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Sample records for duodenoscopy

  1. 十二指肠镜联合腹腔镜治疗胆囊和胆总管结石的临床分析%Duodenoscopy combined with laparoscopy in the treatment of gallstone and choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    周政; 黄志刚; 王光明; 刘有理; 章社民

    2016-01-01

    目的:评价十二指肠镜联合腹腔镜治疗胆囊结石和胆总管结石的临床效果,与传统开腹胆囊切除、胆总管切开取石比较分析。方法选择60例胆囊结石并胆总管结石患者,按随机数字表法分为双镜微创组和开腹组,其中30例双镜微创组先行内镜胰胆管造影(ERCP)+十二指肠乳头 Oddis 括约肌切开术(EST)+胆总管取石术,再行腹腔镜胆囊切除术(LC 术)。另外30例行传统开腹胆囊切除+胆总管切开取石术。将两组的手术时间、平均住院时间、并发症发生率进行比较分析。结果双镜微创组26例患者 ERCP +EST +胆总管取石术成功,胆总管结石全部取出,术后留置鼻胆管引流;4例由于结石过大未取出,留置胆管支架。25例1周内行三孔法 LC 术。10例并发胰腺炎,2例患者年龄较大,合并高血压病等基础病,治疗后2周行 LC 术。双镜微创组创伤小,出血量少,恢复快,但容易并发胰腺炎。传统开腹组创伤大,出血量较多,12例结石未完全取出,容易并发切口感染,恢复时间长。结论ERCP 联合 LC 术用于治疗胆囊、胆总管结石具有效果好、创伤小、术后并发症少、恢复快等优点,临床疗效满意。%Objective To evaluate the clinical effect of duodenoscopy combined with laparoscopy in the treatment of gallstone and cho-ledocholithiasis,and to compare with traditional cholecystectomy and choledocholithotomy.Methods Sixty patients of gallstone and choledocholithiasis admitted were randomized into minimally invasive double endoscopic group and laparotomy group.The 30 patients of minimally invasive double endoscopic group were firstly given endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic sphincterotomy(EST)+choledocholithotomy,then given laparoscopic cholecystectomy (LC).The other 30 patients underwent tradition-al cholecystectomy and choledocholithotomy.The operation

  2. 十二指肠镜联合腹腔镜手术治疗老年胆囊结石合并胆总管结石124例%Duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis in 124 aged patients

    Institute of Scientific and Technical Information of China (English)

    尹小军; 张荣春; 王向平; 郭学刚

    2012-01-01

    目的 探讨十二指肠镜联合腹腔镜续贯治疗老年患者胆囊结石合并肝外胆管结石的疗效.方法 回顾分析2010年1月至12月246例老年患者(年龄大于等于60岁)胆囊结石合并肝外胆管结石的临床资料,按手术方式的不同分为微创组和传统手术组.微创组(n=124)采用十二指肠镜下内镜乳头括约肌切开术(EST)取石再行腹腔镜胆囊切除术(LC),传统手术组(n=122)采用传统开腹胆囊切除术胆总管切开取石T管引流术,对比两组住院时间、并发症和结肠功能恢复时间等.结果 微创组与传统手术组比较,住院时间短、并发症低和术后结肠功能恢复时间短,差异均有明显的统计学意义(P<0.01);两组手术时间无统计学差异(P>0.05).结论 十二指肠镜联合腹腔镜续贯治疗老年胆囊结石合并肝外胆管结石具有微创、安全、疗效良好等优点.%Objective To evaluate the efficacy of duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis and to discuss its clinical significance. Methods The clinical data of 246 aged patients with cholecyslithiasis complicated with choledocholithiasis ( age ≥ 60 years) from January 2010 to December 2010 were retrospectively analyzed. The patients were divided into the minimally invasive group (n =124) and the conventional surgery group (n = 122). The patients in the minimally invasive group were underwent duodenoscopy,endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) while those in the conventional surgery group (n = 122) were experienced traditional open cholecystectomy,choledocholithotomy and T-tube drainage. The hospital stay, complications and recovery time of the colon function were compared between the two groups. Results The hospital stay was shorter in the minimally invasive group compared with that in the conventional therapy group,P 0. 05 ) . Conclusion consecutive treatment of

  3. Gastric duplication associated with pancreas divisum diagnosed by a multidisciplinary approach before surgery

    Institute of Scientific and Technical Information of China (English)

    Marta; Di; Pisa; Gabriele; Curcio; Gianluca; Marrone; Mariapina; Milazzo; Marco; Spada; Mario; Traina

    2010-01-01

    We report a unique case of communicating gastric duplication associated with pancreas divisum,diagnosed with a multidisciplinary approach,including X-rays,computed tomography,magnetic resonance imaging,esophagogastro duodenoscopy,ultrasound endoscopy and histology. We believe that this approach constitutes a fuller diagnostic evaluation,resulting in better and safer surgery.

  4. Flexible Gastrointestinal Endoscopy in Ferrets (Mustela putorius furo).

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    Pignon, Charly; Huynh, Minh; Husnik, Roman; Jekl, Vladimir

    2015-09-01

    Gastrointestinal disease is a common complaint in ferrets (Mustela putorius furo). Their relatively simple and short gastrointestinal tract makes them good candidates for flexible endoscopy. However, apart from a few references in biomedical research articles, there is little information on the use of flexible endoscopy in ferrets. This review describes patient preparation, equipment, and select gastrointestinal endoscopy techniques in ferrets, including esophagoscopy, gastroscopy, duodenoscopy, percutaneous endoscopic gastrostomy, jejunoileoscopy, colonoscopy, and biopsy.

  5. Are gastric hyperplastic polyps an additional manifestation in celiac disease?

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    Dore, Maria Pina; Pes, Giovanni Mario; Rocchi, Chiara; Loria, Maria Francesca; Soro, Sara; Bassotti, Gabrio

    2017-01-01

    Abstract Gastric polyps are frequently reported in patients undergoing upper endoscopic procedures. In this retrospective study, the association between hyperplastic polyps and celiac disease in Northern Sardinia was estimated. Age, gender, body mass index, and medications taken in the 2 preceding months, including proton-pump inhibitors (PPIs), H2 receptor blockers (anti-H2), Helicobacter pylori status, endoscopic findings, and histology from charts of patients undergoing esophago-gastro-duodenoscopy were reviewed. Polyps were classified as hyperplastic, fundic gland, inflammatory, and adenomatous. 3.7% (423/11379) patients had celiac disease. Prevalence of gastric polyps was 4.2% (3.8% among celiac vs 4.2% nonceliac patients). Inflammatory polyp was the most common histotype (55.8% and 56.2%) followed by fundic gland polyps (31.4% and 43.7%), hyperplastic (8.7% and 0%), and adenomas, in celiac and nonceliac patients, respectively. Fundic gland polyps were more common in PPI users (odds ratio: 4.06) than in nonusers (2.65, P = 0.001) among celiac and nonceliac patients. Age older than 50, female gender, esophago-gastro-duodenoscopy year, and PPI use were associated with the presence of polyps, whereas active H pylori infection was not. Gastric polyps were common in Sardinian patients undergoing esophago-gastro-duodenoscopy. However, the previously reported association between hyperplastic polyps and celiac disease was not confirmed in our study. PMID:28151870

  6. Unusual case of a large midoesophageal diverticulum mimicking unstable angina pectoris.

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    Hoffmann, J C; Pistorius, G; Müller, P; Zeitz, M

    2002-04-01

    We describe a 77-year-old lady who presented with progressive retrosternal pain radiating to the left arm and the back. After exclusion of cardiac causes a large midoesophageal diverticulum was found on oesophago-gastro-duodenoscopy. Importantly, the retrosternal pain completely disappeared after endoscopic removal of impacted food from the diverticulum. After the surgical resection the patient became fully asymptomatic. This is the first example of angina-like chest pain which definitively resulted from a midoesophageal diverticulum. Therefore, midoesophageal diverticula should be considered as a rare differential diagnosis of exercise-induced retrosternal pain.

  7. Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Daniel; Ahn; Praveen; Guturu

    2010-01-01

    The PillCam ESO(Given Imaging,Israel) or esophageal capsule endoscopy(ECE) is a novel technique used in the diagnostic evaluation of esophagus.Many studies have been performed to compare the accuracy of ECE against the current gold standard esophagogastro-duodenoscopy and a meta-analysis recently published by Lu et al suggests that ECE may have an acceptable sensitivity and specificity in detecting esophageal varices.We would like to discuss the importance and implication of publication bias in this meta-an...

  8. [Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics].

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    Peghini, M; Rajaonarison, P; Pecarrere, J L; Razafindramboa, H; Andriantsoavina, H; Rakotomalala, M; Ramarokoto, N

    1996-01-01

    The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.

  9. Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy

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    Oliver J. Ziff

    2013-01-01

    Full Text Available Colonoscopy is widely accepted as the gold-standard screening technique for detecting malignancies in the distal gastrointestinal tract in patients with symptoms suggestive of colon cancer. However, this procedure is not without risk, including colonic perforation. We report a patient who was managed conservatively after colonoscopy induced perforation. Eighteen months after appearing to make a full recovery, he presented with an upper gastrointestinal bleed. Oesophago-gastro-duodenoscopy (OGD revealed large gastric fundal varices and computed tomography (CT revealed splenic vein thrombosis. The ensuing left-sided (sinistral hypertension explains the development of the fundal varices in the presence of normal liver function. At surgery, a persistent abscess cavity was identified and cultures from this site grew Streptococcus anginosus. Curative splenectomy was performed and the patient made a full recovery. We advocate more prompt operative intervention in selected cases of iatrogenic colonic perforation with primary repair to prevent late complications.

  10. An impacted pancreatic stone in the papilla induced acute obstructive cholangitis in a patient with chronic pancreatitis.

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    Yoo, Kwang-Ho; Kwon, Chang-Il; Yoon, Sang-Wook; Kim, Won Hee; Lee, Jung Min; Ko, Kwang Hyun; Hong, Sung Pyo; Park, Pil Won

    2012-03-01

    Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well.

  11. [A case of hemorrhagic cholecystitis associated with Churg-Strauss syndrome].

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    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Tabata, Taku; Koizumi, Koichi; Kurata, Masanao; Horiguchi, Shinichiro; Hishima, Tsunekazu

    2016-01-01

    A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion. On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder. We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome.

  12. Megaduodenum in a patient with acromegaly

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    Belinda George

    2012-01-01

    Full Text Available Introduction: Acromegaly is associated with enlargement of all organs including the gastro intestinal system. However, there are no previous reports of occurrence of megaduodenum in patients with acromegaly. Discussion: We present the case of a 47 year old male who was diagnosed to have acromegaly 13 years ago and had undergone transsphenoidal surgery twice with incomplete removal of the pituitary macro-adenoma and received radiotherapy following the second surgery. Patient has been on replacement therapy for hypocortisolism, hypothyroidism and hypogonadism since 10 years. Post glucose growth hormone level continued to remain unsuppressed; however, patient never received any medical therapy for acromegaly. He was evaluated with esophago-gastro-duodenoscopy for recurrent abdominal pain and distension, which showed an elongated and tortuous megaduodenum. These findings were verified with a barium study which revealed dilated stomach, first and second part of duodenum with no evidence of a distal obstruction. Conclusions: We report this finding in view of the rare association.

  13. Diffuse duodenal nodular lymphoid hyperplasia: a large cohort of patients etiologically related to Helicobacter pylori infection

    Science.gov (United States)

    2011-01-01

    Background Nodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes. There are no published reports of its association with Helicobacter pylori infection. Methods From March 2005 till February 2010, we prospectively followed all patients with diffuse duodenal nodular lymphoid hyperplasia (DDNLH). Patients underwent esophagogastroduodenoscopy with targeted biopsies, colonoscopy, and small bowel video capsule endoscopy. Duodenal nodular lesions were graded from 0 to 4 based on their size and density. Patients were screened for celiac sprue (IgA endomysial antibody), immunoglobulin abnormalities (immunoglobulin levels & serum protein electrophoresis), small intestine bacterial overgrowth (lactulose hydrogen breath test), and Helicobacter pylori infection (rapid urease test, and histological examination of gastric biopsies). Patients infected with Helicobacter pylori received sequential antibiotic therapy and eradication of infection was evaluated by 14C urea breath test. Follow up duodenoscopies with biopsies were performed to ascertain resolution of nodular lesions. Results Forty patients (Males 23, females 17; mean age ± 1SD 35.6 ± 14.6 years) with DDNLH were studied. Patients presented with epigastric pain, vomiting, and weight loss. Esophagogastroduodenoscopy showed diffuse nodular lesions (size varying from 2 to 5 mm or more) of varying grades (mean score ± 1SD 2.70 ± 0.84) involving postbulbar duodenum. Video capsule endoscopies revealed nodular disease exclusively limited to duodenum. None of the patients had immunoglobulin deficiency or small intestine bacterial overgrowth or positive IgA endomysial antibodies. All patients were infected with Helicobacter pylori infection. Sequential antibiotic therapy eradicated Helicobacter pylori infection in 26 patients. Follow up duodenoscopies in these patients showed significant reduction of duodenal nodular lesions score (2.69 ± 0.79 to 1.50 ± 1

  14. Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual

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    Kim, Jin Woong [Chonnam National University Hwasun Hospital, Department of Radiology, Hwasun-gun, Jeollanam-do (Korea, Republic of); Shin, Sang Soo [Chonnam National University Medical School, Department of Radiology, Gwangju (Korea, Republic of); Chonnam National University Medical School, Center for Aging and Geriatrics, Gwangju (Korea, Republic of); Heo, Suk Hee; Lim, Hyo Soon; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam National University Medical School, Department of Radiology, Gwangju (Korea, Republic of); Choi, Yoo Duk [Chonnam National University Medical School, Department of Pathology, Gwangju (Korea, Republic of); Park, Young Kyu [Chonnam National University Medical School, Department of Surgery, Gwangju (Korea, Republic of); Park, Chang Hwan [Chonnam National University Medical School, Department of Internal Medicine, Gwangju (Korea, Republic of)

    2012-03-15

    To evaluate the accuracy of 64-section multidetector CT with CT gastrography for determining the depth of mural invasion in patients with gastric cancer according to the 7th edition of the AJCC cancer staging manual. A total of 127 patients with gastric cancer and who had undergone both esophago-gastro-duodenoscopy and 64-section CT were included in this study. Two radiologists independently reviewed the preoperative CT images with respect to the detectability and T-staging of the gastric cancers. The sensitivity, specificity, accuracy and overall accuracy of each reviewer for the T staging of gastric cancer were calculated. Overall, gastric cancer was detected in 123 (96.9%) of the 127 cancers on the CT images. Reviewer 1 correctly staged 98 gastric cancers, and reviewer 2 correctly classified 105 gastric cancers. The overall diagnostic accuracy of the T staging was 77.2% (98/127) for reviewer 1 and 82.7% (105/127) for reviewer 2. 64-section CT using CT gastrography showed a reasonable diagnostic performance for determining the T staging in patients with gastric cancer according to the 7th edition of the AJCC cancer staging manual. (orig.)

  15. Adenocarcinoma of the third portion of the duodenum in a man with CREST syndrome

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    Fragulidis Georgios

    2008-10-01

    Full Text Available Abstract Background CREST (Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasias syndrome has been rarely associated with other malignancies (lung, esophagus.This is the first report of a primary adenocarcinoma of the third portion of the duodenum in a patient with CREST syndrome. Case presentation A 54-year-old male patient with CREST syndrome presented with colicky postprandial pain of the upper abdomen, diminished food uptake and a 6-Kg-body weight loss during the previous 2 months. An ulcerative lesion in the third portion of the duodenum was revealed during duodenoscopy, with a diagnosis of adenocarcinoma on biopsy specimen histology. The patient underwent a partial pancreatoduodenectomy. No adjuvant therapy was instituted and follow-up is negative for local recurrence or metastases 21 months postoperatively. Conclusion CREST syndrome has been associated with colon cancer, gastric polyps, familial adenomatous polyposis (FAP syndrome and Crohn's disease; however, this is the first report of a primary adenocarcinoma of the duodenum in a patient with CREST syndrome. However, any etiologic relationship remains to be further investigated.

  16. Usefulness of biopsying the major duodenal papilla to diagnose autoimmune pancreatitis: A prospective study using TgG4-immunostaining

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Hitoshi Nakajima; Naoto Egawa; Kouji Tsuruta; Atsutake Okamoto

    2006-01-01

    AIM: To examine the histological and immunohistochemical findings of biopsy specimens taken from the major duodenal papilla of autoirnrnune pancreatitis (AIP)patients.METHODS: The major duodenal papilla in the resected pancreas of 3 patients with AIP and of 5 control patients [pancreatic carcinoma (n = 3) and chronic alcoholic pancreatitis (n = 2)] was irnrnunostained using anti-CD4-T cell, CD8-T cell and IgG4 antibodies. Forceps biopsy specimens taken from the major duodenal papilla of 2patients with AIP and 5 control patients with suspected papillitis were prospectively taken during duodenoscopy and immunohistochernically examined.RESULTS: Moderate or severe lyrnphoplasrnacytic infiltration including many CD4-positive or CD8-positive T lymphocytes and IgG4-positive plasma cells (≥10/HPF),was observed in the major duodenal papilla of all 3 patients with AIP. The same findings were also detected in the biopsy specimens taken from the major duodenal papilla of 2 patients with AIP, but in controls, there were only a few (≤3/HPF) IgG4-positive plasma cells infiltrating the major duodenal papilla.CONCLUSIONS: An abundant infiltration of IgG4-positive plasma cells is specifically detected in the major duodenal papilla of patients with AIP. Although this is a preliminary study, IgG4-irnmunostaining of biopsy specimens taken from the major duodenal papilla may support the diagnosis of AIP.

  17. Interaction of Ethnicity and H. pylori Infection in the Occurrence of Microscopic Colitis.

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    Sonnenberg, Amnon; Turner, Kevin O; Genta, Robert M

    2017-04-01

    Previous studies found that microscopic colitis is inversely associated with Helicobacter pylori infection and that microscopic colitis is characterized by a marked ethnic variation. The aim of the present study was to test whether an underlying ethnic variation of H. pylori infection is responsible for the ethnic variation of microscopic colitis. The Miraca Life Sciences Database is a large national electronic repository of histopathologic records of patients distributed throughout the entire USA. A cross-sectional study evaluated the influence of age, gender, ethnicity, and histologic diagnosis of H. pylori on the occurrence of microscopic colitis among subjects who underwent esophago-gastro-duodenoscopies plus colonoscopy. The total study population comprised 228,506 subjects, of whom 28,890 carried a diagnosis of H. pylori gastritis and 3460 microscopic colitis. Female sex, old age, and H. pylori infection exerted the strongest influence on the occurrence of microscopic colitis. In comparison with the population comprising Caucasians and African-Americans, microscopic colitis was less common among subjects of Hispanic (0.34, 0.27-0.47), East Asian (0.13, 0.06-0.22), Indian (0.31, 0.10-0.73), or Middle Eastern descent (0.28, 0.07-0.74). All these ethnic subgroups were also characterized by a higher prevalence of H. pylori than the comparison group. A low prevalence of H. pylori was significantly associated with a high prevalence of microscopic colitis (R (2) = 0.91, p microscopic colitis.

  18. A rare case of iron-pill induced gastritis in a female teenager: A case report and a review of the literature.

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    Meliţ, Lorena Elena; Mărginean, Cristina Oana; Mocanu, Simona; Mărginean, Maria Oana

    2017-07-01

    The treatment of iron-deficiency anemia with oral iron supplements can present side-effects on the GI tract mucosa including necrosis, ulceration, or ischemia. The particular endoscopic findings and the histopathological exam will establish the diagnosis of erosive gastritis with iron deposits in the gastric mucosa. We present the case of a 14-year-old female admitted in our clinic for upper digestive hemorrhage, nausea, melena, and abdominal pain. Her personal history revealed iron deficiency anemia receiving oral iron supplements for approximately 2 weeks. The laboratory tests at the moment of admission pointed out anemia, increased level of serum iron, increased liver transaminases, a decreased level of ferritin, but with normal levels of both total iron-binding capacity and transferrin. The eso-gastro-duodenoscopy revealed multiple brown deposits on the surface of the gastric mucosa and multiple hemorrhagic lesions, under the aspect of erosions all over the gastric mucosa, but more severe in the antral part, and the histopathological exam confirmed the presence of iron deposits at this level. Iron-pill induced gastritis is a rare, under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact.

  19. Primary small-cell neuroendocrine carcinoma of the duodenum – a case report and review of literature

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    Nagai Hideo

    2004-08-01

    Full Text Available Abstract Background Small-cell neuroendocrine carcinoma in the duodenum is an extremely rare neoplasm with poor prognosis. Case presentation A 57-year-old man presented with sudden onset gastrointestinal bleeding and fainting attacks. Duodenoscopy and hypotonic duodenography revealed a 3 × 3 cm protruding tumor with ulcerations situated opposite the ampulla of Vater in the second part of the duodenum. Local excision of the tumor was performed, followed by adjuvant chemotherapy with 5-fluoro uracil and leucovorin. Examination of the tumor by immunohistochemistry and electron microscopy indicated it to be neuroendocrine in nature, expressing synaptophysin and AE1/AE3, and containing dense core granules. The patient showed no sign of recurrence and has been disease-free for more than 48 months after surgery. Conclusions Most cases of small-cell neuroendocrine carcinoma in the duodenum show rapid progression of the disease, and even radical surgery with or without chemotherapy do not prevent death. We report a rare subtype of small-cell neuroendocrine carcinoma. This subtype appears to have a much better prognosis, and may be amenable to local excision, if the lesion is away from the ampulla of Vater.

  20. [Clinical trial with a preparation based on propolis "propolisina" in human giardiasis].

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    Miyares, C; Hollands, I; Castañeda, C; González, T; Fragoso, T; Currás, R; Soria, C

    1988-01-01

    The results of a clinic assay with an extract made out of propolis (bee glue) or "Propolisina" were showed with the aim of showing its effectivity against giardiasis. One hundred and thirty eight patients were studied 48 children and 90 adults, in 2 groups and they selected aleatorily to be treated with "Propolosina" or an imidazole derivate (tinidazole). The method for an exact diagnosis in children was duodenal aspiration and in adults duodenal mucosa frotis by means of duodenoscopy. Similar studies were carried out as a cure criterium in a 5-day term after being through with the treatment. Propolisina was used with different concentrations: in children (concentration at 10%) results showed a 52% cure. In 40 adults (concentration at 20%) it was obtained a similar result to that of tinidazole; and when propolisina concentration was elevated at 30% in the remaining 50 patients there was a higher effectivity (60 of cure Vs 40% with tinidazole). This work shows the success of this natural product, which is very easy to obtain in Cuba and with no side effects in the treatment of this intestinal parasitism, what is of great economical importance for our countries.

  1. A giant gastric bezoar in billroth II stomach: a case report on successful endoscopic removal via repeated fragmentation and dissolution technique negating the need for surgical intervention

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    Jin Yu Chieng

    2016-08-01

    Full Text Available A 76-year-old gentleman presented with anemia. He had a history of perforated duodenal ulcer six years ago, with Billroth II repair performed. A large gastric bezoar (8X6cm2 with a clean base ulcer at the anastomotic junction was found during the initial Oesophago-gastro-duodenoscopy (OGDS. Rapid urease test was negative. He presented with melena during the subsequent follow up (OGDS showed a Forrest Ib prepylori ulcer. We have successful removed the gastric bezoar with dissolution therapy initially (injection of coke-cola into the bezoar, followed by drinking 325ml coca-cola twice daily, followed by four attempts of OGDS with endoscopic fragmentation. Histopathology reported as degenerated vegetable matter, acellular debris mixed with scattered fungal and bacterial colonies, which was compatible with bezoar. Follow up OGDS showed complete clearance of the bezoar. Coca-cola ingestion should be considered as initial treatment as it is non-invasive, and it enables further successful endoscopic fragmentation.

  2. 86例胆道蛔虫症的诊疗回顾%Review of the Diagnosis and the Treatment of 86 Cases of Biliary Ascariasis

    Institute of Scientific and Technical Information of China (English)

    李洪明; 周仕勇; 刘林

    2013-01-01

    目的:回顾性分析86例胆道蛔虫症患者的诊疗过程,探讨胆道蛔虫症的诊疗方法。方法:首先予以中药乌梅汤加肠虫清口服,高压氧治疗,未能成功者施以十二指肠镜检查结合ERCP方法治疗,二者均失败后采用胆道探查术。结果:采用多种方法相结合的综合治疗患者均治愈。结论:采用多种方法相结合治疗胆道蛔虫症的综合疗法值得推广。%Objective:To retrospectively analyze the diagnosis and the treatment process of 86 cases of biliary ascariasis.Method:Firstly patients were given the decoction of fructus mume and oral zentel,hyperbaric oxygen therapy,if this method failed then patients were imposed the duodenoscopy combined with the ERCP treatment,if both methods were failed then patients were given the duct exploration.Result:The patients treated by comprehensive treatment combined multiple methods were all cured.Conclusion:The comprehensive treatment combined with multiple methods to treat biliary ascariasis is worthy of promoting.

  3. Selenium intoxication with selenite broth resulting in acute renal failure and severe gastritis

    Directory of Open Access Journals (Sweden)

    Kamble P

    2009-01-01

    Full Text Available Selenium (Se is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF. The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN, affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP and platelet concentrates and hemo-dialysis. The patient was discharged five weeks after admission and her renal functions reco-vered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.

  4. Low phospholipid associated cholelithiasis: association with mutation in the MDR3/ABCB4 gene

    Science.gov (United States)

    Rosmorduc, Olivier; Poupon, Raoul

    2007-01-01

    Low phospholipid-associated cholelithiasis (LPAC) is characterized by the association of ABCB4 mutations and low biliary phospholipid concentration with symptomatic and recurring cholelithiasis. This syndrome is infrequent and corresponds to a peculiar small subgroup of patients with symptomatic gallstone disease. The patients with the LPAC syndrome present typically with the following main features: age less than 40 years at onset of symptoms, recurrence of biliary symptoms after cholecystectomy, intrahepatic hyperechoic foci or sludge or microlithiasis along the biliary tree. Defect in ABCB4 function causes the production of bile with low phospholipid content, increased lithogenicity and high detergent properties leading to bile duct luminal membrane injuries and resulting in cholestasis with increased serum gamma-glutamyltransferase (GGT) activity. Intrahepatic gallstones may be evidenced by ultrasonography (US), computing tomography (CT) abdominal scan or magnetic resonance cholangiopancreatography, intrahepatic hyperechogenic foci along the biliary tree may be evidenced by US, and hepatic bile composition (phospholipids) may be determined by duodenoscopy. In all cases where the ABCB4 genotyping confirms the diagnosis of LPAC syndrome in young adults, long-term curative or prophylactic therapy with ursodeoxycholic acid (UDCA) should be initiated early to prevent the occurrence or recurrence of the syndrome and its complications. Cholecystectomy is indicated in the case of symptomatic gallstones. Biliary drainage or partial hepatectomy may be indicated in the case of symptomatic intrahepatic bile duct dilatations filled with gallstones. Patients with end-stage liver disease may be candidates for liver transplantation. PMID:17562004

  5. Synchronous gastric adenocarcinoma and pancreatic ductal adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Mirko Muroni; Francesco D'Angelo; Massimo Pezzatini; Simone Sebastiani; Samantha Noto; Emanuela Pilozzi; Giovanni Ramacciato

    2010-01-01

    BACKGROUND: The association between gastric and pancreatic carcinoma is a relatively rare condition. In gastric carcinoma patients, the prevalence of second tumors varies 2.8% to 6.8% according to the reported statistics. Gastric cancer associated with pancreatic cancer is uncommon. METHODS: We report a case of a 73-year-old patient hospitalized for vomiting and weight loss. Esophagogastro-duodenoscopy demonstrated an ulcerative lesion of the gastric antrum. Computed tomography and magnetic resonance showed a gastric thickening in the antral and pyloric portion and a nodular mass (3×1.7 cm) in the uncinate portion of the pancreas. RESULTS: The patient underwent pancreaticoduoden-ectomy according to Whipple regional typeⅠFortner. Histological examination of the specimen demonstrated a moderately differentiated adenocarcinoma of the stomach and a poorly differentiated ductal adenocarcinoma of the pancreas. CONCLUSIONS: Long survival is rare in patients with associated gastric and pancreatic cancer. Surgical resection remains the only potentially curative treatment.

  6. Epidemiology of Helicobacter pylori among multiracial community in Northern Peninsular, Malaysia:effect of age across race and gender

    Institute of Scientific and Technical Information of China (English)

    Sreenivasan Sasidharan; Subramanion Jo Thy Lachumy; Manickam Ravichandran; Lachimanan Yoga Latha; Surasa Rao Surya Gegu

    2011-01-01

    Objective: To study the epidemiology of Helicobacter pylori (H. pylori) infection according to age group. Methods: H. pylori infection data among 1 965 consecutive patients referred to the Endoscopy Unit collected at Sungai Petani Hospital for oesophagogastro-duodenoscopy (OGD). The patients were divided into 9 age groups (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89 and 90-99 years). In addition these groups were further divided into three minor group namely young adults (10-39), older adults (40-69) and geriatric groups (70-99). Results: Overall prevalence of infection of H. pylori was analyzed and found that the prevalence increase with age (P<0.05). When the patients divided by ethnic and gender group with age, prevalence rate among young adults and older adults significantly higher (P<0.05) compared to geriatric groups across all races and gender (P<0.05). Furthermore, significantly higher number of males were infected compared to female (P<0.05) but such trend was only observed among older adult groups. In addition, there is a significant differences in H. pylori infection prevalence rates among ethnic groups (highest in Indians adults, followed Chinese and low in Malays, P<0.05). Conclusions:The overall prevalence of H. pylori did increase with age group across ethnicity and gender, in Northern Peninsular Malaysia.

  7. 胆道及十二指肠恶性梗阻多支架置入治疗及体会%Experience of multiple biliary and duodenal stenting in the treatment of malignant biliary and duodenal obstruction

    Institute of Scientific and Technical Information of China (English)

    施云星; 王广勇; 曾晓虹; 吕礁; 周国中; 刘长云; 覃林花

    2014-01-01

    Objective To investigate the therapeutic effects of combined biliary and duodenal stenting in the treatment of ma-lignant biliary and duodenal obstruction.Methods Medical data concerning 3 cases of malignant biliary and duodenal obstruction trea-ted with combined biliary and duodenal stenting in our hospital were summarized.PTCD biliary metallic stent placement was first per-formed in one patient with recurrent gastric tumor, and then duodenal stent insertion was done under gastroscopy.Biliary metallic stent and duodenal metal stenting was performed concurrently under duodenoscopy in one patient with periampullary cancer.Due to jaundice after surgery, biliary plastic stenting through duodenal metal stent mesh was performed in the patient.There was one patient with duode-nal cancer, who was first treated with inner and outer biliary drainage through PTCD, and then biliary metallic stent was placed through the sinus, and finally duodenal metal stenting was performed under duodenoscopy.Results Total bilirubin after stenting in the 3 pa-tients decreased significantly, and symptoms of upper digestive obstruction were improved considerably, and no serious complications occurred in the 3 patients.Conclusion Multiple metal stenting was an effective method for the treatment of malignant biliary and duo-denal obstruction, and could improve the life quality of patients as well.Methods for the placement of multiple stents could be different in one patient from another.%目的:探讨联合应用胆道支架及十二指肠支架治疗胆道及十二指肠恶性梗阻的疗效。方法总结我院3例胆道及十二指肠恶性梗阻患者行胆道及十二指肠支架治疗的资料。1例胃癌复发患者,先经皮经肝穿刺胆道引流术( PTCD)下胆道金属支架置入,然后行胃镜下胃十二指肠支架置入;1例壶腹周围癌患者,十二指肠镜下胆道金属支架及十二指肠内金属支架同时置入,术后因再次黄疸,经十二

  8. [Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting].

    Science.gov (United States)

    Arismendi-Morillo, G; Hernández, I; Mengual, E; Abreu, N; Molero, N; Fuenmayor, A; Romero, G; Lizarzábal, M

    2013-01-01

    Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI. One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi. The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer. Copyright © 2012 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  9. A rare case of fever of unknown origin: inflammatory myofibroblastic tumor of the liver. Case report and review of the literature.

    Science.gov (United States)

    Kruth, Jens; Michaely, Henrik; Trunk, Markus; Niedergethmann, Marco; Rupf, Ann-Katrin; Krämer, Bernhard K; Göttmann, Uwe

    2012-12-01

    We present the case of a rare cause of fever of unknown origin (FUO). FUO is challenging for patients as well as for physicians as there are more than 200 differential diagnoses of FUO (1,2). Pointing out a diagnosis often requires numerous noninvasive and invasive procedures that sometimes even fail to explain the fever. Our patient was admitted twice to our hospital due to remitting fever rising up to 40 degrees C without any subjective discomfort. At the first presentation no clinical focus could be identified. This included the examination of multiple blood and urine cultures, serology, autoimmune serology, transesophageal echocardiography, CT-scan of the lung and the abdomen, and bone scintigraphy. Elevated C-reactive protein (268 mg/l) decreased spontaneously and fever disappeared after 4 weeks. However, the patient was re-admitted 4 months later with identical symptoms. Multiple blood and urine cultures, serology, bone marrow examination, CT-scan of the lung and the abdomen, esophago-gastro-duodenoscopy and colonoscopy still showed no pathological findings. MRI-scan of the abdomen identified a liver tumor of 3.3 cm in diameter in segment 6 without typical signs of an adenoma, focal nodular hyperplasia or hepatocellular carcinoma. Biopsy of the suspect liver lesion revealed an inflammatory myofibroblastic tumor (inflammatory pseudotumor). After surgical resection of the tumor elevated inflammation markers as C-reactive protein normalized and fever disappeared. One year after surgery no more episodes of fever re-occurred. An inflammatory myofibroblastic tumor of the liver can be a rare cause of fever of unknown origin. MRI-scan can be an additional imaging tool to identify previously not recognized liver tumors.

  10. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Khalid Mumtaz; Shahid Majid; Hasnain A Shah; Kashif Hameed; Ashfaq Ahmed; Saeed Hamid; Wasim Jafri

    2007-01-01

    AIM: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC)sclerotherapy of gastric varix (GV).METHODS: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.RESULTS: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-Ⅰ) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV- Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P <0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7(57%). Three patients died after repeat sclerotherapy,one during transjugular intrahepatic portosysternic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).CONCLUSION: GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding.In hospital mortality of patients with bleeding GV is 6%.

  11. Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy

    Institute of Scientific and Technical Information of China (English)

    F Mugica; G Urdapilleta; A Castiella; A Berbiela; F Alzate; E Zapata; L Zubiaurre; P Lopez; JI Arenas

    2007-01-01

    AIM: To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.RESULTS: The indications included intradiverticular papilla in 26 patients (49%), stenosis of a previous sphincterotomy in 19 patients (35.8%), small size of the papilla in 4 patients (7.5%), Billroth Ⅱ gastrectomy in 3 patients (5.6%), and coagulopathy in one patient (1.9%). The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients (39.6%) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2%) presented complications: haemorrhage in 1 patient (1.9%) and mild pancreatitis in 6 patients (11.3%). The mean hospital stay in case of complications was of 3 ± 0.63 d.CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.

  12. The influence of Helicobacter pylori on the ethnic distribution of esophageal eosinophilia.

    Science.gov (United States)

    Sonnenberg, Amnon; Dellon, Evan S; Turner, Kevin O; Genta, Robert M

    2017-06-01

    Environmental factors associated with ethnicity may contribute to the occurrence of eosinophilic esophagitis. Our study aimed to investigate the influence of Helicobacter pylori on the ethnic variation of esophageal eosinophilia in a large national sample of patients undergoing esophago-gastro-duodenoscopy. The Miraca Life Sciences Database is an electronic repository of histopathologic patient records. A case-control study evaluated the influence of ethnicity on the occurrence of esophageal eosinophilia and how age, gender, and histologic diagnosis of H. pylori modify this relationship. The total study population comprised 596 479 subjects, of whom 25 969 harbored a diagnosis of esophageal eosinophilia. Young age, male sex, and H. pylori infection in declining order exerted the strongest influence on the occurrence of esophageal eosinophilia. In comparison with the population comprising of Caucasians and African-Americans, esophageal eosinophilia was less common among patients of African (OR=0.10, 95% CI=0.01-0.46), Middle Eastern (0.22, 0.15-0.31), East Asian (0.32, 0.26-0.38), Indian (0.28, 0.21-0.37), Hispanic (0.40, 0.37-0.43), or Jewish descent (0.58, 0.51-0.66), but more common among patients of Northern European descent (1.25, 1.07-1.45). With the exception of Northern Europeans, all ethnic subgroups were characterized by a higher prevalence of H. pylori than the comparison group. A low prevalence of H. pylori was significantly associated with a high prevalence of esophageal eosinophilia (R(2) =0.90, Ppylori and esophageal eosinophilia, H. pylori infection may be in part responsible for the observed ethnic distribution of esophageal eosinophilia. © 2016 John Wiley & Sons Ltd.

  13. Single-stage management with combined tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis.

    Science.gov (United States)

    Lv, Fujing; Zhang, Shutian; Ji, Ming; Wang, Yongjun; Li, Peng; Han, Wei

    2016-12-01

    The aim of this study was to investigate the value of a single stage with combined tri-endoscopic (duodenoscopy, laparoscopy and choledochoscopy) approach for patients with concomitant cholecystolithiasis and choledocholithiasis. Fifty-three patients with combined gallbladder stones and common bile duct stones from February 2014 to April 2015 were randomized assigned to two groups: 29 patients underwent single-stage surgery with combined duodenoscope, laparoscope and choledochoscope (combined tri-endoscopic group), and 29 patients underwent endoscopic sphincterotomy to remove common bile duct stones followed by laparoscopic cholecystectomy several days later (control group). The success rate of complete stone removal, procedure-related complication, hospital stay and the cost of hospitalization were compared between the two groups. Altogether, 53 patients (29 patients in combined tri-endoscopic group and 24 patients in control group) successfully underwent the surgery and ERCP procedure. Three patients in the control group developed post-ERCP pancreatitis. One case of bile leaking and one case of residual stone were noted in the combined tri-endoscopic group. There were no significant differences between the two groups with regard to both complete stone removal [96.6 % (28/29) vs. 100 % (24/24)] and procedure-related complication rate [3.4 % (1/29) vs. 12.5 % (3/24)] (p > 0.05). No open surgery was required in either group. There were significant differences between the two groups with regard to hospital stay (6.72 ± 1.3 days vs. 10.91 ± 1.6 days, p tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis was just as safe and successful as the control group. In addition, it resulted in a shorter hospital stay and less cost.

  14. Identification of clinical and simple laboratory variables predicting responsible gastrointestinal lesions in patients with iron deficiency anemia

    Directory of Open Access Journals (Sweden)

    Songul Serefhanoglu, Yahya Buyukasik, Hakan Emmungil, Nilgun Sayinalp, Ibrahim Celalettin Haznedaroglu, Hakan Goker, Salih Aksu, Osman Ilhami Ozcebe

    2011-01-01

    Full Text Available Iron deficiency anemia (IDA is a frequent disorder. Also, it may be a sign of underlying serious diseases. Iron deficiency points to an occult or frank bleeding lesion when occurred in men or postmenopausal women. In this study, we aimed to evaluate the diagnostic yield of endoscopy in patients with IDA and to define predictive factors of gastrointestinal (GI lesions causing IDA. Ninety-one patients (77 women, 14 men; mean age: 43 years who were decided to have esophago-duodenoscopy and/or colonoscopy for iron deficiency anemia were interviewed and responded to a questionnaire that included clinical and biochemical variables. The endoscopic findings were recorded as GI lesions causing IDA or not causing IDA. Endoscopy revealed a source of IDA in 18.6 % of cases. The risk factors for finding GI lesions causing IDA were as follows: male gender (p= 0.004, advanced age (> 50 years (p= 0.010, weight loss (over 20% of total body weight lost in last 6 month (p= 0.020, chronic diarrhea (p= 0.006, change of bowel habits (p= 0.043, epigastric tenderness (p= 0.037, raised carcinoembryonic antigen (CEA level (normal range: 0-7 ng/mL (p= 0.039, < 10 gr/dl hemoglobin (Hb level (p=0.054. None of these risk factors had been present in 21 (23% women younger than 51 years. In this group, no patient had any GI lesion likely to cause IDA (negative predictive value= 100%. In multivariate analysis, advanced age (p=0.017, male gender (p< 0.01 and weight lost (p=0.012 found that associated with GI lesions in all patients. It may be an appropriate clinical approach to consider these risk factors when deciding for gastrointestinal endoscopic evaluation in iron deficiency anemia.

  15. The research application of endoscopic double stents for malignant obstructive jaundice%内镜下双支架联合治疗恶性梗阻性黄疸的探讨

    Institute of Scientific and Technical Information of China (English)

    董琳; 郭建阳; 黄允宁; 杨世杰; 杨勇

    2012-01-01

    目的 探讨金属支架联合塑料支架在治疗恶性梗阻性黄疸中的应用.方法 对42例行十二指肠镜下放置金属支架联合塑料支架的患者,与单纯放置金属支架41例及单纯放置塑料支架39例做比较,观察其生存时间及更换支架的次数.结果 十二指肠镜下放置金属支架联合塑料支架42例生存时间较后两者明显延长,同时可以更换金属支架内的塑料支架.结论 十二指肠镜下放置金属支架联合塑料支架在恶性梗阻性黄疸中解决了过去不能更换支架的困难.同时延长了患者的生存期.%Objective To investigate the application of metal and plastic stents for malignant obstructive jaundice. Methods Therapeutic efficacy was compared among the 42 cases of plastic and metal stent placement, 41 cases of metal stent placement and 39 cases of plastic stent placement under duodenoscopy. The survival time and the numbers of stent replacement were compared. Results The survival time in group of combined application of metal stent placed plastic stent was significantly longer than the two others. Moreover the plastic stents can be replaced within the metal stent. Conclusion The application of metal and plastic stents for malignant obstructive jaundice can solve the difficulty of stent replacement and extend the survival of patients.

  16. Prevalence of coeliac disease in idiopathic hypoparathyroidism and effect of gluten-free diet on calcaemic control.

    Science.gov (United States)

    Saha, Soma; Saini, Savita; Makharia, Govind K; Datta Gupta, Siddhartha; Goswami, Ravinder

    2016-04-01

    Patients with idiopathic hypoparathyroidism (IH) require variable doses of calcium and 1-α-(OH)D. The reasons for such variability are not clear. As autoimmune mechanisms may play a role in IH, there is a possibility of coexistent coeliac disease with calcium/vitamin D malabsorption. We assessed the prevalence of coeliac disease and antitissue transglutaminase autoantibodies (anti-tTGAbs) in IH and analysed the effect of a gluten-free diet on calcaemic control. A total of 171 patients with IH and 126 healthy controls were screened for anti-tTGAb. IH patients with anti-tTGAb >20 RU/ml underwent duodenoscopy and intestinal biopsy; those with biopsy-proven coeliac disease were followed up on a gluten-free diet. Eleven of 171 (6·4%) patients with IH and seven of 126 (5·6%) controls had anti-tTGAb (P = 0·81). There was no difference in the clinical and biochemical parameters at diagnosis and during long-term follow-up of 7·2 ± 4·8 year (mean serum total calcium = 1·88 ± 0·16 vs 1·82 ± 0·36 mmol/l, P = 0·52; phosphorus = 1·81 ± 0·17 vs 1·87 ± 0·36 mmol/l, P = 0·53) in IH patients with and without anti-tTGAb. Although CaSRAb positivity was comparable in the two groups, IH patients with anti-tTGAb had higher TPOAb positivity (45·5% vs 12·8%, P = 0·02). Coeliac disease was diagnosed in only 2/9 patients with IH on biopsy, both of whom showed improved calcaemic control with a gluten-free diet. The prevalence of coeliac autoimmunity (6·4%) and coeliac disease (1·2%) in patients with IH seems to be similar to that in the general population. Notwithstanding this modest prevalence, it is important to be aware of the potential occurrence of coeliac disease with IH and the beneficial effect of a gluten-free diet on calcium control. © 2015 John Wiley & Sons Ltd.

  17. 家族性腺瘤性息肉病伴发上消化道息肉57例分析%Upper-gastrointestinal polyps found in cases of familial adenomatous polyposis

    Institute of Scientific and Technical Information of China (English)

    徐晓东; 傅传刚; 宋宁; 张卫; 刘连杰; 孟荣贵; 于恩达

    2012-01-01

    目的 探讨家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)患者伴发上消化道息肉(胃及十二指肠)的发生率、内镜下的表现特征及其病理学特点.方法 对上海第二军医大学长海医院2004年1月至2010年6月收治的57例临床诊断为FAP患者采用胃镜、十二指肠侧视镜进行上消化道病变的筛查,并对发现的息肉样病灶进行组织学活检,分析FAP伴胃及十二指肠息肉的发病状况.结果 本组57例FAP患者中发生胃内息肉38例,占67%,息肉多数位于胃体和胃窦部,为增生性息肉;十二指肠息肉12例,占21%,其中7例为腺瘤性息肉.结论 上消化道息肉是FAP最常见的大肠外病变,胃内息肉多为增生性息肉;而十二指肠可能伴发腺瘤性息肉,属癌前病变.%Objective To discuss the incidence,endoscopic manifestion and pathological features of the upper-gastrointestinal polyps ( stomach and deodenum) in FAP patients. Methods During 2004 -2010 a total 57 FAP patients at Changhai Hospital underwent screening for polyps in upper-gastrointestinal tract by gastroscopy and sideward-viewing duodenoscopy. Biopsies were taken on the polypoid lesions.Results Gastric polyps were found in 38 patients (67%).Most polyps were located at gastric body and antrum,the pathologic diagnosis was hyperplastic. Duodenal polyps were found in 12 patients (21%) including 7 cases of adenomatous polys. Conclusions Upper- gastrointestinal polyps are the most common extra-colonic manifestion in FAP. Most stomach polyps are located at gastric body and antrum and are hyperplastic.Polyps at duodenum may be adenomatous,which is a precusor of carcinoma.

  18. The clinical and radiological observation of endoscopic retrograde cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Park, Choong Shik; Park, Byoung Lan; Chun, Hyun Woo; Kim, Byung Geun; Park, Hong Bae [Kwangju Christian Hospital, Kwangju (Korea, Republic of)

    1981-12-15

    Endoscopic retrograde cholangiopancreatography (ERCP) is a new diagnostic method for pancreatic and biliary disease which has been made possible by the development of fiberoptic duodenoscopy. It has been thought that ERCP will serve an important role in the early detection of pancreatic cancer, but in order to detect minor lesions of the pancreas and improve the diagnostic accuracy of resectable pancreatic cancer, Endoscopic Retrograde Parenchymography of the pancreas (ERPP) was developed recently. The authors analyzed 117 cases of ERCP performed at the Kwangju Christian Hospital between January and December 1980, and compared them with the final diagnosis. The results were as follows: 1. One of 117 cases, successful visualization of the duct of concern was achieved in 105 cases. Of these, 25 cases were ERPP. 2. The ratio of males to females was 1.44 : 1. Most patients were in the 4th to 6th decade. 3. The commonest clinical manifestations were upper abdominal pain (77 cases), jaundice (23 cases), indigestion, vomiting and abdominal mass, in order of frequency. 4. Out of 46 cases of suspected pancreatic diseases, the pancreatic duct was visualized in 36 cases, and 24 cases revealed pathognomonic findings. These were diagnosed as 16 cases of pancreatic cancer, 4 cases of chronic pancreatitis, 2 cases of pancreatic pseudocyst and 2 cases of periampullary cancer with pancreas invasion. In pancreatic cancer findings were; encasement, local dilatation, delayed excretion, poor filling, obstruction of pancreatic duct, accompanying C.B.D. obstruction or stenosis and so called double duct sign. The chronic pancreatitis findings included; ductal dilatation (with or without) obstruction, tortuosity with dilated saccular lateral branching, stone formation and the parenchymal filling defect. 5. Out of 71 cases of suspected biliary tract disease, the biliary tract was visualized in 57 cases, and in 31 cases abnormalities were suggested; such as 20 cases of biliary stone, 1 case

  19. 利胆排石汤联合纤维十二指肠镜治疗胆总管结石40例%Lidan Paishi Decoction Combined with Fiber Endoscopic Treatment in 40 Cases with Common Bile Duct Stones

    Institute of Scientific and Technical Information of China (English)

    牛贵义

    2013-01-01

    Objective: To observe clinical curative effect of fiber duodenoscopy combined Lidan Paishi decoction (LPD) in treatment of common bile duct stones. Method: Eighty cases of common bile duct stones were randomly divided into observation group and control group, 40 cases in each. The 2 groups were given anti-infective, maintenance of water, electrolyte, acid-base balance as foundation treatment. The control group was given the fibers treated with endoscopy, based on the control treatment the observation group was given LPD treatment, before and after 1 week of operation daily. Two groups were observed in patients with fever, jaundice, abdominal pain and other clinical symptoms integral improvement and before treatment and after treatment at 3 months total bilirubin ( TBil) , amylase ( AMY) , alanine aminotransferase ( ALT) , aspartate aminotransferase (AST) levels. Result: Jaundice, fever, nausea and vomiting, abdominal pain and other symptoms integral in the observation group after treatment group were (0.75 ±0. 12) , (0.87 ±0.15), (0.81 ±0.18), (0.54±0.26), the control group were (1.57 ±0.22) , (1.43 ±0.37), (1.47 ±0.24), (1. 74 ± 0. 26), the two group were significantly improved (P < 0. 05 ) , and the TBil and Amy of observation group were better than that of the control group (P <0. 05). TBil, AMY, ALT, AST index after treatment in observation group were (12.54 ±2.25) Ixmol·L-1, (48.43 ±18.87), (33. 54 ±6. 42) , (33.34±4.25) U ·L-1, control group were (19. 75 ±6. 25) Ixmol·L-1, (84.53 ±13.57), (34.71 ±6.24), (33.94 ±5.16) U ·L-1, two groups were significantly improved (P <0. 05) , and the TBil and Amg of the observation group were better than that of the control group (P < 0. 05). Conclusion: Fiber duodenoscopy combined LPD for the treatment of common bile duct stones can improve clinical symptoms and serum TBil, AMY levels.%目的:观察纤维十二指肠镜联合利胆排石汤治疗胆总管结石的临床疗效.方法:将80例胆总管结

  20. Particularity and Treatment Strategy of Patients with Hemobilia Taking Anticoagulants%服用抗凝药患者胆道出血的特殊性和处理策略

    Institute of Scientific and Technical Information of China (English)

    何平; 梁杰雄; 何力生; 邵天松; 宋辉; 郭洋; 张明

    2014-01-01

    Objective:To explore the clinical manifestations,treatment and particularity of patients with hemobilia taking anticoagulant in perioperative period.Method:The clinical manifestations,diagnosis and treatment process of 23 cases with hemobilia in our hospital from January 1998 to December 2012 were analyzed retrospectively.Result:Most of patients with biliary tract hemorrhage of upper gastrointestinal bleeding symptoms,there were 6 cases with cholangitis as the first symptom.Can generally be found by B-ultrasound and CT primary lesion,and the celiac artery through duodenoscopy angiography.12 cases were given surgery,4 cases selective arterial embolization,conservative treatment in 7 cases.For patients taking warfarin anticoagulation vitamin K1 was available,depending on the circumstances of aspirin treatment in patients with perioperative available low molecular weight heparin(LMWH) transition.19 cases cured,accounting for 82.6%,4 cases were deaths,accounting for 17.4%.Conclusion:The good results of hemilia patient could be achieved by accurate diagnosis,exact operation and active perioperative management or effective conservative therapy.%目的:探讨胆道出血患者的临床表现、治疗及服用抗凝药患者围手术期处理的特殊性。方法:回顾性分析1998年1月-2012年12月笔者所在医院收治的23例胆道出血患者临床表现、诊断和治疗过程。结果:本组胆道出血患者大多伴有上消化道出血的症状,6例以胆管炎为首发症状。一般可以通过B超和CT发现原发病灶,通过十二指肠镜和腹腔动脉造影确诊。其中12例经过手术治疗,4例行选择性动脉栓塞术治疗,7例进行保守治疗。对于服用华法林的患者可用维生素K1抗凝,阿司匹林的患者根据情况处理,围手术期可用低分子肝素过渡。治愈19例,占82.6%,死亡4例,占17.4%。结论:准确的诊断、积极有效的围手术期处理与正确的术中处理或有效的

  1. CARCINOID TUMOR OF THE DUODENUM: a rare tumor at an unusual site. Case series from a single institution

    Directory of Open Access Journals (Sweden)

    Jaques WAISBERG

    2013-03-01

    disease. Only one (5% patient died due to liver metastases of the duodenal carcinoid. Conclusions Duodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy.

  2. Colangiopancreatografia endoscópica retrógrada (CPRE intraoperatória como alternativa no tratamento de coledocolitíase Intraoperative endoscopic retrograde cholangiopancreatography (CPRE as an alternative for choledocholithiasis treatment

    Directory of Open Access Journals (Sweden)

    Eric Ettinger Júnior

    2007-03-01

    -operative endoscopic retrograde cholangiopancreatography. AIM: To report a case of a patient who underwent intraoperative CPRE as a solution to choledocholithiasis treated unsuccessfully by CPRE. CASE REPORT:- We present a case report of a 45-year-old patient, female, who was admitted to an emergency room with abdominal pain in the epigastrius and right hypochondrium. Ultrasonography showed choledocholithiasis, and the patient was indicated to a pre-operative endoscopic retrograde cholangiopancreatography, by which the catheterization of papilla was unsuccessful. The patient was then, submitted to a laparoscopic cholecystectomy and exploration of the common bile ducts by preoperative and intraoperative endoscopic retrograde cholangiopancreatography with the catheterization of papilla being guided by a guiding thread which was introduced through the cystic duct. A duodenoscopy with the capture of the guiding thread was performed, allowing the passage of papillotome, giving sequence to the preoperative endoscopic retrograde cholangiopancreatography, by which gallstones were removed. The patient had a satisfying recovery being discharged on the second post-operative day. CONCLUSION: In this case, the choledocholithiasis management by intraoperative endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy was considered both safe and effective.

  3. Gambaran Klinis dan Endoskopi Saluran Cerna Bagian Atas Pasien Dispepsia di Bagian RSUP Dr. M. Djamil Padang

    Directory of Open Access Journals (Sweden)

    Citra Yuriana Putri

    2016-08-01

    -gastrointestinal’s lesions in patient with dyspepsia. The design of this research was an observational descriptive study. The subject of this study are consist of 54 patients with dyspepsia who have performed esophagogastro- duodenoscopy  (EGD examination in Integrated Diagnostics Installation of Dr. M. Djamil Hospital Padang from May to June 2014. Data were collected by filling the questionnaire through an interview, recording the results of endoscopic examination. The results showed that the majority of dyspepsia patients’ complaints were heartburn (98.15%, the degree of complains is moderate (38.89%, the incidence of alarm sign most experienced by male, the most  risk factor of dyspepsia was the consumption of fatty foods (92.59%, the most endoscopic diagnosis of dyspepsia was gastritis (61.11%, and the most upper gastrointestinal lesion of dyspepsia was located in gastric (85.19%Keywords: dyspepsia, clinical findings, endoscopy

  4. 胆道内镜对肝移植术后胆管损伤变化的观察%Diagnosis and treatment of biliary injury after orthotopic liver transplantation with choledochofibroscope

    Institute of Scientific and Technical Information of China (English)

    杨玉龙; 张宝善; 冯秋实; 谭文翔

    2010-01-01

    Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT.%目的 对原位肝移植术后胆道并发症进行内镜观察和治疗,为肝移植胆管损伤机制的研究提供参考和帮助.方法 利用胆道内镜技术,对肝移植术后正常组、胆管损伤组、肝动脉损伤组的病例进行观察,内镜下取活检进行病理分析.对于无T管者,应用子母胆道镜进行.结果 正常的9例肝内外胆

  5. CARCINOID TUMOR OF THE DUODENUM: a rare tumor at an unusual site. Case series from a single institution

    Directory of Open Access Journals (Sweden)

    Jaques WAISBERG

    2013-03-01

    disease. Only one (5% patient died due to liver metastases of the duodenal carcinoid. Conclusions Duodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy. Contexto Carcinoides duodenais são extremamente raros e as características e o comportamento biológico dessa neoplasia permanecem indefinidos. Objetivo Analisar as características clinicopatológicas de doentes com carcinoide duodenal ressecado. Métodos Vinte doentes (12 mulheres e 8 homens foram estudados. A média de idade dos doentes foi de 66,4 ± 5,8 anos (43 a 88 anos. Os dados do quadro clínico, diagnóstico, tratamento e prognóstico dos doentes com tumor carcinoide do duodeno submetidos a ressecção da lesão no período de 18 anos (1993-2011 foram analisados. Resultados Os sintomas mais frequentes foram dispepsia (50% e epigastralgia (45%, seguidos por perda de peso (10% e vômitos (5%. Não foram observados doentes com síndrome carcinoide. A lesão estava localizada na primeira porção do duodeno em 15 (75% pacientes, na segunda porção em 4 (20% e na terceira porção em 1 (5%. O diagnóstico de tumor carcinoide foi estabelecido pela biopsia endoscópica excisional em 19 (95% pacientes e pelo exame histopatológico da peça cirúrgica em um (5%. O tamanho médio dos tumores foi de 1,1 cm ± 0,4