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Results for “Endoscopy, Digestive System”

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PubMed1990

Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively.

Upper gastrointestinal hemorrhage is one of the more important complications of cirrhosis and a major cause of death in such patients. The main sites of bleeding are esophageal varices, gastritis, and peptic ulcers. In order to determine the prevalence of either potential bleeding lesions or of other endoscopic findings in hemodynamically stable individuals with various etiologies of cirrhosis, 510 consecutive cirrhotic patients, evaluated for possible orthotopic liver transplantation (OLTx) underwent an upper gastrointestinal endoscopy for combined diagnostic and therapeutic purposes. The patients were divided into two main groups: 319 patients with parenchymal liver disease and 191 patients with cholestatic liver disease. Gastritis was found significantly more often in patients with parenchymal liver disease than in those with cholestatic liver disease (49.8% vs 30.9%; P less than 0.001). In contrast, the prevalence of esophagitis, esophageal and gastric varices, gastric ulcer, duodenal ulcer, and duodenitis was similar in both groups. Normal endoscopic findings were present in 5.0% of the parenchymal group and 11.5% of the cholestatic group (P less than 0.02). Ascites and encephalopathy were found significantly more often in subjects with parenchymal liver disease as compared to those with cholestatic liver disease. Portal hypertension and its degree, as assessed by the presence and size of esophageal varices, was similar in both groups, and in both groups there was a statistically significant qualitative trend of increasing prevalence of esophageal varices with increasing severity of disease as estimated using Pugh-Child's criteria.

Cholestasis↗

PubMed1987

Complications of fiberoptic gastrointestinal endoscopy--five years' experience in a central hospital.

Complications in relation to fiberoptic gastrointestinal endoscopy were recorded prospectively during the five-year period 1980-1984. Diagnostic esophago-gastroduodenoscopy (EGD) had non-fatal complications in ten out of 7,314 procedures (0.14%) and three deaths (0.04%). Therapeutic EGD had non-fatal complications in eight out of 440 procedures (1.8%) and two deaths (0.5%). Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) had non-fatal complications in 15 out of 1,930 procedures (0.8%) and one death (0.05%). Therapeutic ERCP had non-fatal complications in 14 out of 554 procedures (2.5%) and six deaths (1.1%). Diagnostic colonoscopy had non-fatal complications in five out of 3,538 procedures (0.14%) and therapeutic colonoscopy in 21 out of 1,055 procedures (2.0%). There were no deaths in connection with diagnostic or therapeutic colonoscopy. The recommendations based on this series are: Put greater emphasis on a proper evaluation of indications and contraindications. Avoid sedation of patients with respiratory failure. If possible, postpone procedures which may cause bleeding in patients with impaired hemostasis until proper correction has been achieved.

Biopsy↗

PubMed2003

Biliary access loops for intrahepatic stones: results of jejunoduodenal anastomosis.

BACKGROUND: Patients with intrahepatic calculi require multiple interventions following successful surgical stone clearance for recurrent stones and cholangitis. The present paper describes the results of a technique of in-continuity side-to-side jejunoduodenal anastomosis (JDA) that provides endoscopic access to the hepaticojejunostomy and intrahepatic ducts. This operation is compared to other techniques in a critical appraisal of various biliary access procedures described for long-term management of intrahepatic -calculi. METHODS: A retrospective analysis of clinical data of 13 patients who underwent biliary drainage procedures with access loops for intrahepatic calculi during the period March 1990 to December 2000 was performed. The postoperative course of patients and the feasibility of postoperative endoscopic access to the hepaticojejunostomy and intrahepatic ductal system in treatment of recurrent cholangitis were assessed. Nine patients underwent JDA, two underwent permanent-access hepaticojejunostomy (PAH) and two others underwent an interposition hepaticojejunoduodenostomy (IHJ). RESULTS: The analysis revealed no major procedure-related complications or mortality. Endoscopic access (using forward-viewing gastroscope) was possible in 100% of cases following JDA, and with difficulty in both cases after PAH. Endoscopic access in the two patients with IHJ failed because of technical reasons. Recurrent cholangitis was seen in seven patients (54%) - two out of two patients in the PAH group, one out of two in the IHJ group and four out of nine in the JDA group. This required 12 endotherapy sessions (mean: 1.5 procedures per patient). CONCLUSION: In-continuity side-to-side JDA allows easy access of conventional gastroduodenoscopes to the biliary tree for removal of recurrent/residual intrahepatic stones. The technique has advantages over other access loop procedures in the long term management of recurrent intrahepatic stones.

Adult↗

PubMedDate not supplied

Virtual pancreatoscopy of pancreatic cancer.

BACKGROUND/AIMS: Virtual endoscopy is a new method of diagnosis using computer processing of three-dimensional images data sets. However, there are few reports about the clinical application of virtual endoscopy for the pancreas. In this study, we evaluated the feasibility of surface-rendered magnetic resonance virtual endoscopy for pancreatic cancer. METHODOLOGY: Twenty-six cases of pancreatic cancer were studied. Fifteen patients had pancreatic head cancer, 7 had pancreatic body cancer, and 4 had pancreatic tail cancer. Twelve patients underwent surgical resection of the pancreas. Magnetic resonance imaging data were acquired with a 1.5-T clinical imager (Signal.5; GE Medical Systems, USA). We used a multislab single-shot fast spin-echo sequence. Section thickness was between 2 and 3 mm in the coronal plane. Three-dimensional reconstructed images and virtual endoscopic images were generated with Advantage Windows by GE. RESULTS: Virtual endoscopic images could be generated in 20 patients with pancreatic cancer (76.9%). In these cases, we were able to observe the inner surface of the pancreatic duct and the stricture from not only the pancreatic head but also the pancreatic tail. Clear virtual images could not be generated in 6 cases. We were able to divide the 20 cases in which images could be generated into groups according to the appearance of the stricture. The edge of the stricture appeared to be protruding in 4 cases (15.4%), and appeared to be polygonal in 13 cases (50.0%). In 3 cases, we recognized the existence of a stricture, but the detail of the stricture was unclear. CONCLUSIONS: Virtual endoscopy caused minimal discomfort compared to real endoscopic examination, and it can access cystic lesions and the pancreatic duct behind the stricture. It is concluded that virtual endoscopy for pancreatic cancer has potential clinical utility.

Aged↗

PubMedDate not supplied

Long-term patency of Wallstent endoprostheses in benign biliary obstructions: experimental results.

PURPOSE: Coated and noncoated Wallstents were implanted in dogs with experimental benign common bile duct stenoses to monitor the long-term patency of self-expanding stents in the biliary system. MATERIALS AND METHODS: Experimental common bile duct stenoses were induced with a thermal laser in 12 dogs. Three silicone-coated and 14 noncoated stents were implanted. The animals were followed up from 3 to 25 months by means of cholangiography, cholangioscopy, measurements of liver enzyme levels, autopsy, and histology. RESULTS: Silicone coated stents failed in all cases, resulting in two total occlusions and one stent dislodgment to the bowel. Noncoated stents led to marked mucosal hyperplasia and stent narrowing in most cases, but with follow-up of more than 12 months, hyperplasia underwent regression and--except in one case--neither an increase in liver enzyme levels nor stent occlusion occurred. Histologically, the extent of hyperplasia was related to the stent position within the duct wall. With stents in the mucosal layer, hyperplasia was excessive. Once the stent entered the submucosal layer, hyperplasia was decreased. CONCLUSION: In an experimental setting, mucosal hyperplasia did not compromise patency of noncoated stents in benign bile duct stenosis and regressed with late follow-up after 12 months.

Animals↗

PubMed2002

Impact of physician specialty on the cost of nonvariceal upper GI bleeding care.

OBJECTIVE: Upper GI bleeding (UGIB) is a common medical emergency that leads to a high consumption of medical resources and costs. We aimed to analyze the influence of physician specialty on the costs of nonvariceal UGIB care. METHODS: We retrospectively assessed 350 nonvariceal UGIB episodes that were primarily cared for by gastroenterologists (n = 142), internists (n = 67), or surgeons (n = 141). Gastroenterologists followed evidence-based clinical protocols that included early endoscopy and early hospital discharge for uncomplicated bleeding. A risk score system was used to control for severity of illness. Linear regression analyses were performed to find out predictors of costs and the influence of specialist care on length of stay (LOS). RESULTS: The overall mean hospital cost was significantly lower in patients cared for by gastroenterologists (EUR 1,630) than in those managed by internists (EUR 3,745, p < 0.001) or surgeons (EUR 2,513, p < 0.05). The mean LOS was the variable with highest influence on total cost. Patients cared for by gastroenterologists had a mean LOS significantly shorter (7.3 days) than that of those treated by internists (16.2 days, p < 0.001) or surgeons (11 days, p < 0.001). Hospital costs and LOS differences were maintained when adjusting for severity of illness. In caring for low risk patients, nongastroenterologists had a higher probability of having a hospital stay longer than 4 days (odds ratio = 18.4, Cl = 4.6-73.6, p < 0.001). CONCLUSION: The implementation of specific evidence-based protocols by gastroenterologists reduces length of hospital stay and saves medical costs in patients with nonvariceal UGIB, especially those at low risk.

Aged↗

PubMed2000

Watermelon stomach following and preceding systemic sclerosis.

OBJECTIVES: To report two patients with watermelon stomach associated with systemic sclerosis (SSc) and review the literature on that subject. METHODS: We describe the clinical presentation, course and outcome of our two patients and reviewed the medical literature registered in the MedLine PubMed database from 1966 to 1999 by using the key words watermelon stomach, gastric antral vascular ectasia, systemic sclerosis, scleroderma. RESULTS: The two patients presented with microcytic hypochromic anemia. Esophagogastroscopy showed multiple linear vascular malformations in the antrum compatible with watermelon stomach. They responded to Nd-Yag laser therapy with resolution of the lesions and improvement of the anemia. Patient 1 had a history of diffuse SSc while patient 2 developed limited SSc 2 years after the diagnosis of watermelon stomach. A literature review disclosed 16 documented case reports of watermelon stomach associated with SSc, 14 of whom were women. In most cases, watermelon stomach occurred in patients with established SSc but in some it antedated it by several years. In many cases, other autoimmune syndromes such as hypothyroidism, primary biliary cirrhosis, and Sjögren's syndrome were present. The presenting symptom was iron deficiency anemia, which in 11 cases was severe enough to require blood transfusions. Nine patients were successfully treated with several transendoscopic treatments, four required surgical intervention, and in three treatment was not specified. CONCLUSION: Although watermelon stomach is a rare syndrome, it is recognized as a cause of persistent bleeding in patients with SSc. Awareness of this condition may increase its recognition and treatment.

Anemia, Hypochromic↗

PubMed1996

Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial.

BACKGROUND AND STUDY AIMS: Rebleeding after initial endoscopic hemostasis remains an important determinant of poor prognosis in patients with ulcer hemorrhage. Prospective identification of patients who are at high risk for rebleeding, and directing further therapeutic measures in these patients, would be expected to improve the prognosis. PATIENTS AND METHODS: We used our previously described scoring system (the Baylor Bleeding Score) to identify patients at increased risk for rebleeding after initially successful endoscopic hemostasis, and randomized them into retreatment and no-retreatment groups. Patients in the retreatment group received additional endoscopic heat probe therapy at 24 hours, the follow-up was otherwise similar. Forty men with major ulcer hemorrhage were randomized, 19 to the retreatment group and 21 to the no-retreatment group. Patients in the two groups had similar Baylor Bleeding Scores, blood transfusion needs (median three vs. two units), ulcer sites (duodenal 57% vs. 43%), stigmata of hemorrhage (actively bleeding 68% vs 67%), and received similar initial endoscopic therapy (heat probe 240 J vs. 300 J). Patients in the retreatment group received additional heat probe therapy (median 165 J) at 24 hours. RESULTS: Rebleeding, requiring significantly more blood transfusion, occurred in 24% of the no-retreatment group patients compared to none of the retreatment group patients (p < 0.05). CONCLUSIONS: Endoscopic retreatment after successful initial endoscopic hemostasis prevents rebleeding in highrisk patients with ulcer bleeding.

Adult↗

PubMed1992

Vascular malformations of the gastrointestinal tract.

The advent of fiberoptic endoscopy, which became widespread in the evaluation of gastrointestinal bleeding throughout the late 1970s and 1980s, has dramatically changed both our understanding of the extent to which vascular malformations account for gastrointestinal blood loss and our ability to treat these lesions at the time of diagnosis. Colonic vascular malformations appear to be the single most common cause of acute or recurrent gastrointestinal bleeding episodes in patients over 60 years of age, being responsible for the bleeding in as many as 35% of such patients. Although less common as a cause of upper gastrointestinal bleeding, these lesions still account for 2% to 5% of bleeding lesions in older patients. Diagnosis is accomplished by endoscopy, and the vascular malformations can then be coagulated via the endoscope using one of a number of thermal systems. The argon laser, the heater probe, and the BICAP system are all effective and safe throughout the gastrointestinal tract, especially in the cecum and right colon, where the majority of sporadic vascular malformations occur. Monopolar cautery and the Nd:YAG laser are equally efficacious, but their greater and less predictable depth of coagulation make them much less safe in the cecum and right colon. There are no apparent advantages in terms of efficacy and safety between laser treatment and the other thermal modalities. The laser has the advantage of being quicker, which is especially important when treating large or multiple lesions. The other modalities have the advantages of portability and low relative cost. Endoscopic therapy with lasers or other thermal devices is nonspecific. The effects are achieved by thermally coagulating the mucosal vascular lesions, allowing the coagulated tissue to slough, and leaving a mucosal ulceration that subsequently heals with re-epithelialization. Endoscopic coagulation has thus been reported effective in the treatment of gastrointestinal mucosal vascular lesions regardless of their etiology or characteristics. It has been effective for sporadic vascular malformations, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease), radiation proctocolitis, the blue rubber-bleb nevus syndrome, and diffuse gastric antral vascular ectasia (the watermelon stomach). As we move through the 1990s and beyond, these endoscopic modalities offer an effective, relatively safe, and clearly less invasive treatment option for the many patients who experience acute, recurrent, or chronic gastrointestinal bleeding from any of these lesions.

Blood Vessels↗

PubMedDate not supplied

Evaluation of extrahepatic perfusion of anticancer drugs in the right gastric arterial region on fused images using combined CT/SPECT: is extrahepatic perfusion predictive of gastric toxicity?

BACKGROUND: Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinomas of the liver. Since hepatic arteries also supply the stomach and duodenum, HAI may result in unwanted infusion into the upper gastrointestinal tract and consequent gastric toxicity. Using fused images obtained with a combined SPECT/CT system, we assessed extrahepatic perfusion (EHP) and its correlation with gastrointestinal toxicity in patients receiving HAI. METHODS: We studied 41 patients with primary or metastatic carcinoma of the liver who received HAI chemotherapy consisting of 5-fluorouracil and cisplatin. All underwent abdominal SPECT using a (99m)Tc-MAA (185 MBq) instrument and an injection rate of 0.1 ml/min, identical to the chemotherapy infusion rate. Delivery was through an implantable port. We analyzed the distribution of the anticancer agent on fused images and the relationship between EHP of the right gastric arterial region and gastric toxicity. All patients underwent esophagogastroduodenoscopy (EGDS). RESULTS: Of the 41 patients, 11 (27%) manifested enhancement of the duodenal and gastric pyloric region on fused images. EGDS at the time of reservoir placement detected gastric ulcers in 10 of these patients. CONCLUSION: Fusion imaging with combined SPECT/CT reflects the actual distribution of the infused anticancer agents. The detection of EHP on fused images is predictive of the direct gastric toxicity from anticancer agents in patients undergoing HAI.

Adult↗

PubMed2007

The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study.

The aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction with care to date and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute: heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P > 0.05), and high satisfaction levels (90.1+/-3.0 for dexmedetomidine versus 84.9+/-4.5 for midazolam; P > 0.05). Retching and endoscopist satisfaction were significantly different in patients receiving dexmedetomidine versus those receiving midazolam (88.8+/-6.5 versus 73.5+/-16.4, P < 0.05; and 20.6+/-4.4 versus 45.2+/-6.0; P < 0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P < 0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy.

Adult↗

PubMed2002

[Fiber-optic intubation with non-invasive ventilation with an endoscopic facial mask].

OBJECTIVES: To assess the feasibility and safety of a new technique of fiberoptic bronchoscopy (FOB) tracheal intubation (TI) with noninvasive ventilation (NIV) via an endoscopic full facial mask with two openings, in case of acute respiratory failure (ARF) temporally improved by NIV, but requiring a mechanical ventilation. STUDY DESIGN: Clinical, prospective, open, noncomparative trial of feasibility with direct individual profit. PATIENTS: Sixteen patients with ARF (age: 60 +/- 17 years, PaO2 = 59 +/- 16 mmHg, PaCO2 = 64 +/- 26 mmHg, PaO2/FIO2 = 142 +/- 70 before NIV) (m +/- SD), requiring TI. Including were: TI necessity (SpO2 < 90% or hypercapnic despite NIV, dependence of NIV, exhaustion, septic syndrome), clinical and SpO2 improvement with NIV. METHODS: After i.v. injection of 5 mg midazolam and topical anesthesia (TA) of the nose, the endoscopic mask (modified Fibroxy, Péters) was applied to the face, fixed with elastic straps, then connected to the ventilatory support system with IPAP = 20 cmH2O, EPAP = 5 to 12 cmH2O, FIO2 = 1. A tube was slid on the FOB. As soon as SpO2[[[nbsp] 94%, the extremity of the FOB, was inserted through the lower opening of the mask, slid in the nostril, positioned in front of the glottis for AL, then pushed in the trachea authorizing AL and i.v. injection of 0.15 mg.kg-1 of etomidate (Ramsay[[[nbsp]3). The tube was then slid in the trachea, then, FOB was removed from trachea. RESULTS: The FOB intubation was easy at the patient's, without any failure or any complication. The procedure was 6.7 +/- 2 min. SpO2 significantly improved during TI, from 84 +/- 5% (FIO2 = 0.6 +/- 3) to 97 +/- 1 (FIO2 = 1 +/- 0), without decrease in oxygen saturation off 90%. Arterial pressure decreased only after the 5th min. The quantities of midazolam and of etomidate used were 4.6 +/- 2 mg and 12 +/- 4 mg. Three patients benefited from EPAP > 10 cmH2O. CONCLUSION: Fiberoptic tracheal intubation with NIV via an adapted endoscopic facial mask is a safe technique in patient with ARF temporally improved by NIV. This procedure requires TA and conscious sedation.

Bronchoscopy↗

PubMed2000

Safety and efficacy of recombinant human interleukin 10 in chronic active Crohn's disease. Crohn's Disease IL-10 Cooperative Study Group.

BACKGROUND & AIMS: Interleukin (IL)-10 is a cytokine with potent anti-inflammatory properties. We investigated the safety and efficacy of different doses of human recombinant (rhu)IL-10 in patients with Crohn's disease (CD). METHODS: A prospective, multicenter, double-blind, placebo-controlled study was conducted in 329 therapy-refractory patients with CD. Clinical improvement was defined by a reduction of the Crohn's Disease Activity Index (CDAI) by 100 points or more and clinical remission by a decrease of the CDAI to <150 points. At selected centers, patients underwent ileocolonoscopies and activation of the nuclear factor-kappa B (NF-kappa B) system was assessed in biopsy specimens. RESULTS: Subcutaneous treatment with rhuIL-10 over 28 days induced a fully reversible, dose-dependent decrease in hemoglobin and thrombocyte counts but no clinically significant side effects. No differences in the induction of remission were observed between rhuIL-10 groups (1 microg, 18% [9.6-29.2]; 4 microg, 20% [11.3-32.2]; 8 microg, 20% [11.1-31.8]; 20 microg, 28% [18-40.7]; and placebo, 18% [9.6-29.6]). Clinical improvement was observed in 46% (33.7-59) in the 8-microg/kg rhuIL-10 group in comparison with 27% (17-39.6) in patients taking placebo. Responders to rhuIL-10 showed inhibition of NF-kappaB p65 activation in contrast to nonresponders. CONCLUSIONS: Up to 8 microg/kg of rhuIL-10 was well tolerated. A tendency toward clinical improvement but not remission was observed in the 8-microg/kg dose group. Further studies should delineate which subgroups of patients with CD benefit from rhuIL-10 therapy.

Adult↗

PubMed2001

Quantitative analysis of red color sign in the endoscopic evaluation of esophageal varices.

BACKGROUND AND STUDY AIMS: Bleeding due to esophageal variceal rupture is associated with an extremely high mortality rate. Variceal bleeding is frequent in patients who have a red color sign on endoscopy. However, the red color sign is subjectively evaluated on the basis of color tone and the shape of the varices. To allow standardization and facilitate consensus, an objective method of assessing the red color sign is needed. In this study, a system was established for quantifying the red color sign during endoscopic evaluation. PATIENTS AND METHODS: Between July 1995 and February 1997, 55 untreated patients with portal hypertension and esophageal varices identified on upper gastrointestinal endoscopy were enrolled in the study. Images obtained about 5 cm oral to the esophagogastric junction during endoscopy were stored on magnetic optical disks using an endoscopic image processor. The still images were transmitted to a computer and analyzed using computer software. The RGB components (R, red; G, green; B, blue) were measured at points showing flare consistent with the red color sign. The endoscopic assessment was based on the Japanese Research Society for Portal Hypertension's general rules for recording endoscopic findings in esophagogastric varices. RESULTS: The ratio of the red color area to the variceal area increased with increasing red color grade. There were significant positive correlations between the R and G, and G and B components. This suggests that comparing the R components alone would allow assessment of the color differences in the red color area and in the varices. The R value was significantly higher in the red color area (115 +/- 20) than in the varices (57 +/- 19). An R value of 90 was found at the boundary between the two parts (P < 0.001). CONCLUSIONS: The red color area can be automatically calculated and quantified using the analysis program. Improvements in data storage methods may allow real-time evaluation during endoscopy in the future.

Aged↗

PubMedDate not supplied

[Endoscopic treatment of obstructive jaundice at a second level national health system hospital].

BACKGROUND AND AIMS: The difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) in our patients in the reference hospitals within a few days of diagnosis of obstructive jaundice led us to perform this technique in our center. We expected to perform a small number of ERCP annually. We analyzed the success rate of initial biliary drainage and the complications of this procedure. PATIENTS AND METHODS: We performed a retrospective study. From 1997-1999 we carried out 240 ERCP. In 128 patients, 140 ERCP were performed for obstructive jaundice (58,3%). The final diagnosis was choledocholithiasis in 69 patients (54%), tumors in 35 (27%), dilatation of the biliary tract without obstruction at cholangiography in 21 (17%) and benign stenosis of the biliary tract in 3 (2%). RESULTS: The mean procedure time for ERCP was 5.26 ( 2.8) days. Cholangiography was successfully performed in 117 patients (91.4%). Effective therapeutic endoscopy was performed in 111 patients (86.7%). Jaundice was resolved in 62 patients (90%) with choledocholithiasis, 55 (80%) by stone removal and in 7 (10%) by prosthesis. Resolution was also achieved in 25 (71.5%) tumors, mainly by prosthesis, and in 100% of patients with benign stenosis. In all patients with dilatation of the biliary tract without obstruction, biliary sphincterotomy was performed. Complications were found in 15 patients (11.7%) and two (1.56%) died. CONCLUSIONS: The majority of patients with obstructive jaundice can be satisfactorily treated in a center with our characteristics. However, in tumors, the figures for drainage were slightly lower than those reported in the medical literature.

Adult↗

PubMed1994

Recognition and rapid diagnosis of upper gastrointestinal cytomegalovirus infection in marrow transplant recipients. A comparison of seven virologic methods.

This is a retrospective study of 54 consecutive upper gastrointestinal endoscopies in marrow graft recipients performed to determine the incidence and distribution of CMV infection in symptomatic patients and to compare the sensitivities of 7 CMV detection techniques. At each endoscopy, 3 biopsies were obtained from the esophagus, stomach, and duodenum. Each of the 3 biopsies was assayed for CMV by different techniques. Enteric CMV was identified by one or more techniques in 52 of 486 (11%) biopsies from 14 infected patients. All patients infected with CMV initially had nausea and vomiting. In 13 of these patients, there was esophageal CMV, often associated with stomach (10 patients) and duodenal (7 patients) involvement. CMV infection of the esophagus was never identified cytologically in esophageal imprints or histologically, immunohistologically, or by DNA hybridization in esophageal epithelial cells. The most sensitive diagnostic methods were conventional and centrifugation cultures, which each identified CMV in 17 of the 30 (57%) organs positive by any technique. Indirect fluorescent antibody (IFA) staining for a late CMV antigen detected 53%, followed by in situ DNA hybridization (40%), IFA and immunoperoxidase (IP) staining for an early CMV antigen (37% and 43%), and routine histology (30%). Although no single detection technique is completely adequate for the rapid identification of CMV in small endoscopic biopsies, centrifugation culture is the method of choice, with supplementary immunohistology and in situ hybridization of archival tissue if needed.

Adult↗

PubMed2004

Per-rectal portal scintigraphy is complementary to ultrasonography and endoscopy in the assessment of portal hypertension in children with chronic cholestasis.

UNLABELLED: We evaluated the clinical usefulness of 99mTc-pertechnetate per-rectal portal scintigraphy (PPS) in the assessment of portal circulation in children with chronic cholestasis. METHODS: PPS percentage shunt index (%SI) (the amount of radionuclide that shunts the liver and reaches the systemic blood after injection in the rectum) was measured in 22 children (mean age, 7.2 +/- 4.9 y) and compared with established clinical, laboratory, and endoscopic and imaging parameters of portal hypertension (PH). Fourteen children had surgically treated biliary atresia, and 8 had chronic intrahepatic cholestasis. Six clinically well children served as control subjects. RESULTS: The %SI was 14.3 +/- 3.1 and 34.7 +/- 18.8 in controls and in patients, respectively (P < 0.01). A cutoff of 19% correctly allocated 100% of controls and 86% of patients. Mean %SI values were significantly higher in patients with biliary atresia, a high risk of pretransplantation death, esophageal varices (EV) at endoscopy, and an abnormal value for the ratio of lesser omentum thickness to abdominal aorta diameter (LO/Ao) at ultrasonography. Correlations between %SI values and several ultrasonographic continuous variables were statistically significant only for LO/Ao ratios (r = 0.51; P = 0.005) and spleen longitudinal diameters (r = 0.53; P = 0.01). The presence of EV could correctly be predicted only when values of %SI were greater than 30% (100% specificity; 56% sensitivity). Endoscopic and PPS findings agreed for a diagnosis of PH with EV in 3 of 7 patients with normal or borderline ultrasonographic LO/Ao ratios. PPS patterns and %SI values became normal in 3 children who underwent liver transplantation. CONCLUSION: In children with chronic cholestasis, PPS may be an advantageous, minimally invasive tool complementary to ultrasonography and endoscopy for better assessment and follow-up of PH before and after liver transplantation.

Adolescent↗

PubMedDate not supplied

Serological markers for coeliac disease: is it time to change?

BACKGROUND: Anti-gliadin and anti-endomysium antibodies are useful markers in the screening and follow-up of coeliac disease. The recent finding that tissue transglutaminase is the main auto-antigen of anti-endomysium has led to the discovery of anti-tissue transglutaminase antibodies. AIM: To compare, in a prospective study, the diagnostic accuracy of anti-tissue transglutaminase, anti-gliadin and anti-endomysium antibodies in a large series of adult patients. METHODS: The study involved 80 consecutive subjects undergoing upper gastrointestinal tract endoscopy for suspected coeliac disease (subsequently confirmed in 40 cases), 195 coeliac patients on a gluten-free diet, and 70 patients with different gastrointestinal disor ders and normal duodenal histology. Anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies levels were measured using commercial kits. RESULTS: The diagnostic sensitivity and specificity of anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies were, respectively, 95% and 89.1%, 100% and 97.3%, and 100% and 98.2%: the agreement between the markers was substantial or almost perfect. In terms of follow-up, the positivity of the markers varied according to the strict adherence to, and duration of the gluten-free diet; the agreement between antiendomysium and anti-tissue transglutaminase antibodies was almost perfect. CONCLUSIONS: Anti-endomysium and anti-tissue transglutaminase antibodies are both highly efficient for routine laboratory screening: the choice of one or the other will depend on the available facilities. However, neither can replace intestinal biopsy for general population screening because, in this case, their respective positive predictive values are only 15.7% and 21.8%. During follow-up, anti-gliadin retain their value as an early predictor of gluten ingestion.

Adolescent↗