Four hundred fifty consecutive patients with dysphagia were evaluated radiologically over a 14-month period; 127 of these (28.2%) were also examined endoscopically. The most common abnormality seen was dysmotility (34%), followed by hiatal hernia, benign stricture, and esophagitis. Correlation with endoscopy was generally good. Radiologic study demonstrated all cases of esophageal malignancy; radiologic/endoscopic correlation was also strong in patients with moderate or severe esophagitis, though the radiologist had some difficulty detecting mild inflammation. Endoscopy failed to demonstrate some benign strictures. Radiologic study was relatively accurate in detecting significant organic disease; most motility disorders were not detected by endoscopy. For these reasons, as well as lower cost, increased convenience, and patient comfort, radiologic assessment is recommended as the primary method of evaluating patients with dysphagia.
Several recent studies have shown a proximal shift in the distribution of colonic carcinoma compared to older studies. Because of the association between polyps and cancer, the authors evaluated the distribution of colonic polyps in 3,664 consecutive patients who had a colon examination over a period of 14 months. A total of 967 colorectal polyps were found in 633 patients. In all, 502 polyps (52%) were proximal to the rectosigmoid. Older patients had significantly more right-sided polyps and fewer rectosigmoid lesions. Large polyps occurred more frequently in the right colon, and this was also statistically significant. Gender has no effect on polyp distribution. The authors conclude that the importance of screening for polyps, particularly on the right side of the colon, increases with age.
Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Additional findings, not seen in all patients, included (d) edema involving the base of the ulcer and/or the adjacent bowel wall and (e) loss of fascial planes between the base of the ulcer and the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a confident diagnosis of this important complication of peptic ulcer disease.
With the advent of fiberoptic endoscopy and modern radiographic techniques, the majority of detected polyps are less than 1 cm. During a seven-month period, we studied 140 patients who had radiographically demonstrated colonic polyps that were confirmed by pathologic study. Tissue specimens were obtained by proctoscopy, colonoscopy, or surgery. There were 222 polyps of which 144 (65%) were 1 cm or less in size, with the preponderance (80%) of these being adenomatous. Of the 82 polyps that ranged in size from 6-10 mm, 68 (83%) were adenomas, including one carcinoma and five villous adenomas. Forty-seven (72%) of the diminutive polyps (less than or equal to 5 mm) were adenomatous, including two with atypia. Our results correspond to those of several recent endoscopic studies, reporting that a small colonic polyp is most likely to be adenomatous, and that it possesses the potential for growth and malignant transformation. The detection of small polyps during barium enema examination is thus warranted, particularly in the proximal colon where the majority are adenomatous. The clinical management of polyps is becoming more aggressive, and the removal of even small lesions (less than or equal to 5 mm) is now performed if they are found incidentally during colonoscopy.
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