Background and Objectives:Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP.Patients and Methods:A prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively.Results:Technical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical success occurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days).Conclusion:Data relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction.
Paciente do sexo feminino, 51 anos, submetida à colonoscopia em outubro de 2008, com diagnóstico de colite segmentar do ângulo esplênico e pólipo do cólon descendente. O exame histopatológico revelou, respectivamente, colite crônica da flexura esplênica e adenoma tubular com displasia de baixo grau de cólon descendente. Iniciou uso de mesalazina e foi solicitada nova colonoscopia em junho de 2009 para avaliação do processo inflamatório do ângulo esplênico, que revelou a presença de inúmeras lesões subepiteliais, localizadas no ângulo esplênico e cólon descendente, preenchidas por ar e entremeadas por áreas de aspecto endoscópico normal, sugestivas de pneumatose intestinal.Pneumatose intestinal constitui-se pela presença de gás no interior da parede intestinal. Sua incidência é desconhecida, pois a maioria dos pacientes apresenta-se sem sintomas clínicos. Pode ser encontrada tanto em crianças quanto em adultos, porém a maioria dos casos em crianças é secundário à enterocolite necrotizante, doença que se apresenta com alta mortalidade. A patogênese não é claramente conhecida, no entanto, o caráter multifatorial é sugerido, incluindo causas mecânicas, infecciosas e auto-imune 1
A total of 38,686 colonoscopies were performed between January 1985 and December 2012 at Hospital Sírio-Libanês, in São Paulo, Brazil. Two hundred thirty-four patients (0.6%) had acute lower gastrointestinal bleeding of moderate or severe intensity. A definitive diagnosis was possible in 151 cases, 64.5% of these patients.This study was approved by the Institutional Review Board. Medical charts were reviewed.All examinations were done under sedation by the same medical team.The predominant sources of bleeding were colonic diverticula (73 patients; 31%), ischemic or infectious colitis (18 patients; 7.7%) and radiation proctitis (18 patients; 7.7%).A specific therapeutic intervention was performed on 61 of the 151 patients who had the diagnosis confirmed (40.4%), according to the source of bleeding. Most patients with postpolypectomy bleeding were treated with injection of epinephrine (40%) and clipping (40%). Patients with angiodysplasia were treated predominantly with argon plasma coagulation (42%).Injection of epinephrine was the most frequent treatment, regardless of the source of bleeding (34.4%), followed by argon plasma coagulation (31.1%).Control of active hemorrhage was achieved endoscopically in 98.8% of the patients.Our data shows that early colonoscopy in the management of patients with suspected acute lower gastrointestinal bleeding is a useful tool for diagnosis and treatment.
Introduction Colonoscopy enables detailed endoscopic evaluation of the interior of the colon. Changes observed via colonoscopy may be subtle or pronounced and can sometimes mimic those of other diseases, such as deep intestinal endometriosis. The diagnosis of endometriosis in the distal sigmoid and rectum by colonoscopy has been described in previous case reports.
Objective We aimed to correlate the endoscopic changes found in the distal sigmoid and rectum with the presence of endometrial deposits confirmed by transrectal ultrasound (TRUS).
Methods We included 50 female patients referred to the endoscopy department at our institution for colonoscopy, rectosigmoidoscopy, or TRUS, who exhibited one or more symptoms associated with endometriosis.
Results The colonoscopic findings were normal in 36 patients but showed alterations in 14 patients. Among the latter, TRUS revealed involvement of the sigmoid and/or rectal wall in 11 patients.
Conclusions The endoscopic changes in the distal sigmoid or rectum described in this study were strongly associated with endometrial deposits confirmed using TRUS.
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