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1.
World J Gastroenterol ; 27(34): 5700-5714, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34629795

RESUMO

Incidental pancreatic cysts are commonly encountered with some cysts having malignant potential. The most common pancreatic cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. Risk stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound (EUS) or surgical resection. Surgery should be reserved for patients with malignant cysts or cysts at high risk for developing malignancy as suggested by various risk features including solid mass, nodule and dilated main pancreatic duct. EUS may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on imaging. Various cyst fluid markers including carcinoembryonic antigen, glucose, amylase, cytology, and DNA markers help distinguish mucinous from nonmucinous cysts. This review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or surgery. For presumed low risk cysts, surveillance strategies will be discussed. Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines.


Assuntos
Cisto Pancreático , Neoplasias Pancreáticas , Líquido Cístico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Humanos , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia
2.
BMC Gastroenterol ; 21(1): 365, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620107

RESUMO

OBJECTIVE: To determine the accuracy of endoscopic ultrasonography (EUS) in the diagnosis of upper gastrointestinal submucosal lesions (SMLs). METHODS: This was a retrospective study involving patients diagnosed with SMLs using EUS and confirmed by histopathology from November 2014 to December 2020 at The Third Xiangya Hospital of Central South University. RESULTS: A total of 231 patients with SMLs were examined by EUS. Histologically, 107 lesions were stromal tumors, and 75 lesions were leiomyomas. Stromal tumors were mainly located in the stomach (89.7%), and leiomyomas were predominantly seen in the esophagus (69.3%). The diagnostic accuracy of EUS for stromal tumors and leiomyomas was 80.4% and 68.0%, respectively. The diagnostic accuracy was highest for lesions located in the muscularis mucosa. The mean diameter of stromal tumors measured using EUS was significantly larger than that of leiomyomas (21.89 mm vs. 12.35 mm, p < 0.001). Stromal tumors and leiomyomas originated mainly from the muscularis propria (94.4%) and the muscularis mucosa (56.0%), respectively. Compared with the very low-risk and low-risk groups of stromal tumors according to the National Institute of Health guidelines, the intermediate-risk and high-risk groups were more likely to have a lesion > 3 cm (p < 0.001) and a surface ulcer (p < 0.01) identified by EUS. CONCLUSIONS: EUS has good diagnostic value for the diagnosis of upper gastrointestinal SMLs based on the lesion size and the muscle layer of origin. The diagnostic accuracy of EUS lesions is related to the origin, and the diagnostic accuracy is greatest in the mucosal muscularis layer. Stromal tumors > 3 cm and a surface ulcer on EUS are likely to be intermediate or high risk for invasion.


Assuntos
Leiomioma , Trato Gastrointestinal Superior , Diagnóstico Diferencial , Endossonografia , Humanos , Leiomioma/diagnóstico por imagem , Estudos Retrospectivos
3.
Internist (Berl) ; 62(10): 1015-1024, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34542657

RESUMO

Chronic pancreatitis is characterized by recurrent inflammatory episodes. The diagnosis is based on the detection of pathognomonic morphological alterations by ultrasound-based methods as well as computed tomography and magnetic resonance imaging. In addition, imaging techniques play an important role for the differential diagnostics of potential complications in patients with chronic pancreatitis and for regular monitoring of patients with increased cancer risk. This article summarizes the current guideline recommendations for medical imaging procedures in chronic pancreatitis.


Assuntos
Endossonografia , Pancreatite Crônica , Humanos , Imageamento por Ressonância Magnética , Pancreatite Crônica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Z Gastroenterol ; 59(9): 933-943, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34507372

RESUMO

BACKGROUND AND STUDY AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for the treatment of biliary obstruction of any etiology. However, cannulation failure of the common bile duct (CBD) by ERCP occurs in 5-10%. Alternatives after a failed ERCP are re-ERCP by an expert endoscopist, percutaneous transhepatic cholangio drainage (PTCD), (balloon) enteroscopy-assisted ERCP, or surgery. Endoscopic ultrasonography-guided drainage of the bile ducts (EUS-BD) is becoming the standard of care in tertiary referral centers for cases of failed ERCP in patients with malignant obstruction of the CBD. In expert hands, EUS-guided biliary drainage has excellent technical/clinical success rates and lower complication rates compared to PTCD. Despite the successful performance of EUS-BD in malignant cases, its use in benign cases is limited. The aim of this study (design, systematic prospective clinical observational study on quality assurance in daily clinical practice) was to evaluate the efficacy and safety of EUS-BD in benign indications. PATIENTS AND METHODS: Patients with cholestasis and failed ERCP were recruited from a prospective EUS-BD registry (2004-2020). One hundred and three patients with EUS-BD and benign cholestasis were extracted from the registry (nTotal = 474). Indications of EUS-BDs included surgically altered anatomy (n = 65), atypical bile duct percutaneous transhepatic cholangio orifice at the duodenal junction from the longitudinal to the horizontal segment (n = 1), papilla of Vater not reached due to the gastric outlet/duodenal stenoses (n = 6), papilla that cannot be catheterized (n = 24), and proximal bile duct stenosis (n = 7). The primary endpoint was technical and clinical success. Secondary endpoints were procedure-related complications during the hospital stay. RESULTS: 103 patients with EUS-BD and benign cholestasis were extracted from the registry (nTotal=474). Different transluminal access routes were used to reach the bile ducts: transgastric (n = 72/103); -duodenal (n = 16/103); -jejunal (n = 14/103); combined -duodenal and -gastric (n = 1/103). The technical success rate was 96 % (n = 99) for cholangiography. Drainage was not required in 2 patients; balloon dilatation including stone extraction was sufficient in 17 cases (16.5 %; no additional or prophylactic insertion of a drain). Transluminal drainage was achieved in n = 68/103 (66 %; even higher in patients with drain indication only) by placement of a plastic stent (n = 29), conventional biliary metal stents (n = 24), HotAXIOS stents (n = 5; Boston Scientific, Ratingen, Germany), Hanaro stents (n = 6; Olympus, Hamburg, Germany), HotAXIOS stents and plastic stents (n = 1), HotAXIOS stents and metal stents (n = 1) and metal stents and plastic stents (n = 2). Techniques for stone extraction alone (nSuccessful=17) or stent insertion (nTotal = 85; nSuccessful=85 - rate, 100 %) and final EUS-BD access pathway included: Rendezvous technique (n = 14/85; 16.5 %), antegrade internal drainage (n = 20/85; 23.5 %), choledochointestinostomy (n = 7/85; 8.2 %), antegrade internal and hepaticointestinostomy (n = 22/85; 25.9 %), hepaticointestinostomy (n = 21/85; 24.7 %), choledochointestinostomy and hepaticointestinostomy (n = 1/85; 1.2 %).The complication rate was 25 % (n = 26) - the spectrum comprised stent dislocation (n = 11), perforation (n = 1), pain (n = 2), hemorrhage (n = 6), biliary ascites/leakage (n = 3) and bilioma/liver abscess (n = 3; major complication rate, n = 12/68 - 17.6 %). Re-interventions were required in 19 patients (24 interventions in total). DISCUSSION: EUS-BD can be considered an elegant and safe alternative to PTCD or reoperation for failed ERCP to achieve the necessary drainage of the biliary system even in underlying benign diseases. An interventional EUS-based internal procedure can resolve cholestasis, avoid PTCD or reoperation, and thus improve quality of life. Due to the often complex (pathological and/or postoperative) anatomy, EUS-BD should only be performed in centers with interventional endoscopy/EUS experience including adequate abdominal surgery and interventional radiology expertise in the background. This enables adequately adapted therapeutic management in the event of challenging complications. It seems appropriate to conduct further studies with larger numbers of cases to systematize the approach and peri-interventional management and to successively develop specific equipment.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase , Colestase/diagnóstico por imagem , Colestase/cirurgia , Ducto Colédoco , Drenagem , Endossonografia , Estudos de Viabilidade , Humanos , Estudos Prospectivos , Qualidade de Vida , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção
5.
Nihon Shokakibyo Gakkai Zasshi ; 118(9): 884-889, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34511556

RESUMO

A 60-year-old male patient had alcoholic chronic pancreatitis. Three months prior, he had undergone an exchange of pancreatic duct stents. In December 201X-1, magnetic resonance imaging and computed tomography (CT) scan results showed a caput pancreatic mass and common bile duct dilatation. We considered that it was because of chronic pancreatitis and decided to follow up by imaging studies. Further, in March 201X, a CT scan result revealed worsening of the mass and bile duct dilation. We assessed the mass by endoscopic ultrasound and fine-needle aspiration. Histological findings revealed to an interstitial tissue infiltrated by several neutrophils and plasma cells and abscess-forming inflammation like sulfur granule. The mass was improved by antibiotic administration for 6 months.


Assuntos
Actinomicose , Neoplasias Pancreáticas , Actinomicose/diagnóstico por imagem , Actinomicose/tratamento farmacológico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos , Tomografia Computadorizada por Raios X
6.
Z Gastroenterol ; 59(9): 983-990, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34507376

RESUMO

Cholecystectomy is the gold standard in the treatment of acute cholecystitis, but has a significantly increased risk in multimorbid patients or in the severe course of acute cholecystitis. In such cases, drainage of the damaged gallbladder in combination with antibiotic therapy may be superior to primary surgery. The drainage can either be performed as sonographically guided percutaneous transhepatic gallbladder drainage or as EUS-guided transmural stent placement or endoscopic-transpapillary gallbladder drainage. These minimally invasive alternatives to cholecystectomy can be used both as long-term therapy for permanently inoperable patients and temporarily for patients in whom the cholecystectomy is intended after improvement of the general condition. In this overview, the various drainage methods are discussed with regard to technical requirements, immediate and long-term clinical results and complications. With advances in stent design, EUS-guided transmural stent placement from the stomach or duodenum into the gallbladder is becoming the preferred method of gallbladder drainage in centers with the appropriate expertise.


Assuntos
Colecistite Aguda , Endossonografia , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Drenagem , Endoscopia , Humanos , Stents , Resultado do Tratamento
7.
Clinics (Sao Paulo) ; 76: e2701, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34378728

RESUMO

OBJECTIVES: Pancreatic pseudocysts (PPC) are fluid collections with a well-defined wall that persist for more than 4 weeks inside or around the pancreas as a result of pancreatic inflammation and/or a ductal lesion. PPC have been successfully treated with endoscopic ultrasound (EUS)-guided drainage using different stents. This study aimed to evaluate the safety and efficacy of EUS-guided drainage of PPC using double-pigtail plastic stents in a tertiary hospital. METHODS: Patients with PPC referred for EUS-guided drainage between May 2015 and December 2019 were included in this case series. The primary endpoint was to evaluate the efficacy (clinical success) and safety (adverse events and mortality) of EUS-guided drainage of PPC. Secondary endpoints included technical success and pseudocyst recurrence. RESULTS: Eleven patients (mean age, 44.5±18.98 years) were included in this study. The etiologies for PPC were acute biliary pancreatitis, chronic alcoholic pancreatitis, and blunt abdominal trauma. The mean pseudocyst size was 9.4±2.69 cm. The clinical success rate was 91% (10/11). Adverse events occurred in three of 11 patients (27%). There were no cases of mortality. The technical success rate was 100%. Pseudocyst recurrence was identified in one of 11 patients (9%) at 12 weeks after successful clinical drainage and complete pseudocyst resolution. CONCLUSION: EUS-guided transmural drainage of PPC using double-pigtail plastic stents is safe and effective with high technical and clinical success rates.


Assuntos
Pseudocisto Pancreático , Adulto , Drenagem , Endossonografia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Plásticos , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção
8.
Ultrasonics ; 117: 106558, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34461527

RESUMO

Coronary artery disease is the most common type of cardiovascular disease, affecting > 18 million adults, and is responsible for > 365 k deaths per year in the U.S. alone. Wall shear stress (WSS) is an emerging indicator of likelihood of plaque rupture in coronary artery disease, however, non-invasive estimation of 3-D blood flow velocity and WSS is challenging due to the requirement for high spatial resolution at deep penetration depths in the presence of significant cardiac motion. Thus we propose minimally-invasive imaging with a catheter-based, 3-D intravascular forward-viewing ultrasound (FV US) transducer and present experiments to quantify the effect of the catheter on flow disturbance in stenotic vessel phantoms with realistic velocities and luminal diameters for both peripheral (6.33 mm) and coronary (4.74 mm) arteries. An external linear array ultrasound transducer was used to quantify 2-D velocity fields in vessel phantoms under various conditions of catheter geometry, luminal diameter, and position of the catheter relative to the stenosis at a frame rate of 5000 frames per second via a particle imaging velocimetry (PIV) approach. While a solid catheter introduced an underestimation of velocity measurement by > 20% relative to the case without a catheter, the hollow catheter introduced < 10% velocity overestimation, indicating that a hollow catheter design allowing internal blood flow reduces hemodynamic disturbance. In addition, for both peripheral and coronary arteries, the hollow catheter introduced < 3% deviation in flow velocity at the minimum luminal area compared to the control case. Finally, an initial comparison was made between velocity measurements acquired using a low frequency, catheter-based, 3-D intravascular FV US transducer and external linear array measurements, with relative error < 12% throughout the region of interest for a flow rate of 150 mL/min. While further system development is required, results suggest intravascular ultrasound characterization of blood flow velocity fields in stenotic vessels could be feasible with appropriate catheter design.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Imageamento Tridimensional , Ultrassonografia de Intervenção/métodos , Cateteres , Constrição Patológica , Endossonografia , Desenho de Equipamento , Humanos , Imagens de Fantasmas , Estudo de Prova de Conceito , Transdutores
9.
Adv Clin Exp Med ; 30(9): 885-891, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34410046

RESUMO

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a well-established method for the diagnosis of solid pancreatic lesions. However, the diagnostic yield of EUS-FNA for pancreatic lesions varies at around 70-90%. Samples from EUS-FNA consist of cells and tissues that can be analyzed separately, and the results can be combined for a final diagnosis. OBJECTIVES: To investigate the effect of cytological and histological analysis of EUS-FNA samples on the final diagnosis, and identify factors that may affect the accuracy of the cytological, histological, and overall analysis. MATERIAL AND METHODS: A single-center prospective observational study was conducted at a tertiary university hospital from July 2018 to June 2019. Patients who underwent EUS-FNA for pancreatic solid lesions with a 22-gauge EUS-FNA needle were included in our study. Liquid-based cytological analysis of the specimen and histological analysis of the whitish core were performed, and factors that affected the diagnostic accuracy of each analysis were evaluated. RESULTS: In 63 EUS-FNA samples, the overall diagnostic accuracy was 87.3%, which was significantly higher than the cytological accuracy of 73.8% (p = 0.031) and the histological accuracy of 69.8% (p = 0.001). Factors that affected the results differed in each group: 1) cytological analysis: size, location, and approach method; 2) histological analysis: specimen weight; and 3) overall analysis: size, location, and approach method. CONCLUSIONS: Histologic evaluation of core material obtained from EUS-FNA improved diagnostic accuracy, and factors that affected each result were analyzed. Further studies with prospective randomized trials are recommended to support our data.


Assuntos
Neoplasias Pancreáticas , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Humanos , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Prospectivos
10.
World J Gastroenterol ; 27(27): 4342-4357, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34366608

RESUMO

Chronic pancreatitis (CP) is a progressive condition caused by several factors and characterised by pancreatic fibrosis and dysfunction. However, CP is difficult to diagnose at an early stage. Various advanced methods including endoscopic ultrasound based elastography and confocal laser endomicroscopy have been used to diagnose early CP, although no unified diagnostic standards have been established. In the past, the diagnosis was mainly based on imaging, and no comprehensive evaluations were performed. This review describes and compares the advantages and limitations of the traditional and latest diagnostic modalities and suggests guidelines for the standardisation of the methods used to diagnose early CP.


Assuntos
Técnicas de Imagem por Elasticidade , Pancreatopatias , Pancreatite Crônica , Endossonografia , Humanos , Pancreatite Crônica/diagnóstico por imagem
14.
J Med Case Rep ; 15(1): 396, 2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34304731

RESUMO

BACKGROUND: Subdiaphragmatic abscesses are sometimes caused by intraabdominal infections. We report a case of endoscopic ultrasound-guided transgastric drainage. CASE PRESENTATION: A 75-year-old Asian man was referred to our hospital for treatment for upper gastrointestinal bleeding. On admission, blood tests showed a marked inflammatory response, and abdominal computed tomography showed free air in the abdominal cavity and a left subdiaphragmatic abscess. Therefore, the patient was diagnosed with an intraabdominal abscess associated with a perforated duodenal ulcer. Because he did not have generalized peritonitis, fasting and antibiotic treatment were the first therapies. However, because of the strong pressure on the stomach associated with the abscess and difficulty eating, we performed endoscopic ultrasound-guided transgastric drainage. After treatment, the inflammatory response resolved, and food intake was possible. The patient's condition remains stable. CONCLUSIONS: Drainage is the basic treatment for subdiaphragmatic abscesses; however, percutaneous drainage is often anatomically difficult, and surgical drainage is common. We suggest that our success with endoscopic ultrasound-guided transgastric drainage in this patient indicates that this approach can be considered in similar cases and that it can be selected as a minimally invasive treatment method.


Assuntos
Abscesso Abdominal , Úlcera Duodenal , Abscesso Subfrênico , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Idoso , Drenagem , Úlcera Duodenal/complicações , Endossonografia , Humanos , Masculino
16.
BMJ Open ; 11(7): e046505, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253667

RESUMO

INTRODUCTION: The management of small pancreatic neuroendocrine neoplasms (PNENs) remains controversial. The standard treatment for PNENs is surgical resection; however, invasiveness of surgical procedure remains higher and the incidence of postoperative adverse events is still high. Recently, the efficacy and safety of endoscopic ultrasonography (EUS)-guided ethanol injection for small PNENs has been preliminarily demonstrated. Thus, a multicentre prospective study is being conducted to evaluate the efficacy and safety of EUS-guided ethanol injection therapy for small PNENs. METHODS AND ANALYSIS: The major eligibility criteria are the presence of pathologically diagnosed grade (G) 1 tumour, a tumour size of ≤15 mm and non-functional PNEN or insulinoma. For treatment, we will use a 25-gauge needle and pure ethanol. Contrast-enhanced CT (CE-CT) will be performed on postoperative day 3-5, and if enhanced areas of the tumour are still apparent, an additional session is scheduled during the same hospitalisation period. We set the total amount of ethanol per session to 2 mL. To evaluate the efficacy and safety, CE-CT will be performed at 1 and 6 months after treatment. The primary endpoint is the percentage of subjects who achieved all of the following evaluated points. Efficacy will be evaluated based on the achievement of complete ablation (defined as no enhanced area within the tumour on CE-CT) at 1 and 6 months. Safety will be evaluated based on the avoidance of severe adverse events within 1 month after treatment, continuing severe pancreatic fistula at 1 month after treatment and the incidence and/or exacerbation of diabetes mellitus at 6 months after treatment. ETHICS AND DISSEMINATION: This protocol has been approved by Okayama University Certified Review Board (approval number. CRB19-007). The results will be submitted to peer-reviewed journals and will be presented at international conferences. TRIAL REGISTRATION NUMBER: jRCTs061200016.


Assuntos
Técnicas de Ablação , Neoplasias Pancreáticas , Endossonografia , Etanol , Humanos , Estudos Multicêntricos como Assunto , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/tratamento farmacológico , Estudos Prospectivos
18.
World J Gastroenterol ; 27(26): 4194-4207, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34326619

RESUMO

Endoscopic ultrasound tissue acquisition, in the form of both fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), is utilized for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA has potential limitations associated with cytological aspirations, including inability to determine histologic architecture, and a small quantitative sample for further immunohistochemical staining. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. However, it remains unclear which technique should be used and for which lesions. Comparative trials are plagued by heterogeneity at every stage of comparison; including variable needles used, and different definitions of endpoints, which therefore limit generalizability. Thus, we present a review of prospective trials, systematic reviews, and meta-analyses on studies examining EUS-FNA vs EUS-FNB. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions, and yield conflicting results in terms of demonstrating the superiority of one method. However, consistent among trials is the potential for diagnosis with fewer passes, and a larger quantity of sample achieved for next generation sequencing. With regard to subepithelial lesions and lymph node biopsy, fewer prospective trials exist, and larger prospective studies are necessary. Based on the available literature, we would recommend EUS-FNB for peri-hepatic lymph nodes.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pancreáticas , Endossonografia , Humanos , Linfonodos/diagnóstico por imagem , Agulhas , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Prospectivos
19.
J Int Med Res ; 49(7): 3000605211023696, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34256638

RESUMO

Esophageal tuberculosis is rare among digestive system diseases. We herein present two cases of esophageal tuberculosis. One patient presented with a choking sensation and pain in the chest, and the other presented with loss of appetite and emaciation. Both patients had an esophagomediastinal fistula, underwent endoscopic ultrasonography and fine-needle aspiration, were clinically diagnosed with esophageal tuberculosis, received antituberculosis treatment, and exhibited clinical improvement. These two rare cases suggest that the possibility of esophageal tuberculosis should be considered in patients with an esophagomediastinal fistula. Endoscopic ultrasonography and fine-needle aspiration can be performed to assist the diagnosis. Good clinical results can often be achieved with timely antituberculosis treatment.


Assuntos
Fístula , Tuberculose , Antituberculosos/uso terapêutico , Endossonografia , Esôfago/diagnóstico por imagem , Humanos , Tuberculose/complicações , Tuberculose/diagnóstico por imagem , Tuberculose/tratamento farmacológico
20.
Scand J Gastroenterol ; 56(8): 972-977, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34236273

RESUMO

BACKGROUND: EUS-guided gastroenterostomy (EUS-GE) with lumen-apposing metallic stents (LAMS) in patients with gastric outlet obstruction (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. In severely ill patients, the method can provide improved quality of life (QoL) and symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine. AIM: To assess the technical and clinical success and safety of EUS-GE. MATERIAL AND METHODS: A dual center retrospective case series of 33 consecutive patients with GOO due to malignant (n = 28) or non-malignant conditions (n = 5). The patients were treated with EUS-GE using cautery enhanced LAMS. Procedures were performed guided by EUS and fluoroscopy in general anesthesia or conscious sedation. RESULTS: Technical success was achieved in all patients. The median procedure time was 71 min and the median hospital stay was three days. Thirty (91%) patients were able to resume oral nutrition after the procedure. Ten patients (30%) experienced adverse events (AEs), including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12%). All stent-related AEs were handled endoscopically. Five patients (15%) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5-76), and 13 patients with obstructing malignancies lived 12 weeks or longer. CONCLUSION: EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The method has potential hazards and should only be offered in expert centers that regularly perform the procedure.


Assuntos
Obstrução da Saída Gástrica , Qualidade de Vida , Endossonografia , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Gastroenterostomia , Humanos , Estudos Retrospectivos , Stents , Ultrassonografia de Intervenção
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