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1.
Medicine (Baltimore) ; 99(8): e19261, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080134

RESUMO

Barrett's esophagus has 0.5% to 7% risk of progression to esophageal adenocarcinoma. The method of obtaining biopsies to diagnose Barrett's is challenging. Seattle protocol has been considered as the gold standard, however its difficulty limits its applicability in practice. Narrow band imaging guided biopsy has been proposed as an alternative.To investigate the accuracy, sensitivity, specificity and applicability of Narrow band guided biopsy as a screening tool for Barret's esophagus in gastroesophageal reflux patients.Endoscopy was done in 2 different sessions 2 weeks apart for 100 patients in Alexandria, Egypt. Patients had at least one of the following: Chronic Gastroesophageal reflux disease, frequent Gastroesophageal reflux disease, or two or more risk factors for Barrett's esophagus. All patients with known Barrett's esophagus were excluded.Seventeen patients had Barrett's esophagus either by one of the two techniques or by both, 4 patients by both methods, 7 patients by narrow band imaging alone and 6 patients by Seattle protocol alone (P < .001, κ = 0.461). Sensitivity, specificity, negative predictive value and positive predictive value for Seattle protocol were 58.8%, 100%, 92.2%, 100% vs 76.5%, 100%, 95.4%, 100% respectively for narrow band imaging. A mean of 7.73 samples/patient was taken in Seattle protocol vs 3.42 samples in narrow band imaging (P < .001). A mean of 8.63 minutes was consumed in Seattle protocol vs 2.65 minutes in narrow band imaging (P < .001).Narrow band imaging guided biopsy might have higher accuracy, sensitivity and negative predictive value as well as fewer number of biopsies and shorter time of the procedure compared to Seattle protocol which might increases its applicability as screening protocol for Barrett's esophagus. However, further larger multicentric studies are needed.


Assuntos
Esôfago de Barrett/diagnóstico , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Biópsia Guiada por Imagem , Imagem de Banda Estreita , Adolescente , Adulto , Idoso , Biópsia , Egito , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
4.
Medicine (Baltimore) ; 99(5): e18659, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000372

RESUMO

INTRODUCTION: Zenker's diverticulum (ZD) refers to a pouch-like structure similar to the esophageal lumen formed from the herniation of the esophageal mucosa; this structure makes it difficult for food to pass through the esophagus to the stomach. The development of endoscopic technology has made minimally invasive surgical treatments for ZD possible. PATIENT CONCERNS: A female 72-year-old patient was admitted to our hospital due to recurrent dysphagia for more than 5 years. A 62-year-old female patient underwent a gastroscopic examination due to recurrent dysphagia for 10 years and aggravated dysphagia accompanied by bad breath for 1 year. DIAGNOSIS: A significant diverticulum with food residue at the entrance of the esophagus was found on gastroscopy in both cases. INTERVENTIONS: After completing a relevant examination and excluding surgical contraindications, both patients underwent submucosal tunneling endoscopic septum division. OUTCOMES: Both patients were discharged after symptoms alleviated on postoperative day 4. A 3-month follow-up gastroscopy showed the disappearance of the diverticulum and recovery of the esophageal anatomical structure. No symptom relapse was found at the 6-month follow-up assessment. CONCLUSION: Submucosal tunneling endoscopic septum division has become the most common minimally invasive treatment option. It is efficient and safe for relieving symptomatic ZD in the short term.


Assuntos
Esofagoscopia/métodos , Divertículo de Zenker/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade
6.
Dis Mon ; 66(1): 100850, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30808502

RESUMO

Barrett's esophagus (BE) is characterized by a change in the mucosal lining of the distal esophagus whereby the squamous epithelium of the esophagus is replaced by the metaplastic columnar epithelium. It is a pre-malignant lesion associated with esophageal adenocarcinoma. Patients with gastroesophageal reflux disease who have additional risk factors (Caucasian race, male gender, age > 50 years, tobacco use, and central obesity) should undergo an esophagogastroduodenoscopy to screen for Barrett's esophagus. Patients with Barrett's esophagus should undergo endoscopic surveillance every 3-5 years if no dysplasia is found. Patients with Barrett's esophagus who are found to have dysplasia should be treated endoscopically. We present a comprehensive review of the pathophysiology, diagnosis, surveillance and management of Barrett's esophagus.


Assuntos
Esôfago de Barrett/diagnóstico , Esôfago de Barrett/terapia , Adenocarcinoma/etiologia , Adenocarcinoma/terapia , Crioterapia , Progressão da Doença , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/terapia , Esofagoscopia , Humanos , Obesidade/complicações , Fotoquimioterapia , Inibidores da Bomba de Prótons/uso terapêutico , Ablação por Radiofrequência , Fatores de Risco , Fumar/efeitos adversos , Conduta Expectante
7.
Gastroenterology ; 158(1): 111-122.e10, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31593702

RESUMO

BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is an allergen-mediated inflammatory disease with no approved treatment in the United States. Dupilumab, a VelocImmune-derived human monoclonal antibody against the interleukin (IL) 4 receptor, inhibits IL4 and IL13 signaling. Dupilumab is effective in the treatment of allergic, atopic, and type 2 diseases, so we assessed its efficacy and safety in patients with EoE. METHODS: We performed a phase 2 study of adults with active EoE (2 episodes of dysphagia/week with peak esophageal eosinophil density of 15 or more eosinophils per high-power field), from May 12, 2015, through November 9, 2016, at 14 sites. Participants were randomly assigned to groups that received weekly subcutaneous injections of dupilumab (300 mg, n = 23) or placebo (n = 24) for 12 weeks. The primary endpoint was change from baseline to week 10 in Straumann Dysphagia Instrument (SDI) patient-reported outcome (PRO) score. We also assessed histologic features of EoE (peak esophageal intraepithelial eosinophil count and EoE histologic scores), endoscopically visualized features (endoscopic reference score), esophageal distensibility, and safety. RESULTS: The mean SDI PRO score was 6.4 when the study began. In the dupilumab group, SDI PRO scores were reduced by a mean value of 3.0 at week 10 compared with a mean reduction of 1.3 in the placebo group (P = .0304). At week 12, dupilumab reduced the peak esophageal intraepithelial eosinophil count by a mean 86.8 eosinophils per high-power field (reduction of 107.1%; P < .0001 vs placebo), the EoE-histologic scoring system (HSS) severity score by 68.3% (P < .0001 vs placebo), and the endoscopic reference score by 1.6 (P = .0006 vs placebo). Dupilumab increased esophageal distensibility by 18% vs placebo (P < .0001). Higher proportions of patients in the dupilumab group developed injection-site erythema (35% vs 8% in the placebo group) and nasopharyngitis (17% vs 4% in the placebo group). CONCLUSIONS: In a phase 2 trial of patients with active EoE, dupilumab reduced dysphagia, histologic features of disease (including eosinophilic infiltration and a marker of type 2 inflammation), and abnormal endoscopic features compared with placebo. Dupilumab increased esophageal distensibility and was generally well tolerated. ClinicalTrials.gov, Number: NCT02379052.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Transtornos de Deglutição/tratamento farmacológico , Esofagite Eosinofílica/tratamento farmacológico , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/imunologia , Método Duplo-Cego , Esofagite Eosinofílica/complicações , Esofagite Eosinofílica/imunologia , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/efeitos dos fármacos , Mucosa Esofágica/imunologia , Esofagoscopia , Feminino , Humanos , Subunidade alfa de Receptor de Interleucina-4/imunologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Placebos/administração & dosagem , Placebos/efeitos adversos , Resultado do Tratamento , Adulto Jovem
13.
Z Gastroenterol ; 57(12): 1481-1486, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31826279

RESUMO

INTRODUCTION: Distal esophageal spasm (DES), a relatively rare condition, is characterized by simultaneous contractions of the distal esophagus and manifested by dysphagia and chest pain. Several treatment options are recommended, such as pharmacological therapy, endoscopic interventions, and surgical myotomy. Recently, per-oral endoscopic myotomy (POEM) has been adopted as an effective and less-invasive treatment due to its excellent short-term clinical outcomes. Nevertheless, few reports describe its long-term effects. CASE PRESENTATION: A 65-year-old woman complained of chest pain accompanied with dysphagia and weight loss for 4 months. A series of examinations suggested that she was suffering from DES and then POEM was performed. During the 2.5-year follow-up, we observed an exciting long-term outcome. Interestingly, hematoxylin and eosin staining verified a large number of eosinophils in the muscularis externa, which was absent in the mucosa of the esophagus of the patient. CONCLUSIONS: We herein report a case of DES who underwent POEM to eliminate persistent esophageal contractions. Eckardt score, esophageal emptying test, and high-resolution manometry were assumed to monitor the efficacy of POEM. During treatment and 2.5 years after operation, esophageal muscle biopsies and/or mucosal tissues were obtained. This case has been presented to describe that POEM could be a strategy for DES with a long-term curative effect and that eosinophils in the muscle layer of the esophagus might be involved in the pathogenesis of DES. What is more, we reviewed literature to find similar cases reported in the past.


Assuntos
Transtornos de Deglutição/etiologia , Divertículo Esofágico/cirurgia , Transtornos da Motilidade Esofágica/cirurgia , Espasmo Esofágico Difuso/diagnóstico por imagem , Espasmo Esofágico Difuso/cirurgia , Esofagoscopia/métodos , Miotomia/métodos , Idoso , Transtornos de Deglutição/diagnóstico , Divertículo Esofágico/complicações , Transtornos da Motilidade Esofágica/fisiopatologia , Espasmo Esofágico Difuso/complicações , Feminino , Humanos , Manometria , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(44): e17714, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689807

RESUMO

This study aimed to compare clinical results, symptom relief, quality of life and patient satisfaction after the 2 most common procedures for achalasia treatment: laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD).Patients treated at University Hospital of Heidelberg with LHM or EBD were included. A retrospective chart review of perioperative data and a prospective follow-up of therapeutic efficiency, Gastrointestinal Quality of Life Index (GIQLI) and patient satisfaction was conducted.Follow-up data (mean follow-up: 75.1 ±â€Š53.9 months for LHM group and 78.9 ±â€Š45.6 months for EBD) were obtained from 36 patients (19 LHM; 17 EBD). Eckardt score (median (q1,q3): 2 (1,4) in both groups, P = .91, GIQLI (LHM: 117 (91.5, 126) vs EBD: 120 (116, 128), P = .495) and patient satisfaction (3 (2,3) vs 3 (2,4), P = .883) did not differ between groups. Fifteen patients (78.9%) in LHM group and 11 (64.7%) in EBD group (P = .562) stated they would undergo the intervention again. All patients with EBD had at least 2 dilatations (100%), whilst only 2 patients (10.5%) had dilatation after LHM (P < .001). There were no complications after EBD, but 2 after LHM (10.5%, P = .517).Both LHM and EBD are able to control symptoms and provide similar quality of life and patient satisfaction. However, reintervention rate was higher following EBD, hence LHM provided a more sustained treatment than EBD.


Assuntos
Dilatação/estatística & dados numéricos , Acalasia Esofágica/cirurgia , Esofagoscopia/estatística & dados numéricos , Miotomia de Heller/estatística & dados numéricos , Dilatação/instrumentação , Dilatação/métodos , Esofagoscopia/métodos , Feminino , Seguimentos , Miotomia de Heller/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(48): e18105, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770232

RESUMO

RATIONALE: The ingestion of a foreign body (FB) with complete impaction of the esophagus is not common. Here we report a rare case of successful retrieval of a spherical stone in the esophagus of a man with mental retardation, using gallbladder grasping forceps and rigid endoscope. PATIENT CONCERNS: A mental retarded man came to the emergency department presenting with recurrent nausea, vomiting, and dysphagia after swallowing a spherical stone. He had previously undergone an FB extraction under general anesthesia by fiberoptic esophagoscopy, which failed. DIAGNOSIS: The diagnosis of FB ingestion was confirmed by anteroposterior plain film x-ray of the chest and chest computed tomography (CT), which showed the ingested spherical FB in the upper esophagus. INTERVENTIONS: After multiple failed attempts using other instruments, the FB was successfully removed with gallbladder grasping forceps through a rigid esophagoscope. OUTCOMES: The patient was discharged without any complications. The nasogastric tube was extubated at the 10-day follow-up. LESSONS SUBSECTIONS AS PER STYLE: For esophageal retrieval of uncommon FBs, the instrument used is crucial. We report our experience retrieving a large and spherical FB in the upper esophagus using gallbladder grasping forceps. This proved to be an effective strategy, eliminating the need for thoracotomy.


Assuntos
Esofagoscopia/instrumentação , Esôfago/lesões , Corpos Estranhos/cirurgia , Instrumentos Cirúrgicos , Adulto , Esofagoscopia/métodos , Esôfago/cirurgia , Humanos , Deficiência Intelectual/complicações , Masculino
17.
Acta Gastroenterol Belg ; 82(3): 355-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566321

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of endoscopic submucosal multi-tunnel dissection (ESMTD) for early esophageal cancer lesions larger than 3 cm in diameter or cumulatively greater than 1/2 lumen size. METHOD: Early esophageal cancer lesions in 15 patients were detected by endoscopy and endoscopic ultrasonography in our endoscopy center from December 2012 to June 2015. All lesions were successfully resected by ESMTD and diagnosed by pathology, and therapeutic efficiency and safety were followed after surgery. RESULTS: All 15 of the early esophageal cancer lesions were resected by ESMTD. The pathological results showed 9 moderately differentiated and 6 highly differentiated squamous cell carcinomas. En bloc resection was achieved in 13 lesions, with negative lateral and basal margins on pathology, whereas the other 2 required additional surgery. The average diameter of the resected lesions was 4.2±0.9 cm. The mean procedure time was 94.7±52.9 min. Esophageal stenosis was observed in 7 patients for whom esophageal water balloon dilatation was performed. No residual or recurrent lesion was found during the 6-36-month follow-up period. CONCLUSION: ESMTD is a safe and efficient technique for treating large early esophageal cancer lesions. Grasping the key techniques of this procedure can reduce operating difficulty and shorten the operating time.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Endossonografia/métodos , Neoplasias Esofágicas/cirurgia , Estenose Esofágica , Esofagoscopia , Humanos
19.
Khirurgiia (Mosk) ; (10): 13-20, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626234

RESUMO

OBJECTIVE: To analyze the effectiveness of vacuum-assisted closure system for esophageal anastomotic leakage. MATERIAL AND METHODS: There were 10 patients with upper gastrointestinal anastomotic leakage who were treated at our institution in 2015-2018. Vacuum aspiration system was applied in all cases. RESULTS: Esophageal wall defect was successfully closed in 9 out of 10 patients after 2-4 courses and the system was eliminated in 11 days on the average. Localized cavity with granulation tissue developed in 1 patient after 5 courses and the system was also eliminated. CONCLUSION: Endoscopic vacuum-assisted therapy is an innovative, minimally invasive, economically profitable and successful method for anastomotic leakage. This procedure should be taken into consideration and widely used in multi-field hospitals.


Assuntos
Fístula Anastomótica/cirurgia , Doenças do Esôfago/cirurgia , Esofagectomia/efeitos adversos , Esôfago/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Anastomose Cirúrgica , Fístula Anastomótica/etiologia , Esofagoscopia , Humanos
20.
Rev Med Suisse ; 15(667): 1859-1864, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617973

RESUMO

Upper gastrointestinal bleeding is an urgent entity associated with a high mortality of about 10 %. Its urgent management includes medical interventions such as volume repletion, blood transfusions, the use of proton pump inhibitors, as well as upper gastrointestinal endoscopy. Whilst the benefit of esophago-gastro-duodenoscopy is clearly demonstrated, the ideal timing for this intervention is less well established. Initial management and pharmacological interventions are important and well-integrated into protocols.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirurgia , Transfusão de Sangue , Duodenoscopia , Esofagoscopia , Gastroscopia , Humanos , Inibidores da Bomba de Prótons/uso terapêutico
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