ABSTRACT: Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of innumerable small discrete nodules involving a variable segment of the gastrointestinal tract. The association between nodular lymphoid hyperplasia and other benign and malignant diseases has been clearly described, with an increased risk of gastrointestinal tumours, namely gastrointestinal lymphoma. However, the association with extraintestinal lymphoma seems extremely rare. The authors present a clinical case of a patient with nodular lymphoid hyperplasia of the small and large intestine that subsequently developed an extraintestinal lymphoma (diffuse large B-cell lymphoma).
Acta gastro-enterologica Belgica 06/2012; 75(2):260-2. · 0.64 Impact Factor
ABSTRACT: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level.
evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding.
we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively.
with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy´s lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively.
intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2012; 104(4):190-6. · 1.55 Impact Factor
ABSTRACT: Capsule endoscopy (CE) can be prevented by difficulties in swallowing the device and/or its gastric retention. In such cases, endoscopic delivery of the capsule to duodenum is very useful. We describe the indications and outcomes of cases in which traditional endoscopic techniques allowed placement of the capsule in duodenum.
This is a retrospective, descriptive case series. All patients in the above conditions were identified and indications for CE, endoscopic-placement technique, complications and completeness of small bowel imaging were registered.
Endoscopic-assisted delivery of the capsule was necessary in 13 patients (2.1% of all CE; 7 males; mean age--47.9 +/- 24.9 years, range 13 to 79 years). Indications for endoscopic delivery included: inability to swallow the capsule (7), gastric retention in previous exams (3), abnormal upper gastrointestinal anatomy (3). In eight patients, the capsule was introduced in GI tract with: foreign body retrieval net alone (3), retrieval net and a translucent cap (2), prototype delivery device (2) or a polypectomy snare (1). Five patients ingested the capsule that was then placed in duodenum with a polypectomy snare (3) or a retrieval net (2). No major complications occurred. Complete small bowel examination was possible in 10 patients (77%).
Endoscopic placement of capsule endoscope in the duodenum is rarely needed. However it may be safely performed by different techniques avoiding some limitations of CE. The best methods for endoscopic delivery of the capsule in the duodenum seem to be retrieval net with a translucent cap when the patient is unable to swallow the device or a retrieval net only to capture the capsule in the stomach when the patients swallows it easily.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 01/2009; 100(12):758-63. · 1.55 Impact Factor
ABSTRACT: Dieulafoy's lesion is usually considered to be a rare cause of gastrointestinal bleeding and little information is available about the long-term follow-up of this condition. We studied the clinical pattern and long-term outcome in patients with Dieulafoy's lesion who were managed in a gastrointestinal intensive care unit.
We reviewed the data on the diagnosis, treatment, and outcome of 70 patients admitted to our unit for acute upper gastrointestinal bleeding due to Dieulafoy's lesion. Endoscopic hemostasis was performed in 69 cases. Patients underwent surgery if endoscopic therapy failed. A phone interview was carried out to assess the long-term clinical outcome.
Dieulafoy's lesion accounted for 4 % of cases of upper gastrointestinal bleeding in patients admitted during the period studied. The mean number +/- SD of endoscopies required to establish the diagnosis was 1.4 +/- 0.75. Endoscopic hemostasis was initially successful in 91.3 % of patients, while nearly 16 % of patients required surgery because endoscopic therapy failed. The overall mortality rate was 8.6 %. None of the 52 patients who were followed up by phone reported recurrent bleeding after discharge from hospital, in a mean follow-up period of 69 months.
Dieulafoy's lesion is a not uncommon cause of severe recurrent gastrointestinal bleeding. Endoscopic therapy is safe and effective in achieving permanent hemostasis. The long-term prognosis for Dieulafoy's lesion is excellent, even when patients are treated using endoscopic methods alone.
Endoscopy 06/2004; 36(5):416-20. · 5.21 Impact Factor