Search

Background and Aim: The proper visibility of mucosa during esophagogastroduodenoscopy (EGD) is crucial for the detection of early upper gastrointestinal tract lesions. In contrast to colonoscopy, no validated scoring system for the assessment of upper gastrointestinal mucosal cleanliness has been developed so far. The aim of the study was to create and validate standardized grading system (POLPREP) to assess the mucosal cleanliness during EGD. Methods: To assess the visibility of mucosa during EGD, 4‐point scale was developed (0–3). Twelve operators assessed 18 images of esophagus, stomach, and duodenum twice (in 2 weeks interval). In validation round, the images and endoscopy reports of 443 EGDs performed in six centers were assessed. Results: The inter‐observer accordance of POLPREP was 0.8 (intra‐class correlation coefficient; 0.79 consultants, 0.85 trainees). The intra‐observer repeatability was 0.64 (Fleiss kappa value; 0.64 consultants, 0.64 trainees). The lesions detection rate was significantly higher in clean (scores 2 and 3; 19.7%) than in "unclean" segments (score 1; 7.7%, P = 0.049). Score 3 was associated with over three‐fold higher lesion detection than score 1 (odds ratio 3.2, 95% confidence interval 1.1–9; P = 0.03). Conclusions: The proposed POLPREP scale allows for unified assessment of upper gastrointestinal tract mucosal cleanliness. The higher cleanliness scores are related with greater upper gastrointestinal pathologies detection. [ABSTRACT FROM AUTHOR]

3 a A pediatric colonoscope was advanced through the lumen of the AXIOS stent. b The common bile duct cannulation with visible guidewire. c, d Implantation of self-expandable metal stent. Plastic stent removal and self-expandable metal stent implantation were performed through the AXIOS stent lumen using a pediatric colonoscope (PCF-H190, Olympus) (Video 1,Fig. [Extracted from the article]

And, finally, easy placement of a metal stent was achieved using the rendezvous method. The procedure was complicated by mesh migration and rectal necrosis requiring several surgical interventions, including an anterior resection of the rectum with surgical colostomy formation. [Extracted from the article]

Endosonography (EUS), which combines routine endoscopy and ultrasound examination, has been rarely used in the routine diagnostic of portal hypertension. Gastroduodenoscopy is still the method of choice for the diagnosis of varices but it only allows for analysis of superficial varices. Endosonography offers much more detailed analysis of several features of portal hypertension, not detected with routine endoscopy. In this report we systematically review the current and potential future applications of EUS in the diagnostics of gastric varices. [ABSTRACT FROM AUTHOR]

Introduction: Patients with acute cholecystitis who are unsuitable for cholecystectomy undergo conservative treatment or percutaneous transhepatic gallbladder drainage. As these two methods are not always successful, further treatment options are needed. One increasingly popular method is endoscopic ultrasound-guided gallbladder drainage (EUSGBD), whereby stents are placed so as to create a permanent fistula connecting the gallbladder to the stomach or the duodenal bulb, thus enabling drainage of its contents to the gastrointestinal tract., Aim: To present our early experience with EUSGBD for the treatment of cholecystitis in patients who are not suitable for cholecystectomy., Material and Methods: The procedure was performed in 5 patients with acute cholecystitis. Two patients also had symptoms of biliary obstruction due to pancreatic head cancer. An ultrasound endoscope was used to create a fistula between the gallbladder and the stomach or between the gallbladder and the duodenal bulb, in which a self-expandable metallic stent (SEMS) was placed., Results: All procedures were performed with no perioperative complications. In all patients, the clinical symptoms of cholecystitis subsided within 3-15 days. In those patients who also showed symptoms of biliary obstruction, these symptoms subsided within 3-6 days following the procedure., Conclusions: The EUSGBD seems to be an effective and safe treatment for acute cholecystitis in patients unsuitable for cholecystectomy. It can also be used to treat jaundice caused by obstruction of the common bile duct, when no other methods can be used. The method is particularly promising in cases of concurrent acute cholecystitis and common bile duct obstruction., Competing Interests: The authors declare no conflict of interest.

Publication is summarization of existing data being results of literature review and our experience on usefulness of selenium as a diagnostic marker selection for control examinations in surveillance and as a marker of patients with high risk of cancers.

Aim: To investigate the indications, resection rate, and safety of endoscopic submucosal dissection (ESD) for neoplastic lesions in the gastrointestinal tract at a European referral center., Methods: We carried out a retrospective analysis of the ESD procedures performed in our center for mucosal neoplastic and submucosal lesions of the gastrointestinal tract. The duration of the procedure, en bloc and complete (R0) resection rates, and complication rates were evaluated. Variables were reported as mean ± SD or simple proportions. Univariate analysis and comparisons of procedure times and resection rates were performed using Mann-Whitney U tests, or χ(2) tests for dichotomous variables., Results: Between 2007 and 2011, ESD was performed in a total of 103 patients (46.7% male, mean age 64.0 ± 12.7 years). The indications for the procedure were epithelial tumor (n = 54), submucosal tumor (n = 42), or other (n = 7). The total en bloc resection rate was 90.3% (93/103) and R0 resection rate 80.6% (83/103). The median speed of the procedure was 15.0 min/cm(2). The complete resection rate was lower for submucosal tumors arising from the muscle layer (68%, 15/22, P < 0.05). Resection speed was quicker for submucosal tumors localized in the submucosal layer than for lesions arising from the muscularis propria layer (8.1 min/cm(2) vs 17.9 min/cm(2), P < 0.05). The R0 resection rate and speed were better in the last 24 mo (90.1%, 49/54 and 15.3 min/cm(2)) compared to the first 3 years of treatment (73.5%, 36/49, P < 0.05 and 22.0 min/cm(2), P < 0.05). Complications occurred in 14.6% (n = 15) of patients, including perforation in 5.8% (n = 6), pneumoperitoneum in 3.9% (n = 4), delayed bleeding in 1.9% (n = 2), and other in 2.9% (n = 3). Only one patient with delayed perforation required surgical treatment. During the mean follow-up of 26 ± 15.3 mo, among patients with R0 resection, recurrence occurred in one patient (1.2%)., Conclusion: ESD is an effective and safe method for resection of neoplastic lesions with low recurrence. Speed and the R0 resection rate increased after 50 procedures.

This article presents a rare case of portal biliopathy, a secondary cholangiopathy, in a young man whose first clinical manifestation was bleeding from esophageal varices. Portal biliopathy may mimic primary sclerosing cholangitis and it can develop secondary to portal vein thrombosis usually acquired in early childhood. Narrowing and dilatation of biliary tree develops as a consequence of compression of common bile duct by collaterals. Clinical symptoms are mainly cholestatic jaundice and abdominal pain. Complications include recurrent cholangitis and secondary biliary cirrhosis. The article provides information on the pathogenesis, clinical symptoms and treatment of portal biliopathy and problems related to differential diagnosis with primary sclerosing cholangitis (PSC).

Background/aims: Obstruction of the main pancreatic duct in chronic pancreatitis (CP) leads to an increased intraductal and intraparenchymal pressure causing pain. In this study we evaluated the outcome of surgical treatment of CP including the quality of life following Partington-Rochellepancreaticojejunostomy (PRP) performed for intractable pain., Methodology: Between July 2002 and May 2008, PRP was performed in 17 patients in whom the diameter of the main pancreatic duct exceeded 7mm and there was no inflammatory tumor in the pancreatic head. Perioperative morbidity and mortality were analyzed in all patients. The long term outcome including the quality of life (Karnofsky index) was evaluated in 9 patients who were followed with a mean 28 (range 13-60) months since surgery., Results: Complications in the postoperative period were found in 3 (18%) patients including 1 death due to a myocardial infarction shortly after surgery. All patients submitted to the long-term evaluation reported a significant (p < 0.0001) pain reduction by an average of 6.2 (5-8) points in a 10-points visual analogue scale. The Karnofsky index increased significantly from a mean 52% (40-70%) before surgery up to 82% (70-90%) following surgery and long-term., Conclusions: PRP leads to a substantial quality of life improvement in patients with CP.

Benign solid tumors of the liver may be one of the great diagnostic difficulties among the hepatic problems. The most common of them are: haemangiomas, adenomas, nodular regenerative hyperplasia (NRH) and focal nodular hyperplasia (FNH). There are several useful ways of imaging for those lesions (USG, CT, MR), which are helpful in decision-making and further management. This article presents a summary of the main information on benign solid tumors of the liver based on internet database MEDLINE. Also, it contains some proceedings of treatment and control for patients with those lesions, which can help to differentiate benign and malignant hepatic tumors.

Thrombophilia in adults is one of main causes of portal vein thrombosis. Esophageal and gastric varices, ascites and hypersplenism are well known complications of portal hypertension. There are controversial issues on the management, especially anticoagulant therapy and surgical treatment of these patients. We present a 42-years old woman with a history of three acute coronary episodes suffering from recurrent variceal bleeding due to portal and splenic vein thrombosis in the course of myeloproliferative disorder and protein C deficiency. It was 10 months delay of diagnosis. She was successfully treated with medical and surgical treatment (esophageal stapler transection, cardial devascularization, and splenectomy). In the paper we discuss complexity of diagnosis and surgical treatment.

Upper gastrointestinal endoscopy plays a major role in the diagnostic and treatment of the complications of portal hypertension in patients with liver cirrhosis. Endosonography (EUS), which combines routine endoscopy and ultrasound examination has been so far infrequently used in these cohort of patients despite the fact that it offers much more detailed analysis of several features of portal hypertension, not detected with routine endoscopy. These include detection of so called "deep varices", assessment of the thickness of gastric wall, differentiation between thickened folds and varices or detection of subclinical amounts of ascitic fluid. In this paper we systematically review the current and potential future applications of EUS in the diagnostic and treatment of patients with liver cirrhosis.

This paper presents a case report of a 61 year-old man who had diagnosed in colonoscopy rectal cancer of early stage. In endosonography (EUS) intramucosal lesion without enlargement of regional lymph nodes was demonstrated. The patient was qualified for endoscopic therapy by submucosal dissection (ESD). The treatment was performed without any complications. The histological findings confirmed an early stage of rectal cancer--This, according to TNM classification.