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At least 1,225 records · Page 68Linked to original sources

PubMed2007

A new approach to blue rubber bleb nevus syndrome: the role of capsule endoscopy and intra-operative enteroscopy.

Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular malformation disorder with cutaneous and visceral lesions frequently associated with serious, even fatal bleeding and anemia. The syndrome is considered to be autosomaly predominantly inherited. Intra-operative enteroscopy (IOE) is the best method of identification of all lesions (particularly the small ones, less than 3 mm) and treatment by endoscopic electro-coagulation or surgical excision. Capsule wireless endoscopy is optimal for screening before the IOE and for monitoring the effect of therapy (in patients with BRBNS). We report two cases of BRBNS. Anemia, gastrointestinal bleeding, gastrointestinal malformations and multifocal venous malformations of the skin were present in both of our cases. Gastrointestinal lesions were identified by gastroscopy, colonoscopy and capsule endoscopy. The multiple venous malformations were treated partly by endoscopic electro-coagulation (lesions up to 4 mm in diameter) and by wedge resection. Both of our patients were 12-year-old girls at the time of operation. In the first patient 31 venous malformations of the small bowel were coagulated, two were resected by the surgeon. In the second patient 20 lesions were coagulated endoscopically and another 31 nevi were resected during an 8 h procedure. The first girl is doing fine 4 years after the procedure, the second was allowed home 2 weeks after the procedure in excellent condition. IOE is a unique method of small bowel investigation and concurrently provides a solution for pathological findings. Capsule endoscopy is a feasible non-invasive screening procedure. We believe that a radical eliminatory approach by means of combined surgery and IOE is indicated for the BRBNS to prevent ongoing gastrointestinal bleeding.

Arteriovenous Malformations↗

PubMed2000

Antral web--a rare cause of vomiting in children.

Antral web is a rare cause of gastric-outlet obstruction. We report a case of gastric antral web with intermittent vomiting in a 10-year-old girl who received medical treatment for 6 months. The literature on this anomaly is reviewed with respect to differential diagnosis on the basis of upper gastrointestinal radiographic series, gastroscopy, and treatment planning.

Abdominal Pain↗

PubMed1998

Mechanism of fatal air embolism after gastrointestinal endoscopy.

Although venous air embolism is a known complication in medical practice in general, only a single case of upper gastrointestinal endoscopy complicated by venous air embolism with consecutive acute cardiovascular failure has so far been described in literature. Here we show that gastroscopy may be accompanied by massive, i.e. fatal venous air embolism. If a vessel in the gastrointestinal tract is exposed but does not collapse (in the case of a gastric ulcer, for example) air insufflated under pressure by the gastroscope may lead to a fatal air embolism. Our tests using a commercial gastroscope revealed that an overpressure of up to 43 kPa (kiloPascals) is reached without the rinsing function while an overpressure of up to 45 kPa is measured if the rinsing function is operated simultaneously. The maximum flow rates without resistance were 100 ml/min for rinsing liquid (purified water) and 2000 ml/min for air. Our results suggest that air insufflation by the gastroscope may result in a critical air embolism within very few seconds on condition that a connection with the vascular system exists. However, this complication is extremely rarely encountered. We propose that CO2 should be administered in place of air or alternatively the maximum pressure should be considerably reduced to avoid a fatal outcome in routinely performed gastroscopical examinations.

Cause of Death↗

PubMed2000

Multifocal epithelioid angiosarcoma of the small intestine.

A 67-year-old man presented with weight loss, intermittent severe abdominal pain and melaena. Initial radiology (including abdominal ultrasonography), gastroscopy and colonoscopy did not demonstrate any lesions that could explain the complaints. Three weeks later, upper gastrointestinal and small-bowel barium studies revealed two areas in the small intestine with an abnormal mucosal pattern. Explorative laparotomy revealed three tumoral lesions. Three partial enterectomies were performed. Gross examination showed centrally depressed dark reddish tumoral lesions extending from the mucosa throughout the full thickness of the bowel wall (diameter varying between 1.6 cm and 2.2 cm). The tumours, composed of large, plump, polygonal cells showing little architectural differentiation, were mainly situated in submucosa and muscularis propria. The growth pattern appeared rather solid. The epithelioid cells showed pronounced nuclear pleomorphism and atypia with central large nucleoli. There were several small blood vessels with occasional anaplastic endothelial cells. Immunohistochemical staining demonstrated an intense expression of CD 31, CD 34, factor VIII related antigen and keratin. This supported the diagnosis of an epithelioid angiosarcoma. The patient died 3 months after diagnosis. Tumours of the small intestine are very rare, and angiosarcomas of the small intestine are even more rare. Epithelioid variants have only been described in two patients and only one of these had a multifocal presentation. The prognosis is very poor. Because of the epithelioid growth pattern and the cytokeratin expression, these tumours may erroneously be diagnosed as a carcinoma.

Abdominal Pain↗

PubMed2000

Gastric polyps: an update of their pathology and biological significance.

Gastric polyps are clinically important lesions that are frequently encountered in routine pathology (2-3% of all gastroscopies). Polyps may occur sporadically or in polyposis syndromes, such as familial adenomatous polyposis coli (FAP), Peutz-Jeghers syndrome, juvenile polyposis, Cowden's disease and Cronkhite-Canada syndrome. In biopsy specimens taken during routine gastroscopic examinations, it is almost always possible to differentiate between neoplastic and non-neoplastic polyps and to type polyps. In this review, we focus on the morphological spectrum of gastric polyps in an attempt to assist the pathologist and the gastroenterologist in recognising the lesion and in treating patients with gastric polyps, respectively. Further, we propose that the World Health Organization (WHO) classification should be modified to include the following categories: non-neoplastic polyps (WHO: tumour-like lesion), hamartomatous polyps/polyps of polyposis syndromes (WHO: tumour-like lesion), heterotopic tissue polyps (WHO: tumour-like lesion), neoplastic polyps (WHO: epithelial, non-epithelial and endocrine tumours) and reactive polypoid lesions.

Biopsy↗

PubMed2006

Laparoscopic resection of gastrointestinal stromal tumors: not all tumors are created equal.

BACKGROUND: Laparoscopic resection has become an accepted approach to gastrointestinal stromal tumors (GISTs), with acceptable early results published in the literature. Long-term recurrence rates, however, are still unclear, and the management of tumors in challenging locations requires exploration. METHODS: A retrospective analysis of all patients undergoing a laparoscopic resection of gastric GIST in our institution between November 1997 and July 2004 was performed. RESULTS: A total of 14 patients with 15 tumors were evaluated, 5 of which were located high on the lesser curve. All the patients had an attempted laparoscopic approach, with the following procedures performed: stapled wedge excision (n = 8), excision and manual sewing technique (n = 4), and distal gastrectomy (n = 1). Overall, there was a 15% (n = 2) conversion rate. Lesions found in the fundus and greater curvature areas were easily resected via simple stapled wedge excision. High lesser curve tumors were more difficult to manage and required a combination of methods for complete excision and preservation of the gastrointestinal junction including intraoperative gastroscopy, excision and manual sewing technique, and reconstruction over an esophageal bougie. There were no postoperative complications, and the length of hospital stay was 4.6 +/- 1.9 days. At a median follow-up period of 46.5 months (mean, 37.4 +/- 26 months), one patient experienced a recurrence (18 months postoperatively), with eventual disease-related death. CONCLUSION: The laparoscopic approach to gastric GIST tumors is safe and associated with acceptable short- and intermediate-term results. High lesser curve GISTs can be safely approached laparoscopically using various techniques to ensure an adequate resection margin without compromise of the GE junction.

Adult↗

PubMed1997

Resection of a gastric leiomyoma using combined laparoscopic and gastroscopic approach.

Laparoscopy has added a new perspective to the diagnosis and treatment of abdominopelvic disease. A wide variety of gastric procedures have been completed with laparoscopy in the past several years. The authors here present successful resection of a submucosal gastric leiomyoma laparoscopically with the combined use of intraoperative gastroscopy for localization. A 2.5 x 2.0 cm submucosal gastric nodule is resected with ample margins laparoscopically. Intraoperative endoscopy is used for accurate localization because the lesion was not visible to the laparoscope on the serosal surface of the organ. Laparoscopic surgery can be applied to the traditional surgical principles with equal efficacy in selected patients.

Aged↗

PubMed1997

Endoscopic hydrostatic balloon dilation of ulcer-induced pyloric stenosis in rheumatoid arthritis and secondary amyloidosis.

We describe a 50-year-old Japanese woman with rheumatoid arthritis who presented with near-complete gastric outlet obstruction. The patient also suffered from secondary gastrointestinal and cardiac amyloidosis. Gastroscopy revealed multiple huge gastric antral ulcers in which amyloid deposits were identified on histologic examination. The ulcers became scars after treatment with omeprazole, which cause in severe pyloric stenosis. Endoscopic hydrostatic balloon dilation under fluoroscopic guidance was performed twice for 10 min. The pyloric outlet remained sufficiently patent 22 months later.

Amyloidosis↗

PubMed1999

Gastroscopic-assisted laparoscopic wedge resection of B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Helicobacter pylori has been implicated as an etiologic agent for B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma. This tumor is considered a low-grade entity with an associated indolent course. Some instances of tumor regression with adequate antibiotic treatment and irradication of H. pylori have been reported. Gastric malignancy and more specifically, lymphoma, should be considered in all patients with recurrent or nonhealing ulcers. Diagnostic and treatment strategies for these patients remain controversial. Two patients were evaluated, one for recurrent disease, another for a 3-cm nonhealing ulcer. Both patients refused total gastrectomy. Both patients underwent gastroscopy with simultaneous laparoscopic visualization. The mucosal lesions were identified and removed via laparoscopic stapled wedge resection. A combined endoscopic and laparoscopic approach can be considered as an alternative to radical surgery in the treatment strategy of these tumors. Wedge resection allows for staging and thorough pathologic classification. Further studies are necessary to define the natural history and the role of laparo-endoscopy in the diagnosis, staging, and treatment of B-cell gastric MALT lymphoma.

Aged↗

PubMed2001

Serologic diagnosis of Helicobacter pylori infection in outpatients aged 45 years or less.

The diagnostic accuracy of serological tests for Helicobacter pylori was studied in 145 consecutive outpatients aged 45 years or less referred for gastroscopy. Helicobacter pylori infection can be detected by serological tests, including rapid whole-blood tests. The low prevalence of the disease in young people may have a negative effect on the positive predictive value of a test. In this study, the presence of Helicobacter pylori was assessed by a biopsy urease test and histological examination, and by several serological tests: a rapid whole-blood test on fingerstick blood, a latex agglutination serum test, a commercial enzyme immunoassay (EIA) test, and an in-house EIA for detection of antibodies of both the IgG and IgA classes. Helicobacter pylori infection was diagnosed with invasive tests in 21 (14.5%) patients. The sensitivity, specificity, and positive and negative predictive values of the EIA-based tests, compared to histological examination, were 100%, 96-97%, 81-84%, and 100%, respectively. The positive predictive value of the latex agglutination test was 78%, whereas it was only 47% for the whole-blood rapid test used. Although the results of the whole-blood rapid test were unsatisfactory, the quantitative EIA-based tests could reliably detect Helicobacter pylori among young patients, in whom the prevalence of the infection is low.

Adult↗

PubMed1987

Protection by misoprostol against naproxen-induced gastric mucosal damage.

The protective effect of misoprostol against naproxen-induced gastric mucosal damage was the subject of a double-blind, randomized, parallel-group study. Thirty-two healthy subjects were treated with naproxen 500 mg twice daily and either misoprostol 200 micrograms or matching placebo twice daily for seven days. Gastroscopy was performed before and after the treatment period and the mucosa was assessed for erosive and petechial lesions according to a predetermined scoring scheme. Of 25 evaluable subjects, 12 were treated with misoprostol and 13 were treated with placebo. The mean overall endoscopic score was 1.24 +/- 0.09 with placebo and 0.26 +/- 0.07 with misoprostol. The difference, 0.98, was highly significant (p less than 0.001), with 95 percent confidence limits of 0.74 to 1.22. All subjects in the placebo group had higher mean scores than any in the misoprostol group. The scores for erosive and bleeding lesions in the antrum and corpus/fundus of the stomach were all reduced by administration of misoprostol. In conclusion, the results clearly demonstrate that misoprostol protects the gastric mucosa of humans against naproxen-induced damage.

Adolescent↗

PubMed1987

Endoscopic studies of nabumetone in patients with rheumatoid arthritis. A comparative endoscopic and histologic evaluation.

Gastric tolerance to 1 g of nabumetone administered in a single nightly dose was assessed in two trials in patients with rheumatoid arthritis. Gastroscopy and histology of mucosal biopsy specimens were performed before and after the end of treatment in both trials. Trial 1 was an open study that compared the effects of 1 g of nabumetone at night with those of naproxen (dose, 500 mg twice daily) and indomethacin (dose, 50 mg three times daily) in 41 hospitalized patients. After three weeks of treatment, nabumetone was significantly better tolerated than naproxen or indomethacin. Trial 2 was a randomized trial with 24 patients per group that compared 1 g of nabumetone given at night with 250 mg of naproxen given in the morning and 500 mg given at night for a period of three months. This single-blind study revealed that the number of patients with microscopic or macroscopic mucosal lesions was significantly smaller following intake of nabumetone. Concerning efficacy, as judged clinically by a rheumatologist, treatment with nabumetone was superior as well.

Adult↗

PubMed1988

Role of H2-receptor blockers in the prevention of gastric injury resulting from nonsteroidal anti-inflammatory agents.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can produce injury to the gastric and duodenal mucosa. The histamine (H2)-receptor blocker cimetidine was studied to determine whether protection of the gastric mucosa of normal volunteers could be provided against a single dose of aspirin, 1,300 mg. Gastric mucosal injury was assessed with gastroscopy performed two hours after aspirin intake. Three liquid cimetidine doses were administered over 24 hours prior to the aspirin dose, the last dose one hour before the aspirin. The 200-mg and 400-mg doses of cimetidine protected a sufficient number of subjects to warrant further study. In the second study, these two doses were further examined to determine whether three doses were necessary and whether the final dose could be coadministered with the aspirin instead of one hour before. Concomitant administration of a single dose of cimetidine with aspirin was found to protect the gastric mucosa from aspirin damage as effectively as the other cimetidine regimens employed. A final, double-blind comparison of cimetidine, 200 mg, with placebo administered with the aspirin, 1,300 mg, confirmed that cimetidine protected the gastric mucosa from the hemorrhagic effects of aspirin.

Aspirin↗

PubMed1981

Cancer of the stomach.

Carcinoma of the stomach, although its incidence is decreasing in the United States, is still a fatal disease. The results today are actually no better than they were 30 years ago because we are still making late diagnoses. In order to improve our results in the treatment of cancer of the stomach, we must perform fiberoptic gastroscopy in individuals over age 40 who have gastric complaints that do not respond readily to conservative medical therapy. At the time of endoscopy, multiple biopsies of gastric mucosa must be taken. Only in this way can early enough diagnoses be made to increase the survival rate in gastric carcinoma.

Adult↗

PubMed1982

Perceived needs for gastrointestinal endoscopic training in surgical residencies.

Questionnaires sent to directors of 126 university surgical residency programs analyzed the availability and quality of fiberoptic gastrointestinal endoscopic training. Seventy percent responded: 59 percent of their programs included some endoscopy training. Only half of the respondents believed their residents were adequately trained in endoscopic techniques. Although 67 percent of institutions had at least one surgeon performing endoscopy, many did not involve surgical residents in their cases. Insufficient caseloads were the rule, with fewer than 30 patients available to each resident for gastroscopy in 63 percent of the programs and for colonoscopy in 89 percent. Only half of all directors were satisfied with their relation with gastroenterology with respect to endoscopy. Gastroenterology service monopolized the performance of endoscopy at 41 percent of the universities. Since endoscopy is helpful in the management of many gastrointestinal disorders treated by surgeons, training surgical residents in such techniques is advisable. To do so properly, program directors must recruit skilled faculty and provide more concentrated endoscopic rotations with adequate caseloads or develop truly sharp educational experiences with their colleagues in gastroenterology.

Colonoscopy↗

PubMed1985

Effects of aspirin and an aspirin-acetaminophen combination on the gastric mucosa in normal subjects. A double-blind endoscopic study.

Coadministration or preadministration of acetaminophen with aspirin affords partial protection against aspirin-induced gastric mucosal injury in animals. Recently, it was reported that preadministration of acetaminophen in humans yielded similar protection. That study used pylorus occlusion, intravenous atropine, and exogenous acid, and thus may not have mimicked the usual clinical situation. We studied a clinical regimen, in 7 normal volunteers. We coadministered acetaminophen (1.95 or 2.6 g/day) and aspirin (in a 1:1 ratio) and used gastroscopy to evaluate if there was gastric mucosal protection. Aspirin alone was used as a positive control. We found the expected significant increase in mucosal damage associated with increasing aspirin dose (p less than 0.05) comparing the lowest and highest aspirin doses (1.95 g vs. 3.9 g) after 7 days of continuous therapy. There was no difference in the degree of mucosal injury when receiving the same dose of aspirin (p = 0.38) whether or not acetaminophen was administered in a dose equal to that of aspirin. Thus, in a more normal clinical situation, we were unable to confirm the findings from the pylorus-occluded model, i.e., we failed to identify either a beneficial effect, or a trend, for protection from gross mucosal damage by the coadministration of acetaminophen and aspirin in equal dosages.

Acetaminophen↗

PubMed1988

Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients.

A retrospective study was undertaken to compare the complications of surgical feeding gastrostomy in 100 consecutive patients with those of percutaneous nonendoscopic gastrostomy in 133 consecutive patients. The age and sex distribution and indications for gastrostomy were similar in both groups. Thirty-day mortality in the surgical group was 12% and in the percutaneous group 7.5%. Complications requiring surgical treatment occurred in 8% and 1.5% of the surgical and percutaneous patients, respectively. Significant nonsurgical complications, such as bleeding, aspiration, and myocardial infarction, occurred in 11% of patients undergoing surgical gastroscopy and 3.0% of those with percutaneous gastrostomy. Minor complications, such as mild wound infection and pericatheter leakage, occurred in 14% of surgical patients and in 0.7% of percutaneous patients. Overall, there were significantly fewer complications with percutaneous gastrostomy than with surgical gastrostomy (p less than 0.01). We conclude that percutaneous, nonendoscopic gastrostomy is safer than surgical gastrostomy and hence the preferred method for long-term enteral feeding.

Adolescent↗

PubMed1995

Anisakidosis: report of 25 cases and review of the literature.

Anisakidosis (previously known as anisakiasis) is a disease caused by the accidental ingestion of larval nematodes (Anisakis and sometimes Pseudoterranova) in raw fish. Two groups of patients are studied: 5 clinical cases and 20 serological diagnoses. 55 French cases are already published. Most of them complained of acute symptoms, which occurred within 12 h of eating the seafood meal--epigastric pain, occlusion, diffuse abdominal pain, and appendicitis. Larvae were attached to the gastric mucosa (25 cases), including an inflammatory response (erythema, oedema ulceration). Diagnosis of anisakiasis is made by gastroscopy which allows removal of the worms, and cures the patients. In gastro-intestinal tract X-rays, oedema in the mucosa, pseudo tumour formation, and filling defects (worm) were observed. In chronic infections, cases with intermittent feelings of ill health and abdominal pain, lasting from several weeks to months, were misdiagnosed as another intestinal disease. Positive serological reactions are helpful, and surgery is necessary for resection of the lesion; diagnosis is made histologically by an eosinophilic granuloma, and the presence of a larva with Y shaped lateral cords. Infestation rate is high in fishes: cod (88%), rock fish (86%), herring (88%), salmon, mackerel. Public health education should discourage the eating of raw fish. Thorough cooking to 70 degrees C or adequate freezing to -20 degrees C for 72 h are the best preventive measures. Such legislation is only in force in the Netherlands, where cases have decreased dramatically.

Abdominal Pain↗