RESUMO
OBJECTIVE: To investigate the usefulness of endoscopic gastrostomy and long-term complications. BACKGROUND DATA: Endoscopic gastrostomy is well established as the procedure of choice for long-term feeding, given the low morbidity-mortality and ease of placement. METHOD: We evaluated retrospectively one hundred endoscopically placed gastrostomy feeding tubes and complications occurring more than 30 days after placement were recorded. RESULTS: Gastrostomy feeding tubes remained in place for a mean of 92 days (range 30-547 days). Fifteen percent developed evident gastroesophageal reflux, two patients developed aspiration pneumonia and one presented with infection at the site of gastrostomy. Our long-term complications rate thus was 3.0% and 0% mortality. CONCLUSIONS: Our experience suggests that endoscopic gastrostomy is a relatively simple procedure, associated with very low morbidity and mortality. It is the procedure of choice in patients requiring long-term enteral nutrition.
Assuntos
Gastrostomia , Adolescente , Adulto , Idoso , Criança , Endoscopia , Estudos de Avaliação como Assunto , Seguimentos , Refluxo Gastroesofágico/etiologia , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Humanos , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVE: The aim of this study was to determine the frequency of adenomas as well as sensitivity, specificity, positive and negative predictive values of FS for polyp screening in two groups of asymptomatic individuals using colonoscopy (CP) as the gold standard. BACKGROUND: Flexible sigmoidoscopy (FS) is the screening procedure of choice for polyps and colorectal carcinoma (CRC) in asymptomatic individuals. However, the validity of this approach has been questioned, specially in subjects with a family history of CRC. METHODS: A total of 92 asymptomatic individuals were included in two groups: group A: with a family history (1st or 2nd degree relatives) of polyps or CRC (fifty-eight), and group B: without a family history and > 50 years (thirty-four). FS was simulated with the videocolonoscope until 60 cm, and was continued into the cecum. The number, type and localization of polyps were noted for each, FS and CP. The values mentioned previously were calculated according to established formulas. Comparisons were performed using Chi square test. RESULTS: Adenomas were found in twenty individuals in group A (34.4%) and 7 in group B (20.5%), p = NS. Sensitivity for FS in group A was 42% vs 71% in group B, with a negative predictive value of 44.5 and 93%, respectively. CONCLUSION: Colonoscopy is probably the screening procedure of choice in individuals with a family history of polyps or CRC. The utility of FS for screening purposes in asymptomatic individuals without a family history seems adequate, although more studies are required in different populations in our country.
Assuntos
Adenoma/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Pólipos Intestinais/diagnóstico , Sigmoidoscopia , Fatores Etários , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Fatores SexuaisRESUMO
The role of gallbladder motility (GBM) in gastrointestinal diseases has been frequently ignored. Recently however, the introduction of new diagnostic methods and data on the normal physiology of gallbladder emptying and refilling have placed this interesting area of gastrointestinal motility where it justly deserves. In this way it has been possible to recognize and further study the pathophysiologic mechanisms involved in some clinical situations with a higher-than expected frequency of gallstones (GS). It has also been possible to identify with more clarity the role GBM has in the chain of events that lead to GS development and thus, to plan prevention or therapeutic strategies. The discovery of new drugs with effects on GBM have also permitted to further advance in the knowledge of normal physiologic mechanisms and to have access to possible future treatments. Also pathologic entities have been clearly defined, such as chronic acalculous cholecystitis. In this review we present recent knowledge on normal GBM physiology and its clinical applications as well consequences of its dysfunction.