Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract

Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.

Evaluation of supporting role of early enteral feeding via tube jejunostomy following resection of upper gastrointestinal tract

Today, early diagnosis of upper gastrointestinal [GI] tract malignancies and their surgical resection is becoming more feasible. One of the important side effects in upper GI tract malignancies is malnutrition which has direct relationship with postoperative complications. Nonetheless, there is no easy regimen of nutrition for these patients especially for the first week after operation. Accordingly we present a simple method for improving feeding such patients via tube jejunostomy. The aim of this study was to investigate the impact of early enteral feeding [EEF] on postoperative course after complete resection of upper gastrointestinal tract malignancy and reconstruction. Between September 2005 to September 2008, 60 consecutive patients [22 female, 38 male] with upper GI tract malignancies who had undergone complete resection and reconstruction enrolled in this study. The patients randomly divided equally in two groups of control and EEF. Control group was treated with traditional management of nil by mouth and intravenous fluids for the first five postoperative days and then with liquids and enteral regular diet when tolerated. In EEF group the patients were fed by tube jejunostomy from 1[st] postoperative day and assessed for nutritional status before surgery and 5 days after surgery. Both groups were monitored on the basis of weight gain, clinical and paraclinical parameters and postoperative complications. Sixty patients were randomly divided to two equal groups. Surgical procedures were similar in two groups and no significant difference in demographic and basic nutritional status were found. On 5[th] postoperative day serum albumin was 4.2 +/- 0.4 g/dl in EEF and 3.6 +/- 0.3 g/dl in control group [p= 0.041]. Also serum transferrin was 260.8 +/- 2.5 mg/dl and 208 +/- 1.8 mg/dl in EEF and control group respectively [p<0.001]. Moreover, hospital stay was shorter in EEF group [7.7 +/- 3.1 vs. 14 +/- 2.5 days, p=0.009].There were four [13.3%] anasatomotic leakages in control group and one [3.3%] in EEF group [p=0.353]. Also there was six [20%] wound infection in control group and three [10%] in EEF group [p=0.472]. The EEF by tube jejunostomy can be an effective method of feeding patients in postoperative days of resection of GI malignancies. Postoperative hospital stay would be shorter and the level of laboratory parameters especially serum transferrin is higher in EEF in comparison with control group. It also may reduce postoperative complications such as wound infection and enterocutaneous fistula

RE: Tips and Tricks of Percutaneous Gastrostomy Under Image Guidance in Patients with Limited Access

No abstract available.

Upper gastrointestinal endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana

Objectives: To study the indications for endo-scopy, the endoscopic diagnosis and other lessons learnt.. Methods: A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results: A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 + 0.5 and females 43.7 + 0.6 years. Epi-gastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duo-denal ulcer (19.6%), acute gastritis (12.7%), duo-denitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion: The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ul-cer is usually associated with H. pylori infection and is the commonest cause of upper gastrointesti-nal bleeding

Corpo estranho no trato digestivo superior: relato de caso / Foreign Body in superior gastrointestinal tract: case report

Os autores relatam um caso de ingestão de corpo estranho incomum na prática médica. Um objeto metálico identificado (um talher - garfo) de aproximadamente 20cm de comprimento. Após a ingestão, o mesmo, ficou impactado na cavidade gástrica. Foi realizada uma radiografia de abdome que constatou o fato. A paciente foi encaminhada para a endoscopia (EDA) e sem sucesso de remoção foi feito um procedimento cirúrgico, onde foi exteriorizado o objeto, e a paciente evoluiu com um bom prognóstico...