RESUMEN
BACKGROUND/AIMS: Recently, endoscopic detachable snare ligation (EDSL) has become increasingly common as treatment for colonic diverticular hemorrhage. This study aimed to evaluate the efficacy and safety of EDSL in comparison with endoscopic clipping (EC) as treatment for colonic diverticular hemorrhage. METHODS: From April 2013 to September 2017, 131 patients were treated with EDSL or EC at the Tokyo Metropolitan Bokutoh Hospital. We retrospectively evaluated patient characteristics and clinical outcomes, including early rebleeding rates (rebleeding within 30 days after initial hemostasis) and complications for each procedure. RESULTS: Of 131 patients, 44 and 87 were treated with EDSL and EC respectively. We initially achieved endoscopic hemostasis in all patients. The early rebleeding rate was significantly lower for EDSL (6.8%, 3 patients) than for EC (23.0%, 20 patients). There were no differences in the total procedure time (43 vs. 45 min, p = 0.84) or time to hemostasis after identification of bleeding site (12 vs. 10 min, p = 0.23). There were no severe complications following EDSL. CONCLUSION: The results of this study suggest that EDSL is superior to EC as treatment for colonic diverticular hemorrhage. EDSL may provide improvements in the clinical course of patients with colonic diverticular hemorrhage.
Asunto(s)
Enfermedades del Colon/cirugía , Colonoscopía/métodos , Divertículo del Colon/complicaciones , Hemorragia Gastrointestinal/cirugía , Hemostasis Endoscópica/instrumentación , Ligadura/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Colon/etiología , Femenino , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica/métodos , Humanos , Ligadura/métodos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: We previously reported preliminary safety results for a new method, endoscopic detachable snare ligation (EDSL), for diverticular hemorrhage. This method does not need endoscope removal to attach a ligation device after detection of the bleeding site. The aim of the present study was to evaluate the efficacy and safety of EDSL in a larger patient population. METHODS: This prospective study was conducted in 12 institutions. Patients suspected of having diverticular hemorrhage without serious systemic disease were enrolled. The primary endpoint was early (within 30 days) recurrent bleeding rate in patients treated with EDSL. The secondary endpoints were overall early recurrent bleeding rate in patients with definite diverticular bleeding and adverse events in patients treated with EDSL. RESULTS: From June 2015 to March 2017, bleeding diverticula were detected in 123 of 205 enrolled patients (60%), of whom 101 (82%) were treated with EDSL. Most patients (20/22) in whom EDSL was not successful were treated with clipping. The early recurrent bleeding rate was 7.9% (95% confidence interval, 2.6%-13.2%; 8/101) in patients who could be treated with EDSL. The median total endoscopic and EDSL procedure time was 40 minutes (interquartile range, 15-71) and 4 minutes (interquartile range, 1-7), respectively. Two mild adverse events, colonic diverticulitis and temporary abdominal pain, were observed. CONCLUSION: EDSL was confirmed to be useful and safe for treatment of colonic diverticular hemorrhage. (Clinical trial registration number: UMIN 000001858.).
Asunto(s)
Divertículo del Colon/complicaciones , Hemorragia Gastrointestinal/cirugía , Hemostasis Endoscópica/métodos , Dolor Abdominal/etiología , Anciano , Anciano de 80 o más Años , Colonoscopía , Diverticulitis del Colon/etiología , Femenino , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica/efectos adversos , Humanos , Ligadura/efectos adversos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Prospectivos , RecurrenciaRESUMEN
BACKGROUND AND STUDY AIMS: Colonic diverticular hemorrhage is the most common cause of lower intestinal bleeding. We tried to develop a convenient and reliable hemostatic method, endoscopic detachable snare ligation (EDSL), to treat diverticular hemorrhage and retrospectively explored its safety and efficacy. PATIENTS AND METHODS: The definitive bleeding diverticulum was ligated with a detachable snare, instead of a rubber band, in a procedure similar to endoscopic band ligation. Removal of the scope to attach a ligation device and reinsertion for treatment are not needed in this method. RESULTS: From November 2013 to September 2014, EDSL was used to treat 8 patients with colonic diverticular hemorrhage. The mean procedure time required for hemostasis after identification of the bleeding diverticulum was 5â±â2 minutes. Sustained hemostasis was achieved in 7 patients (88â%), and early rebleeding occurred in 1 patient, in whom the applied suction seemed inadequate. No complications occurred in any patient. CONCLUSIONS: EDSL may be a safe and effective treatment for colonic diverticular hemorrhage. However, additional studies are warranted to confirm these initial exploratory data.
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Colonoscopía/métodos , Divertículo del Colon/complicaciones , Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/métodos , Anciano , Anciano de 80 o más Años , Colonoscopía/instrumentación , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica/instrumentación , Humanos , Ligadura/instrumentación , Ligadura/métodos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
We performed a retrospective study on the use of cetuximab or panitumumab alone in patients with KRAS wild-type metastatic colorectal cancer between November 2008 and February 2012. Twenty-two patients were analyzed and classified as PS 0/1 (good PS group)and PS 2/3/4 (poor PS group)with 11 patients in each group. The response rate, disease control rate, median progression-free survival, and median overall survival were 9%, 73%, 5.1 months (95%confidence interval[CI]: 1.5-8.7), and 16 months (95% CI: 8.8-24), respectively, in the good PS group, and the corresponding values in the poor PS group were 0%, 18%, 0.7 months (95% CI: 0.3-1.0), and 1.5 months (95% CI: 0.7-2.4). Grade 3 or 4 adverse events were skin toxicities (2 patients with grade 3 toxicities), panitumumab-related interstitial lung disease (1 patient with grade 4 toxicity), and cetuximab infusion-related reaction (1 patient with grade 4 toxicity). No treatment-related deaths were observed. In conclusion, the efficacy and safety of cetuximab or panitumumab monotherapy in patients with a good PS in our study were similar to those reported in previous clinical trials, whereas patients with a poor PS showed poorer outcomes.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Cetuximab , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Panitumumab , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas p21(ras) , Estudios Retrospectivos , Resultado del Tratamiento , Proteínas ras/genéticaRESUMEN
BACKGROUND: Submucosal and lymphovascular (SM/LV) invasions of early gastric cancer (EGC) are difficult to diagnose accurately prior to endoscopic submucosal dissection (ESD), and are occasionally found in resected specimens, requiring additional gastrectomy and lymph node dissection. We performed a retrospective study to determine the risk factors for SM/LV invasions. METHODS: We analyzed clinicopathological data (age, sex, cancer location, gross morphology, multifocality, tumor size, histological differentiation, depth of invasion, and the presence or absence of lymphovascular invasion) in patients receiving ESD between 2007 and 2012 and presenting with EGC of 2.0 cm or smaller in size, a differentiated-type adenocarcinoma, and without ulceration. RESULTS: Of 208 lesions consecutively resected by ESD, 143 lesions in 132 patients were included in this study. Submucosal and lymphovascular invasions were detected in 16 lesions. Multivariate analysis revealed three independent risk factors for SM/LV invasions: dominant histology of moderately-differentiated or papillary adenocarcinoma, gross type of 0-IIa + IIc or IIc + IIa, and tumor size of ≥1.5 cm. Lesions exhibiting more than two of these three risk factors were associated with having a 47 % increased incidence of SM/LV invasion (odds ratio 15; 95 % confidence interval 4.6-49.0; P < 0.0001). CONCLUSIONS: Moderately-differentiated or papillary adenocarcinoma, 0-IIa + IIc or IIc + IIa, and a tumor size of ≥1.5 cm were identified as independent risk factors for SM/LV invasion among EGCs which appeared to be an endoscopically good indication for ESD. Careful surveillances including endoscopic ultrasonography or enhanced computed tomography might be needed for high risk patients before ESD.
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Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Gastroscopía/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patología , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Disección/métodos , Femenino , Humanos , Mucosa Intestinal/patología , Escisión del Ganglio Linfático , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/cirugíaRESUMEN
Double balloon endoscopy (DBE) is useful for diagnosing many intestinal diseases and for endoscopic procedures. We report a case of chronic diarrhea in a 58-year-old Japanese man. He was initially suspected to have malabsorption syndrome. DBE showed reduction of folds, scalloping, mucosal nodularity and granularity. Pathological examinations of biopsies from the jejunum showed severe villous atrophy with subepithelial collagen bands. These findings led to the final diagnosis of collagenous sprue (CS). With1 month of total parenteral nutrition followed by a low-gluten diet, his symptoms gradually improved. CS has never been reported before in Japan. DBE is useful for making a diagnosis of CS, and may be considered for patients who are suffering from diarrhea of unknown cause.
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Esprue Colágeno/diagnóstico , Endoscopía Capsular , Colágeno/metabolismo , Esprue Colágeno/dietoterapia , Esprue Colágeno/terapia , Dieta Sin Gluten , Enteroscopía de Doble Balón , Humanos , Inmunohistoquímica , Yeyuno/patología , Masculino , Persona de Mediana Edad , Nutrición Parenteral , Tomografía Computarizada por Rayos XRESUMEN
A 45-year-old man presented with severe abdominal distention with massive ascites due to a diffusely disseminated peritoneal tumor. A core needle biopsy specimen was obtained from the peritoneal lesion. Histological diagnosis was epithelioid type mesothelioma. He did not choose to receive chemotherapy. For 2.5 years, he went without medical intervention, and his disease gradually progressed, leading to a worsening of his symptoms. The patient then chose to be treated with combination chemotherapy of cisplatin and pemetrexed, followed by pemetrexed alone. There was remarkable tumor shrinkage and his symptoms improved. These effects have been sustained for two years after the initial chemotherapy. Chemotherapy appears to have contributed to survival prolongation for this patient. This case exemplifies the fact that malignant peritoneal mesothelioma may progress slowly when fits with some good prognostic factors, and it is important to consider the prognostic factors.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Mesotelioma/tratamiento farmacológico , Neoplasias Peritoneales/tratamiento farmacológico , Ascitis/etiología , Cisplatino/administración & dosificación , Glutamatos/administración & dosificación , Guanina/administración & dosificación , Guanina/análogos & derivados , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Mesotelioma/complicaciones , Mesotelioma Maligno , Persona de Mediana Edad , Pemetrexed , Neoplasias Peritoneales/complicaciones , Neoplasias Peritoneales/patología , Resultado del TratamientoRESUMEN
BACKGROUND: A Japanese postmarketing survey of panitumumab revealed that panitumumab-associated interstitial lung disease (ILD) occurred in approximately 1% (19/1767) of patients, causing death in 36.8% of these cases. CASE REPORT: We report the case of a 60-year-old Japanese man who developed ILD associated with panitumumab therapy (third-line therapy) for metastatic sigmoid colon cancer involving the liver, lymph nodes, and lungs. 2 months after the initiation of panitumumab therapy, he developed a progressive nonproductive cough, dyspnea, and a fever, and was diagnosed with ILD. Intravenous pulse methylprednisolone treatment led to quick recovery. The patient had some risk factors for ILD associated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors. CONCLUSION: Further studies are required to elucidate the association between anti-EGFR antibodies and ILD.
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Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/secundario , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedades Pulmonares Intersticiales/prevención & control , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico , Masculino , Persona de Mediana Edad , Panitumumab , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
Dihydropyrimidine dehydrogenase (DPD) deficiency induces severe adverse events in patients receiving fluoropyrimidines. We encountered a 64-year-old DPD-deficient man with a severe capecitabine-related gastrointestinal disorder. He received capecitabine-containing chemotherapy after rectal cancer resection. During the first course of chemotherapy, he developed severe diarrhea, a fever, and hematochezia. Endoscopy revealed mucosal shedding with bleeding throughout the gastrointestinal tract. DPD deficiency was suspected because he developed many severe adverse events of capecitabine early and was finally confirmed based on the finding of a low DPD activity level in peripheral blood mononuclear cells. After one month of intensive care, hemostasis and mucosal healing were noted, although his gastrointestinal function did not improve, and he had persistent nutritional management issues.
Asunto(s)
Deficiencia de Dihidropirimidina Deshidrogenasa , Neoplasias del Recto , Antimetabolitos Antineoplásicos/efectos adversos , Capecitabina/efectos adversos , Deficiencia de Dihidropirimidina Deshidrogenasa/inducido químicamente , Deficiencia de Dihidropirimidina Deshidrogenasa/complicaciones , Deficiencia de Dihidropirimidina Deshidrogenasa/tratamiento farmacológico , Fluorouracilo/efectos adversos , Humanos , Leucocitos Mononucleares , Masculino , Persona de Mediana Edad , Neoplasias del Recto/complicaciones , Neoplasias del Recto/tratamiento farmacológicoRESUMEN
The aging of the population has resulted in atrial fibrillation (AF) becoming increasingly prevalent. Treatment focuses on the prevention of thromboembolism through the use of catheter ablation or drug therapy with anticoagulants, such as warfarin or direct oral anticoagulants (DOACs). Dabigatran-induced exfoliative esophagitis has been reported as a rare side effect of DOACs. Although most cases are mild, some result in severe outcomes. However, the etiology of exfoliative esophagitis remains incompletely understood. The aim of this study is to investigate the etiology of exfoliative esophagitis and identify its risk factors by observational study.The participants were 524 patients using anticoagulants who received catheter ablation for AF and subsequently underwent upper gastrointestinal endoscopy at University of Tsukuba Hospital. Exfoliative esophagitis was noted in 21 (4.0%) patients. Potential risk factors for exfoliative esophagitis were examined retrospectively by comparing patients with and without this condition across the following parameters that were extracted retrospectively from the electronic medical records: physical characteristics, comorbidities, blood-based cardiac markers, echocardiographic and endoscopic findings, and current medications.Regarding physical characteristics, patients with exfoliative esophagitis had significantly higher body weight and BMI. No association was observed between exfoliative esophagitis and comorbidities. Associations were also not found for cardiac markers, echocardiographic findings, or endoscopic findings. In terms of current medications, patients receiving oral dabigatran showed the highest prevalence of exfoliative esophagitis at 8.8% (13/148). The adjusted odds ratio of dabigatran for exfoliative esophagitis was 10.3 by multivariable logistic regression analysis.Obesity and oral dabigatran were found to be significant risk factors for exfoliative esophagitis.
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Antitrombinas/efectos adversos , Fibrilación Atrial/tratamiento farmacológico , Dabigatrán/efectos adversos , Esofagitis/inducido químicamente , Anciano , Fibrilación Atrial/complicaciones , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Retrospectivos , Factores de RiesgoRESUMEN
A 62-year-old man was referred to our department with suspected intussusception due to an ileal tumor. Tumor markers including soluble interleukin-2 receptor were not elevated. Contrast-enhanced computed tomography and color Doppler ultrasonography showed a distinct ileal tumor without intratumoral blood flow or surrounding lymphadenopathies. Retrograde single-balloon enteroscopy revealed a submucosal tumor in the ileum that was hard and ulcerated. Partial intestinal resection was performed, and the lesion was diagnosed as an inflammatory myofibroblastic tumor. The patient had no recurrence over 2 years without additional treatment after surgery. This rare tumor should be kept in mind as a cause of ileal intussusception in adult and a multidisciplinary approach is vital to characterize it.
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Enfermedades del Íleon , Neoplasias del Íleon , Intususcepción , Adulto , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Íleon , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
Background and study aims Esophageal endoscopic submucosal dissection (ESD) is technically difficult because of narrow working spaces and ease of perforation due to the lack of serosa. HybridKnife is a recently developed ESD device that is combined with the high pressure waterjet ERBEJET 2 system to lift mucosa. We hypothesized that this waterjet could make submucosal dissection safer and studied this in porcine esophagus. Materials and methods Water pressures of 30â-â70âbar were tested to determine the appropriate pressure for waterjet ESD with HybridKnife (WJ-ESD) in one pig. WJ-ESD safety and completion were compared with those of conventional ESD using DualKnife (C-ESD) as a reference. Each of three virtual esophageal lesions in two pigs were resected alternatively using both methods from the lower to upper esophagus. For WJ-ESD, the submucosa, apart from hard fibrous tissues, was dissected using water pressure alone. Results Using 50âbar of water pressure resulted in the best balance between proper dissection and view-disturbing water backflow. The dissection speeds for the lower, middle, and upper esophagus were 0.2, 0.9, and 0.2âcm2/min in 50âbar WJ-ESD and 1.1, 0.5, and 1.0âcm2/min in C-ESD, respectively. Minor bleeding was frequent in WJ-ESD, but was easily stopped by electrocoagulation with the same needle. No perforation was observed in either procedure. Thermal damage to dissected tissues appeared mild, and the extent of muscle injury was lower for WJ-ESD (4, 6, and 8â%) compared with C-ESD (14, 16, and 7â%). Conclusions WJ-ESD could be completed safely for porcine esophagus with less damage to the muscle layer compared with C-ESD.
RESUMEN
Combination chemotherapy of mFOLFOX6 (5-fluorouracil, leucovorin, and oxaliplatin) plus panitumumab, a fully human monoclonal antibody against epidermal growth factor receptor (EGFR), is one of the standard treatments for metastatic colorectal cancer (mCRC) without KRAS mutation. A few reports suggested no need of dose adjustment of cetuximab, a similar chimeric anti-EGFR antibody, in patients with renal impairment. However, panitumumab combined with cytotoxic drugs for hemodialysis patients has not been reported. We herein report a case of a hemodialysis mCRC patient successfully treated with mFOLFOX6 and panitumumab combination therapy.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Ciego/tratamiento farmacológico , Receptores ErbB/antagonistas & inhibidores , Anticuerpos Monoclonales/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Ciego/patología , Receptores ErbB/genética , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/administración & dosificación , Leucovorina/uso terapéutico , Masculino , Persona de Mediana Edad , Mutación , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/uso terapéutico , Panitumumab , Diálisis RenalRESUMEN
Ulcerative colitis (UC) is known to be associated with an increased risk of colorectal cancer. However, the occurrence of non-epithelial malignancies is uncommon. An elevated lesion in the descending colon was found in a 51-year-old woman with a 30-year history of UC. Despite tumor progression, repeated biopsies showed no cancerous findings. Because the lesion was highly suspected to be a malignant tumor, a partial colectomy was performed. The pathological diagnosis was leiomyosarcoma. Leiomyosarcoma of the gastrointestinal tract is rare, and this is only the third known case reported in patients with UC.
Asunto(s)
Colitis Ulcerosa/complicaciones , Neoplasias del Colon/complicaciones , Leiomiosarcoma/complicaciones , Colectomía , Neoplasias del Colon/cirugía , Femenino , Humanos , Leiomiosarcoma/cirugía , Persona de Mediana EdadRESUMEN
We report the case of a 58-year-old woman who was referred to our hospital due to frequent bloody mucus diarrhea. She was diagnosed with cap polyposis based on typical endoscopic and histological findings. Colonoscopy revealed multiple, reddish, mucus-capped polypoid lesions from the rectum to the sigmoid colon. A pathological examination revealed that the polyps were covered by erosive and inflamed granulation tissue with decreased crypt cells. Laboratory data indicated positive values for Helicobacter pylori immunoglobulin G antibody and hypoproteinemia. Metronidazole, H. pylori eradication, and levofloxacin therapies were not effective; however, the subsequent administration of betamethasone enema dramatically improved the clinical symptoms and endoscopic findings. The hypoproteinemia was normalized after the therapy. The dose of the betamethasone enema was tapered gradually, and no recurrence was observed 6 months after discontinuation of the treatment. This case suggests that betamethasone enema may be considered as the second treatment choice for cap polyposis patients after H. pylori eradication, metronidazole or levofloxacin therapy.