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2.
Endoscopy ; 54(7): 663-670, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-34496422

RESUMEN

BACKGROUND: Data on endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs) are insufficient owing to their rarity. There are two main ER techniques for SDETs: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In addition, modified EMR techniques, such as underwater EMR (UEMR) and cold polypectomy, are becoming popular. We conducted a large-scale retrospective multicenter study to clarify the detailed outcomes of duodenal ER. METHODS: Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs; defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using the Kaplan-Meier method. RESULTS: In total, 3107 patients (including 1017 undergoing ESD) were included. En bloc resection rates were 79.1 %, 78.6 %, 86.8 %, and 94.8 %, and delayed AE rates were 0.5 %, 2.2 %, 2.8 %, and 6.8 % for cold polypectomy, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher in the ESD group than in non-ESD groups for lesions < 19 mm (7.4 % vs. 1.9 %; P < 0.001), but not for lesions > 20 mm (6.1 % vs. 7.1 %; P = 0.64). The local recurrence rate was significantly lower in the ESD group than in the non-ESD groups (P < 0.001). Furthermore, for lesions > 30 mm, the cumulative local recurrence rate at 2 years was 22.6 % in the non-ESD groups compared with only 1.6 % in the ESD group (P < 0.001). CONCLUSIONS: ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs.


Asunto(s)
Neoplasias Duodenales , Resección Endoscópica de la Mucosa , Neoplasias Duodenales/patología , Neoplasias Duodenales/cirugía , Resección Endoscópica de la Mucosa/efectos adversos , Resección Endoscópica de la Mucosa/métodos , Humanos , Mucosa Intestinal/patología , Japón , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Resultado del Tratamiento
3.
Surg Endosc ; 36(7): 5084-5093, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-34816305

RESUMEN

OBJECTIVES: Gastrointestinal (GI) perforations are one of the major adverse events of endoscopic procedures. Polyglycolic acid (PGA) sheets with fibrin glue have been reported to close GI perforations. However, its clinical outcome has not yet been fully investigated; thus, we conducted a multicenter retrospective observational study to assess the efficacy of PGA sheeting for GI perforation. METHODS: The medical records of patients who underwent PGA sheeting for endoscopic GI perforations between April 2013 and March 2018 in 18 Japanese institutions were retrospectively analyzed. PGA sheeting was applied when the clip closure was challenging or failed to use. Perforations were filled with one or several pieces of PGA sheets followed by fibrin glue application through an endoscopic catheter. Nasal or percutaneous drainage and endoscopic clipping were applied as appropriate. Clinical outcomes after PGA sheeting for intraoperative or delayed perforations were separately evaluated. RESULTS: There were 66 intraoperative and 24 delayed perforation cases. In intraoperative cases, successful closure was attained in 60 cases (91%). The median period from the first sheeting to diet resumption was 6 days (interquartile range [IQR], 4-8.8 days). Large perforation size (≥ 10 mm) and duodenal location showed marginal significant relationship to higher closure failure of intraoperative perforations. In delayed perforation cases, all cases had successful closure. The median period from the first sheeting to diet resumption was 10 days (IQR, 6-37.8 days). No adverse events related to PGA sheeting occurred. CONCLUSION: Endoscopic PGA sheeting could be a therapeutic option for GI perforations related to GI endoscopic procedures.


Asunto(s)
Adhesivo de Tejido de Fibrina , Adhesivos Tisulares , Humanos , Endoscopía Gastrointestinal , Adhesivo de Tejido de Fibrina/uso terapéutico , Ácido Poliglicólico/uso terapéutico , Estudios Retrospectivos , Adhesivos Tisulares/uso terapéutico , Resultado del Tratamiento
6.
Endoscopy ; 51(7): 619-627, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30861532

RESUMEN

BACKGROUND: Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Recent reports have described the efficacy of the endoscopic shielding method with polyglycolic acid (PGA) sheets and fibrin glue for the prevention of adverse events after ESD. The aim of the present study was to investigate whether the PGA shielding method provides additional benefit in preventing post-ESD bleeding compared with standard care. METHODS: This was a prospective, multicenter, randomized controlled trial. Patients at high risk of post-ESD bleeding were enrolled in the study. Before ESD, patients were randomized to either the PGA group or the control group. After completing ESD in the PGA group, PGA sheets were placed onto the ulcer floor and adhered with fibrin glue. The primary end point was the post-ESD bleeding rate. RESULTS: 140 eligible patients were enrolled from September 2014 to September 2016, and 137 were included in the intention-to-treat analysis (67 in the PGA group and 70 in the control group). Post-ESD bleeding occurred in three patients (4.5 %) in the PGA group and in four patients (5.7 %) in the control group; there was no significant difference between the two groups (P > 0.99). Post-ESD bleeding tended to occur later in the control group than in the PGA group (median 12.5 days [range 8 - 14] vs. 2 days [range 0 - 7], respectively). CONCLUSION: The PGA shielding method did not demonstrate a significant effect on the prevention of post-ESD bleeding.


Asunto(s)
Resección Endoscópica de la Mucosa/efectos adversos , Endoscopía Gastrointestinal/métodos , Adhesivo de Tejido de Fibrina/farmacología , Hemorragia Posoperatoria/prevención & control , Neoplasias Gástricas/cirugía , Anciano , Resección Endoscópica de la Mucosa/métodos , Femenino , Estudios de Seguimiento , Hemostáticos/farmacología , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento
7.
Clin J Gastroenterol ; 10(6): 524-529, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29094323

RESUMEN

A female in her 70s underwent esophagogastroduodenoscopy (EGD) for screening, and a 0-IIa lesion measuring approximately 15 mm was detected in the descending portion of the duodenum. Due to the malignant potency of the lesion, endoscopic submucosal dissection (ESD) was performed. Microperforation occurred during ESD. The lesion was removed en bloc and the post-ESD ulcer bed was closed with clips. The next day, the patient had abdominal pain and computed tomography (CT) revealed a small amount of free air in the retroperitoneal space. Since there were no findings to suggest panperitonitis, conservative medical management including fasting and antibiotics was continued. Abdominal pain subsequently improved. However, EGD on the 8th day after ESD for follow-up showed shedding of the post-ESD ulcer that penetrated the retroperitoneal space. A surgical approach was not indicated because a few days may have already passed since postoperative perforation occurred and the spread of inflammation to the retroperitoneum was suspected. In an attempt to promote closure of the perforated cavity, we patched polyglycolic acid sheets and fibrin glue to the cavity wall on days 17, 18, and 20 after ESD. The formation of granulation tissue was detected in the cavity one week later. CT showed an abscess in the right retroperitoneum, for which CT-guided abscess puncture was performed. Thereafter, the cavity gradually decreased. After the initiation of oral intake on postoperative day (POD) 63, the general condition of the patient was stable and she was discharged on POD 87. Polyglycolic acid sheets with fibrin glue and CT-guided abscess puncture were useful for closing the large cavity that developed after duodenal postoperative perforation.


Asunto(s)
Absceso/terapia , Neoplasias Duodenales/cirugía , Duodeno/lesiones , Resección Endoscópica de la Mucosa/efectos adversos , Adhesivo de Tejido de Fibrina , Perforación Intestinal/terapia , Ácido Poliglicólico , Complicaciones Posoperatorias/terapia , Punciones , Absceso/diagnóstico por imagen , Anciano , Duodeno/diagnóstico por imagen , Endoscopía del Sistema Digestivo , Femenino , Humanos , Tomografía Computarizada por Rayos X
8.
Endosc Int Open ; 4(6): E661-4, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27556075

RESUMEN

BACKGROUND AND STUDY AIMS: Many medical institutions in Japan perform endoscopic mucosal dissection (ESD) to treat early gastric cancer. Perforations can occur during ESD, and clipping has been reported as useful for treating small pinhole perforations. However, it is often difficult to close postoperative perforations because they usually have large diameters, and the muscle layer around the perforated region is often fragile, so additional open surgery is the only currently used method to treat large perforations and delayed perforations. Another method for large perforation is needed to treat perforations endoscopically. Ono et al. reported a case in which a postoperative perforation was closed using a polyglycolic acid (PGA) sheet and fibrin glue. In addition, it has been used by the authors' group to repair duodenal injuries that occur during ESD. We report 3 cases in which PGA sheets and fibrin glue were successfully used to repair postoperative gastric perforations endoscopically. This method is simple, safe, and effective, and is a new way to treat large perforations and delayed perforations that occur following ESD.

9.
Nihon Hinyokika Gakkai Zasshi ; 107(1): 39-43, 2016.
Artículo en Japonés | MEDLINE | ID: mdl-28132990

RESUMEN

Rectourethral fistulais a relatively rare complication of radical prostatectomy but is extremely difficult to treat. We report a case with post-laparoscopic radical prostatectomy rectourethral fistula, treated with only endoscopic shielding.A 75-year-old man had undergone laparoscopic radical prostatectomy for prostate cancer, cT2cN0M0. Although there was no finding of rectal injury during the operation, pneumaturia, pyuria and diarrhea appeared at postoperative day 21 and diagnosed rectourethral fistula by colonoscopy and amidotrizoic acid enema. The fistula did not close spontaneously. Four months after the prostatectomy, we treated with endoscopic shielding by use of polyglycolic acid sheets and fibrin glue. The fistula have not recurred for 20 months after the endoscopic procedure.This method is simple and less-invasive for patients. We think it is worth trying this method before surgical management for narrow rectourethral fistula following radical prostatectomy.


Asunto(s)
Colonoscopía/métodos , Laparoscopía/métodos , Complicaciones Posoperatorias/terapia , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Fístula Rectal/terapia , Enfermedades Uretrales/terapia , Fístula Urinaria/terapia , Anciano , Adhesivo de Tejido de Fibrina/uso terapéutico , Humanos , Masculino , Ácido Poliglicólico/uso terapéutico , Resultado del Tratamiento
10.
Dig Endosc ; 26 Suppl 2: 23-9, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24750144

RESUMEN

BACKGROUND AND AIM: To verify the current status in Japan on endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADET) by a multicenter case series through a questionnaire survey. METHODS: Nine endoscopists and a surgeon responded to a questionnaire on endoscopic diagnosis of SNADET. The subjects of this survey were histologically confirmed SNADET that were endoscopically or surgically resected from 2007 to 2012. This survey collected data of 364 patients with 396 SNADET. RESULTS: Of the 396 SNADET, 121 were histologically diagnosed as low-grade dysplasia (LGD), 112 as high-grade dysplasia (HGD), and 163 as superficial adenocarcinoma (SAC) including 153 mucosal carcinomas and 10 submucosal carcinomas. Total number of SNADET increased from 125 in the first half to 271 in the second half of the survey period. Compared to LGD, a significantly greater number of HGD or SAC was found in the tumors having a diameter >5 mm as well as solitary or predominantly red color. Preoperative endoscopic diagnosis indicated significantly higher sensitivity and accuracy and significantly lower specificity for HGD or SAC of final histology than preoperative biopsy. Ten submucosal carcinomas had 0-I or 0-IIa+IIc macroscopic-type tumors with red color. CONCLUSIONS: This multicenter case series study suggested that the number of resected SNADET is dramatically increasing in Japan. Tumor diameter >5 mm and red color seemed to be signs for tumors of HGD or SAC. Preoperative endoscopy may provide a more reliable diagnosis of final histology of HGD or SAC than preoperative biopsy. Further studies are warranted for establishing endoscopic features of submucosal carcinoma.


Asunto(s)
Adenocarcinoma/patología , Carcinoma/patología , Neoplasias Duodenales/patología , Duodenoscopía/métodos , Mucosa Intestinal/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Anciano , Ampolla Hepatopancreática , Biopsia con Aguja , Carcinoma/diagnóstico , Carcinoma/cirugía , Estudios de Cohortes , Estudios Transversales , Diagnóstico Diferencial , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/cirugía , Endoscopía/métodos , Femenino , Humanos , Inmunohistoquímica , Japón , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Encuestas y Cuestionarios
11.
Dig Endosc ; 26 Suppl 2: 46-9, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24750148

RESUMEN

Delayed perforation after duodenal endoscopic submucosal dissection (ESD) occurs at a high rate because the duodenal wall is very thin and the artificial ulcer after resection is exposed to bile and pancreatic juice. We investigated the application of the combination of a polyglycolic acid (PGA) sheet and fibrin glue. PGA sheets comprise materials widely used in surgery for absorbable thread. Fibrin glue is a heated blood product and is used for hemostasis during operations. We developed a combined method using both materials. We have used this method in two cases. One case involved an elevated lesion located in the lower duodenal angle of the duodenum. The other involved an elevated lesion in the second portion of the duodenum. About 1 week after ESD, the PGA sheets remained covering the ulcer and delayed perforation did not occur. We were able to easily carry out this method for several parts of the duodenum. This method may be helpful for the prevention of delayed perforation after duodenal ESD.


Asunto(s)
Carcinoma/cirugía , Neoplasias Duodenales/cirugía , Duodenoscopía/métodos , Perforación Intestinal/prevención & control , Ácido Poliglicólico/farmacología , Adhesivos Tisulares/uso terapéutico , Implantes Absorbibles , Anciano , Carcinoma/diagnóstico , Disección , Neoplasias Duodenales/diagnóstico , Duodenoscopía/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Mucosa Intestinal/patología , Mucosa Intestinal/cirugía , Masculino , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo , Muestreo , Factores de Tiempo , Resultado del Tratamiento , Técnicas de Cierre de Heridas
12.
Dig Endosc ; 23(2): 176-81, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21429025

RESUMEN

AIM: Although the treatment of early gastric cancer with endoscopic submucosal dissection (ESD) has been widely carried out, a standardized method of sedation for ESD has not been established. The purpose of the present study was to evaluate the efficacy and safety of sedation with dexmedetomidine (DEX). METHODS: We conducted a randomized study involving 90 patients with gastric tumors who were intended to be treated with ESD. The patients were sedated either with DEX (i.v. infusion of 3.0 µg/kg per h over 5 min followed by continuous infusion at 0.4 µg/kg per h [n = 30]), propofol (PF [n = 30]), or midazolam (MDZ [n = 30]). In all groups, 1 mg MDZ was added i.v. as needed. RESULTS: En bloc resection of the gastric tumor was achieved in 88 (98%) patients. None of the DEX-sedated patients showed a significant reduction of the oxygen saturation level. The percentage of patients who showed body movement in the DEX group was significantly lower than those in the PF and MDZ groups, and the mean dose of additional MDZ in the DEX group was significantly smaller than that in the MDZ group. The rate of effective sedation was significantly higher in the DEX group compared with the MDZ or PF group. The mean length of ESD in the DEX group was 65 min, which was significantly shorter than in the other two groups. No DEX-sedated patient developed major surgical complications. CONCLUSIONS: Sedation with DEX is effective and safe for patients with gastric tumors who are undergoing ESD.


Asunto(s)
Adenocarcinoma/cirugía , Adenoma/cirugía , Sedación Consciente , Dexmedetomidina , Disección/métodos , Mucosa Gástrica/cirugía , Gastroscopía/métodos , Hipnóticos y Sedantes , Neoplasias Gástricas/cirugía , Adenocarcinoma/patología , Adenoma/patología , Anciano , Anciano de 80 o más Años , Nivel de Alerta/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Mucosa Gástrica/patología , Humanos , Infusiones Intravenosas , Masculino , Midazolam , Persona de Mediana Edad , Estadificación de Neoplasias , Propofol , Estudios Prospectivos , Neoplasias Gástricas/patología
14.
Nihon Shokakibyo Gakkai Zasshi ; 105(9): 1367-74, 2008 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-18772578

RESUMEN

We present a 68 years old woman who was referred to our department due to impaired liver function. Hepatitis A IgM antibody and anti-nuclear antibody were positive, IgG, and gamma-globulin were elevated. Percutaneous liver biopsy was performed and autoimmune hepatitis was suspected pathologically. Oral administration of ursodeoxycholic acid was started and liver function was normalized three months later. The improvement of a hepatitis image was examined by percutaneous liver biopsy one year later. Although hepatitis A IgM antibody was positive throughout the course, hepatitis A virusemia was not considered the cause of persistent positive hepatitis A. IgM antibody could not be clarified. There was a possibility of a non-specific reaction and abnormalities in antibody production control were considered possible. We present this case and discuss the previous literature.


Asunto(s)
Colagogos y Coleréticos/uso terapéutico , Hepatitis A/inmunología , Hepatitis Autoinmune/tratamiento farmacológico , Hepatitis Autoinmune/inmunología , Inmunoglobulina M/sangre , Ácido Ursodesoxicólico/uso terapéutico , Anciano , Femenino , Humanos
15.
Int J Clin Oncol ; 12(1): 59-62, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-17380444

RESUMEN

We report here the case of a 63-year-old man who had a diffuse large B-cell lymphoma associated with hemophagocytic syndrome (HPS). The lymphoma involved the spleen, bilateral adrenal glands, and paraaortic lymph nodes of the abdomen. In both the bone marrow and lymph nodes, hemophagocytosis was evident, and the laboratory findings were consistent with HPS. The lymphoma cells showed a CD4+, CD5+, CD10-, CD19+, CD20+, CD25+ and surface immunoglobulin microalpha/kappa+ immunophenotype. The patient was unintentionally treated with rituximab alone, resulting in complete resolution of the lymphomatous lesions as well as the features of HPS in response to the initial two doses of rituximab, although he developed gastric hemorrhage requiring vigorous resuscitation. After the completion of eight doses of rituximab, the patient remains free of disease with an excellent performance status.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Linfohistiocitosis Hemofagocítica/complicaciones , Linfoma de Células B/complicaciones , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Neoplasias Abdominales/complicaciones , Neoplasias Abdominales/tratamiento farmacológico , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/tratamiento farmacológico , Anticuerpos Monoclonales de Origen Murino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Rituximab , Neoplasias del Bazo/complicaciones , Neoplasias del Bazo/tratamiento farmacológico , Factor de Transcripción CHOP/uso terapéutico
16.
Nihon Shokakibyo Gakkai Zasshi ; 104(1): 57-63, 2007 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-17230008

RESUMEN

We present the case of a 67-year-old man with primary malignant fibrous histiocytoma (MFH) of the diaphragm. He was admitted to our hospital with anorexia and loss of body weight. High serum levels of AST, ALT, ALP and gamma-GTP were observed. Several imaging studies disclosed a large tumor on the right side of the diaphragm to the right lobe of the liver. The entire tumor was resected, and histopathological examination of the specimen revealed the characteristics of MFH. MFH originating from the diaphragm is very rare, and we present the case of this patient in addition to a discussion of previous literature.


Asunto(s)
Diafragma/patología , Histiocitoma Fibroso Maligno/diagnóstico , Histiocitoma Fibroso Maligno/patología , Pruebas de Función Hepática , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias de los Músculos/patología , Anciano , Diagnóstico por Imagen , Diafragma/cirugía , Histiocitoma Fibroso Maligno/cirugía , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Neoplasias de los Músculos/diagnóstico , Neoplasias de los Músculos/cirugía , Invasividad Neoplásica
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