Upper gastrointestinal problems in inhalational ketamine abusers.

OBJECTIVE: To study the association between upper gastrointestinal (GI) problems and inhalational ketamine abuse. METHODS: This is a retrospective study of 64 ketamine abusers treated from 2001 to 2008. Variables studied included clinical presentations, findings of upper GI endoscopy, abstinence from ketamine and relief of epigastric pain. RESULTS: The following patients with (i) a previous history of upper GI problem; (ii) a history of non-steroidal anti-inflammatory drug (NSAID), aspirin or other substance abuse; and (iii) a known history of Helicobacter pylori (H. pylori) infection were excluded. The study group thus consisted of 37 ketamine abusers, of whom 28 had upper GI symptoms. Overall 14 of these patients had an upper endoscopy performed. The endoscopic diagnoses were: 12 (85.7%) with gastritis, one (7.1%) with gastroduodenitis, and one (7.1%) normal finding. Test for H. pylori, infection was negative. Abstinence from ketamine was found to be associated significantly with relief of symptoms (P= 0.027). Logistic regression showed the odds ratio of symptomatic relief for abstinence versus continued use of ketamine is 12.5 (95% CI[1.20, 130.6], P= 0.035). In patients whom an upper GI endoscopy was performed, H. pylori negative gastritis was the commonest histopathological finding (78.6%). Despite the use of medications, symptoms are commonly not relieved and that is associated with the continued abuse of ketamine. CONCLUSION: Ketamine abusers frequently presented with upper GI symptoms, the commonest of which is epigastric pain (73% of abusers). Abstinence from ketamine abuse can lead to the relief of symptoms, which is an important message for ketamine abusers.

Endosonographic surveillance of small gastrointestinal tumors originating from muscularis propria.

INTRODUCTION: Submucosal tumors (SMT) are not uncommonly found during upper endoscopy. Management for small SMT originating from muscularis propria (MP) is controversial. Data regarding regular endoscopic ultrasound (EUS) surveillance is scarce. We report our experience in using EUS to monitor these tumors. METHODS: Patients with SMT originated from MP as confirmed by EUS were recruited. The maximal diameter, echo pattern, presence of cystic spaces and regularity of extra-luminal margin were documented. Patients with large tumors (maximal diameter > 3 cm), heterogeneous echo pattern, presence of cystic spaces or irregular extra-luminal margin were offered surgery in view of malignant risk. Patients with small tumor and benign EUS features were offered regular EUS surveillance or surgery if they wished. The progress of those patients who underwent EUS surveillance were studied. RESULTS: From January 2002 to December 2007, there were 93 patients with SMT originating from MP. Forty-nine patients had a small tumor and benign EUS features. Only two of these patients chose surgery. The histopathological results were low risk gastrointestinal stromal tumor (GIST) in both patients. Twenty-three patients elected to undergo regular EUS surveillance for a mean period of 17.3 months (range 6-42 months). Three patients (13.0%) showed interval increase in tumor size. There was no change in other EUS features. Surgery was performed in these 3 patients. Histological examination revealed schwannoma in 2 patients and low risk GIST in 1 patient. CONCLUSION: It remains unclear whether EUS surveillance for small tumors originating from MP in the upper gastrointestinal tract is useful.

Current utilization and performance status of endoscopic ultrasound in a community hospital.

OBJECTIVE: Endoscopic ultrasound (EUS) is an essential tool for cancer staging and investigating gastrointestinal diseases. Although it is not a widespread skill, as its expanded indications became much more advanced so did its popularity and hospital acceptance. We aimed to study the utilization and indications of upper EUS in a Hong Kong community hospital. The secondary aim was to assess our accuracy in staging of esophageal and gastric cancer and in evaluating submucosal tumors. METHODS: All patients who had undergone upper EUS in Tuen Mun Hospital from January 2002 to December 2006 were recruited. Their background data, indications, radiological investigations, upper endoscopy and operation records and histopathologic results were retrieved for analysis. The accuracy of EUS in esophageal cancer staging, gastric cancer staging and evaluating submucosal tumors was assessed by comparing surgical and histopathologic findings. RESULTS: A total of 645 upper EUS examinations were performed and there has been a steady increase in EUS utilization in our hospital. The most common indications were evaluating submucosal tumors and staging esophageal and gastric cancer. The accuracy of T and N staging of esophageal cancer was 71.2 and 79.7%, respectively and for gastric cancer was 64.0 and 74.7%, respectively. Endoscopic ultrasound was 70% accurate in identifying lesions arising from the submucosal layer and 100% accurate in identifying lesions from the muscularis propria. CONCLUSION: Endoscopic ultrasound is an accurate method and its demand is increasing. The performance in a community hospital can be further improved and its utilization should expand to other indications.