Search

A 54-year-old female presented to the Emergency Department due to 1 month lower right quadrant abdominal pain, with fever in the last 2 days. Three years before, she had been diagnosed with Familial Adenomatous Polyposis and had undergone prophylactic total proctocolectomy with ileal pouch, with no perioperative complications. Blood analysis showed an elevated C-reactive protein (7.8mg/dL). The abdominopelvic CT showed an irregular pelvic collection with air bubbles, lined by a thickened enhancing wall, lymphadenopathies and mesenteric fat densification. Endoscopic evaluation showed bulging of the ileal pouch wall. These findings were suggestive of a pelvic abscess and the patient was empirically treated with piperacillin/tazobactam, with clinical improvement. Two months later, the symptoms recurred. CT scan was repeated, showing persistence of the previously described pelvic collection, in communication with the intestinal lumen, associated with a soft tissue infiltrative tumour in the mesentery and at the site of the previous ileostomy. Endoscopic evaluation showed, in the closed end of the pouch, two fistulous openings leading to an ulcerated and friable lesion. Ultrasound-guided biopsy revealed fascicles with elongated, spindled cells of uniform appearance and pale cytoplasm, set in a collagenous stroma, without signs of cytologic atypia. Immunohistochemistry showed nuclear beta-catenin staining. These findings were suggestive of a desmoid tumour. After a multidisciplinary meeting, a derivation ileostomy was placed and systemic treatment with tamoxifen was began. This case illustrates the importance of considering the patient as a whole, including knowledge of past medical and family history, that may alert to alternative diagnosis. This case illustrates the importance of considering the patient as a whole, including knowledge of past medical and family history, that may alert to alternative diagnosis.

Subclinical intestinal inflammation is common in Crohn's disease (CD). We aimed to explore its impact in the disease progression of infliximab-treated patients and the usefulness of fecal calprotectin (FC) and C-reactive protein (CRP) as surrogate minimally invasive biomarkers.The registry-based, prospective, observational, multicenter DIRECT (study to investigate the correlation of fecal calprotectin with serum Drug levels and development of an antI-dRug antibodiEs among adult patients with inflammatory bowel disease reCeiving anti-TNF-alfa treatment or vedoluzimab treatment) study followed infliximab-treated CD patients for 2 years in a tertiary care setting. Persistent inflammation definition was based on FC (150 μg/g,250 μg/g, or350 μg/g) or serum CRP (3 μg/mL) concentrations over 2 consecutive or at least 3 visits. Patients were categorized according to a composite outcome reflecting disease progression that incorporated surgery; hospitalizations; new fistulae, abscess, or stricture; and treatment escalation.Of 322 DIRECT study patients, 180 asymptomatic, infliximab treated on maintenance regimen were included in the analysis. Patients developing the composite endpoint (n = 96) presented higher median levels of FC (205 [interquartile range, 98-515] μg/g; P = .045) but not of CRP (2.50 [interquartile range, 0.80-6.00] μg/mL; P = .895). Biomarker-defined persistent subclinical inflammation prevalence ranged from 24% to 81%. Considering FC250 μg/g in 2 consecutive visits, prevalence was 50%, odds of achieving the endpoint were increased 3-fold (odds ratio, 2.996 [95% confidence interval, 1.557-5.776]), and time-to-outcome occurrence was significantly lower among subjects with persistent inflammation (median time: 11 months). Both clinical-related and treatment-related components were significantly associated with persistent inflammation. Definitions based on CRP3 μg/mL, FC150 μg/g, FC350 μg/g, double biomarkers (FC250 μg/g and/or CRP3 μg/mL), or more visits did not improve predictive ability.Persistent inflammation, defined simply and readily by FC250 μg/g over 2 consecutive visits, was associated with a significantly higher risk and shorter time to occurrence of a composite outcome reflecting disease progression in asymptomatic infliximab-treated CD patients.

Radiofrequency ablation therapy is an effective endoscopic option for the eradication of Barrett’s esophagus that appears to reduce the risk of esophageal cancer. A concern associated with this technique is the development of subsquamous/buried intestinal metaplasia, whose clinical relevance and malignant potential have not yet been fully elucidated. Fewer than 20 cases of subsquamous neoplasia after the successful radiofrequency ablation of Barrett’s esophagus have been reported to date. Here, we describe a new case of subsquamous neoplasia (high-grade dysplasia) following radiofrequency ablation that was managed with endoscopic resection. Our experience suggests that a meticulous endoscopic inspection prior to and after radiofrequency ablation is fundamental to reduce the risk of buried neoplasia development.

Background: Narrow-band imaging (NBI) allows “in vivo” classification of colorectal polyps. Objectives: We evaluated the optical diagnosis by nonexpert community-based endoscopists in routine clinical practice, the impact of training, and whether the endoscopists could achieve the threshold for the “do not resect” policy. Methods: This was an observational study performed in two periods (P1 and P2). Endoscopists had no prior experience in NBI in P1 and applied the technique on a daily basis for 1 year before participation in P2. Lesions were classified by applying the NBI International Colorectal Endoscopic (NICE) and Workgroup serrAted polyps and Polyposis (WASP) classifications, simultaneously. Results: A total of 290 polyps were analyzed. The overall accuracyof optical diagnosis was 0.75 (95% CI 0.68-0.81) in P1, with an increase to 0.82 (95% CI 0.73-0.89) in P2 (p = 0.260). The accuracy of the NICE/WASP classifications to differentiate adenomatous from nonadenomatous histology was 0.78 (95% CI 0.72-0.84) in P1 and 0.86 (95% CI 0.77-0.92) in P2 (p = 0.164); assignments made with a high confidence level achieved statistical significance (13% improvement, 95% CI 3-22%; p = 0.022). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 81% (95% CI 64-93%) and 80% (95% CI 59-93%) in P1 and P2, respectively. Conclusions: Nonexpert endoscopists achieved moderate accuracy for real-time optical diagnosis of colorectal lesions with the NICE/WASP classifications. The overall performance of the endoscopists improved after sustained use of optical diagnosis, but did not achieve the standards for the implementation of the “do not resect” strategy. Introdução: O narrow-band imaging (NBI) permite a classificação “in-vivo” dos pólipos colo-rectais. Objectivos: Avaliámos o diagnóstico óptico na prática clínica diária em endoscopistas da comunidade, sem experiência prévia em NBI, o impacto do treino e se estes conseguiam atingir o limiar da estratégia de “não ressecar”. Métodos: Estudo observacional, realizado em dois períodos (P1 e P2). Os endoscopistas não apresentavam experiência prévia em NBI em P1 e aplicaram a técnica diariamente durante um ano antes da participação em P2. As lesões foram classificadas aplicando as classificações NBI International Colorectal Endoscopic (NICE) e Workgroup serrated polypS and Polyposis (WASP), simultaneamente. Resultados: Foram analisados 290 pólipos. A acuidade global do diagnóstico óptico foi de 0.75 (IC 95%, 0.68-0.81) em P1, aumentando para 0.82 (IC 95%, 0.73-0.89) em P2 (p = 0.260). A acuidade das classificações de NICE/WASP na diferenciação de histologia adenomatosa de não-adenomatosa foi de 0.78 (IC 95%, 0.72-0.84) em P1, e 0.86 (IC 95%, 0.77-0.92) em P2 (p = 0.164); as predições realizadas com alto grau de confiança alcançaram significado estatístico (melhoria de 13%, IC 95%, 3-22%; p = 0.022). O valor preditivo negativo para histologia adenomatosa dos pólipos diminutos recto-sigmóides foi de 81% (IC 95%, 64-93%) e 80% (IC 95%, 59-93%), em P1 e P2, respetivamente. Conclusões: Endoscopistas sem experiência em NBI alcançaram acuidade moderada no diagnóstico óptico em tempo real de lesões colo-rectais, utilizando as classificações de NICE/WASP. O desempenho global melhorou após a utilização contínua do diagnóstico óptico, mas não alcançou o limiar definido para a implementação da estratégia de “não ressecar”.

Background: Fatigue is a common symptom reported in inflammatory bowel disease (IBD) patients. It can be severe and modify the self-perception of disease. Objective: To evaluate the contribution of clinical and demographic factors to the level of fatigue in IBD patients. Methods: Patients consecutively observed in an outpatient IBD clinic during a 9-month period were studied. Demographic and clinical data were collected. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). A FACIT-F score Results: One hundred and five patients were evaluated. Of them, 57.1% had Crohn´s Disease (CD) and 42.9% had Ulcerative Colitis. Also 85.0% and 77.8% were in clinical remission, respectively. The mean FACIT-F score was 39.63 ± 9.67. Severe fatigue was observed in 17.1% of patients. Female gender and active CD were significantly associated with a severe level of fatigue (p = .05 and p = .04). There was no significant correlation between the level of fatigue (severe vs. non-severe) and type of IBD, hemoglobin, C-reactive protein, ferritin levels or previous surgeries. Patients under biological therapy had a significantly higher level of fatigue and a higher rate of previous hospitalizations (p = .02). Conclusions: Fatigue level is a simple and useful tool to evaluate the disease’s impact in patients’ life, and it should, therefore, be included in clinical practice. Biological therapy was associated to higher levels of fatigue. Future studies should evaluate the impact of therapy on the level of fatigue.

Endoscopic full-thickness resection (EFTR) is an emerging technique for the treatment of various conditions for which classic endoscopic resection techniques have failed or were considered to be at high risk for perforation. The full-thickness resection device (FTRD) is an over-the-scope system which allows a single-step EFTR. The aim of our study is to describe our experience in EFTR of colorectal lesions using the FTRD.Nine patients (10 colorectal lesions) were proposed for EFTR. Safety, R0 resection and endoscopic treatment success were evaluated.Reasons for referral included nonlifting adenomas (EFTR is a feasible, reasonable time-consuming, safe, and promising endoscopic resection technique.FTRD is an additional tool for difficult-to-treat colorectal lesions.A ressecção endoscópica transmural (RET) é uma técnica promissora para o tratamento de várias lesões não passíveis de ressecção endoscópicapelas técnicas convencionais ou naquelas em que estes procedimentos apresentam elevado risco de complicações.O “full-thickness resection device” (FTRD) é um sistema pré-montado, que se acopla ao colonoscópio e que permite efetuar RET com um procedimento único. Pretende-se descrever a experiência do nosso centro na realização de RET com o FTRD.Nove doentes (10 lesões cólicas) foram propostos para RET. Foram avaliadas a segurança, ressecção R0 e taxa de sucesso do procedimento endoscópico.As indicações para o procedimento incluíram adenomas (A RET é uma técnica exequível e segura para a terapêutica de lesões coloretais.A RET parece ser uma promissora ferramenta adicional para manejo de lesões colo-rectais difíceis de tratar.

ispartof: ENDOSCOPY vol:50 issue:11 pages:E318-E319 ispartof: location:Germany status: published

Pyogenic granuloma is a benign vascular lesion, uncommon in the gastrointestinal tract, and extremely rare in the small bowel. The diagnosis can be challenging prior to surgery, because of its unusual endoscopic appearance. We present a case of pyogenic granuloma of the jejunum diagnosed by capsule endoscopy and double-balloon enteroscopy and successfully managed by surgical resection.

Revela-se de primordial importância estudar o autoconceito, o coping e a saúde mental de adolescentes com Paralisa Cerebral. Essa população tem sido muito pouco estudada. Além disso, essas variáveis podem contribuir para a adaptação desses jovens que se confrontam com situações mais adversas, podendo ser fatores protetores e de risco da sua saúde psicológica. Estudamos uma amostra de 78 sujeitos com Paralisia Cerebral (idades entre os 12 e os 19 anos). Encontramos os seguintes resultados: a) as moças apresentam valores de psicopatologia mais elevados do que os rapazes; b) à medida que aumenta a idade diminuem os valores do autoconceito e aumentam os do “coping não ativo”; c) alguns tipos de diagnóstico de paralisia cerebral diferenciam-se pelo autoconceito; d) o autoconceito correlaciona-se negativamente com todos os índices de psicopatologia; e) o “coping não ativo” correlaciona-se negativamente com a ansiedade e com alguns índices de sintomatologia psicopatológica do BSI. It is very important to study self-concept, coping and mental health in adolescents suffering from Cerebral Palsy. This population has been rarely studied. Besides, these variables can contribute to the adaptation of these youth that face very adverse conditions, and can be protective and risk factors to their psychological health. We studied a sample of 78 subjects suffering from Cerebral Palsy (aged between 12 and 19 years old). We found the following results: a) girls show higher levels of psychopathology than boys, b) with age, the values of self-concept are lower and the values of “non active coping” are higher, c) some types of diagnosis of Cerebral Palsy differentiate themselves by the self-concept, d) self-concept correlates negatively with all indexes of psychopathology, e) “non active coping” correlates negatively with anxiety and some indexes of psychopathological symptomatology from BSI. C’est très important d’étudier le concept de soi, le coping et la santé mentale des adolescents souffrant de Paralysie Cérébrale. Cette population est très peu étudiée. Et ces variables peuvent contribuer pour l’adaptation de ces jeunes qui se confrontent avec des situations très adverses, pouvant être facteurs protecteurs ou de risque de leur santé psychologique. Nous avons étudié un échantillon de 78 sujets souffrant de Paralysie Cérébrale (âgés de 12 à 19 ans). On a trouvé les résultats suivants : a) les filles présentent des valeurs de psychopathologie plus hautes que les garçons ; b) au fur et à mesure que l’âge augmente les valeurs du concept de soi baissent et augmentent ceux du « coping non-actif » ; c) il y a des différences entre certains types de diagnostique en ce qui concerne le concept de soi ; d) le concept de soi se corrélationne négativement avec tous les indexes de psychopathologie ; e) le « coping non-actif » se corrélationne négativement avec l’anxiété et certains indexes de symptomatologie du BSI. Es de primordial importancia estudiar el auto-concepto, el coping y la salud mental de adolescentes con Parálisis Cerebral. Esta población ha sido muy poco estudiada. Además, estas variables pueden contribuir para la adaptación de estes jóvenes que se enfrentan con situaciones más adversas, podiendo ser factores protectores y de riesgo de su salud psicológica. Estudiamos una muestra de 78 sujetos con Parálisis Cerebral (edades entre los 12 y 18 años). Encontramos los siguientes resultados: a) las mujeres presentan valores de psicopatología más elevados que los hombres; b) a la medida que aumenta la edad disminuyen los valores de auto-concepto y aumentan los del “coping no activo”; c) algunos tipos de diagnóstico de Parálisis Cerebral se diferencian por el auto-concepto; d) el auto-concepto se correlaciona negativamente con todos los índices de psicopatología; e) el “coping no activo” se correlaciona negativamente con la ansiedad y con algunos índices de sintomatología psicopatológica do BSI.