[show abstract][hide abstract] ABSTRACT: Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection.
Gut and liver 09/2011; 5(3):391-4. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Clinical demand for total colonoscopy is increasing. Several articles have reported on the usefulness of a cap for faster cecal intubation and reduced patient discomfort, but results for polyp and adenoma detection have been inconsistent.
To assess the efficacy of a cap attached to the tip of a colonoscope for detection and resection of polyps by experienced colonoscopists.
Prospective, randomized, controlled trial.
A tertiary referral center.
A total of 329 patients who underwent colonoscopic EMR were randomized to cap-assisted colonoscopy (CAC) (CAC group, n = 166) or regular colonoscopy (RC) (RC group, n = 163).
Cecal intubation time, total procedure time, required time for colonoscopic EMR of each polyp, and missing polyp rate.
The cecal intubation time in the CAC group and RC group was 5.3 ± 3.3 minutes and 5.8 ± 3.7 minutes, respectively (P = .170). The total procedure time in the CAC group and RC group was 23.0 ± 15.5 minutes and 29.2 ± 13.4 minutes, respectively (P = .626). The time required for colonoscopic EMR of each polyp in the CAC group and RC group was 3.5 ± 4.5 minutes and 4.2 ± 5.1 minutes, respectively (P = .010). The number of polyps during the initial colonoscopy in the CAC group and RC group was 2.2 ± 1.7 and 2.0 ± 1.8, respectively (P = .221). The number of detected polyps during colonoscopic EMR in the CAC group and RC group was 3.4 ± 2.7 and 2.7 ± 1.9 (P = .003). The number of missed polyps in the CAC group and RC group was 1.1 ± 1.5 and 0.8 ± 0.9 (P = .024).
CAC may reduce the time required for colonoscopic EMR of each polyp and may also improve the polyp detection rate.
[show abstract][hide abstract] ABSTRACT: Food residue is frequently observed in the gastric remnant after distal gastrectomy, despite adequate preparation. We devised a water-intake method to reduce food residue in the gastric remnant by drinking large quantities of water in a short time. The aims of this study were to identify the risk factors for food residue and to study the effectiveness of this new method for endoscopy preparation.
A cohort of 708 patients who underwent distal gastrectomy for gastric cancer was reviewed prospectively. Sixty patients with large amounts of food residue were randomly divided into two groups: a water-intake group (n=40) and a prolonged fasting group (n=20).
The incidences of a large amount of food residue were 15.7%, 5.8%, 7.5%, and 2.8% at 3, 12, 24, and 36 months, respectively, after distal gastrectomy. Independent risk factors for food residue were endoscopy at 3 months, diabetes mellitus, a body mass index of <19.5, and laparoscopic surgery. The proportion of successful preparations at follow-up endoscopy was higher for the water-intake group (70%) than for the prolonged fasting group (40%, p=0.025).
The water-intake method can be recommended as a preparation for endoscopy in patients who have had repetitive food residue or risk factors after distal gastrectomy.
Gut and liver 09/2009; 3(3):186-91. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Primary neuroendocrine carcinoma of the gallbladder is extremely rare because normal gallbladder mucosa does not contain neuroendocrine cells. Neuroendocrine cells can be detected at sites of intestinal metaplasia induced by chronic inflammation, which may be the initial step in the development of neuroendocrine tumor of the gallbladder. Anomalous union of the pancreaticobiliary duct (AUPBD) is an uncommon congenital anomaly that is frequently associated with choledocholithiasis, cholangitis, pancreatitis, and cancer of the gallbladder or bile duct. In AUPBD, cancers of the gallbladder and bile duct can be induced by chronic inflammation. We report herein a case of large-cell neuroendocrine tumor of the gallbladder associated with AUPBD.
Gut and liver 09/2009; 3(3):231-4. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: When standard methods of biliary cannulation fail, needle-knife fistulotomy may be used. However, large stones cannot be easily extracted through the necessarily smaller opening made when using the fistulotomy technique.
We report the efficacy and safety of endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in patients in whom cannulation is difficult.
A case series.
A tertiary referral center.
Six patients (6 of 115, 5.2%) with bile duct stones in whom cannulation by the conventional method had failed underwent fistulotomy and large-diameter (12-15 mm) balloon dilation through the fistulotomy tract.
Successful biliary cannulation, outcome of therapy, and post-ERCP complications including pancreatitis were recorded.
Biliary cannulation was successful in 6 of 6 patients (100%) with fistulotomy. After endoscopic large-diameter balloon dilation of the fistulotomy tract, stone extraction was successfully performed in 6 of 6 patients. None of the patients developed post-ERCP pancreatitis. One of the 6 patients had minor delayed bleeding, which stopped spontaneously.
A small case series, retrospective design, and no control group.
Endoscopic large-diameter balloon dilation through the fistulotomy tract may be a feasible and safe alternative method for the removal of bile duct stones in patients in whom cannulation is difficult.
[show abstract][hide abstract] ABSTRACT: To investigate the prognosis of paraquat-induced ocular surface injury and the therapeutic efficacy of amniotic membrane transplantation for the treatment of ocular surface damage.
Twenty patients (26 eyes) with ocular surface injury caused by paraquat were studied. Twelve patients (14 eyes) underwent amniotic membrane transplantation combined with medical treatment (group A), and 8 patients (12 eyes) received medical treatment only (group B). Visual acuity, time to epithelial defect closure, stromal haze, and complications were analyzed.
The grade of the ocular surface injury was mild in 19 eyes (73.1%). Visual acuity improved in 20 eyes (76.9%). The epithelial defect healed completely in 25 eyes (96.2%), with a mean healing time of 16.04 +/- 6.22 days. At the final visit, 80.8% of cases had no stromal haze. The mean time to epithelial defect closure was 13.43 +/- 3.55 days in group A and 19.18 +/- 7.25 days in group B (P = 0.03). Complications included punctal stenosis (2 eyes) and pannus (1 eye) in group A and conjunctivalization (1 eye) and symblepharon (1 eye) in group B.
Paraquat-induced ocular surface injury had a relatively good prognosis. Amniotic membrane transplantation was helpful in shortening the time to closure of the epithelial defect.
[show abstract][hide abstract] ABSTRACT: Irritable bowel syndrome (IBS) is a biopsychosocial disorder. 5-Hydroxytryptamine (5-HT) plays a crucial role in the control of gastrointestinal motility, sensation, and secretion. This study investigated changes in platelet-depleted plasma 5-HT and their correlation with psychopathology in IBS patients and healthy subjects.
This study involved 21 subjects with IBS and 13 healthy subjects. Fasting and 1-hr postprandial plasma 5-HT concentrations were measured. The SCL-90R symptom checklist was used for the assessment of current psychological symptoms.
Fasting and postprandial plasma 5-HT concentrations were significantly higher in IBS patients (15.11+/-13.51 ng/mL and 16.31+/-14.21 ng/mL, respectively) than in healthy subjects (5.55+/-4.14 ng/mL and 6.25+/-4.82 ng/mL, respectively; p<0.05). There were no significant changes between fasting and 1-hr postprandial 5-HT concentration in IBS subtypes and healthy subjects. Scores on all SCL-90R subscales except for the interpersonal-sensitivity subscale were significantly higher in IBS patients than in healthy subjects. No correlation was found between SCL-90R items and platelet-depleted plasma 5-HT concentration.
5-HT might play a critical role in IBS, and psychopathological factors are correlated with IBS.
Gut and liver 03/2009; 3(1):26-30. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Endoscopic retrograde biliary drainage (ERBD) by using a plastic stent is suggested to be as effective as endoscopic nasobiliary drainage (ENBD) for temporary biliary drainage in acute suppurative cholangitis (ASC). However, there are few studies that compared ERBD and ENBD in ASC.
We compared the safety and efficacy of ERBD and ENBD for temporary biliary drainage in patients with ASC.
A case series.
A tertiary-referral center.
Eighty patients with ASC underwent endoscopic biliary drainage with ENBD (n = 41) and ERBD (n = 39).
Clinical outcomes, including complications related to ERCP and complications related to the type of the indwelling catheter.
Endoscopic biliary drainage was successfully achieved in all patients (100%). There were no significant differences in the demographic data between the 2 groups. There were no differences in the improvement of clinical and laboratory parameters between the 2 groups. Overall ERCP-related complication rates in the ENBD and ERBD groups were 31.7% and 38.5%, respectively (P = .527). Hyperamylasemia occurred in 18 patients, 12.2% in the ENBD group (5/41) and 33.3% in the ERBD group (13/39) (P = .024). Without endoscopic sphincterotomy (EST), there was no statistically significant difference in the incidence of hyperamylasemia between the 2 groups. However, with an EST, hyperamylasemia was more frequent in the ERBD group (12/28 [42.9%]) than in the ENBD group (3/27 [11.1%]) (P = .008).
A single-center experience.
Endoscopic biliary decompression, whether by ERBD or ENBD, is an effective treatment for patients with ASC. However, more frequent hyperamylasemia with ERBD and EST deserves further evaluation.