Gastrointestinal stromal tumor in jejunum: diagnosis using contrast-enhanced ultrasonography and double-balloon enteroscopy.
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Biomedical subjects
Publications and source records attributed to Daisuke Kamino.
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BACKGROUND: Small-bowel bleeding is difficult to treat and diagnose. The recent introduction of wireless capsule endoscopy permits examination of the entire small intestine, but this method lacks tissue sampling and therapeutic capabilities. Recently, Yamamoto et al established a double-balloon insertion method for enteroscopy that allows examination of the entire small bowel and interventional options. OBJECTIVE: To evaluate double-balloon enteroscopy in patients with obscure GI bleeding. SETTING: Single-center prospective study. PATIENTS: Thirty-one consecutive patients with obscure GI bleeding (13 females, 18 males; mean age 56.4 +/- 3.2 years). Criteria for inclusion in the study were documented iron deficiency anemia (hemoglobin level <10 g/dL or a decrease of >2 g/dL over > or =2 months); upper endoscopy not revealing a site/cause of blood loss; and similarly uninformative lower endoscopy including examination of the terminal ileum. INTERVENTIONS: Endoscopic biopsy or therapy was performed as clinically indicated. MAIN OUTCOME MEASUREMENTS: Diagnostic yield for patients with obscure GI bleeding and patient follow-up. RESULTS: Double-balloon enteroscopy was completed without complications in all patients. Bleeding points were identified in 23 patients (74.2%). In 21 (91.3%) of these 23 patients the cause of blood loss was identified and treated with no further bleeding at 8.5 +/- 0.6 months of follow-up. LIMITATIONS: Small number of patients. CONCLUSIONS: These data suggest that double-balloon enteroscopy is useful for evaluation and treatment of patients with GI bleeding of obscure origin.
OBJECTIVE: Contrast-enhanced ultrasonography has become a method of choice for evaluating gastric blood flow, but intermittent scanning techniques can sometimes distort the results. Low-mechanical index imaging using Definity as the injected contrast material has been advocated for real-time evaluation of microperfusion in other organs. We investigated the reliability of low-mechanical index imaging using Definity in the evaluation of gastric mucosal blood flow. MATERIAL AND METHODS: Under general anesthesia, 10 beagle dogs weighing 9-10 kg underwent real-time harmonic imaging under low acoustic power (mechanical index = 0.2) after intravenous contrast injection using Definity (60 mg/kg). Laser Doppler flow measurement was also performed to evaluate gastric mucosal blood flow. After administration of a diclofenac sodium suppository, low-mechanical index imaging and laser Doppler flowmetry were repeated. RESULTS: Real-time visualization of gastric mucosal blood flow was successful in all dogs undergoing low-mechanical index imaging with Definity. Quantitative assessment of gastric mucosal blood flow was successful in eight dogs. After diclofenac sodium administration, gastric mucosal blood flow measured by both laser Doppler flowmetry and contrast ultrasonography decreased in seven of eight dogs; in the other dog, gastric mucosal blood flow increased slightly. A strong positive correlation was evident between blood flow measured by laser Doppler flowmetry and low-mechanical index imaging (r=0.777, p<0.005). CONCLUSIONS: Low-mechanical index imaging with Definity is a non-invasive way to evaluate gastric mucosal blood flow in real-time, high-resolutional images, which may have additional important gastrointestinal tract applications.
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BACKGROUND: High-frequency catheter probe US provides detailed images when the scanning plane is perpendicular to the area of interest and the latter is within the focal zone. A multibending endoscope has been developed that has two bending sections that can be deflected independently. The aim of this study was to determine whether this new endoscope enhances high-frequency catheter probe US. METHODS: High-frequency catheter probe US was performed with the multibending endoscope in 33 patients with upper-GI lesions. The endoscope was carefully maneuvered until the scanning plane was perpendicular to the area of interest and the target area was within the focal zone of the probe. The effects of deflecting the second bending section on the image and on the rotating elements in the probe were evaluated. RESULTS: For 28 lesions, no improvement was observed with use of both bending sections. However, for 5 lesions, the US image was improved by use of the second bending section. These lesions were located in the stomach on the lesser or greater curve. In no instance did deflection of both bending sections result in uneven rotation of the mechanical elements in the probe. CONCLUSIONS: For certain lesions, US images obtained with a catheter probe can be improved by using an endoscope with a second bending section.