Assuntos
Falso Aneurisma/tratamento farmacológico , Coagulantes/uso terapêutico , Artéria Esplênica/diagnóstico por imagem , Trombina/uso terapêutico , Adulto , Falso Aneurisma/diagnóstico por imagem , Endossonografia , Humanos , Injeções Intralesionais , Masculino , Radiografia , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Endoscopic ultrasonography (EUS) has evolved over the past 20 years with the emergence of novel diagnostic and therapeutic indications. Our goal was to identify the best evidence supporting the use of EUS. MATERIALS AND METHODS: A six-step approach was employed to develop recommendations using accepted methodology. Twenty-two experienced endosonographers identified topics and reviewed studies using MeSH (medical subject headings) terminology and free text in PubMed. Medline and society abstracts were reviewed if necessary. The quality of evidence, the strength of recommendations, and level of consensus were graded and voted on. RESULTS: Consensus was reached for several clinical scenarios for which the impact of EUS findings was supported by a high level of evidence. These included diagnosis and staging of esophageal cancer, differential diagnosis of subepithelial lesions, thickened gastric folds, assessment of peritoneal involvement in patients with gastric cancer, mucosa-associated lymphoid tissue lymphoma, diagnosis of common bile duct/gallbladder stones, diagnosis of chronic pancreatitis, differential diagnosis of a solid mass in patients with chronic pancreatitis, differential diagnosis of pancreatic cyst, rectal cancer staging, and diagnosis and staging of non-small-cell lung cancer. The recommendations were adopted by the Brazilian Society of Gastrointestinal Endoscopy. Several indications continue to emerge and require additional validation.
Assuntos
Conferências de Consenso como Assunto , Endossonografia , Medicina Baseada em Evidências , HumanosRESUMO
BACKGROUND AND STUDY AIMS: There have so far been no prospective studies on the value of flexible endoscopy for removing foreign bodies in the upper gastrointestinal tract. This study presents a clinical analysis of accidents with foreign bodies and prospectively evaluates the effectiveness of flexible endoscopy for removing them. PATIENTS AND METHODS: A total of 105 cases of foreign-body ingestion in the upper gastrointestinal tract were evaluated, 29 (27.6 %) in children and 76 (72.4 %) in adults. Thirty patients (28.5 %) had esophageal strictures. RESULTS: Thirty-nine of the foreign bodies (37.1 %) consisted of food and 66 (62.9 %) were not food-related. The success rate of foreign-body extraction using only a conventional flexible endoscope and accessories for treatment was 98.0 %, and with only a polypectomy snare and rat-toothed forceps it was 91.2 %. Complications at the moment of foreign-body removal occurred in nine patients (8.6 %); there was only one (1 %) esophageal perforation. The incidence of complications related to the duration of foreign-body impaction was six (10.5 %) with foreign bodies impacted for up to 24 h, 13 (52.0 %) for those impacted for 24-48 h, and three (60.0 %) for those impacted for 48-72 h ( P < 0.05). CONCLUSIONS: The flexible endoscope is an effective and safe device for removing foreign bodies from the upper gastrointestinal tract, with a high success rate using only the polypectomy snare and the rat-toothed forceps as accessories. If foreign-body impaction lasts for more than 24 h, there is a significant increase in the incidence of complications.
Assuntos
Endoscópios Gastrointestinais , Corpos Estranhos/terapia , Trato Gastrointestinal Superior , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Endoscopia Gastrointestinal , Humanos , Lactente , Pessoa de Meia-Idade , Maleabilidade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Gastric antral vascular ectasia or watermelon stomach is a rare but important cause of upper gastrointestinal bleeding. The authors report the first case of gastric antral vascular ectasia associated with a gastric carcinoid in a cirrhotic patient. The article provides a literature review with emphasis on etiology, endoscopic features and treatment of this entity.