Search

The safety profile of a therapeutic procedure is almost more important than its efficacy. This concept is particularly true for those developing procedures, like Peroral Endoscopic Myotomy (POEM), which are supposed to mimic and reproduce what is usually done by a surgical operation that is recognized as the therapeutic gold standard. The first human POEM was performed in 2008 in Japan. Since then, few groups of investigators have begun to perform POEM and have published their preliminary experiences. The published results are encouraging, demonstrating good results of safety and efficacy. Pneumoperitoneum, pneumomediastinum, small perforations of the mucosal flap, and mild bleeding are very frequent events during POEM, but should not be considered as significant complications, because they are self-limited or can be managed during the procedure, and do not substantially alter the postoperative course. Few significant complications have been reported in the literature including aspiration pneumonia, mediastinal hematoma, delayed hemorrhage, pneumothorax, esophageal perforation, peritonitis, and dehiscence of the esophageal closure. No mortality has been reported to date. Analysis of the published series confirms the excellent safety profile of the POEM procedure. Some clinical points appear to be of significant importance, in terms of safety, especially the use of carbon dioxide instead of room air for insufflation and meticulous hemostasis during the procedure. Thorough cleaning of the esophagus and antibiotic prophylaxis may play significant roles in the prevention of infections. © 2013 Elsevier Inc.

Background: Small-bowel contents can hamper the quality of video-capsule endoscopy (VCE). No standardized protocol has been proposed and overnight fasting remains the proposed preparation for VCE. Aims: The aim was to evaluate the effects of 2 regimens of bowel preparation on small intestine cleansing, diagnostic yield and capsule transit times. Methods: This is a prospective, randomized, blinded, and controlled study. Sixty patients referred for VCE were randomized into 2 groups. Group A ingested 2. l of a polyethylene glycol and simethicone solution 16. h before VCE. Group B were instructed to consume a fibre-free diet and allowed to consume clear liquids the day before VCE. The small-bowel cleansing was graded as " complete" if the entire wall was assessable, " incomplete" if more than 50% of the wall was visible, and " insufficient" if less than 50% of the wall was visible. Results: In group A, a " complete" , " incomplete" and " insufficient" small-bowel cleansing was achieved in 42%, 39% and 19% of cases respectively. In group B, a " complete" , " incomplete" and " insufficient" small-bowel cleansing was achieved in 43%, 33% and 24% of cases respectively. No significant differences were observed between the two groups, regarding small-bowel cleansing level (p=0.65). No differences were also observed in the diagnostic yield (48.2%, 13.8% and 38% vs 65.5%, 6.9% and 27.6% of positive, suspicious and no findings respectively, in groups A and B [p=0.39]) and small-bowel transit times (mean 288. min and 299. min in groups A and B respectively [p=0.70]). Conclusions: The results of the present study do not support the use of 2. l of a polyethylene glycol and simethicone solution before VCE. © 2009 Editrice Gastroenterologica Italiana S.r.l.

n/a

no abstract

An analysis of the present and potential future water supply scenarios for the Copiapo valley is summarised with details of the deficit in the long-term underground water balance., An analysis of the present and potential future water supply scenarios for the Copiapo valley is summarised with details of the deficit in the long-term underground water balance.

n/a

In GERD patients in whom pharmacological therapies are ineffective and anti-reflux surgery is not indicated, a viable option could be proposed. To date, several endoscopic antireflux procedures, involving sewing, injection and/or implant, and radiofrequency are available. The sewing techniques demonstrated good clinical results, with reduction in proton pump inhibitors consumption; despite significant changes in esophageal manometry and/or acid exposure time reduction and healing of esophagitis were noted only in few patients.

Background and study aims: The aim of the study was to evaluate the safety, feasibility, and efficacy of transnasal placement of the Medtronic Bravo capsule for wireless esophageal pH monitoring. Patients and methods: Forty patients with symptomatic gastroesophageal reflux disease were prospectively evaluated. All patients underwent upper gastrointestinal endoscopy and esophageal manometry. The Bravo capsule was then introduced transnasally and released 5 cm above the upper margin of the lower esophageal sphincter. Serial radiographs were performed weekly until capsule release. Results: Of the 40 patients who were evaluated, 38 (95%) were eligible to undergo the procedure. Transnasal placement proved impossible in one patient (2.5%). Overall, a total of 39 procedures were performed in 38 patients (the procedure was repeated in one patient because of accidental intragastric fixation). Esophageal placement was successful in 36/39 procedures (92.3%). The mean duration of the procedure was 10 minutes (range 5-16 minutes). Adverse events were noted in five of the 39 procedures (12.8%), mild epistaxis in two patients (5.1%) and pharyngeal irritation in three patients (7.7%). After the procedure, a slight "foreign body" sensation was reported by 20 of the 36 patients (55.5%) who had undergone successful esophageal placement; two patients (5.5%) experienced severe retrosternal pain necessitating endoscopic removal of the capsule. At the end of the study, 34 of the 38 patients (89.5%) stated that they would be willing to undergo the test again if necessary. Conclusions: Transnasal placement of the Bravo pH capsule is safe, well tolerated, does not require sedation, and avoids endoscopy and its complications. © Georg Thieme Verlag KG Stuttgart.

Background: Patients with chronic abdominal pain consult gastroenterologists frequently, requiring a large number of examinations. Aim: To assess the diagnostic yield of capsule endoscopy in patients with chronic abdominal pain of unknown origin and negative diagnostic work-up. Patients: From January 2002 to September 2004, 16 patients (10 female; mean age 42.7 years) who complained of chronic abdominal pain were referred to our unit for capsule endoscopy. Methods: Chronic abdominal pain was defined as continuous or almost continuous, for at least 3 months and without criteria for other gastrointestinal disorders. All patients had a previous diagnostic work-up including abdominal ultrasonography, oesophagogastroduodenoscopy, colonoscopy and small bowel follow through, performed within 2 months. Results: Capsule endoscopy was normal in 12 patients (75%). Small bowel abnormalities were found in three patients, but were considered irrelevant. In one patient (6.3%), capsule endoscopy revealed ileal erosions and inflammation and was retained in a stricture undetected by radiology. This patient underwent elective surgery which revealed an ileal carcinoid neoplasm. Conclusions: Capsule endoscopy identified a specific cause of chronic abdominal pain in only one patient. Capsule endoscopy is a safe procedure but does not seem to play an important role in the evaluation of patients with chronic abdominal pain of unknown origin. © 2006.

n/a

Oesophageal pH testing is a valuable tool in the management of gastro-esophageal reflux disease, especially for confirming the diagnosis of non-erosive reflux disease or for monitoring non-responders. However, transnasal intubation interferes with diet and activities, reducing patients' compliance. A catheter-free pH-monitoring system has recently become available, but, to date, advantages and limitations of this device have not been fully explored.