RESUMO
BACKGROUND: The use of antithrombotic agents for the prevention of cerebro-cardioembolic events has increased, and recent guidelines have recommended the continued administration of low-dose aspirin (LDA) during endoscopic procedures with a high risk of bleeding. However, the influence of LDA on intraoperative bleeding control status during Endoscopic submucosal dissection (ESD) remains unclear. METHODS: We examined 293 consecutive patients who underwent ESD for gastric cancers between January 2014 and February 2018. Patients administered with LDA (n = 52) were compared with those without antithrombotic therapy (n = 241; control) by propensity-score matching (PSM) concerning outcomes of ESD. RESULTS: PSM analysis yielded 50 matched pairs. Comparison showed similar values for frequency of intraoperative major bleeding: 1 (0-4) times (median [range]) in the LDA group and 0 (0-5) in the control group respectively (p = 0.710). Others (frequency of preventive coagulation, procedure time, decrease of hemoglobin levels, en bloc resection, complete resection) were the same with a few adverse events including perforation (0%), and thromboembolism (0%). Postoperative bleeding rate was 1.9% in LDA group. Multivariate analysis indicated that location U and circumference on the posterior wall were associated with for multiple major intraoperative bleeding. CONCLUSION: The study suggests that gastric ESD can be safely accomplished without cessation of LDA.
Assuntos
Aspirina/administração & dosagem , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Ressecção Endoscópica de Mucosa/efeitos adversos , Fibrinolíticos/administração & dosagem , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Estudos de Casos e Controles , Ressecção Endoscópica de Mucosa/normas , Feminino , Fibrinolíticos/efeitos adversos , Mucosa Gástrica/cirurgia , Hemorragia Gastrointestinal/etiologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/etiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Tromboembolia/prevenção & controle , Resultado do Tratamento , Suspensão de Tratamento/normasRESUMO
Phlegmonous gastritis is a rare but often fatal acute pyogenic infection of the stomach. We herein report three cases of phlegmonous gastritis with different causes: the long-term placement of a nasogastric feeding tube, bacteremia associated with cellulitis in a diabetic patient, and an adverse reaction to paclitaxel/carboplatin chemotherapy for cancer of unknown primary cause, which were classified as primary, secondary, and idiopathic types, respectively. Coping with the increasing morbidity rate associated with the diverse background of such patients requires a thorough understanding of the clinical features and image findings associated with this entity.
Assuntos
Celulite (Flegmão)/diagnóstico por imagem , Celulite (Flegmão)/fisiopatologia , Gastrite/diagnóstico por imagem , Gastrite/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Bacteriemia/complicações , Celulite (Flegmão)/etiologia , Feminino , Gastrite/etiologia , Humanos , Intubação Gastrointestinal/efeitos adversos , MasculinoRESUMO
A 60-year-old man presented with odynophagia after bronchial artery infusion chemotherapy for pulmonary metastasis of hepatocellular carcinoma. Esophagogastroduodenoscopy (EGD) revealed an esophageal ulcer in the middle thoracic esophagus. An esophageal biopsy demonstrated no malignancy. However, the symptoms had not improved after a month. EGD was performed again and showed a white cord lump at the bottom of the same esophageal ulcer identified before, showing no improving tendency. A repeated biopsy of the lump revealed actinomycosis, and the symptoms were improved by the oral administration of ampicillin. We herein report a case in which esophageal actinomycosis with a unique morphology of refractory esophageal ulcer was rapidly improved by the administration of antibiotics.
Assuntos
Actinomicose/diagnóstico , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/microbiologia , Úlcera/microbiologia , Actinomicose/tratamento farmacológico , Actinomicose/patologia , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Doenças do Esôfago/tratamento farmacológico , Doenças do Esôfago/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera/patologiaRESUMO
Primary enterolith is a rare condition that can induce ileus and intestinal perforation. We report the first case of a true primary enterolith treated by balloon-assisted enteroscopy. The patient presented with a small intestinal ileus. After its improvement following the insertion of an ileus tube, radiography with amidotrizoate sodium meglumine detected a round, movable defect in the ileum measuring 42 mm diameter. The patient was diagnosed with a primary enterolith based on her past history. The enterolith was fractured and removed using balloon-assisted enteroscopy. This case suggests that balloon-assisted enteroscopy may be an effective non-invasive treatment option for enteroliths.
Assuntos
Dor Abdominal/etiologia , Cálculos/complicações , Enteroscopia de Duplo Balão , Íleus/diagnóstico , Obstrução Intestinal/etiologia , Cálculos/diagnóstico por imagem , Endoscopia Gastrointestinal , Feminino , Humanos , Íleus/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Perfuração Intestinal , Laparoscopia , Masculino , Radiografia , Resultado do TratamentoRESUMO
BehÒ«et's disease (BD) is a chronic disorder involving multiple organ systems including the small and large intestines. A 46-year-old female diagnosed with intestinal BD presented with ileocecal perforation and diffuse peritonitis and subsequently underwent ileocolic resection with ileostomy. After surgery, she suffered from refractory para-ileostomal ulceration associated with BD. Most importantly, however, treatment with infliximab was significantly effective in healing the ulceration. This is the first report of para-ileostomal ulceration associated with BD successfully treated with infliximab, suggesting the possible use of infliximab as a therapeutic option for para-stomal ulcers related to BD.
Assuntos
Síndrome de Behçet/cirurgia , Ileostomia/efeitos adversos , Infliximab/uso terapêutico , Enteropatias/tratamento farmacológico , Úlcera/tratamento farmacológico , Feminino , Humanos , Enteropatias/etiologia , Pessoa de Meia-Idade , Úlcera/etiologiaRESUMO
BACKGROUND AND AIM: Endoscopic submucosal dissection (ESD) is the established therapy for superficial gastrointestinal neoplasms. However, management of the artificial ulcers associated with ESD has become important and the relationship between ulcer healing factors and treatment is still unclear. We aimed to evaluate ESD-related artificial ulcer reduction ratio at 4 weeks to assess factors associating with ulcer healing after ESD that may lead to optimal treatment. METHODS: Between January 2009 and December 2013, a total of 375 lesions fulfilled the expanded criteria for ESD. We defined ulcer reduction rate <90% as (A) poor-healing group; and rate ≥90% as (B) well-healing group. After exclusion, 328 lesions were divided into two groups and analyzed. These two groups were compared based on clinicopathological/endoscopic features, concomitant drugs, and treatment. RESULTS: Ulcer reduction rate was significantly correlated with factors related to the ESD procedure (i.e. procedure time, submucosal fibrosis, and injury of the proper muscle layer, in univariate analysis. Multivariate logistic regression analysis showed that submucosal fibrosis (F2) (P = 0.03; OR, 16.46; 95% CI, 1.31-206.73) and injury of the proper muscle layer (P = 0.01; OR, 4.27; 95% CI, 2.04-8.92) were statistically significant predictors of delayed healing. CONCLUSION: This single-center retrospective study indicated that ESD-induced artificial ulcer healing was affected by submucosal fibrosis and injury of the proper muscle layer, which induced damage to the muscle layer. Therefore, the preferable pharmacotherapy can be determined on completion of the ESD procedure.
Assuntos
Dissecação/métodos , Mucosa Gástrica/cirurgia , Gastroscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/prevenção & controle , Cicatrização , Idoso , Feminino , Seguimentos , Mucosa Gástrica/patologia , Humanos , Masculino , Imagem de Banda Estreita , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Úlcera Gástrica/etiologia , Úlcera Gástrica/patologia , Cirurgia Assistida por Computador , Fatores de Tempo , Resultado do TratamentoAssuntos
Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Esofagoscopia , Esôfago/cirurgia , Cirrose Hepática/complicações , Idoso , Dissecação , Neoplasias Esofágicas/patologia , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa/cirurgia , Estudos RetrospectivosAssuntos
Carcinoma de Células Escamosas/terapia , Dissecação/métodos , Neoplasias Esofágicas/terapia , Esofagoscopia/métodos , Esôfago/patologia , Mucosa Intestinal/cirurgia , Recidiva Local de Neoplasia/cirurgia , Terapia de Salvação/métodos , Idoso , Carcinoma de Células Escamosas/diagnóstico , Quimiorradioterapia/métodos , Neoplasias Esofágicas/diagnóstico , Carcinoma de Células Escamosas do Esôfago , Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Endoscopia Gastrointestinal/métodos , Neoplasias Esofágicas/cirurgia , Segunda Neoplasia Primária/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Idoso , Dissecação/efeitos adversos , Dissecação/métodos , Endoscopia Gastrointestinal/efeitos adversos , Esofagectomia , Estudos de Viabilidade , Feminino , Mucosa Gástrica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Taxa de SobrevidaRESUMO
We describe the case of a 74-year-old female with a mesenteric lymph node abscess caused by a Yersinia enterocolitica infection. She had been administered an immunosuppressive drug and was admitted to the hospital due to a high fever, right lower abdominal pain and advanced leukocytosis. We initially diagnosed her with lymphadenitis based on the symptoms and the imaging studies. However, conservative treatment with antibiotics did not yield any improvement, and abscess formation was suspected. Surgical treatment was performed, and the culture from the drainage fluid grew Y. enterocolitica. The histological findings suggested that an ulcerative lesion of the terminal ileum was the entry port of Y. enterocolitica. The pathogen infected the mesenteric lymph nodes and spread along the ileocecal lymphatic vessels, resulting in the formation of an abscess. We also provide a review of the previously published literature on lymph node abscesses due to Y. enterocolitica infections.
Assuntos
Abscesso/cirurgia , Doenças Linfáticas/microbiologia , Doenças Linfáticas/cirurgia , Yersiniose/cirurgia , Yersinia enterocolitica , Idoso , Feminino , Humanos , MesentérioRESUMO
We herein describe the case of a 51-year-old man with a duodenocolic fistula (DCF) caused by a stomal ulcer. The patient complained of watery diarrhea, dysgeusia and malnutrition. His medical history included distal gastrectomy with Billroth I reconstruction for duodenal ulcer perforation. A combination study using endoscopy and contrast imaging confirmed the presence of DCF. Laparotomic fistulectomy was performed, which resulted in the patient's recovery from diarrhea and malnutrition. The histological findings suggested that the fistula had originated from a stomal ulcer. In patients with chronic watery diarrhea of obscure origin following gastrectomy, DCF is a possible cause of the diarrhea.