Performing high-quality colonoscopy is one of the important goals of gastroenterology practices and requires achieving a high level of bowel cleansing, performing good and safe polypectomy, and ...detecting all polyps present in the colon. This article summarizes currently available techniques and technologies to maximize mucosal visualization. Several maneuvers can be applied during insertion and withdrawal of the colonoscope to optimize mucosal visualization and decrease the number of missed polyps. Newly developed technologies support the endoscopist in the detection of polyps. Each technique is reviewed, with emphasis on the impact on colorectal polyp detection.
We describe the case of a 58-year-old man with recurrent adenocarcinoma at the site of an esophagogastrostomy that we treated by radical surgical resection and jejunal interposition. Oral intake was ...started on the 6th postoperative day and the patient was discharged on the 11th postoperative day. Seven months after the surgical procedure no signs of tumor recurrence were detected. Resection of localized (recurrent) esophageal cancer may well be a valuable treatment option and is therefore an interesting therapeutic option in patients with recurrent disease. However this needs to be investigated in a randomized controlled trial.
ERCP as an outpatient treatment: a review Jeurnink, Suzanne M., MSc; Poley, Jan Werner, MD; Steyerberg, Ewout W., PhD ...
Gastrointestinal endoscopy,
07/2008, Volume:
68, Issue:
1
Journal Article
Peer reviewed
Background ERCP on an outpatient basis could be as safe as on an inpatient basis and may also reduce medical costs. Objective To review the available literature to determine the safety of an ERCP ...performed on an outpatient basis. Design A review of the published literature was performed by searching PubMed, the Cochrane Library, EMBASE, and the Web of Science. Patients Patients who were undergoing an ERCP. Interventions An ERCP on an inpatient or outpatient basis. Main Outcome Measurements Patient and treatment characteristics, complications, and prolonged hospital admissions and readmissions. Results Eleven studies were included in this review, of which 5 were comparative studies, 5 were prospective studies, and 1 was a retrospective study. In these series, a total of 2483 patients underwent an ERCP on an outpatient basis and 2320 patients were admitted overnight after an ERCP. Complications were seen in 184 of 2483 outpatients (7%), of which 72% of complications (107/149) presented within 2 to 6 hours, 10% (15/149) within 6 to 24 hours, and 18% (27/149) more than 24 hours after the ERCP. Three percent of the inpatients (82/2320) developed a complication, of which 95% of complications (78/82) presented within 24 hours and 5% (4/82) presented more than 24 hours after the ERCP. A prolonged hospital stay after an ERCP was indicated in 6% of the designated outpatients (148/2483), whereas 3% of outpatients (74/2149) and <1% of inpatients (4/2320) were readmitted after discharge. Limitations Limited data available. Conclusions This review shows that, with a selective policy, an ERCP on an outpatient basis seems as safe as when performed on an inpatient basis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background It has been suggested that Barrett's esophagus (BE) is associated with an increased risk of developing colorectal neoplasia, but this has no been reported consistently. Aim To study ...whether BE is associated with an increased risk of colorectal neoplasia, and if it is, whether it is dependent on use of proton-pump inhibitors (PPIs) or aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Design Case-control study. Setting Endoscopic database of the Palo Alto Veterans Affairs Health Care System. Population 268 veterans with BE were matched with 268 controls without BE. Intervention Controls had undergone upper GI endoscopy within 14 days of the corresponding case. Colonoscopy was performed within 6 months in cases and controls. Main outcome measure Development of colorectal neoplasia. Results Colorectal neoplasia was present in 162 of 268 (60%) BE patients and in 105 of 268 (40%) controls ( p < 0.001). The presence of BE (odds ratio OR 2.02: 95% CI 1.35, 3.04), but also increasing age (OR 1.24 per decade: 95% CI 1.04, 1.48) and alcohol use (OR 1.70: 95% CI 1.16, 2.50) were associated with an increased risk of colorectal neoplasia in multivariable logistic regression analysis, whereas PPIs (OR 0.99: 95% CI 0.66, 1.48) and aspirin/NSAIDs (OR 0.90: 95% CI 0.61, 1.33) had no meaningful effect. Limitations This was a retrospective study. Conclusions Veterans with BE are at an increased risk of developing colorectal neoplasia. This association is independent from the use of PPIs or aspirin/NSAIDs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
46.
Esophageal cancer Siersema, Peter D
Gastroenterology clinics of North America,
12/2008, Volume:
37, Issue:
4
Journal Article
Peer reviewed
The incidence of esophageal cancer, in particular esophageal adenocarcinoma, is increasing, largely due to an increase in risk factors for adenocarcinoma. When esophageal cancer is confirmed by upper ...endoscopy, staging is required for the optimal selection of patients who should undergo esophageal resection. Neoadjuvant chemoradiation may be able to improve survival after esophageal cancer surgery. Endoscopic therapy for early esophageal neoplasia is effective and safe, with the best results being obtained by an individualized approach using endoscopic mucosal resection, ablative therapy, or both. Finally, dysphagia from esophageal cancer can be successfully treated with stent placement or single-dose brachytherapy. Future research should establish whether combinations of chemotherapy with or without radiation therapy play a role in survival.
Background Large sessile polyps almost always contain villous tissue with appreciable premalignant potential and tend to recur locally after colonoscopic resection. Developing new endoscopic ...techniques for the removal of polyps requires a large animal model of colorectal polypoid lesions. So far, no appropriate large animal model of a colorectal or other GI polyp has been described in the English literature. Objective Our purpose was to develop a large animal model simulating large, perfused and viable, sessile colorectal polypoid lesions, with distinct easily detectable histologic features. Setting An animal laboratory. Interventions Two simulated rectal polyps, using 2 different techniques, were created in each of 10 animals. The polyps were simulated by ovarian tissue that was introduced either intraluminally through the rectal wall or into a dissected submucosal space in the rectal wall. In 2 animals the created polyps were endoscopically resected. Results All submucosal lesions were sessile-like polypoid lesions because the base of the polyp was the widest diameter of the lesion. All transmural polypoid lesions had short and thick pedicles. Resection by snaring and cutting was demonstrated to be feasible. Main Outcome Measurements The mean measurements of the submucosal-simulated polyps were as follow: 1.74 cm (±0.32) × 2.07 cm (±0.42) × 1.51 cm (±0.27). The mean measurements of the transmural-simulated polyps were significantly larger: 2.55 cm (±0.52) × 3.57 cm (±1.1) × 2.7cm (±0.64). Limitation This model does not simulate a real intestinal neoplasia. Conclusion Either method, the submucosal or the transmural, could be helpful in the research and development efforts of surgical and endoscopic treatments of intestinal polyps.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background It is well known that a learning curve exists for performing EUS. Objective To determine whether the number of EUS investigations performed in a center affects the results of esophageal ...cancer staging. Design We compared EUS in the evaluation of T stage and the presence of regional and celiac lymph nodes in a low-volume center where <50 EUS/endoscopist/y were performed with reported results from 7 high-volume EUS centers. Setting A reference center for esophageal cancer (>90 cases/y) but a low-volume center for EUS when it comes to individual endoscopists. Patients From 1994 to 2003, 244 patients underwent EUS, without specific measures to pass a stenotic tumor or FNA and with postoperative TNM stage as the criterion standard in the low-volume EUS center. In the high-volume centers, 670 EUS investigations for esophageal cancer were performed, if needed, with dilation, and with postoperative TNM stage and/or FNA as the criterion standard. Interventions Retrospective analysis. Main Outcome Measurements Sensitivity and specificity of EUS for esophageal cancer staging. Results In the low-volume center, results of EUS for T3 staging in patients in whom passage of the EUS probe was possible were almost comparable for sensitivity (85% vs 88%-94%) but were lower for specificity (57% vs 75%-90%), whereas both sensitivity (58% vs 75%-90%) and specificity (87% vs 94%-97%) for T1 or T2 stages were lower than those reported in the high-volume centers. In the low-volume center, sensitivities of EUS for regional (45% vs 63%-89%) and celiac (19% vs 72%-83%) lymph nodes were lower, whereas specificities (75% vs 63%-82% and 99% vs 85%-100%, respectively) were comparable with those from high-volume centers. Results in the low-volume EUS center were worse if the EUS probe could not pass the stricture, which occurred in almost 30% of patients. Limitations Both FNA and dilation before EUS for stenotic tumors were not performed in the low-volume EUS center. Conclusions The results of EUS performed in a low-volume EUS center compared unfavorably with those reported from high-volume EUS centers. The results of this study suggest that preoperative staging by EUS should be performed by experienced and dedicated EUS endoscopists to optimize staging of esophageal cancer.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
