Asunto(s)
Antineoplásicos/uso terapéutico , Tumor Carcinoide/tratamiento farmacológico , Octreótido/uso terapéutico , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Somatostatina/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Adulto , Tumor Carcinoide/etiología , Femenino , Gastrinas/sangre , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Endocrina Múltiple Tipo 1/complicaciones , Neoplasias Gástricas/etiología , Síndrome de Zollinger-Ellison/complicacionesRESUMEN
Endoscopic ultrasonography (EUS) was performed in 82 patients with primary gastric lymphoma. EUS correctly diagnosed lymphoma in 76/82 patients, with a sensitivity of 93%. Positive predictability was 91%, specificity 98%, and negative predictability 98%. Diagnostic accuracy was 97%. In the evaluation of lymphoma, depth invasion EUS was correct in 87% of cases. EUS disclosed metastatic perigastric lymph nodes in 15/27 patients, with a sensitivity of 56%. Positive predictability was 100%, specificity 100%, and negative predictability 82%. Diagnostic accuracy was 85%. Differential diagnosis with EUS among lymphoma, linitis plastic and Ménétrier's disease was difficult. Large particle biopsy must be considered when EUS diagnosis of these diseases remains uncertain.
Asunto(s)
Linfoma no Hodgkin/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
It is evident that endoscopic ultrasonography could have a great clinical role in the selection of the best treatment for the individual patient because it allows the simultaneous visualization of a large part of the portal venous system and its collaterals. It has not been shown that the same kind of treatment is suitable for every patient with portal hypertension, and failure of a particular treatment may be attributable to an incorrect selection of patients. Further perspective studies with EUS in patients with portal hypertension are thus necessary in order to clearly state the cost-benefit of this technique in the management of these subjects.
Asunto(s)
Hipertensión Portal/diagnóstico por imagen , Sistema Porta/diagnóstico por imagen , Endoscopía del Sistema Digestivo , Humanos , Hipertensión Portal/terapia , Escleroterapia , Resultado del Tratamiento , UltrasonografíaRESUMEN
Precise staging of reflux esophagitis is very important for therapeutic decisions; in fact, chronic gastroesophageal reflux may cause transmural inflammation that leads to fibrosis with loss of esophageal wall compliance. In reflux esophagitis, endoscopic stating is limited to mucosal injury, while endoscopic ultrasonography (EUS) is able to visualize changes in the layer structure and localized or diffuse thickenings of the esophageal wall. In order to evaluate the usefulness of EUS in reflux esophagitis, a prospective study of 31 patients and ten normal subjects was performed. Endoscopic reflux esophagitis was staged as: E1 (erythema, n = 7), E2 (erosions, n = 13), E3 (ulcers, n = 11). EUS findings were recorded and evaluated at five different levels, starting from the gastroesophageal junction, using a quantitative method, the center line method. With this method, the sectorial and mean thickness, and area were calculated for each level. There was a significant difference between patients with reflux esophagitis and normal subjects in our study. E3 patients showed a significant upward involvement of the wall far from the visible lesions. Mild esophagitis may also cause esophageal wall thickening, involving even the entire wall. There was no correlation between the onset time of symptoms and the degree of thickening. In conclusion, EUS seems to be an important supplement to endoscopy in staging reflux esophagitis, as the progression of the inflammation is not related to the endoscopic findings.
Asunto(s)
Esofagitis Péptica/diagnóstico por imagen , Esofagitis Péptica/patología , Adulto , Anciano , Esofagoscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía IntervencionalRESUMEN
Unlike the adult form, childhood celiac disease has not hitherto been associated with a particular endoscopic pattern. The upper gastrointestinal tracts of 46 children with various stages of celiac disease and of 27 children with conditions other than celiac disease were examined by an endoscopist unaware of the clinical details of the patients. The scalloped configuration of duodenal folds was shown to have a sensitivity of 88% and a specificity of 87% in the diagnosis of subtotal villus atrophy. Attention to this finding, described here for the first time in childhood celiac disease, may be helpful for the diagnosis of this condition.
Asunto(s)
Enfermedad Celíaca/patología , Duodeno/patología , Adolescente , Enfermedad Celíaca/diagnóstico , Niño , Preescolar , Endoscopía Gastrointestinal , Humanos , Lactante , Estudios Prospectivos , Sensibilidad y EspecificidadAsunto(s)
Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Esófago/patología , Adenocarcinoma/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Esofagoscopía/métodos , Humanos , Laparoscopía , Estadificación de Neoplasias , UltrasonografíaAsunto(s)
Endoscopía Gastrointestinal/normas , Neoplasias Gastrointestinales/diagnóstico por imagen , Ultrasonografía/normas , Endoscopios Gastrointestinales , Endoscopía Gastrointestinal/métodos , Estudios de Evaluación como Asunto , Neoplasias Gastrointestinales/epidemiología , Neoplasias Gastrointestinales/patología , Humanos , Estadificación de Neoplasias , Sensibilidad y Especificidad , Ultrasonografía/instrumentación , Ultrasonografía/métodosAsunto(s)
Gastroenterología , Cirugía General , Ultrasonografía , Abdomen/diagnóstico por imagen , Sistema Digestivo , Educación Médica , Endoscopía/métodos , Gastroenterología/educación , Cirugía General/educación , Humanos , Monitoreo Intraoperatorio , Ultrasonografía/instrumentación , Ultrasonografía/métodosRESUMEN
Using endoscopic ultrasonography (EUS) a large part of the portal venous system can be visualized. In 40 patients with portal hypertension (PH) and in 48 control subjects EUS displayed the azygos, splenic, mesenteric and portal veins in both groups. However, esophageal and gastric varices, peri- esophageal and peri-gastric collateral veins and submucosal gastric venules were displayed only in patients with PH. EUS was inferior to endoscopy for detecting and grading esophageal varices (p less than 0.0005), but superior in the detection of varices in the fundus of the stomach (p less than 0.0005). EUS cannot be considered a reliable method for the study of esophageal varices: it has an overall sensitivity of 50%, does not permit flow measurements, and does not provide information that could be used to estimate the risk of bleeding. EUS has been demonstrated to be superior to endoscopy in the diagnosis of gastric varices. This finding is extremely important for the optimal selection of treatment of patients with portal hypertension. EUS can detect portal hypertensive gastropathy; thus inflammatory gastritis can be more easily distinguished from congestive gastropathy and therapeutic decisions are strongly influenced.
Asunto(s)
Endoscopía del Sistema Digestivo/métodos , Várices Esofágicas y Gástricas/diagnóstico por imagen , Hipertensión Portal/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Vena Ácigos/diagnóstico por imagen , Humanos , Sensibilidad y Especificidad , Ultrasonografía/métodosRESUMEN
The presumptive diagnosis of gastric submucosal tumors can be made by endoscopic ultrasonography (EUS) but histological confirmation is still required. A special guillotine biopsy device (Flexi-Temno) which enables collection of adequate submucosal samples by the endoscopic approach was therefore evaluated. After visualization by EUS the guillotine needle biopsy was performed in 21 patients with submucosal tumors of the stomach. There were 2 failures in 2 patients with leiomyomas. The diagnosis suggested by EUS was confirmed by guillotine biopsy in 17 cases. Guillotine biopsy detected 2 cases of unsuspected leiomyosarcoma which were confirmed surgically. In cases of solid submucosal tumors confirmed on EUS, the guillotine needle biopsy enables a definitive histologic diagnosis. Thus malignancies can be detected when EUS findings are not significant.
Asunto(s)
Biopsia con Aguja/instrumentación , Leiomioma/patología , Neoplasias Gástricas/patología , Estómago/patología , Estudios de Evaluación como Asunto , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Agujas , Neoplasias Gástricas/diagnóstico por imagen , UltrasonografíaRESUMEN
We report a case of primary esophageal non-Hodgkin's T-cell lymphoma in a young white female. At admission, endoscopy revealed large, irregularly shaped, esophageal ulcerations with super imposed candidiasis. Endoscopic ultrasonography to assess submucosal alterations and periesophageal involvement revealed a diffuse hypoechogenic thickening (up to 5 mm) of the esophageal wall, a pattern consistent with lymphomatous infiltration. Definitive diagnosis was made with the aid of histology and immunohistochemistry.
Asunto(s)
Neoplasias Esofágicas/patología , Linfoma de Células T/patología , Adolescente , Neoplasias Esofágicas/diagnóstico por imagen , Esofagoscopía , Femenino , Humanos , Linfoma de Células T/diagnóstico por imagen , UltrasonografíaRESUMEN
Two cases of acute pericarditis following endoscopic variceal sclerotherapy (EVS) that were resolved with conservative management are described. This complication arose respectively one and three days after EVS. The possible pathogenesis is the involvement of the pericardium in an inflammatory reaction that develops in the esophageal wall and surrounding tissues. Only five cases have been previously reported in the literature; the authors suppose that this fact may be due to the mild symptoms presented by the patients, which may result in underestimation of this complication. The technical details of EVS in the seven patients with pericarditis were analyzed, but no common etiologic factor was found. The authors strongly advise regular checks for clinical and instrumental signs of acute pericarditis after every session of EVS, so that appropriate management can be undertaken in an early phase and, if necessary, further EVS sessions delayed, in order to avoid cardiac tamponade or constrictive pericarditis.
Asunto(s)
Várices Esofágicas y Gástricas/terapia , Esofagoscopía , Pericarditis/etiología , Escleroterapia/efectos adversos , Enfermedad Aguda , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Endoscopic ultrasonography (EUS) allows a visualization in vivo of the gastric wall. Five ultrasonic layers of different echogenicities are displayed; each corresponds to a precise anatomic structure. In gastric diseases this layering evidently changes. In 10 patients with suspected primary gastric lymphoma, EUS showed a characteristic thickening of the second, the second and third layers, or a diffuse, transmural thickening of the entire wall. A precise correlation between the longitudinal and depth infiltration observed at EUS and the surgical finding was seen in all patients. In three cases in which the preoperative bioptic diagnosis was erroneous (two gastritis and one carcinoma) EUS showed a characteristic echographic pattern for lymphoma, which was confirmed at surgery. There was agreement also, in EUS and surgical findings in all patients, about involvement of neighbor organs. It seems possible that in the future EUS could play an important role in detecting, staging, and planning treatment of lymphoma and other gastric tumors.
Asunto(s)
Linfoma no Hodgkin/diagnóstico , Neoplasias Gástricas/diagnóstico , Ultrasonografía/métodos , Adulto , Anciano , Biopsia , Femenino , Gastroscopía , Humanos , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Gástricas/patologíaRESUMEN
Endoscopic ultrasonography (US) enables high-resolution imaging of the stomach and can demonstrate the different layers of the gastric wall. It has therefore been proposed for use in evaluating the extension of gastric neoplasms. It was performed in nine patients with primary gastric non-Hodgkin lymphoma and in 36 with gastric carcinoma. The US and pathologic findings were correlated in three surgical specimens of gastric lymphoma. Three different US patterns were found in gastric lymphomas: a polypoid pattern (two cases), localized (two cases) or extended (five cases) hypoechoic infiltration, and thickening with superficial ulcerations. Infiltration was confined to the second and third layers of the gastric wall in six cases and was transmural in three. The study of the gastric lymphoma specimens confirmed the accuracy of US in demonstrating the extent of infiltration. Gastric carcinomas had a more echogenic pattern and a different trend of diffusion, with no extended longitudinal hypoechoic infiltration of the superficial layers or extended hypoechoic transmural infiltration.
Asunto(s)
Carcinoma/diagnóstico , Gastroscopía , Linfoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Ultrasonografía/métodos , Adulto , Anciano , Biopsia , Carcinoma/patología , Diagnóstico Diferencial , Femenino , Gastroscopios , Humanos , Metástasis Linfática , Linfoma/patología , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Estómago/patología , Neoplasias Gástricas/patología , Ultrasonografía/instrumentaciónRESUMEN
In order to evaluate possible changes in the portal venous system after endoscopic sclerosis of esophageal varices, 25 cirrhotic patients underwent abdominal ultrasonography before the first session of sclerotherapy and after eradication of esophageal varices had been achieved. The caliber of the portal, splenic, and superior mesenteric veins was measured sonographically in each case. Sonographic results were compared statistically before and after sclerotherapy. Neither evidence of significant variations in the caliber of the portal veins nor thrombotic obliteration was seen. These results support the view that sclerotherapy has no significant negative side effects on the portal venous system.
Asunto(s)
Várices Esofágicas y Gástricas/terapia , Vena Porta/patología , Soluciones Esclerosantes/uso terapéutico , Ultrasonografía , Endoscopía , Femenino , Humanos , Masculino , Venas Mesentéricas/patología , Persona de Mediana Edad , Vena Esplénica/patologíaAsunto(s)
Coagulación Sanguínea/efectos de los fármacos , Plaquetas/efectos de los fármacos , Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrosis Hepática/complicaciones , Soluciones Esclerosantes/uso terapéutico , Várices Esofágicas y Gástricas/sangre , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/sangre , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Factor Plaquetario 4/análisis , beta-Tromboglobulina/análisisAsunto(s)
Alginatos/uso terapéutico , Enfermedades del Esófago/tratamiento farmacológico , Várices Esofágicas y Gástricas/terapia , Soluciones Esclerosantes/efectos adversos , Adulto , Anciano , Enfermedades del Esófago/etiología , Femenino , Ácido Glucurónico , Ácidos Hexurónicos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Úlcera/tratamiento farmacológico , Úlcera/etiologíaRESUMEN
We have established a pre-operative diagnosis in four cases of non-secretory gastric carcinoid of the body and fundus presenting as multiple polyps in three patients, and a single polyp mass in the fourth patient. Clinical and endoscopic findings are not specific, and the pre-operative diagnosis was established by means of biopsy or polypectomy. We observed biochemical and histological differences between multiple and single carcinoids, which might indicate different mechanisms of carcinoid pathogenesis.
Asunto(s)
Tumor Carcinoide/diagnóstico , Gastroscopía , Neoplasias Gástricas/diagnóstico , Adulto , Diagnóstico Diferencial , Duodenoscopía , Esofagoscopía , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/patología , Pólipos/diagnóstico , Pólipos/patología , Neoplasias Gástricas/patologíaRESUMEN
Endoscopic ultrasonography (EUT) allows a better sonographic image of the internal organs. Moreover, it is possible for the first time to explore the upper GI tract wall. To achieve this, three methods are available: 1) direct apposition of the transducer on the mucosa; 2) contact of a small balloon filled with water over the tip of the ultrasonic probe; 3) direct instillation of water. The esophageal wall is explored with the first and second method; the gastric wall is best explored with the third method; the duodenal wall is explored with the second or the third method. Exploration of esophagus and stomach has been achieved in 100% of cases, duodenal exploration in 72% of cases. No complications occurred in this study.