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1.
BMC Gastroenterol ; 24(1): 139, 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38649806

RESUMO

BACKGROUND: Gastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP. METHODS: We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection. RESULTS: GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective. CONCLUSIONS: GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.


Assuntos
Pólipos Adenomatosos , Endossonografia , Mucosa Gástrica , Gastroscopia , Hamartoma , Pólipos , Neoplasias Gástricas , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hamartoma/patologia , Hamartoma/diagnóstico por imagem , Hamartoma/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/diagnóstico por imagem , Mucosa Gástrica/patologia , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/cirurgia , Adulto , Idoso , Pólipos/patologia , Pólipos/cirurgia , Pólipos/diagnóstico por imagem , Gastropatias/patologia , Gastropatias/cirurgia , Gastropatias/diagnóstico por imagem , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Gastrite/patologia , Gastrite/complicações , Gastrite/diagnóstico por imagem , Gastrite Atrófica/patologia , Gastrite Atrófica/complicações , Ressecção Endoscópica de Mucosa
2.
Digestion ; 104(3): 174-186, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36470211

RESUMO

BACKGROUND AND AIM: Small gastric subepithelial lesions (SELs) are sometimes encountered in daily esophagogastroduodenoscopy (EGD) practice, but whether once-annual or twice-annual endoscopy can provide sufficient follow-up remains unclear. Because follow-up based on small-SEL characteristics is important, this study clarified the natural history of gastric SELs less than 20 mm. METHODS: This retrospective multicenter observation study conducted at 24 Japanese hospitals during April 2000 to March 2020 examined small gastric SELs of ≤20 mm diameter. The primary outcome was the rate of size increase of those SELs detected using EGD, with growth times assessed irrespective of SEL pathological diagnoses. RESULTS: We examined 824 cases with tumors of 1-5 mm diameter in 298 (36.2%) cases, 6-10 mm in 344 (41.7%) cases, 11-15 mm in 112 (13.6%) cases, and 16-20 mm in 70 (8.50%) cases. An increase of small gastric SELs was observed in 70/824 patients (8.5%). The SELs larger than 6 mm increased, even after 10 years. No-change and increasing groups had no significantly different malignant findings at diagnosis. In cases of gastrointestinal stromal tumors (GISTs), internal cystic change in endoscopic ultrasound (EUS) is a risk factor for an increased tumor size. The predictive tumor growth cutoff size at initial diagnosis was 13.5 mm. CONCLUSIONS: Small gastric SELs less than 20 mm have an approximately 8.5% chance of increase. Predictive markers for GIST growth are tumor size ≥13.5 mm and internal cystic change in EUS.


Assuntos
Tumores do Estroma Gastrointestinal , Gastropatias , Humanos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Endossonografia , Gastropatias/diagnóstico por imagem , Estudos Retrospectivos
3.
Rev Esp Enferm Dig ; 115(11): 665-666, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37882202

RESUMO

A 47-year-old man presented with a 6-day pain in the right chest. Abdominal CT showed an elliptical homogeneous mass, which was closely related to the posterior wall of the stomach and the lesion grew from the posterior wall of the stomach to the abdominal cavity in the wedge shape. The enhanced scan showed no enhancement in the lesion. The left adrenal gland and the upper pole, pancreas and spleen were changed due to compression. Carbohydrate antigen 72-4 (CA72-4) was 45.1U/ml (0.00~5.30 U/ml). The gastroscopy results showed that there was protruded lesion in the posterior gastric wall and atrophic gastritis in the superficial stomach. Laparoscopic exploration and partial gastrectomy were performed. An 8cm × 7cm tumor was found at the posterior wall of the fundus near the cardia, with smooth serosal surface. The cystic mass was smooth surface, filled with yellow thick liquid. Microscopically, the cystic wall tissue was lined with pseudo-stratified ciliated columnar epithelium, and mucous glands were seen under the epithelium. Pathological diagnosis showed bronchogenic cysts of the gastric submucosal. At 2-month follow-up, the postoperative recovery was good.


Assuntos
Cisto Broncogênico , Gastropatias , Masculino , Humanos , Pessoa de Meia-Idade , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/cirurgia , Gastropatias/diagnóstico por imagem , Gastropatias/cirurgia , Pâncreas , Baço
4.
Rev Esp Enferm Dig ; 115(2): 87-88, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35285665

RESUMO

A 58-year-old man presented to our hospital due to upper abdominal pain for 2 months. Gastroscopy showed a 1.5×1.5×1 cm3 protuberant lesion in the gastric antrum. Magnifying endoscopy with blue laser imaging showed roughly normal micro-surface and micro-vessel structure. Endoscopic ultrasonography showed the lesion originated from the muscularis propria, with low-density irregular cystic echo. Then the patient received treatment of gastrointestinal lesions with endoscopic submucosal dissection. During the operation, it could be seen that the lesion was mainly located in the submucosa, the local depth of which reached the muscularis mucosae. It was tan-white in color, with toughness and cystic tactile sensation. The operation went smoothly and his recovery was good. Pathological studies showed that pancreatic tissue was found in the lesion, which was composed of exocrine acini and ducts. Meanwhile, dilated cystic glands were found in the excised specimens. He was eventually diagnosed as ectopic pancreas in gastric antrum complicated with gastritis cystica profunda (GCP).


Assuntos
Gastropatias , Neoplasias Gástricas , Masculino , Humanos , Pessoa de Meia-Idade , Antro Pilórico/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Gastropatias/cirurgia , Gastropatias/patologia , Endossonografia , Gastroscopia , Endoscopia Gastrointestinal , Neoplasias Gástricas/patologia , Mucosa Gástrica/diagnóstico por imagem
6.
Gastrointest Endosc ; 93(1): 133-139.e4, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32470426

RESUMO

BACKGROUND AND AIMS: Magnetically controlled capsule endoscopy (MCE) has become an efficient diagnostic modality for gastric diseases. We developed a novel automatic gastric lesion detection system to assist in diagnosis and reduce inter-physician variations. This study aimed to evaluate the diagnostic capability of the computer-aided detection system for MCE images. METHODS: We developed a novel automatic gastric lesion detection system based on a convolutional neural network (CNN) and faster region-based convolutional neural network (RCNN). A total of 1,023,955 MCE images from 797 patients were used to train and test the system. These images were divided into 7 categories (erosion, polyp, ulcer, submucosal tumor, xanthoma, normal mucosa, and invalid images). The primary endpoint was the sensitivity of the system. RESULTS: The system detected gastric focal lesions with 96.2% sensitivity (95% confidence interval [CI], 95.7%-96.5%), 76.2% specificity (95% CI, 75.97%-76.3%), 16.0% positive predictive value (95% CI, 15.7%-16.3%), 99.7% negative predictive value (95% CI, 99.74%-99.79%), and 77.1% accuracy (95% CI, 76.9%-77.3%) (sensitivity was 99.3% for erosions; 96.5% for polyps; 89.3% for ulcers; 87.2% for submucosal tumors; 90.6% for xanthomas; 67.8% for normal; and 96.1% for invalid images). Analysis of the receiver operating characteristic curve showed that the area under the curve for all positive images was 0.84. Image processing time was 44 milliseconds per image for the system and 0.38 ± 0.29 seconds per image for clinicians (P < .001). The kappa value of 2 times repeated reads was 1. CONCLUSIONS: The CNN faster-RCNN-based diagnostic program system showed good performance in diagnosing gastric focal lesions in MCE images.


Assuntos
Endoscopia por Cápsula , Gastropatias , Inteligência Artificial , Humanos , Redes Neurais de Computação , Curva ROC , Gastropatias/diagnóstico por imagem
7.
Undersea Hyperb Med ; 48(2): 187-193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975410

RESUMO

Hydrogen peroxide (H2O2) ingestion can cause vascular gas embolism (GE). Hyperbaric oxygen therapy (HBO2) is known to improve neurological abnormalities in patients with arterial gas embolism (AGE). Previously, HBO2 based on the U.S. Navy Table 6 diving protocol has been adopted for treating AGE and preventing the progression of portal venous GE, caused by H2O2 ingestion, to AGE. However, the indication and protocol for HBO2 have not been established for GE related to H2O2 ingestion. Herein, we describe a case in which GE caused by H2O2 ingestion was treated using HBO2 with a short protocol. A 69-year-old female patient presented with abdominal pain, vomiting, and transient loss of consciousness after ingesting 35% H2O2. Computed tomography revealed gastric wall and portal venous gas. She was administered an HBO2 protocol with 2.8-atmosphere absolute (ATA) compression for 45 minutes. This was followed by a 2.0-ATA treatment for 60 minutes with a five-minute air break, after which all gas bubbles disappeared. After HBO2 treatment, brain magnetic resonance imaging revealed focal cytotoxic edema lesions; however, the patient was discharged without additional symptoms.


Assuntos
Anti-Infecciosos Locais/intoxicação , Embolia Aérea/terapia , Peróxido de Hidrogênio/intoxicação , Oxigenoterapia Hiperbárica/métodos , Idoso , Edema Encefálico/diagnóstico por imagem , Embolia Aérea/induzido quimicamente , Embolia Aérea/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Veia Porta/diagnóstico por imagem , Gastropatias/induzido quimicamente , Gastropatias/diagnóstico por imagem , Gastropatias/terapia , Tomografia Computadorizada por Raios X
8.
Rev Esp Enferm Dig ; 113(11): 789-790, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34139857

RESUMO

A 61-year-old male was hospitalized in our department due to Intermittent melena for 4 days. Laboratory tests showed a reduced hemoglobin level (10.7 g/L). Abdominal computed tomography (CT) showed gastric wall thickening in the gastric body.


Assuntos
Tinta , Gastropatias , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Melena , Pessoa de Meia-Idade , Gastropatias/complicações , Gastropatias/diagnóstico por imagem
9.
J Gastroenterol Hepatol ; 35(3): 446-452, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31518449

RESUMO

BACKGROUND AND AIM: The effect of real-time analysis of needle-based confocal laser endomicroscopy (nCLE) for gastric subepithelial lesions (SELs) on the diagnostic value is unclear. The study aimed to investigate the diagnostic efficacy of real-time nCLE for gastric SELs and to assess the technical aspects and safety of real-time nCLE. METHODS: Consecutive patients with gastric SELs ≥ 1 cm were prospectively investigated by endoscopic ultrasound (EUS), followed by nCLE. During EUS-nCLE, real-time nCLE diagnosis was made by an expert endoscopist. The procedure-relative adverse events were assessed and recorded. One-month washout period later, nCLE videos were reviewed off-line by the same endoscopist. The nCLE diagnoses were compared with corresponding pathological results. Additionally, image quality and interobserver agreements for the criteria were evaluated by three experienced endomicroscopists. RESULTS: Except for one failing to be punctured, 60 patients completed EUS-nCLE procedures successfully. Real-time nCLE had high diagnostic accuracies of ≥ 88.3% for gastric SELs. There were no significant differences between real-time and off-line nCLE diagnoses for gastric SELs (P > 0.05). The overall accuracy of real-time nCLE for diagnosis of gastric SELs was 86.7%. There were no procedure-relative adverse events occurred. In addition, the mean image quality score was 3.6 (1 = poor and 5 = excellent). The interobserver agreement was "almost perfect" for ectopic pancreas and "substantial" for gastrointestinal stromal tumor, leiomyoma, and carcinoma. CONCLUSIONS: Endoscopic ultrasound-nCLE could provide in vivo real-time diagnostic imaging with a high diagnostic accuracy. Meanwhile, real-time nCLE was feasible and had a satisfactory safety profile.


Assuntos
Endoscopia Gastrointestinal/métodos , Endossonografia/métodos , Microscopia Confocal/métodos , Agulhas , Gastropatias/diagnóstico , Idoso , Endoscopia Gastrointestinal/instrumentação , Endossonografia/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microscopia Confocal/instrumentação , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Gastropatias/diagnóstico por imagem
10.
Pediatr Radiol ; 50(9): 1180-1190, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32474774

RESUMO

Diagnostic imaging of pediatric gastric masses often provides a challenge for the practicing radiologist. Radiologists should be aware of this relatively unusual pathology, particularly in cross-sectional imaging findings. We will review pediatric gastric masses and mass-like lesions, focusing on neoplastic and inflammatory etiologies.


Assuntos
Anormalidades do Sistema Digestório/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Meios de Contraste , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido
11.
Acta Chir Belg ; 120(1): 57-60, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30103665

RESUMO

Introduction: A parastomal hernia (PSH) is the most common complication of a stoma creation. The PSH contents normally consist of mobile abdominal structures, i.e. omentum and small or large bowel loops. A herniated stomach is thereby very rare, given that only eight cases are reported in the literature.Patients and methods: Two female patients with clinical symptoms of gastric involvement in a PSH were admitted in our centre.Results: Computed tomography (CT) imaging, nasogastric decompression and an efficient operative intervention ensured a good clinical outcome in both patients, but with a long hospital stay and temporary gastroparesis in one patient. Regarding our two cases and the eight cases reported in the literature, mainly older females with colostomies are at risk and most of them need surgery. Conclusions: In patients presenting with obstructive symptoms, one should be aware of a possible gastric outlet obstruction because of its involvement in a PSH, although sporadic. Surgery might be considered as the treatment of choice because conservative treatment mostly fails. Earlier surgery might perhaps also reduce postoperative hospital stay and gastroparesis.


Assuntos
Colostomia/efeitos adversos , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Gastropatias/diagnóstico por imagem , Gastropatias/etiologia , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Hérnia Incisional/cirurgia , Gastropatias/cirurgia , Tomografia Computadorizada por Raios X
14.
Scand J Gastroenterol ; 54(7): 934-937, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31328998

RESUMO

Background: Magnetically controlled capsule endoscopy (MCE) has emerged as a feasible and efficient diagnostic modality for gastric diseases. In a special group of patients, MCE may have an advantage over standard gastroscopy. Objective: This study aimed to evaluate the clinical utility of MCE in high-risk patients for standard gastroscopy. Methods: In this study, patients with high-risk factors for standard gastroscopy were examined by MCE between 1 January 2017 and 31 December 2017. The examination time, results, adverse events and clinical outcome were recorded. Results: Forty-two patients with high-risk factors for standard gastroscopy were enrolled in the present study. All patients successfully underwent MCE without any adverse events. Based on the findings from MCE, the patients were successfully treated. Conclusions: For patients with high-risk factors for standard gastroscopy, MCE could be the perfect alternative examination for gastric diseases. We recommend MCE as the first-line examination for high-risk patients, but its utility should be confirmed in further clinical studies.


Assuntos
Endoscopia por Cápsula/métodos , Gastroscopia/métodos , Gastropatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Magnetismo , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária
15.
Scand J Gastroenterol ; 54(9): 1075-1080, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456461

RESUMO

Crohn's disease is an inflammatory disorder that can affect the entire gastrointestinal tract but typically involves the ileocecal region. Before endoscopy was widely used, involvement of the esophagus, stomach, and duodenum was thought to be rare. Recent publications demonstrated that not only are upper gastrointestinal lesions common in Crohn's disease (affecting up to 75% of the patients), but they also present characteristic endoscopic findings with potential clinical significance. It was suggested that lesions in the stomach with a bamboo joint-like appearance might be an endoscopic biomarker for Crohn's disease. It was also found that this occurrence is related to a more severe disease course. Our review summarizes the literature, as well as our own observations and considerations, concerning the issue of upper gastrointestinal involvement in Crohn's disease and its clinical meaning.


Assuntos
Doença de Crohn/patologia , Duodenopatias/patologia , Doenças do Esôfago/patologia , Gastropatias/patologia , Doença de Crohn/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Endoscopia Gastrointestinal , Doenças do Esôfago/diagnóstico por imagem , Humanos , Gastropatias/diagnóstico por imagem
16.
BMC Gastroenterol ; 19(1): 62, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023238

RESUMO

BACKGROUND: Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can present as a benign lymphoid proliferation or a malignant lymphoma in patients taking MTX. Almost 50% of MTX-LPD cases show spontaneous remission after withdrawal of MTX treatment. Studies have suggested that the hyper-immune state of rheumatoid arthritis, the immunosuppressive state associated with MTX, and the carcinogenicity of the Epstein-Barr virus might contribute to MTX-LPD development. Although most cases of MTX-LPD occur at extranodal sites, few cases of MTX-LPD affecting the stomach and duodenum have been reported. To our knowledge, no other study has reported on the endoscopic observations of dramatic withdrawal and appearance of multiple digestive tract lesions in a short period of time. Herein, we report the clinical course and imaging findings of our case, which may be useful for understanding the pathological condition of MTX-LPD. CASE PRESENTATION: We describe the case of a 70-year-old woman with MTX-LPD of the stomach and duodenum. Disease regression was temporarily achieved after cessation of MTX treatment; however, it subsequently recurred, and complete response was only achieved after six cycles of rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (R-CHOP) chemotherapy. CONCLUSIONS: The first-choice therapy for patients taking MTX who develop suspected MTX-LPD should be the withdrawal of MTX treatment. Even after remission is achieved, patients should be kept under careful observation, and if the disease recurs, chemotherapy should be commenced promptly.


Assuntos
Antirreumáticos/efeitos adversos , Duodenopatias/induzido quimicamente , Transtornos Linfoproliferativos/induzido quimicamente , Metotrexato/efeitos adversos , Gastropatias/induzido quimicamente , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Duodenopatias/diagnóstico por imagem , Duodenopatias/tratamento farmacológico , Duodenopatias/patologia , Endoscopia do Sistema Digestório , Feminino , Humanos , Transtornos Linfoproliferativos/diagnóstico por imagem , Transtornos Linfoproliferativos/tratamento farmacológico , Transtornos Linfoproliferativos/patologia , Prednisona/uso terapêutico , Recidiva , Rituximab , Gastropatias/diagnóstico por imagem , Gastropatias/tratamento farmacológico , Gastropatias/patologia , Vincristina/uso terapêutico , Suspensão de Tratamento
18.
Paediatr Anaesth ; 29(4): 331-337, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30714260

RESUMO

BACKGROUND: Gastric insufflation frequently occurs during facemask ventilation in children. In the present study, we compared the incidence of gastric insufflation between pressure-controlled facemask ventilation and manual facemask ventilation during general anesthesia induction in children. METHODS: Children in the pressure-controlled ventilation group (n = 76) received pressure-controlled facemask ventilation at an inspiratory pressure of 13 cm H2 O. In the manual ventilation group (n = 75), facemask ventilation was manually performed by anesthesiologists, who tried to maintain an inspiratory pressure of 13 cm H2 O. The adjustable pressure limiting valve was set at 13 cm H2 O. The incidence of gastric insufflation during 90 seconds after the initiation of ventilation was assessed using epigastric auscultation and gastric ultrasonography. RESULTS: The incidence of gastric insufflation was significantly higher in the manual  facemask ventilation group than in the pressure-controlled ventilation group (48% vs 12%, respectively; odds ratio 7.78, 95% confidence interval [CI] 3.38-17.9; P < 0.001). The mean peak airway pressure during ventilation was significantly higher in the manual ventilation group than in the pressure-controlled ventilation group (16.1 [3.0] cm H2 O vs 13.0 [0.1] cm H2 O; 95% CI of differences, 2.36-3.71 cm H2 O; P < 0.001). The manual ventilation group exhibited a wide peak airway pressure  range (11-26 cm H2 O) and a wide variation of tidal volume (0-7.0 mL/kg) compared with those of the pressure-controlled ventilation group (13-14 cm H2 O and 0.6-16.0 mL/kg, respectively). CONCLUSION: At an inspiratory pressure of 13 cm H2 O, pressure-controlled ventilation may be more effective than manual ventilation in preventing gastric insufflation while providing stable ventilation in children.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Máscaras Laríngeas , Respiração Artificial/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Auscultação , Pré-Escolar , Humanos , Lactente , Insuflação , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Estômago/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Gastropatias/etiologia , Volume de Ventilação Pulmonar , Ultrassonografia
19.
BMC Surg ; 19(1): 27, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813940

RESUMO

BACKGROUND: Gastroparesis is a syndrome characterized by delayed gastric emptying with associated symptoms. It was reported that the symptoms of diabetic gastroparesis had been greatly improved by transpyloric stent placement. However, the use of stents in benign conditions is considered to be contraindicated because of the increasing risk of complications, such as stent migration, reflux, perforation, bleeding, and, most importantly, new strictures caused by stent-induced tissue hyperplasia. While temporary placement of a self-expanding metallic stent (SEMC) can drastically reduce the risk of complications, few reports are available on the treatment of refractory PSG by temporary transpyloric stent. Does it have a long-term clinical effect after the stent being retrieved? CASE PRESENTATION: After accepting partial resection of the lesser curvature in another hospital, a patient developed refractory gastroparesis. The symptoms hadn't been improved after long-term drug therapy and balloon dilation therapy. Four months after surgery, a fully covered SEMC was placed by endoscopy in our hospital. Gastroparesis had been greatly improved. Two weeks later, the transpyloric stent was retrieved and the patient didn't show recurrent symptoms. Follow-ups were arranged at 3 months, 6 months and 1 year respectively, and there was no evidence of recurrence was found. CONCLUSIONS: This case indicates that temporary transpyloric SEMC is a safe, effective and less invasive alternative for post-surgical gastroparesis patients.


Assuntos
Gastrectomia/efeitos adversos , Gastroparesia/cirurgia , Implantação de Prótese , Piloro/cirurgia , Stents , Adulto , Coristoma/cirurgia , Constrição Patológica/cirurgia , Endoscopia , Feminino , Gastroparesia/diagnóstico por imagem , Gastroparesia/etiologia , Humanos , Masculino , Pâncreas/cirurgia , Piloro/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Gastropatias/cirurgia , Resultado do Tratamento
20.
Pediatr Emerg Care ; 35(8): e152-e153, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28617713

RESUMO

The radiographic finding of gastric emphysema with portal venous gas is classically an ominous finding, associated with a high rate of mortality. Although classically the case, this imaging finding must be quickly correlated with the overall clinical picture, allowing for the essential differentiation between the highly lethal emphysematous gastritis and the much more benign gastric emphysema, each of which has drastically different management strategies. We report a case of gastric emphysema with portal venous gas likely attributable to a gastric outlet obstruction and gastric mucosal defect in a 17-year-old girl with a chief complaint of syncope that was diagnosed in the emergency department and treated conservatively.


Assuntos
Enfisema/complicações , Gastropatias/diagnóstico por imagem , Síncope/etiologia , Adolescente , Tratamento Conservador , Constrição Patológica , Duodenite/diagnóstico por imagem , Duodenite/patologia , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Piloro/patologia , Gastropatias/patologia , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/patologia , Síncope/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Vômito/diagnóstico , Vômito/etiologia
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