CYTOPATHOLOGY, Issue 1 2006
M. Al-Haddad
Non-small cell lung cancer is a common cancer with significant mortality. Accurate and early staging of this cancer has a significant impact on outcome. Endoscopic ultrasound-guided fine needle aspiration of involved mediastinal lymph nodes is critical for staging. Several molecular markers have been identified recently in association with non-small cell carcinoma of the lung that are promising to make early detection of metastatic disease more reliable. [source]

Endoscopic ultrasound-guided fine needle aspiration diagnosis of metastatic sex cord tumor with annular tubules: A case report

DIAGNOSTIC CYTOPATHOLOGY, Issue 8 2006
Lori J. Ryan M.D.
Abstract The cytologic findings of a paratracheal metastasis from a malignant sex cord tumor with annular tubules (SCTATs) diagnosed by endoscopic ultrasound guided fine needle aspiration are described. Cytologic features of SCTATs include the presence of highly cellular aspirates forming simple and complex rosette-like structures around central rounded hyaline material, small nucleoli, and prominent nuclear grooves. These cytologic findings are clearly distinct from the poorly formed rosette-like structures of granulosa-cell tumors and are reminiscent of the low-power appearance of the cribriform variant of adenoid cystic carcinoma. The fine needle aspiration cytologic features of only two other cases have been previously described and, to the best of our knowledge, this is the first case reporting the cytologic diagnosis of a distant metastasis of a SCTATs by endoscopic ultrasound-guided fine needle aspiration. In this case, the distinctive and characteristic cytologic features have allowed the proper diagnosis of a distant metastasis of SCTATs. Diagn. Cytopathol. 2006;34:576,579. © 2006 Wiley-Liss, Inc. [source]

PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERY

DIGESTIVE ENDOSCOPY, Issue 1 2003
Kazuhiro Yada
We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source]

Oral endoscopy as an aid to diagnosis of equine cheek tooth infections in the absence of gross oral pathological changes: 17 cases

EQUINE VETERINARY JOURNAL, Issue 2 2009
P. H. L. RAMZAN
Summary Reasons for performing study: Removal of cheek teeth in all but the aged horse or pony is a serious undertaking with potentially deleterious sequellae. Rigid endoscopy permits detailed examination of the oral cavity and erupted dental tissues and has the potential to assist in the correct identification of the diseased tooth. Objectives: To document oral endoscopic findings associated with infected equine cheek teeth in cases without gross oral pathological changes and thereby determine the usefulness of rigid oral endoscopy as an aid to diagnosis of such infections. Methods: Records of all cases of equine cheek tooth removal attempted under standing sedation over a 38 month period were examined. Cases were excluded from the study if apical infection was associated with gross dental fracture, malalignment, diastema/periodontal pocketing or supernumerary teeth. Endoscopic and radiographic findings were analysed and correlated to diseased tooth location. Results: Seventeen cases of apical dental infection fitting the inclusion criteria (nonresponsive to antibiotics and with no gross oral abnormality of the affected arcade) were identified in which oral endoscopy was used as an aid to diagnosis. In 15 (88%) of the 17 cases, oral endoscopy revealed abnormalities specific to the infected tooth. Focal gingival recession (10/17 cases) was the most common visible abnormality associated with infected teeth. Conclusions: In the majority of cases of apical infection of equine cheek teeth there is visible intraoral evidence implicating the affected tooth. Potential relevance: Oral endoscopy facilitates detailed examination of the mouth and should be considered along with radiography as an important aid to diagnosis in cases of equine dental infection. [source]

Randomized, placebo-controlled trial of low molecular weight heparin in active ulcerative colitis

INFLAMMATORY BOWEL DISEASES, Issue 6 2007
M.A. de Bièvre MD
Abstract Background: In several open and 1 controlled trial, unfractionated heparin was effective in the treatment of active ulcerative colitis (UC). Low molecular weight heparin (LMWH) had a similar effect in several open studies. Methods: We studied the efficacy, safety, and tolerability of LMWH in mild to moderately active UC in a randomized, double-blind, placebo-controlled trial. In all, 29 patients with a mild or moderate recurrence of UC during salicylate treatment were randomized to receive either reviparin 3,436 IU (n = 15) subcutaneously twice daily or placebo (n = 14). The study period was 8 weeks. Treatment was discontinued if there was no improvement at 4 weeks or at any disease progression. Primary outcome measure was clinical improvement at 8 weeks measured by the Colitis Activity Index (CAI) and the Clinical Symptoms Grading (CSG, based on the CAI). Endoscopic and histologic grading and quality of life as measured by the Inflammatory Bowel Disease Questionnaire (IBDQ) were secondary outcome measures. Patients were closely monitored for adverse events. Results: Twenty of 29 patients finished the 8-week treatment period (reviparin versus placebo: 11 versus 9; P = 0.70). There was no difference in CSG, CAI, endoscopic and histologic grading, or IBDQ. Treatment was well tolerated and no serious adverse events occurred. Conclusion: In this study, treatment with LMWH showed no significant clinical advantage compared to placebo in mild to moderately active UC. (Inflamm Bowel Dis 2007) [source]

Oro-facial granulomatosis: Crohn's disease or a new inflammatory bowel disease?

INFLAMMATORY BOWEL DISEASES, Issue 9 2005
FRCP, Jeremy Sanderson MD
Abstract Background: Oro-facial granulomatosis (OFG) is a rare chronic inflammatory disorder presenting characteristically with lip swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Histologically, OFG resembles Crohn's disease (CD), and a number of patients with CD have oral involvement identical to OFG. However, the exact relationship between OFG and CD remains unknown. Methods: Thirty-five patients with OFG and no gut symptoms were identified from a combined oral medicine/gastroenterology clinic. All underwent a standardized assessment of the oral cavity and oral mucosal biopsy to characterize the number of sites affected and the type of inflammation involved. Hematological and biochemical parameters were also recorded. All 35 patients underwent ileocolonoscopy and biopsy to assess the presence of coexistent intestinal inflammation. Results: Ileal or colonic abnormalities were detected in 19/35 (54%) cases. From gut biopsies, granulomas were present in 13/19 cases (64%). An intestinal abnormality was significantly more likely if the age of OFG onset was less than 30 years (P = 0.01). Those with more severe oral inflammation were also more likely to have intestinal inflammation (P = 0.025), and there was also a correlation between the histologic severity of oral inflammation and the histologic severity of gut inflammation (P = 0.047). No relationship was found between any blood parameter and intestinal involvement. Conclusions: Endoscopic and histologic intestinal abnormalities are common in patients with OFG with no gastrointestinal symptoms. Younger patients with OFG are more likely to have concomitant intestinal involvement. In these patients, granulomas are more frequent in endoscopic biopsies than reported in patients with documented CD. OFG with associated intestinal inflammation may represent a separate entity in which granulomatous inflammation occurs throughout the gastrointestinal tract in response to an unknown antigen or antigens. [source]

Endoscopic Versus Conventional Radial Artery Harvest,Is Smaller Better?

JOURNAL OF CARDIAC SURGERY, Issue 4 2006
Oz M. Shapira M.D.
Methods: Data were prospectively collected on 108 consecutive patients undergoing isolated CABG with ERH, and compared to 120 patients having conventional harvest (CH). Follow-up was achieved in 227 patients (99%). At the time of follow-up the severity of motor and sensory symptoms, as well as cosmetic result in the harvest forearm, were subjectively graded using a 5-point scale. Grade 1,high intensity deficits, poor cosmetic result. Grade 5,no deficits, excellent cosmetic result. Results: Hospital mortality, myocardial infarction, and stroke rates were similar between the groups. Follow-up mortality, reintervention rate, and average angina class were also similar. Harvest time was longer in the ERH group (61 ± 24 min vs. 45 ± 11 min, p < 0.001). Three patients in the ERH group were converted to CH and one radial artery was discarded. There were no vascular complications of the hand in either group. Average score of motor (ERH 4.4 ± 0.9, CH 4.2 ± 1.0) or sensory symptoms (ERH 3.7 ± 1.1, CH 3.8 ± 1.2) were similar. In the CH group sensory deficits were observed in the distribution of both the lateral antebrachial cutaneous and the superficial radial nerves (SRN). In contrast, sensory deficits in the ERH group were limited to the distribution of the SRN. Cosmetic result score was higher in the ERH group (ERH 4.2 ± 1.0, CH 3.1 ± 1.4, p < 0.0001). Conclusions: ERH is safe. It is technically demanding with a significant learning curve. Motor and sensory symptoms are not completely eliminated by using a smaller incision, but cosmetic results are clearly superior. [source]

Prospective peer-review audit of paediatric upper gastrointestinal endoscopy

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2007
Edward V O'Loughlin
Aim: To describe the findings of paediatric upper gastrointestinal endoscopy (UGE) and to reduce the rate of normal findings in children undergoing diagnostic UGE. Methods: Upper gastrointestinal endoscopy were performed at a single tertiary referral children's hospital over a 3-year period by four endoscopists. Patients were subgrouped into diagnostic categories (recurrent abdominal pain syndrome (RAP), oesophagitis, coeliac disease and enteropathy/inflammatory bowel disease) and endoscopists recorded their clinical diagnosis as above before each procedure. Endoscopic and biopsy findings were compared with clinical diagnosis. After the first year of audit each endoscopist was appraised of their practice and strategies implemented to reduce the normal UGE. In years 2 and 3 all endoscopists were audited by their peers on a monthly basis. Results: A total of 1172 UGE were performed over a 3-year period. Ninety per cent were diagnostic procedures, of which 48% were normal, 16% identified oesophagitis, 11% coeliac disease, 6% gastritis, 3%Helicobacter pylori and 1% peptic ulcer disease. Peer-review audit significantly reduced the number of normal findings in coeliac disease, RAP and overall (P < 0.01) but not in the groups with presumed oesophagitis or investigation of enteropathy/inflammatory bowel disease. Conclusions: A high proportion of patients undergoing UGE have normal procedures. Peer-review audit can reduce the number of normal procedures particularly in RAP and in the diagnosis of coeliac disease. [source]

The response of Crohn's strictures to endoscopic balloon dilation

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010
T. MUELLER
Aliment Pharmacol Ther,31, 634,639 Summary Background, Endoscopic balloon dilation has been shown to be an alternative to surgery in the treatment of Crohn's symptomatic strictures. Aim, To analyse the impact of the type of the strictures ,de novo or anastomotic , their location and their length on the outcome of endoscopic balloon dilation. Methods, Between December 1999 and June 2008, 55 patients underwent 93 balloon dilations for 74 symptomatic strictures. One stricture was located in the duodenum, 39 strictures were in the terminal ileum, 17 at the ileocoecal anastomosis after a preceding resection and 17 in the colon. Results, Endoscopic treatment was successful in 76% of the patients during an observation period of 44 (1,103) months. Of the patients, 24% required surgery. All patients who underwent surgery had de novo strictures in the terminal ileum. These strictures were significantly longer compared with the ileal strictures that responded to endoscopic treatment [7.5 (1,25) cm vs. 2.5 (1,25) cm; P = 0.006]. Conclusions, The long-term success of endoscopic balloon dilation depends on the type of the strictures, their location and their length. Failure of endoscopic treatment was observed only in long-segment strictures in the terminal ileum. [source]

Systematic review: endoscopic and imaging-based techniques in the assessment of portal haemodynamics and the risk of variceal bleeding

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
S. N. SGOUROS
Summary Background, Invasive measurement of the hepatic venous pressure gradient (HVPG) is regarded as the gold standard for risk stratification and the evaluation of pharmaceutical agents in patients with portal hypertension. Aim, To review the techniques for endoscopic and imaging-based assessment of portal haemodynamics, with particular emphasis on trials where the results were compared with HVPG or direct portal pressure measurement. Methods, Systematic search of the MEDLINE electronic database with keywords: portal hypertension, variceal bleeding, variceal pressure, endoscopic ultrasound, Doppler ultrasonography, magnetic resonance angiography, CT angiography, hepatic venous pressure gradient. Results, Computed tomography angiography and endoscopic ultrasound (EUS) have been both employed for the diagnosis of complications of portal hypertension and for the evaluation of the efficacy of endoscopic therapy. Colour Doppler ultrasonography and magnetic resonance angiography has given discrepant results. Endoscopic variceal pressure measurements either alone or combined with simultaneous EUS, correlate well with HVPG and risk of variceal bleeding and have a low interobserver variability. Conclusions, Endoscopic and imaging-based measurements of portal haemodynamics provide an alternate means for the assessment of complications of portal hypertension. Further studies are required to validate their use in risk stratification and the evaluation of drug therapies in patients with portal hypertension. [source]

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
Y. TOUCHEFEU
Summary Background, Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and accurate technique for diagnosing pancreatic cancer. However, its impact for management of these patients is poorly investigated. Aims, To investigate the diagnostic yield and the therapeutic impact of EUS-FNA in the management of solid pancreatic masses. Methods, One hundred consecutive patients who underwent EUS-FNA for a solid pancreatic mass were included. Aspirates were placed onto glass slides for cytological examination and microbiopsies were fixed in formaldehyde for histology. The impact on clinical management was analysed retrospectively according to different endpoints, such as its impact on indications for chemotherapy, surgery or appropriate follow-up modality. Results, Eight procedures were considered failures and two patients were lost to follow-up. A final diagnosis was obtained in 90 patients. The sensitivity, specificity and accuracy of combined cytology and histology for the diagnosis of malignant or potentially-malignant tumours were 78%, 75%, and 78% respectively. The sensitivity and accuracy of cytology alone were significantly higher than those of histology alone (P = 0.0003). By intention-to-diagnose analysis, EUS-FNA directly influenced the management strategy in 62 of 100 patients. Conclusions, In patients with pancreatic mass and suspected malignancy, EUS-FNA provides an accurate diagnosis in approximately 80% of cases. EUS-FNA directly influences the management in two-thirds of patients. [source]

Endoscopic, Biopsy, and Histopathologic Guidelines for the Evaluation of Gastrointestinal Inflammation in Companion Animals

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010
The WSAVA International Gastrointestinal Standardization Group
First page of article [source]

Lingual Thyroidectomy: Endoscopic and Harmonic-Assisted

THE LARYNGOSCOPE, Issue S1 2009
Melanie W. Seybt MD
No abstract is available for this article. [source]

Development of a New Tissue-Engineered Sheet for Reconstruction of the Stomach

ARTIFICIAL ORGANS, Issue 10 2009
Masato Araki
Abstract We have developed tissue-engineered digestive tracts composed of collagen scaffold and an inner silicon sheet and successfully used it to repair defects in parts of the esophagus, stomach, and small intestine. However, some improvements were demanded for clinical usage because the silicon sheet presented technical difficulties for suturing and endoscopic removal. New tissue-engineered sheet (New-sheet) was composed of a single-piece and reinforced collagen scaffold with biodegradable copolymer. One beagle dog was used to evaluate whether New-sheet could withstand suturing in comparison with native digestive tracts using a tensile tester. Seven beagle dogs had a 5-cm circular defect created in the stomach. New-sheet soaked with autologous peripheral blood or bone marrow aspirate was sutured to the gastric wall. Endoscopic, histological, and immunohistochemical assessment was performed to evaluate regeneration of the stomach up to 16 weeks. Tensile strength testing showed that the mucosal side of New-sheet had strength almost equivalent to the mucosa of the esophagus (P = 0.61). Endoscopically, regeneration of the mucosa started from the circumference after 4 weeks, but a small linear ulcer was still evident at 16 weeks. The regenerated stomach shrank by 60,80% of its original size and histologically showed villous mucosa and underlying dense connective tissue. Immunohistochemically, the regenerated area expressed ,-smooth-muscle actin but was negative for basic calponin, irrespective of the source of soaked blood. New-sheet shows sufficient strength for suturing, no dehiscence, and better biocompatibility for clinical use, although further examination will be necessary to create a functional digestive tract. [source]

Is there a relationship between Helicobacter pylori infection and erosive reflux disease in children?

ACTA PAEDIATRICA, Issue 1 2010
Halil Haldun Emiroglu
Abstract Aim:, The aim of this study was to investigate the relationship between Helicobacter pylori infection and erosive reflux disease in children. Methods:, A total of 206 children [mean age 8.4 ± 4.9 (0.16,18) years] who underwent diagnostic upper endoscopy were tested for H. pylori infection between 2002 and 2005 and the relationship between H. pylori infection and gastro-oesophageal reflux disease was investigated retrospectively. Endoscopic and histopathological findings were examined retrospectively. When reflux-related oesophageal damage was identified as a result of the histological examination of endoscopic biopsy samples collected from distal oesophagus, the patients were diagnosed with gastro-oesophageal reflux disease and divided into two groups: those with macroscopic erosions or ulceration constituted the erosive oesophagitis group; those without constituted the non-erosive reflux disease group. Results:, Prevalence of H. pylori infection was 31.3% in the patients with gastro-oesophageal reflux disease and 36.7% in the control group (p > 0.05). Prevalence of erosive oesophagitis was found to be 23.8% in the patients with H. pylori infection and 41.3% in those without (p > 0.05). Conclusion:, No negative significant association was found between the prevalence of H. pylori infection and erosive oesophagitis. Presence of H. pylori infection did not influence the severity of oesophagitis either. [source]

Endoscopic ultrasound-guided fine needle aspiration diagnosis of metastatic sex cord tumor with annular tubules: A case report

PRELIMINARY EXPERIENCE OF A PROTOTYPE FORWARD-VIEWING CURVED LINEAR ARRAY ECHOENDOSCOPE IN A TRAINING PHANTOM MODEL

DIGESTIVE ENDOSCOPY, Issue 2010
Hiroshi Imaizumi
Oblique-viewing curved linear array (OV-CLA) echoendoscopes have been widely used to perform endoscopic ultrasonography-guided fine needle aspiration and interventional endoscopic ultrasonography. Recently a prototype forward-viewing curved liner array (FV-CLA) echoendoscope was developed. In the present trial, 11 endoscopists participated in a hands-on trial and a questionnaire survey to evaluate the operation performance and visualization performance of a prototype FV-CLA scope in a phantom model designed for training of endoscopic ultrasonography. The results of our trial suggested that the FV-CLA scope is slightly inferior or equivalent to the conventional OV-CLA scope in operation performance, and that the FV-CLA scope is equivalent to the OV-CLA scope with regard to the visualization performance in a phantom model. [source]

ENDOSCOPIC TRANSPAPILLARY CATHETERIZATION INTO THE GALLBLADDER FOR DIAGNOSIS OF GALLBLADDER CARCINOMA

DIGESTIVE ENDOSCOPY, Issue 2 2006
Naohito Uchida
It is often difficult to determine the precise nature of lesions in the gallbladder by radiographic, endoscopic and ultrasonographic methods. The approach to the gallbladder by a percutaneous transhepatic route has been reported. However, there is a possibility of seeding tumor cells into the peritoneal cavity and liver in a percutaneous procedure. On the contrary, transpapillary route can be performed without a possibility of seeding. The double-contrast cholecystography, intragallbladder sonography, direct biopsy of gallbladder lesions and cytology using gallbladder bile have been performed by the procedure of the transpapillary catheterization into the gallbladder. Confirming malignancy by histopathological diagnosis is desirous for determining therapeutic strategy in gallbladder carcinoma. Gathering gallbladder bile is comparatively easier than biopsy of the lesion using the transpapillary catheterization into the gallbladder. Examination of telomerase-related molecules is useful for diagnosis of pancreatic carcinoma. Usefulness of combination assay of human telomerase reverse transcriptase mRNA (hTERT mRNA) and cytology using gallbladder bile obtained by transpapillary catheterization is reported here. However, it would appear that hTERT mRNA is less important in the diagnosis of gallbladder carcinoma than in that of pancreatic carcinoma. When the molecular biological substances with higher sensitivity are found, the reliance of the combination assay of the molecular biological substances and cytology will be established. [source]

CONCURRENT GASTRIC AND COLONIC LOW-GRADE MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMATA IN A PATIENT WITHOUT HELICOBACTER PYLORI INFECTION

DIGESTIVE ENDOSCOPY, Issue 1 2003
HIROYUKI OKADA
Mucosa-associated lymphoid tissue (MALT) lymphomata observed simultaneously in the stomach and colon are rare. We report concurrent gastric and colonic low-grade MALT lymphomata that originated from the same clone in a 58-year-old Japanese man without Helicobacter pylori infection. Endoscopy showed multiple erosive lesions in the gastric body and antrum, and a single flat elevation with an irregular margin in the sigmoid colon. Histopathological findings of both lesions suggested low-grade MALT lymphoma. Lymphoepithelial lesions were evident in the gastric lesions, but not in the colonic lesion. Southern blot analysis of lymphoma cells revealed the same immunoglobulin heavy-chain rearrangement pattern. The chromosomal translocation t(11;18)(q21;q21) was also observed. After six courses of cyclophosphamide, doxorubicin, vincristine and predonisolone, the gastric lesions disappeared endoscopically, while the colonic lesion persisted. A sigmoidectomy was consequently performed. The chromosomal translocation may be related to the pathogenesis of the present MALT lymphoma case without H. pylori infection. It is interesting that the gastric and colonic lesions differed in response to treatment and in their endoscopic and histologic features, despite having the same origin. [source]

Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis

DIGESTIVE ENDOSCOPY, Issue 4 2002
Michio Kaminishi
Background:,Various types of classification of gastritis have been proposed, but no plausible classification has been available until now. The Research Society for Gastritis performed a pilot study to establish an endoscopic classification, taking into consideration the following: (i) ease of use; (ii) permitting everyone the common image; and (iii) presence of histopathological evidence. Methods:,One hundred and fifty-five patients were enrolled and underwent gastroscopy. Eight basic endoscopic and histological types of gastritis (superficial, hemorrhagic, erosive, verrucous, atrophic, metaplastic, hyperplastic and special types) were defined. Gastritis was endoscopically diagnosed according to the definition of the endoscopic types of gastritis. Four or more biopsy specimens were obtained from the lesser and the greater curvatures of the antrum and the corpus of each patient, and the histological findings of gastritis and Helicobacter pylori infection were assessed. The histological diagnosis of gastritis was made according to the definition of histology types of gastritis. The endoscopic and the histological diagnoses were then compared in a blinded fashion. Results:,Endoscopic diagnosis was 62% as sensitive as histological diagnosis for erosive gastritis, 67% for verrucous gastritis and 84% for atrophic gastritis in the antrum. In superficial gastritis, sensitivity was approximately 25% in the corpus, but only 8% in the antrum. Metaplastic and hyperplastic gastritis were correctly diagnosed only in severe cases. Conclusion:,Five basic types of gastritis (superficial, erosive, verrucous, atrophic and special types) should be employed for the new endoscopic gastritis classification. Metaplastic and hyperplastic gastritis are considered to be subtypes of atrophic gastritis and they should be excluded from the basic endoscopic classification. A new definition of gastritis in the antrum accompanied by redness still remains to be investigated. [source]

Three-dimensional endoscopic ultrasonography for the assessment of early gastric carcinoma invasion: could it provide diagnostic innovations?

DIGESTIVE ENDOSCOPY, Issue 2 2002
EMAN A. SABET
Background: This study aimed to evaluate a three-dimensional endoscopic ultrasonographic (3-D EUS) system in the assessment of the tumor invasion depth of early gastric carcinoma. Methods: Sixty-nine macroscopically early cancer lesions in 67 patients were recruited in an in vivo study. The surgically resected gastric specimens of 30 of them were re-examined in an ex vivo study. An Olympus 3-D EUS imaging system was employed in both studies. Diagnostic accuracy for tumor invasion depth was evaluated and compared with histopathological sections stained by H&E and Masson's trichrome stain. Reconstructed surface-rendering images were evaluated and compared with the endoscopic and macroscopic findings. Results: Three-dimensional EUS allowed rapid tomographic assessment of the lesions in both the in vivo and ex vivo studies. The accuracy of 3-D EUS for the assessment of tumor invasion depth was 87% in the in vivo study. The accuracy rate was significantly lower (P = 0.03) for the cancer lesions associated with ulcer fibrosis (74%) than for those with no fibrosis (97%). In the 30 subjects who underwent both studies, the accuracy rates were higher in the ex vivo than the in vivo study (94%vs 77% for all the lesions, and 93%vs 74% for cancers associated with fibrosis), but were not statistically significant. The rates of good surface-rendering images were 64% and 94% in the in vivo and ex vivo studies, respectively. The differences were attributed to the clearer dual-plane reconstruction images obtained in the ex vivo study in absence of motion artifacts. Conclusions: Three-dimensional EUS is a promising imaging technique for the assessment of tumor invasion depth of early gastric cancer. [source]

Familial trends of inheritance in gastro esophageal reflux disease, Barrett's esophagus and Barrett's adenocarcinoma: 20 families

DISEASES OF THE ESOPHAGUS, Issue 1 2007
R. S. Sappati Biyyani
SUMMARY., We reported four families with familial Barrett's esophagus (FBE) in 1993. This follow-up study includes an additional 16 families with FBE, gastroesophageal reflux disease (GERD) and BE-related adenocarcinoma (BEAC) highlighting the familial trends of inheritance. A retrospective survey of endoscopic and histopathological reports on 95 confirmed cases of BE from 1975 to 2005 was performed and a detailed family history was obtained. Five representative pedigrees from a total of 20 are discussed here. These 20 families represent one of the largest cohorts studied over three decades from a single institution. Familial BE is more common than previously thought and the prevalence of GERD, BE and BEAC in these families is distinctly higher than with sporadic cases. The conditions appear to be inherited in an autosomal dominant fashion with incomplete penetrance. Hence diligence in taking family history with BE patients is critical since the endoscopic screening of relatives is warranted in FBE. Earlier diagnosis and surveillance of FBE should hopefully improve outcomes. [source]

Angiolipoma of the esophagus: a rare clinical dilemma

DISEASES OF THE ESOPHAGUS, Issue 3 2006
E. H. Jensen
SUMMARY., Benign tumors of the esophagus are a rare but diverse group of lesions. Although non-malignant in biology, their presence can cause significant morbidity, including dysphagia, bleeding, gastrointestinal obstruction, and even asphyxiation. Diagnosis is frequently made using radiographic and endoscopic means, even in the absence of definitive biopsy. If discovered early, endoscopic or minimally invasive techniques may be used to excise these lesions, with essentially 100% cure rates. However, if discovered late, open excision or even esophagectomy may be required. Angiolipoma represents perhaps one of the rarest of the benign entities to affect the esophagus, with only a few cases reported in the current literature. We present the case of an 85-year-old man who developed complete esophageal obstruction due to a large, pedunculated angiolipoma, requiring open surgical excision. [source]

Transoral laser surgery for supraglottic cancer

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2008
Juan P. Rodrigo MD
Abstract The goal of treatment for supraglottic cancer is to achieve cure and to preserve laryngeal function. Organ preservation strategies include both endoscopic and open surgical approaches as well as radiation and chemotherapy. The challenge is to select the correct modalities for each patient. Endoscopic procedures should be limited to tumors that can be completely visualized during diagnostic microlaryngoscopy. If complete resection can be achieved, the oncologic results of transoral laser surgery appear to be comparable to those of classic supraglottic laryngectomy. In addition, functional results of transoral laser resection are superior to those of the conventional open approach, in terms of the time required to restore swallowing, tracheotomy rate, incidence of pharyngocutaneous fistulae, and shorter hospital stay. The management of the neck remains of paramount importance, as survival of patients with supraglottic cancer depends more on cervical metastasis than on the primary tumor. Most authors advocate bilateral elective neck dissection. However, in selected cases (T1,T2 clinically negative [N0] lateral supraglottic cancers), ipsilateral selective neck dissection could be performed without compromising survival. The authors conclude that with careful selection of patients, laser supraglottic laryngectomy is a suitable, and often the preferred, treatment option for supraglottic cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

Role of endoscopic surgery in the management of selected malignant epithelial neoplasms of the naso-ethmoidal complex

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2007
Piero Nicolai MD
Abstract Background. This study reviews the outcome of patients with adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the naso-ethmoidal complex treated by endoscopic surgery. Methods. Sixteen patients underwent a purely endoscopic excision of AC (n = 12) or SCC (n = 4) at 2 university hospitals. All patients were prospectively followed by endoscopic and MRI evaluations. Results. The tumor originated from the ethmoid in 13 cases and the nasal fossa in 3. Lesions were staged as follows: 5 T1, 10 T2, and 1 T3. Adjuvant radiotherapy was delivered in 7 cases. Follow-up (range, 28,70 months; mean, 47.25) was available for all patients. One patient died for brain metastases 28 months after surgery. Another patient required salvage craniofacial resection and radiotherapy for recurrent AC. Five-year disease-specific and disease-free survival rates were 93.3% and 87.0%, respectively. Conclusions. In selected T1-T2 lesions of the naso-ethmoidal complex, endoscopic surgery seems to offer a satisfactory alternative to external procedures. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source]

Technique of endoscopic retrograde puncture and dilatation of total esophageal stenosis in patients with radiation-induced strictures

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004
Ronald J. Lew MD
Abstract Background. Complete esophageal stenosis can occur after external beam radiation therapy for malignancies. Treatment for this complication has traditionally involved surgery. Methods. A new technique to reestablish luminal patency is described. This minimally invasive technique involves retrograde endoscopy by means of gastrostomy tube tract and puncture of the stenotic occlusion followed by stricture dilatation. The procedure is performed under combined endoscopic and laryngoscopic guidance. Results. Five consecutive patients who had complete esophageal stenoses develop after radiation therapy for malignant disease underwent retrograde endoscopy by way of gastrostomy tube tracts. Stenoses were punctured under endoscopic and laryngoscopic guidance with guide wires. Strictures were dilated with wire-guided balloons or polyvinyl dilators. Luminal patency was established in all patients using this technique without procedural complications. Conclusions. Endoscopic retrograde puncture and dilatation of total esophageal stenoses is safe, effective, and useful to reestablish luminal patency for radiation-induced strictures. This technique should be attempted before more invasive treatments. © 2004 Wiley Periodicals, Inc. Head Neck26: 179,183, 2004 [source]

Impact of Helicobacter pylori Eradication Therapy on Histologic Change in the Distal Esophagus

HELICOBACTER, Issue 4 2006
Masanori Toyoda
Abstract Background:, Although cases of reflux esophagitis (RE) developing after treatment to eradicate Helicobacter pylori have been discussed in some detail, no reports are available concerning the histologic examination of RE both before and after eradication therapy. Materials and methods:, Sixty-one patients and 111 specimens were investigated using endoscopic and histologic techniques. The histologic findings including basal zone height, papillar height, Ki-67 labeling index, and COX-2 expression before and after treatment for H. pylori infection were compared with those in normal controls and patients with endoscopic RE. Results:, Twelve months after eradication therapy, the incidence of newly developed endoscopic RE was 20% (5/25). Basal zone height and papillar height had increased at 1 month, but had returned to pretreatment levels after 12 months of eradication therapy. The Ki-67 labeling index was significantly increased 1 and 12 months after eradication therapy compared to values before treatment. COX-2 expression gradually increased after the treatment. The phenomena linked to esophagitis appeared after eradication therapy. However, the severity and extent of these signs were not so high after the treatment of H. pylori than those in patients with overt reflux esophagitis. Focusing on the patients with hiatal hernia, papillar height and Ki-67 labeling index increased significantly after eradication therapy, values being almost the same as those in the patients with endoscopic RE. Conclusions:, Hiatal hernia plays an important role in the possible occurrence of hidden RE after treatment for a H. pylori infection. [source]

Should Non-Invasive Helicobacter pylori Testing Replace Endoscopy in Investigation of Dyspepsia?

HELICOBACTER, Issue S1 2000
Kenneth McColl
Our knowledge of Helicobacter pylori infection is now changing the way in which we investigate patients presenting with dyspepsia, with noninvasive H. pylori testing replacing endoscopy. Non-invasive H. pylori testing has been shown to be useful in predicting the underlying diagnosis in patients presenting with dyspepsia. Several studies have shown that 20,50% of dyspeptic patients with a positive H. pylori test will have evidence of underlying ulcer disease or duodenitis. In contrast, less than 5% of dyspeptic patients with a negative H. pylori test will have evidence of ulcer disease and in these subjects, the likeliest diagnosis is gastroesophageal reflux disease. This has led to many groups recommending that noninvasive H. pylori testing should be used in place of endoscopy, with all those testing positive being given anti- H. pylori therapy and those testing negative being treated symptomatically. One concern about nonendoscopic management of dyspeptic patients is the possibility of missing underlying malignancy but studies have shown that in western countries this is rare in patients less than 55 years of age presenting with dyspepsia in the absence of sinister symptoms. There is increasing evidence supporting eradication of H. pylori infection in dyspeptic patients without ulcer disease. Meta-analysis of four prospective randomized trials indicates that such treatment is superior to placebo in about 10% of subjects. H. pylori -positive dyspeptic patients are also recognized to have an increased risk of developing ulcer disease in the future which will be removed by treating the infection. Another justification for eradicating the infection in the absence of ulcer disease is the fact that H. pylori infection is now proven to be a risk factor for gastric cancer. Prospective randomized studies comparing endoscopy with noninvasive H. pylori testing in the management of dyspeptic patients indicate that managing dyspepsia by noninvasive H. pylori testing is at least as effective as endoscopic-based management in producing symptomatic resolution and saves a substantial number of endoscopic procedures. There is therefore now substantial evidence indicating that noninvasive H. pylori testing should be used in place of endoscopy to determine the management of younger dyspeptic patients without sinister symptoms and who are not taking nonsteroidal anti-inflammatory drugs. [source]

Upper digestive bleeding in cirrhosis.

HEPATOLOGY, Issue 3 2003
Post-therapeutic outcome, prognostic indicators
Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis. The aim of this multicenter, prospective, cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis. A training set of 291 and a test set of 174 bleeding cirrhotic patients were included. Treatment was according to the preferences of each center and the follow-up period was 6 weeks. Predictive rules for 5-day failure (uncontrolled bleeding, rebleeding, or death) and 6-week mortality were developed by the logistic model in the training set and validated in the test set. Initial treatment controlled bleeding in 90% of patients, including vasoactive drugs in 27%, endoscopic therapy in 10%, combined (endoscopic and vasoactive) in 45%, balloon tamponade alone in 1%, and none in 17%. The 5-day failure rate was 13%, 6-week rebleeding was 17%, and mortality was 20%. Corresponding findings for variceal versus nonvariceal bleeding were 15% versus 7% (P = .034), 19% versus 10% (P = .019), and 20% versus 15% (P = .22). Active bleeding on endoscopy, hematocrit levels, aminotransferase levels, Child-Pugh class, and portal vein thrombosis were significant predictors of 5-day failure; alcohol-induced etiology, bilirubin, albumin, encephalopathy, and hepatocarcinoma were predictors of 6-week mortality. Prognostic reassessment including blood transfusions improved the predictive accuracy. All the developed prognostic models were superior to the Child-Pugh score. In conclusion, prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades. Initial treatment stops bleeding in 90% of patients. Accurate predictive rules are provided for early recognition of high-risk patients. [source]

Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension

HEPATOLOGY RESEARCH, Issue 8 2010
Norihito Watanabe
Aim:, The Clinical Research Committee of the Japan Society for Portal Hypertension has conducted a nationwide questionnaire survey to clarify the current status of ectopic varices in Japan. Methods:, A total of 173 cases of ectopic varices were collected. Results:, Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion. Conslusions:, Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future. [source]