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Biomedical subjects

P E Gillespie

Publications and source records attributed to P E Gillespie.

13 recordsLinked to original sources
PubMed2006

Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up.

BACKGROUND: The long-term efficacy of argon plasma coagulation (APC) in the management of gastrointestinal vascular lesions has not been evaluated in a large and well-defined series. The impact of APC on transfusion requirements and hemoglobin, and technical parameters including complications and number of treatment sessions, is assessed in this series. METHODS: Patients who underwent APC for bleeding gastrointestinal vascular lesions were identified via interrogation of an established endoscopic database, excluding patients with radiation proctitis, tumors, residual polypectomy tissue and acute ulcer bleeding. Follow-up data were collected via interview with patients and referring doctors, review of medical records, and follow-up blood tests. RESULTS: One hundred patients were enrolled, males = 46, median age = 74 yr (range: 19-99 yr). Median follow-up time was 16 months (range: 4-47 months). Lesions treated were arteriovenous malformations (n = 74) and gastric antral vascular ectasia (n = 26). Fifty-three patients required transfusion. In this group, median hemoglobin improved from 66 g/L (range: 35-114) to 111 g/L (range: 55-155, p < 0.001). Median transfusion velocity fell from 2 units/month (range: 0.1-6) to 0 units/month (range: 0-4, p < 0.001). Transfusion requirement was abolished in 77%. In non-transfusion-requiring patients, median hemoglobin improved from 105 g/L (range: 58-143) to 123 g/L (range: 79-158, p < 0.001). No complications occurred. CONCLUSIONS: APC is effective and safe in the management of gastrointestinal vascular lesions.

Adult↗
PubMed1998

Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage.

BACKGROUND: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. We present the preliminary results of an open trial using endoscopic band ligation for non-variceal, non-ulcer bleeding in the gastrointestinal tract. METHODS: Eighteen patients were treated by band ligation between June 1996 and November 1997. The lesions treated were: arteriovenous malformations in 10, Dieulafoy's lesions in 4, Mallory-Weiss tear in 2, and post-colonic polypectomy bleeding in 2. RESULTS: Endoscopic band ligation was successful in 17 of 18 cases, with a follow-up period ranging from 2 to 18 months. The remaining case, a duodenal Dieulafoy's lesion, bled again at 24 hours but was successfully treated by adrenalin injection. CONCLUSIONS: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.

Aged↗
PubMed1996

Laser palliation of inoperable malignant dysphagia: initial and at death.

BACKGROUND: Nd: YAG laser therapy has been shown to be highly effective in the palliation of dysphagia due to inoperable esophageal malignancy. However, the duration of response and the degree of palliation present at death have not been adequately addressed. METHODS: Seventy consecutive patients with inoperable malignant dysphagia (mean age, 70 years; 48 men, 22 women) underwent palliative laser therapy. Dysphagia was assessed on a 5-point scale (0, normal; 4, complete dysphagia) before and after laser therapy and within 2 weeks of death. RESULTS: Ninety-six percent of patients were palliated initially (70% successful, 26% partial). Mean swallowing score improved from 2.3 to 1.1 (p < 0.001) with a mean of 1.9 initial treatment sessions. Swallowing score remained improved in the last two weeks of life at a mean of 1.7 (p < 0.001). Seventy-three percent of patients were palliated at death (36% successful, 37% partial); median survival was six months. The mean total number of laser sessions was 3.4, with a mean time interval between laser sessions of 27.2 days. Complications included one perforation (1.4%) resulting in death. CONCLUSION: Endoscopic laser therapy provides safe and effective initial palliation of inoperable malignant dysphagia. In the majority of patients the palliation is maintained until death.

Aged↗
PubMed1996

Endoscopic laser therapy for watermelon stomach.

Eleven patients (nine females, two males) with anaemia due to acute and chronic gastrointestinal blood loss were found to have gastric antral vascular ectasia (watermelon stomach). Nine patients were transfusion-dependent, receiving a mean of 13.1 units over a mean period of 12.3 months. All patients received neodymium:yttrium-aluminium-garnet laser coagulation with a median of 3.0 treatment sessions. Post-treatment transfusion needs were abolished in six patients and minimal in two patients during a mean follow up of 27.3 months (range 12-60 months). Overall there was a mean reduction in transfusion requirement with treatment from 2.5 units per month to 0.4 units per month (P < 0.02). Mean pretreatment haemoglobin improved from 7.7 to 11.9 g/dL after treatment (P < 0.001). No complications occurred. Laser coagulation is safe and effective treatment for anaemia due to watermelon stomach and should be considered as first line therapy.

Aged↗
PubMed1996

Comparison of three faecal occult blood tests in the detection of colorectal neoplasia.

METHODS AND AIMS: For the detection of colorectal neoplasia, 192 consecutive patients had colonoscopy to evaluate the sensitivity and specificity of three faecal occult blood tests (FOBT). Of 160 evaluable patients (96 female, mean age 51.9), 21 patients (13.1%) had adenomas and three patients (1.9%) had colorectal carcinoma. RESULTS: When comparing all three faecal occult blood tests for the detection of colorectal neoplasia, the sensitivity of Monohaem (43.8%) was superior to both Hemoccult II (25%) and to BM-Test colon albumin (25%). The specificity of Monohaem (94.6%) was greater than both Hemoccult II (88%) and BM-Test colon albumin (89%). Using McNemar's test, Monohaem was a more accurate FOBT than Hemoccult II and BM-Test albumin (p < 0.05). In the 21 patients with adenomatous polyps, FOBT sensitivity seemed to be dependent on polyp size, but not polyp site. CONCLUSIONS: Monohaem, a feacal occult blood test that uses a monoclonal antibody that is specific for human haemoglobin, is a more accurate test in the detection of colorectal neoplasia and should possibly be used in colorectal cancer screening programmes.

Adenoma↗
PubMed1980

Prednisolone absorption in acute colitis.

Peak plasma levels were reduced after an oral dose of 40 mg prednisolone in six patients with severe acute colitis as compared with six normal subjects, though total absorption appeared to be similar; the findings suggest that prednisolone absorption was delayed in acute colitis. A dilutional fall in plasma albumin was observed in normal subjects and in the patients after 40 mg prednisolone by mouth.

Acute Disease↗
PubMed1979

Colonic adenomas--a colonoscopy survey.

A colonoscopy survey of 620 patients with 1049 colon adenomas showed a predominantly left-sided distribution (77%). Of these lesions 97% were amenable to endoscopic removal or ablation. Sixty per cent of patients presented with rectal bleeding as their major symptom. There was agreement between radiology and colonoscopy in only 62% of patients, as many of the studies were single contrast barium enemas, performed before referral. Forty-eight per cent of adenomas in our series were less than 1.0 cm in diameter. Of the larger adenomas (greater than 2.0 cm in diameter) 66% were situated in the sigmoid colon, and of those containing invasive carcinoma (4.8% of the total) an even higher percentage (94%) were in the sigmoid and low descending colon. With increasing polyp size, there was a greater predominance of villous elements and this was associated with a higher risk of malignant change than the more frequent and generally smaller tubular adenoma. Local colonoscopic excision alone is sufficient treatment for adenomas with malignant change unless they are poorly differentiated histologically and providing adequate resection is demonstrated. Twenty-eight patients treated in this way are alive without recurrence at periods from six to 62 months. Although 65% of patients had only one adenoma, and 90% three or less, there is a risk of developing other benign and malignant colon neoplasms and careful follow-up is required.

Adenoma↗
PubMed1978

Gastric candidiasis.

A male, aged 60 with rheumatoid arthritis which was treated with prednisone, developed a severe symptomatic stomal gastritis at the site of a previous Polya partial gastrectomy. The endoscopic appearance of the lesion was similar to that of Candida infection, which is more frequently seen in the oesophagus. Candida albicans was cultured from biopsy specimens, and prompt resolution of the lesion and the patient's symptoms occurred with orally administered antifungal therapy. Primary gastric candidiasis should be considered in compromised patients with symptoms of infection of the upper part of gastrointestinal tract.

Candidiasis↗
PubMed1977

Chronic erosive (verrucous) gastritis. A study of 108 patients.

Chronic erosive gastritis (C.E.G.) is a gastric mucosal lesionwith characteristic radiological and endoscopic appearances. Pyloric gland hyperplasia is seen on histological examination of biopsy specimens. C.E.G. is uncommonly reported in the English literature. In reviewing 3,800 upper gastro-intestinal endoscopies from 1971--1976, 108 patients were diagnosed as having typical features of chronic erosive gastritis, an incidence of 2.8%. There was a significant association with duodenal ulceration and an overall male predominance. The lesion can also co-exist with gastric ulceration and has been observed as an incidental finding in patients examined urgently for upper gastro-intestinal bleeding. In this context C.E.G. should be distinguished from acute mucosal erosions. Symptoms may relate to the accompanying peptic ulceration, although dyspepsia epigastric pain, fullness and nausea may possibly occur with C.E.G. alone.

Adult↗