Improvement of colon cancer diagnosis is a very important medical problem. Methods of fluorescence diagnosis (FD) with 5-aminolevulinic acid (5-ALA) have been used in detection of early cancer on the surface of mucosa. The objective of the study was to estimate the effectiveness of FD with 5-ALA in the detection of malignant lesions in the colon. From 2008 to 2010 full examinations have been performed in 78 patients suffering from colon polyps. For the study we used drug Alasens based on 5-ALA. Fluorescence colonoscopy with Alasens was made using the visual assessment of fluorescence images in combination with local fluorescence spectroscopy. The results of FD were compared with those of final histopathological study. The application of the method during colonoscopy allows specifying diagnosis, identifying areas of colon tumors transformation, and also showing a place for targeted biopsy. Sensitivity and specificity of FD with Alasens were 94.9% and 62.5%, respectively. The application of local fluorescence spectroscopy as a step of the combined approach allows increasing the specificity of fluorescence colonoscopy from 62.5% up to 93.7%.
Obstructive jaundice with duodenal obstruction are often encountered in patients with primary cancer or metastasis to bilipancreatoduodenal zone. Usually palliative surgery involving creation of gastroentero and liver-cholecysteneteroanas-tamosis is used. This palliative surgery carries a high risk of complications and death if performed at the height of jaundice. In this case endoscopic stenting of duodenum or EUS-guided transmural biliary drainage may be preferred method of treatment. At the same time in the majority of patients performing of ERCP in cases of duodenum obstruction is not technically feasible. In this case EUS-guided transmural biliary drainage can be implemented. This clinical case demonstrates endoscopic treatment of a patient with pancreatoduodenal cancer complicated by duodenal obstruction and obstructive jaundice using endosonography and x-ray guided endoscopy.
The aim of review. To generalize literature data on endoscopic and morphological diagnostics of serrated adenomas of the colon. Key points. In 2010 a new variant of histological classification of colonic tumors have been accepted by WHO, according to which serrated neoplasms were defined as separate group of preneoplastic changes, along with colonic adenomas. At the present time hyperplastic polyps and other serrated neoplasms are considered to be precursor lesions for 15 to 20% of sporadic or asymptomatic colorectal cancers located mainly in proximal colon, that progress by specific serrated adenoma-related pathway. Diagnostics of such lesions both on microscopic and macroscopical levels is associated with significant difficulties due to absence of the uniform nomenclature, definite morphological features and endoscopic semiotics. Conclusion. Definition of main morphological and endoscopic diagnostic criteria of all types of serrated adenomas will provide successful diagnostics along with differentiation with other epithelial colonic lesions that is required for proper choice of management approach.
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