Early precut technique for common bile duct cannulation decreases the trend of post-ERCP pancreatitis.
Case seriesPatient: Male, 40; Male, 70Final Diagnosis: Synchronous gastrointestinal carcinoid tumor and colon adenocarcinomaSymptoms: WeaknessMedication: —Clinical Procedure: ColonoscopySpecialty: Gastroenterology and HepatologyObjective:Rare co-existance of disease or pathologyBackground:Coexistence of carcinoid tumor and colorectal adenocarcinoma is rare. In this report, we present two cases and review the current literature for synchronous carcinoid tumor and colorectal carcinoma occurrence.Case Reports:In both cases, the rectal carcinoid tumors and sigmoid colon adenocarcinomas were detected by colonoscopy. The colon adenocarcinomas were effectively treated with a laparoscopic sigmoidectomy and the carcinoids were successfully removed endoscopically. Our 40-year-old patient was the youngest among 17 reported patient cases.Conclusions:These two cases demonstrate that the diagnosis of gastrointestinal carcinoid requires a complete assessment of the remainder of the colon for another primary cancer to achieve a timely treatment management strategy.
Medication nonadherence in inflammatory bowel disease (IBD) may lead to suboptimal control of the disease, decreased quality of life, and poor outcomes. This pilot study evaluated the feasibility, intervention mechanism, and potential effectiveness of a three-month continuous self-improvement (CSI) intervention to enhance medication adherence (MA) in adult nonadherent IBD patients. Adult IBD patients taking a daily or twice-daily dosed maintenance medication were screened electronically for two months to determine baseline MA levels. Nonadherent IBD participants were randomized to the CSI or the attention control (AC) intervention and monitored for three months. The CSI intervention consisted of a data evaluation and system refinement process in which system changes were identified and implemented. The AC group was given educational information regarding IBD disease process, extra-intestinal manifestations of IBD, and medical therapy. Demographic statistics, change scores for within and between-group differences, and effect size estimates were calculated. Nine nonadherent participants (medication adherence score <0.85) were eligible for randomization. The intervention was found feasible and acceptable. Although no statistically significant improvement in MA was found (P=0.14), adherence improved in 3 of 4 of the CSI group and 1 of 2 in the attention control group. The effect size calculation of 1.9 will determine the sample size for future study. The results of this pilot study showed the intervention was feasible and had a positive effect on MA change score and adherence levels. A larger fully powered study is needed to test of the effectiveness of this innovative intervention.
A Dieulafoy's lesion is a dilated, aberrant, submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion. It can be located anywhere in the gastrointestinal tract. We describe a case of massive gastrointestinal bleeding from Dieulafoy's lesions in the duodenum. Etiology and precipitating events of a Dieulafoy's lesion are not well known. Bleeding can range from being self-limited to massive life- threatening. Endoscopic hemostasis can be achieved with a combination of therapeutic modalities. The endoscopic management includes sclerosant injection, heater probe, laser therapy, electrocautery, cyanoacrylate glue, banding, and clipping. Endoscopic tattooing can be helpful to locate the lesion for further endoscopic re-treatment or intraoperative wedge resection. Therapeutic options for re-bleeding lesions comprise of repeated endoscopic hemostasis, angiographic embolization or surgical wedge resection of the lesions. We present a 63-year-old Caucasian male with active bleeding from the two small bowel Dieulafoy's lesions, which was successfully controlled with epinephrine injection and clip applications.
Background: Medication nonadherence in inflammatory bowel disease (IBD) can lead to suboptimal control of the disease, decreased quality of life, and poorer outcomes. This pilot study evaluated the feasibility, intervention mechanism, and potential effectiveness of a threemonth continuous self-improvement (CSI) intervention to enhance medication adherence in adult nonadherent IBD patients. Methods: Adult IBD patients taking a daily or twice-daily dosed maintenance medication were screened for two months to determine baseline medication adherence levels. Adherence was monitored electronically. Nonadherent IBD participants were randomized to receive either the CSI intervention or the attention control intervention and then monitored for three-months. The CSI intervention consisted of a data evaluation and system refinement process in which personal system changes were identified and implemented. The attention control group was given only educational information regarding IBD disease process, extra-intestinal manifestations of IBD, and medical therapy actions and side effects. Demographic statistics, change scores for within and between-group differences, and effect size estimates were calculated. Results: Nine nonadherent participants (medication adherence score <.85) were eligible for randomization. The intervention was found to be feasible and acceptable. System thinking scores trended in the anticipated direction. Although no statistically significant improvement in medication adherence was found (p=0.14), medication adherence improved in 3 of 4 of the CSI group and only 1 of 2 in the attention control group. The effect size calculation of 1.9 will determine the sample size for future study. Conclusions: The results of this pilot study showed the intervention was feasible and had a positive effect on the medication adherence change score and on adherence levels. A larger fully powered study is needed to test of the effectiveness of this innovative intervention.
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