic features of inflammation in allergic diseases and in host defense against parasites. GOALS: To investigate the involvement of eosinophils in inflamed and noninflamed mucosa of patients with inflammatory bowel disease (IBD). STUDY: Specimens of inflamed colonic mucosa from 15 patients with ulcerative colitis (UC) and inflamed and noninflamed colonic mucosa from 15 patients with Crohn's disease (CD) were submitted to histologic and immunohistochemical studies. Twelve patients with irritable bowel syndrome were studied as controls. Sirius red was used to label eosinophils in tissue. EG1, EG2, and anti-hIL-5 were used as primary antibodies in an indirect alkaline phosphatase-labeled immunostaining protocol. Both positive and negative lamina propria cells were assessed by a quantitative grading system and the results expressed as cell numbers per mm. RESULTS: Increased proportions of eosinophils stained with Sirius red, EG1, EG2, and anti-hIL-5+ cells were found in the colon of patients with UC and in inflamed and noninflamed colon of CD patients as compared with controls. Crohn's disease patients showed increased proportions of EG1+ and EG2+ cells as compared with those with UC. Increased proportions of IL-5+ cells were detected in UC patients as compared with those with CD. CONCLUSION: Quantitative eosinophil alterations and IL-5+ cells may indicate enhanced cellular activation with degranulation, which is implicated in the pathogenesis of IBD. Increase in IL-5+ cells may reflect a predominant local Th2 response in UC as compared with CD.

Hemorragia digestiva baixa como complicação de doença diverticular de delgado - Relato de caso / Low gastrointestinal hemorrhage as a complication of small bowel diverticular disease - Case report

A doença diverticular de delgado é uma causa incomum, porém importante, de hemorragia digestiva baixa, devendo ser sempre considerada no diagnóstico diferencial de pacientes nos quais a endoscopia digestiva alta e a colonoscopia foram incapazes de localizar o sítio de sangramento. relata-se caso de sangramento digestivo secundario a divertículo de delgado, com diagnóstico radiológico e tratamento cirúrgico