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1.
Eur J Gastroenterol Hepatol ; 35(2): 174-180, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36574308

RESUMO

OBJECTIVE: The first choice of treatment for rectal neuroendocrine tumors (R-NETs) 10 mm in size is endoscopic resection, there is still controversy concerning the optimal endoscopic treatment for resecting R-NETs. This study evaluated the efficacy and safety of multiple ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (EMR-MLUS) for R-NETs. METHODS: We retrospectively analyzed the data of 62 patients with R-NETs ≤10 mm in size who underwent EMR-MLUS or ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (EMR-LUS) between May 2019 and April 2022, including tumor characteristics, endoscopic complete resection, pathological complete resection, the procedure time, adverse events, and follow-up were compared between the two groups of patients. RESULTS: Of the 62 patients, 19 underwent EMR-MLUS and 43 underwent EMR-LUS. The endoscopic morphology of lesions was statistically different between group EMR-MLUS and group EMR-LUS ( P = 0.015), and most of them were flat and slightly raised lesions in group EMR-MLUS. Although the pathological complete resection rate was slightly higher in the EMR-MLUS group than in the EMR-LUS group (94.74% vs. 90.70%; P = 0.290), the endoscopic complete resection rate was high in both groups. Involvement of the lateral resection margin was found four cases in the ESMR-LUS group; one case of deep resection margin involvement in the EMR-MLUS group. The mean procedure time was longer in the EMR-MLUS group than in the EMR-LUS group (12.79 ± 1.01 min vs. 11.08 ± 1.89 min; P = 0.041). In group EMR-LUS, there were two cases of immediate bleeding; in group EMR-MLUS, one case of perforation, all of them were successfully treated by endoscopy. No recurrence, progression, or metastasis was found in all patients. CONCLUSION: EMR-MLUS is a safe and effective technique that could be considered when removing small rectal NETs, especially flat and slightly raised lesions.


Assuntos
Ressecção Endoscópica de Mucosa , Tumores Neuroendócrinos , Neoplasias Retais , Humanos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Endossonografia , Resultado do Tratamento , Estudos Retrospectivos , Margens de Excisão , Endoscopia Gastrointestinal/efeitos adversos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Neoplasias Retais/etiologia , Mucosa Intestinal/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos
2.
J Clin Gastroenterol ; 57(2): 153-158, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36508253

RESUMO

This statement was written under the auspices of the World Gastroenterology Organization's Guidelines Committee. The authors are members of the Review Team of the WGO Endoscope Disinfection Guideline and have experience in endoscopy, endoscope reprocessing, and microbiology, including biofilms. During the preparation of the WGO Update on Endoscope Disinfection Guidelines, concerns about simethicone on endoscope channel surfaces compromising cleaning and disinfection were raised. Publications on simethicone, including modes of delivery, effectiveness, and risks, have been reviewed. The paper was written as a companion to the new guidelines with a focus on minimizing the risks of simethicone in endoscope reprocessing.


Assuntos
Gastroenterologia , Simeticone , Humanos , Endoscópios , Endoscopia Gastrointestinal/efeitos adversos , Desinfecção
3.
Trials ; 23(1): 995, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36510290

RESUMO

BACKGROUND: Gastrointestinal endoscopy has been associated with difficult experiences and can leave patients with an unpleasant impression. Propofol and midazolam are the most commonly used intravenous anesthetics for sedation during gastrointestinal endoscopy. However, cardiac and pulmonary adverse events are the primary concerns associated with the use of these sedatives. Remimazolam tosylate is an ultra-short-acting benzodiazepine drug with a mild inhibitory effect on the respiratory and circulatory systems. These properties qualify remimazolam tosylate to be used as a replacement for propofol or midazolam as a sedative during gastrointestinal endoscopy. This study aims to describe the efficacy and safety of remimazolam tosylate as a sedative for upper gastrointestinal endoscopy. METHODS: A multicenter, randomized, single-blind, parallel-controlled, noninferiority clinical study will be conducted to evaluate the efficacy and safety of remimazolam tosylate as a sedative during upper gastrointestinal endoscopy. Participants (n = 1800) will be randomized to receive remimazolam tosylate at 0.15 mg/kg (experimental group 1), remimazolam tosylate at 0.2 mg/kg (experimental group 2), or propofol at 1.5 mg/kg (control group). Procedure success will be assessed and defined as the completion of upper gastrointestinal endoscopy without the administration of a rescue sedative agent or more than two top-up doses of the trial drug in any 5-min period after initial administration. Sedation quality will be evaluated using the Modified Observer's Assessment of Alertness/Sedation score. Adverse events will be recorded to evaluate safety. DISCUSSION: This study will determine the optimal dosage of remimazolam tosylate during upper gastrointestinal endoscopy and will describe its efficacy and safety. These findings may contribute to a more comfortable and safer experience for patients compared with that when the conventional sedative propofol is used. TRIAL REGISTRATION: ClinicalTrials.gov NCT04727034. Registered on February 18, 2021.


Assuntos
Midazolam , Propofol , Humanos , Método Simples-Cego , Midazolam/efeitos adversos , Benzodiazepinas , Hipnóticos e Sedativos/efeitos adversos , Propofol/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
4.
Artigo em Inglês | MEDLINE | ID: mdl-36572454

RESUMO

A clear understanding of the potential complications or adverse events (AEs) of diagnostic endoscopy is an essential component of being an endoscopist. Creating a culture of safety and prevention of AEs should be part of routine endoscopy practice. Appropriate patient selection for procedures, informed consent, periprocedure risk assessments and a team approach, all contribute to reducing AEs. Early recognition, prompt management and transparent communication with patients are essential for the holistic and optimal management of AEs. In this review, we discuss the complications of diagnostic upper gastrointestinal endoscopy, including their recognition, treatment and prevention.


Assuntos
Endoscopia Gastrointestinal , Humanos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Medição de Risco
5.
BMC Gastroenterol ; 22(1): 543, 2022 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-36577955

RESUMO

BACKGROUND: There is strong evidence demonstrating the incidence of Acute Coronary Syndrome (ACS) among patients with cirrhosis, with the initiation of antiplatelet therapy being subject to debate due to an increased risk of bleeding. This study aimed to determine mortality among patients presenting with concomitant Acute Variceal Bleeding (AVB) and ACS at Index admission. Furthermore, the recurrence of AVB and ACS among patients discharged with or without antiplatelet therapy was determined. METHODS: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan on patients ≥ 18 years of age admitted to our ER with concomitant ACS and AVB between January 2002 to December 2017. Follow-up for 6 months or till death (if < 6 months), was observed, to help determine the incidence of recurrent AVB and ACS. The incidence of AVB and ACS was then compared amongst patient groups based on the usage of anti-platelet drugs on discharge. RESULTS: A total of 29 patients were included, with a mean age of 58.7 ± 11.0 years. Seven patients died on admission, having worse underlying liver disease. No mortality was reported among the remaining 22 patients. All 22 patients underwent surveillance endoscopy with variceal band ligation until obliteration, as needed. Only 7 patients from the surviving cohort received antiplatelet therapy. After 6.05 ± 1.1 months of follow-up, 1/22 (4.5%) developed recurrent AVB and 2/22 (9.1%) developed cardiovascular events. Importantly, there was no significant difference in the incidence of recurrent AVB (P = 1.000) and ACS (P = 0.091), depending on the use of antiplatelet therapy. CONCLUSION: Concomitant AVB and ACS is a severe disorder with increased mortality among cirrhotic patients at presentation. The incidence of AVB does not seem to exacerbate with the use of antiplatelet agents, provided successful obliteration of varices is achieved using elective band ligation.


Assuntos
Síndrome Coronariana Aguda , Varizes Esofágicas e Gástricas , Varizes , Humanos , Pessoa de Meia-Idade , Idoso , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Gastrointestinal/terapia , Estudos Retrospectivos , Varizes Esofágicas e Gástricas/complicações , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/induzido quimicamente , Cirrose Hepática , Varizes/induzido quimicamente , Varizes/complicações , Endoscopia Gastrointestinal/efeitos adversos
6.
Medicine (Baltimore) ; 101(45): e31543, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397398

RESUMO

Acute upper gastrointestinal bleeding (UGIB) is a typical medical emergency, with an incidence of 84 to 160 cases per 100,000 individuals and a mortality rate of approximately 10%. This study aimed to identify all cases of UGIB hospitalized in a tertiary gastroenterology department, to identify possible predictive factors involved in rebleeding and mortality, potential associations between different elements and the severity of bleeding, and the differences between the upper digestive hemorrhage due to nonvariceal and variceal bleeding. This was an observational, retrospective study of patients with UGIB admitted to the tertiary Department of Gastroenterology between January 2013 and December 2020. A total of 1499 patients were enrolled in the study. One thousand four hundred and ninety-nine patients were hospitalized for 7 years with active upper digestive hemorrhage, 504 variceal bleeding, and 995 nonvariceal bleeding. When comparing variceal with nonvariceal bleeding, in nonvariceal bleeding, the mean age was higher, similar sex, higher mortality rate, higher rebleeding rate, and higher hemorrhagic shock rate. Endoscopy treatment was also performed more frequently in variceal bleeding than in nonvariceal bleeding. Severe anemia was found more frequently in patients with variceal bleeding. The mortality rate was 10% in the entire study group, which was not significantly different between the 2 batches. However, the rebleeding rate is higher in patients with variceal gastrointestinal bleeding.


Assuntos
Varizes Esofágicas e Gástricas , Varizes , Humanos , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Varizes Esofágicas e Gástricas/complicações , Estudos Retrospectivos , Doença Aguda , Endoscopia Gastrointestinal/efeitos adversos , Varizes/complicações
7.
BMC Gastroenterol ; 22(1): 465, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397007

RESUMO

BACKGROUND: Gastrointestinal (GI) bleeding is one of the most impactful complications in patients hospitalized from COVID-19 infection. Limited study has focused on patients with upper GI bleeding (UGIB). This study aimed to identify the risk factors of patients who were hospitalized from COVID-19 infection and developed UGIB as well as the effectiveness of proton pump inhibitor (PPI) prophylaxis in those patients. METHODS: This study was comprised of two phases. The first phase was the retrospective enrollment of patients who were admitted due to COVID-19 infection and developed UGIB between April and August 2021 to evaluate the associated factors of active UGIB. The second phase was a retrospective analysis after PPI prophylaxis protocol from September - October 2021 to assess the benefit of PPI use in those patients. RESULTS: Of 6,373 patients hospitalized, 43 patients (0.7%) had evidence of UGIB. The majority were male 28 (65.1%) with a mean age of 69.1 ± 11.8 years. Twenty-four of 43 patients (55.8%) needed mechanical ventilation, 35 patients (81.4%) received systemic corticosteroids, and 10 patients (23.3%) were taking anticoagulants for venous thromboembolic prophylaxis. Seven of 43 patients (16%) had active UGIB. There was no significant difference in the number of patients taking antiplatelets, anticoagulants, or steroids and the severity of COVID-19 infection between the two groups. An emergency endoscopy or endoscopic hemostasis were performed in 6/7 (85.7%) patients. The multivariate logistic regression analysis revealed two significant factors associated with active UGIB including higher of Glasgow-Blatchford score (GBS) per point (OR = 7.89; 95%CI 1.03-72.87; p = 0.04) and an absence of PPI use (OR 4.29; 95%CI 1.04-19.51; p = 0.04). After prescribing PPI as a prophylaxis, there was a slightly lower incidence of UGIB (0.6% vs 0.7%) in addition to an absence of active UGIB (0% vs 16%). CONCLUSION: Our study demonstrated that the absence of PPI and higher GBS were significant risk factors for active UGIB which required therapeutic endoscopy in patients with COVID-19 infection. We suggest that short-term PPI prophylaxis should be prescribed in those patients once they need hospitalization regardless of the severity of COVID-19 infection to minimize the severity of UGIB.


Assuntos
COVID-19 , Inibidores da Bomba de Prótons , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , COVID-19/complicações , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/prevenção & controle , Fatores de Risco , Endoscopia Gastrointestinal/efeitos adversos , Anticoagulantes/efeitos adversos
8.
BMC Anesthesiol ; 22(1): 348, 2022 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376852

RESUMO

BACKGROUND: Hypobaric hypoxia is common at high altitudes. Whether this exacerbates hypoxia during procedural sedation and whether hypoxia can be alleviated by the use of supraglottic jet oxygenation and ventilation (SJOV) are unknown. This study aimed to compare the incidence of hypoxia during gastrointestinal endoscopy under deep sedation at high altitudes with oxygen supply techniques using either a nasal cannula or SJOV. METHODS: This study was conducted from April 2022 to July 2022 in a tertiary hospital located 3650 m above sea level. Adult patients scheduled for routine gastrointestinal endoscopy under sedation were enrolled and randomized 1:1 to receive SJOV or a nasal cannula during sedation. Moderate hypoxia was the primary outcome, defined as an SPO2 of 75-89% for < 60 s. The secondary outcomes were respiratory-, cardiovascular-, and SJOV-related complications. The influence of characteristics regarding acclimatization to high altitudes (Tibetan ethnic group and erythrocytosis) on the occurrence of hypoxia was analyzed. RESULTS: None of the patients were lost to follow-up. A total of 72 patients were included in the analysis (36 patients in each group). There were 20 (27.8%) patients who experienced moderate hypoxia events. Significantly fewer hypoxic events occurred in the SJOV group than in the nasal cannula group [3 (8.3%) vs. 17 (47.2%), absolute risk difference (95% CI): - 38.9 (- 57.5, - 20.2) %, risk ratio (RR, 95% CI): 0.18 (0.06, 0.55), P < 0.001]. Significantly fewer patients in the SJOV group experienced mild hypoxia (P < 0.001) and severe hypoxia (P = 0.002). No serious adverse events occurred in either of the groups. The Tibetan ethnic group (P = 0.086) and erythrocytosis (P = 0.287) were not associated with the occurrence of hypoxia events. CONCLUSIONS: The incidence of hypoxia was lower with SJOV than with nasal cannula in patients undergoing gastrointestinal endoscopy under deep sedation at high altitudes. The Tibetan ethnic group and erythrocytosis did not influence the occurrence of hypoxia. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT05304923) before enrollment by Dr. Yi Feng on 31/03/2022.


Assuntos
Sedação Profunda , Policitemia , Humanos , Adulto , Policitemia/complicações , Altitude , Hipóxia/epidemiologia , Hipóxia/etiologia , Hipóxia/prevenção & controle , Endoscopia Gastrointestinal/efeitos adversos , Oxigênio , Oxigenoterapia
9.
Artigo em Inglês | MEDLINE | ID: mdl-36351757

RESUMO

OBJECTIVE: Despite international guidelines recommendations to use mortality as a quality criterion for gastrointestinal (GI) procedures, recent studies reporting these data are lacking. Our objective was to report death causes and rate following GI endoscopies in a tertiary university hospital. DESIGN: We retrospectively reviewed all GI procedures made between January 2017 and December 2019 in our tertiary hospital in Switzerland. Data from patients who died within 30 days of the procedure were recorded. RESULTS: Of 18 233 procedures, 251 patients died within 30 days following 345 (1.89%) procedures (244/9180 gastroscopies, 53/5826 colonoscopies, 23/2119 endoscopic ultrasound, 19/911 endoscopic retrograde cholangiopancreatography, 6/197 percutaneous endoscopic gastrostomies). Median age was 70 years (IQR 61-79) and 173/251 (68.92%) were male. Median Charlson Comorbidity Index was 5 (IQR 3-7), and 305/345 procedures (88.4%) were undertaken on patients with an ASA score ≥3. Most frequent indications were suspected GI bleeding (162/345; 46.96%) and suspected cancer or tumourous staging (50/345; 14.49%). Major causes of death were oncological progression (72/251; 28.68%), cardiopulmonary failure or cardiac arrest of unkown origin (62/251; 24,7%) and liver failure (20/251; 7.96%). No deaths were caused by complications such as perforation or bleeding. CONCLUSIONS: Progression of malignancies unrelated to the procedure was the leading cause of short-term death following a GI procedure. After improvements in periprocedural care in the last decades, we should focus on patient selection in this era of new oncological and intensive care therapies. Death rate as a quality criterion is subject to caution as it depends on indication, setting and risk benefit ratio.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Humanos , Masculino , Idoso , Feminino , Estudos Retrospectivos , Centros de Atenção Terciária , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/etiologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos
10.
BMC Gastroenterol ; 22(1): 445, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333660

RESUMO

BACKGROUND: This study aimed to evaluate the usefulness of discharge standards in outpatients undergoing sedative endoscopy by comparing the modified post-anesthetic discharge scoring system (MPADSS) and the modified Aldrete score. METHODS: We prospectively enrolled 376 outpatients who underwent gastrointestinal endoscopy under midazolam sedation; 181 outpatients were assessed regarding discharge after sedative endoscopy using the MPADSS (group M), and 195 patients were assessed by the modified Aldrete score (group A). The clinical characteristics, types of endoscopy, endoscopic outcomes, and anesthesia outcomes were evaluated between the two groups. We compared discharge score, recovery time, and adverse events using propensity-score matching. RESULTS: Propensity-score matching created 120 matched pairs. The proportion of patients who had a recovery time within 60 min after endoscopy was significantly higher in group A than that in group M (42.5% versus 25.0%, respectively; P < 0.01). The proportion of patients who required > 120 min of recovery time after endoscopy was significantly lower in group A than that in group M (0.0% versus 5.0%, respectively; P = 0.03). However, significantly more patients had drowsiness at discharge in group A compared with group M (19.1% versus 5.0%, respectively; P < 0.01). There was no significant difference in the adverse event rate within 24 h of discharge between the groups. CONCLUSIONS: Patients assessed by the modified Aldrete score were allowed to discharge earlier than those assessed by the MPADSS. However, a patient's level of consciousness should be assessed carefully, especially in patients who visit the hospital alone.


Assuntos
Anestésicos , Propofol , Humanos , Hipnóticos e Sedativos/efeitos adversos , Sedação Consciente/efeitos adversos , Pacientes Ambulatoriais , Alta do Paciente , Pontuação de Propensão , Endoscopia Gastrointestinal/efeitos adversos , Propofol/efeitos adversos
13.
Pancreas ; 51(6): 700-704, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-36206472

RESUMO

ABSTRACT: Diagnosing pancreatic heterotopia (PH) is challenging, because it is a rare congenital anomaly. We report the case of a 66-year-old man who presented with ileus and jejunal PH diagnosed using single-balloon enteroscopy. Reviewing 178 cases of small intestinal PH in the literature showed that (1) PH mostly occurred at the duodenum (61.8%), followed by the jejunum (22.5%) and ileum (14.6%); (2) patients with ileal PH were younger (mean, 40.7 vs 54.6 years; P < 0.001), while those with jejunal PH were older (mean, 59.5 vs 51.7 years; P = 0.006); (3) most patients with jejunal PH were females, while those with duodenal or ileal PH were predominantly males (M:F = 0.8:1 vs 2.5:1; P = 0.003); (4) asymptomatic cases were rare (15.2% vs 83.4% in small and nonsmall bowel, respectively); (5) most patients with ileal PH presented with bleeding (61.5%), while the remaining had abdominal pain (42.8%); (6) emergent operation was performed in 11 cases (6.2%), mainly at the jejunum (12.5%) and Meckel's diverticulum (25%); and (7) Heinrich's classification may be inconclusive. Enteroscopy was performed in only 6 cases (3.4%), and earlier diagnosis and further minimally invasive procedures could have been achieved with enteroscopy.


Assuntos
Obstrução Intestinal , Divertículo Ileal , Idoso , Duodeno , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia
14.
Gastrointest Endosc Clin N Am ; 32(4): 597-614, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36202505

RESUMO

Interventional inflammatory bowel disease (IBD) or endoscopic therapy for IBD or IBD surgery-associated complications has emerged as a main treatment modality bridging medical and surgical treatment. It delivers therapy more definitive than medical therapy and less invasive than surgical treatment. The main applications of interventional IBD are strictures, fistulas, abscesses, bleeding, foreign bodies, postoperative complications, and colitis-associated neoplasia. The major endoscopic treatment modalities are balloon dilation, stricturotomy, strictureplasty, fistulotomy, sinusotomy, septectomy, banding ligation, incision and drainage, polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection.


Assuntos
Ressecção Endoscópica de Mucosa , Doenças Inflamatórias Intestinais , Cateterismo/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/cirurgia
15.
Gastrointest Endosc Clin N Am ; 32(4): 699-717, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36202511

RESUMO

Strictures are among the most frequent complications in patients with Crohn's disease (CD), usually requiring a combined medical, surgical, and/or endoscopic approach to treatment. Currently, endoscopic balloon dilation (EBD) is the endoscopic treatment of choice, but its effectiveness is not universal, especially in the long term, and it is not free of complications. The technological evolution of stents in recent years has allowed their use in benign diseases of any origin and location, including inflammatory bowel disease (IBD). The current scientific evidence regarding the use of stents in strictures in IBD is limited and it should not be considered the first option in endoscopic treatment. Self-expandable metal stents (SEMS), but no biodegradable stents (BS), can work in cases that are refractory to anterior endoscopic treatment with EBD, in cases in which EBD is not possible, and in cases with strictures of greater length.


Assuntos
Doença de Crohn , Endoscopia Gastrointestinal , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Dilatação/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Humanos , Stents/efeitos adversos , Resultado do Tratamento
16.
Gastrointest Endosc Clin N Am ; 32(4): 817-827, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36202518

RESUMO

Gastrointestinal endoscopy provides detailed information for diagnosis, differential diagnosis, and disease monitoring and delivers therapy for inflammatory bowel disease. Inflammatory bowel diseases are associated with complications such as strictures, gastrointestinal hemorrhage, fistula, perforation, and abscesses. Endoscopic intervention is a valid therapeutic modality for intestinal strictures and other morbidities. The multisegmental involvement of Crohn's disease, surgically altered bowel anatomy, and the postoperative extensive adhesions have made conventional diagnostic and therapeutic enteroscopy difficult. Intraoperative enteroscopy offers a feasible option for diagnosis and therapy. We report intraoperative enteroscopy in the management of small intestinal strictures and other intestinal morbidities.


Assuntos
Doença de Crohn , Obstrução Intestinal , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Humanos , Obstrução Intestinal/etiologia , Intestino Delgado
17.
Nihon Shokakibyo Gakkai Zasshi ; 119(10): 954-960, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36216546

RESUMO

An 87-year-old man had a self-extracted percutaneous endoscopic gastrojejunostomy tube (PEG-J tube) and underwent PEG-J replacement. He vomited 2 days after the replacement, and bowel bleeding occurred 5 days after the replacement. Therefore, he presented to our hospital. A simple abdominal computed tomography scan showed a target sign in the jejunum on the anus side rather than on the PEG-J tube tip portion, resembling intussusception. We confirmed mucosa necrosis in the intussusception by small-diameter endoscopy and attempted internal treatment. However, resistance was so strong that the internal treatment was difficult;therefore, he underwent a jejunal resection. Although diarrhea and dumping syndrome are common PEG-J complications, there have been few reports of intussusception caused by PEG-J. We report a case of adult-onset intussusception, which was thought to be caused by long-term PEG-J implantation.


Assuntos
Derivação Gástrica , Intussuscepção , Adulto , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Intussuscepção/cirurgia , Jejuno , Masculino , Estômago/cirurgia
18.
Medicine (Baltimore) ; 101(38): e30573, 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36197212

RESUMO

Esophageal motility disorders (EMDs) are the main etiology of nonobstructive dysphagia (NOD), but they are underestimated in Egypt. High-resolution manometry (HRM) with Chicago Classification version 3.0 (CC v3.0) is the current gold standard diagnostic modality to assess EMD in patients with NOD. In this HRM-based study, we aimed to classify EMD among Egyptian patients and explore the relationship between the severity of symptoms and the various groups of EMD. From January 2020 to January 2021, patients with dysphagia were subjected to diagnostic workup, which included symptom questionnaire for Eckardt score, esophagogastroduodenoscopy, barium esophagogram, and HRM. All patients were categorized based on the HRM results using CC version 3.0 after exclusion of those with obstructive esophageal lesions. Of 252 patients with dysphagia, 55 patients with NOD were analyzed according to CC version 3.0. Achalasia was diagnosed in 31 patients (56.4%) (type I: 18 [58.06%]; type II: 9 [29.03%], and type III: 4 [12.9%]), 3 patients (5.5%) with esophagogastric junction outflow obstruction, 2 patients (3.6%) with absent contractility, 4 patients (7.3%) with distal esophageal spasm, 7 patients (12.7%) with ineffective esophageal motility, and 8 patients (14.5%) with normal manometry. Patients with achalasia experienced significantly high regurgitation (96.8% vs 70.8%; P = .016) compared with those without achalasia. Achalasia was the most common EMD in Egyptian patients with NOD. Eckardt score was higher in patients with outflow obstruction and major motor disorder, but it could not differentiate different categories of CC of EMD. HRM is effective in characterization of EMD.


Assuntos
Transtornos de Deglutição , Acalasia Esofágica , Transtornos da Motilidade Esofágica , Bário , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Endoscopia Gastrointestinal/efeitos adversos , Acalasia Esofágica/complicações , Transtornos da Motilidade Esofágica/complicações , Junção Esofagogástrica , Humanos , Manometria/métodos
19.
Acta Gastroenterol Belg ; 85(3): 543, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36198303

RESUMO

Question: A 35-year-old male with a history of HIV infection presented in our department for endoscopy with the complaints of dyspepsia and epigastric pain. Endoscopy revealed flat, maculopapular, reddish or purplish patchy nodular lesions, with different sizes and shapes, involv- ing both the duodenum and stomach (Figure 1 A-B). There was no sign of complications such as hemorrhage, perforation or obstruction. Physical examination re- vealed that the patient had also purple patchy cutaneous lesions (Figure 2). What is the diagnosis? Answer: Histological assessment from the maculopapular and nodular lesions in endoscopic and cutaneous biopsies revealed the diagnosis as Kaposi sarcoma (KS). KS is a low-grade vascular tumor caused by human herpes virus type 8. KS manifests primarily as a cutaneous disorder, with visceral involvement considered to occur subsequently. Gastrointestinal involvement of KS is rare and most commonly clinically silent. AIDS-related KS that is the most common form of KS in the USA and Europe and the most common malignancy in patients with AIDS. GI involvement by KS is a rare endoscopic finding, still scarcely characterized in the literature (1). In conclusion, involvement of the gastrointestinal tract by KS is often asymptomatic, has multiple endoscopic appearances, and a high diagnostic suspicion is needed in this setting.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Soropositividade para HIV , Sarcoma de Kaposi , Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Adulto , Animais , Bovinos , Endoscopia Gastrointestinal/efeitos adversos , Infecções por HIV/complicações , Soropositividade para HIV/complicações , Humanos , Masculino , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/etiologia , Sarcoma de Kaposi/patologia
20.
Surg Endosc ; 36(12): 9469-9475, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36192655

RESUMO

BACKGROUND: Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks. METHODS: All consecutive patients with large (> 10 mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure. RESULTS: A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15 mm) was diagnosed 6 days (IQR 4-9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7 months (IQR 3.8-20.7), GL closure was observed in 82.7% with a median time of 63 days (IQR 40-90). Surgical management was finally necessary in four patients after a median of 186 days (IQR 122-250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up. CONCLUSION: An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL.


Assuntos
Fístula , Obesidade Mórbida , Humanos , Estudos Retrospectivos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Stents/efeitos adversos , Resultado do Tratamento , Endoscopia Gastrointestinal/efeitos adversos , Fístula/complicações , Obesidade Mórbida/cirurgia
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