Análise epidemiológica de pacientes submetidos à endoscopia digestiva alta em uma unidade de saúde de curta permanência / Epidemiological analysis of patients submitted to high digestive endoscopy in a short-stay health unit

Introdução e objetivos: a Endoscopia Digestiva Alta (EDA) representa o método de endoscopia mais usado, e geralmente é realizada sob sedação consciente. Dentre os efeitos adversos (EA) deste exame, os eventos cardiorrespiratórios são os que implicam maior importância, representando cerca de 60% do total, estando relacionados a fatores predisponentes dos pacientes, tais como obesidade, idade e doenças pulmonares prévias. Assim, considerando-se a relevância dos fatores de risco (FR) relacionados ao paciente e seus possíveis efeitos na morbimortalidade geral do procedimento, objetiva-se com o presente trabalho epidemiológico traçar o perfil do paciente que se submete à EDA no Brasil. Métodos: o estudo é transversal com amostragem aleatória de 974 pacientes submetidos à EDA eletiva. O questionário foi aplicado entre janeiro de 2013 e junho de 2013. Resultados: a média de idade foi de 40,88 anos, sendo 11,50% acima dos 60 anos. A média do IMC foi de 26,21kg/m², com 53,18% dos entrevistados apresentando sobrepeso ou obesidade. As morbidades encontradas incluíram hipertensão arterial sistêmica (N=152); outras doenças cardíacas (N=35); doenças respiratórias (N=599); diabetes mellitus (N=43); doença tireoidiana (N=68). Os principais medicamentos utilizados foram os benzodiazepínicos (4,93%) ou outros neuropsiquiátricos, somando 11,59%. O uso de álcool foi relatado por 37,39% e 5,54% eram tabagistas. Apenas 19,40% dos pacientes não apresentavam alguma enfermidade coexistente ou FR. Conclusão: considerando-se a endoscopia e a sedação envolvida, a atenção às variações demográficas e epidemiológicas populacionais assume especial importância, visto que estão diretamente relacionadas ao aumento da probabilidade de ocorrência de EA cardiorrespiratórios durante e após o procedimento. As conclusões deste trabalho devem ser entendidas à luz de seu local de realização, que é uma unidade ambulatorial.

Background: the Upper Gastrointestinal Endoscopy (UGE) represents the most common endoscopic modality and it is usually made with conscious sedation. Among the adverse events of this procedure, the cardiovascular events are the most relevant, comprising around 60% of overall events. It is known that some adverse events are related to patient's risk factors, such as obesity, age and pulmonary disease. Thus, considering the importance of risk factors and their impact in the morbimortality related to the procedure, the aim of this study is to know the epidemiological profile of the patients that need an endoscopy in Brazil. Methods: it is a sectional study with an aleatory sample of 974 patients that was submitted to an elective UGE in the period of January of 2013 and June of 2013. A questionnaire was applied to each individual. Results: the average age of the study was 40.88 years old, with 11.50% being over 60 years old. The body mass index (BMI) average was 26.21 kg/m² among which 53.18% of the interviewed could be classified as overweight or obese. The morbidities founded were high blood pressure (N=152); other cardiac diseases (N=35); respiratory diseases (N=599); diabetes mellitus (N=43); thyroid diseases (N=68). The most used drugs were benzodiazepines (4.93%) or other psychiatric drugs, comprising 11.59%. The use of alcohol was mentioned by 37.39% and 5.54% were smokers. Only 19.40% amongst the patients did not mention any comorbidity or risk factor to the procedure. Conclusion: considering the endoscopy and the sedation involved in the procedure, knowing the demographic and epidemiological differences between populations are of special importance, since they are related to the cardiorespiratory adverse events that can occur during and after an UGE. The conclusions of this study should be interpreted taking into account that it was made in an ambulatory unity.

Twin Rectal Tonsils Mimicking Carcinoid or Mucosa-Associated Lymphoid Tissue Lymphoma

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.

Endoscopic cauterization for treatment of congenital pyriform sinus fistula / 国际儿科学杂志

Congenital pyriform sinus fistula (CPSF) is a rare branchial abnormality,presented as acute suppurative thyroiditis, recurrent neck abscess and cellulitis.In the past, the only way to cure CPSF is surgical resect of the whole lesion in the inflammation quiescent period, which always lead to many complications and high rate of recurrence.Since late 1990s,different kinds of endoscopic procedures have beeen attempted to close the inner orifice of congenital pyriform sinus fistula.After more than 10 years,endoscopic cauterization has been recommended as the first-line treatment for its safety, effective and minimally invasive.This paper introduces and summarizes the theory, procedure, advantages and disadvantages, indications and complications of endoscopic treatment of congenital pyriform sinus fistula.

Outcomes of Laparoscopic Gastrectomy after Endoscopic Treatment for Gastric Cancer: A Comparison with Open Gastrectomy

PURPOSE: Additional gastrectomy is needed after endoscopic resection for early gastric cancer when pathology confirms any possibility of lymph node metastasis or margin involvement. No studies depicted the optimal type of surgery to apply in these patients. We compared the short-term and long-term outcomes of laparoscopic gastrectomy with those of open gastrectomy after endoscopic resection to identify the optimal type of surgery. MATERIALS AND METHODS: From 2003 to 2010, 110 consecutive patients who underwent gastrectomy with lymphadenectomy either by laparoscopic (n=74) or by open (n=36) for gastric cancer after endoscopic resection were retrospectively analyzed. Postoperative and oncological outcomes were compared according to types of surgical approach. RESULTS: Clinicopathological characteristics were comparable between the two groups. Laparoscopic group showed significantly shorter time to gas passing and soft diet and hospital day than open group while operation time and rate of postoperative complications were comparable between the two groups. All specimens had negative margins regardless of types of approach. Mean number of retrieved lymph nodes did not differ significantly between the two groups. During the median follow-up of 47 months, there were no statistical differences in recurrence rate (1.4% for laparoscopic and 5.6% for open, P=0.25) and in overall (P=0.22) and disease-free survival (P=0.19) between the two groups. Type of approach was not an independent risk factor for recurrence and survival. CONCLUSIONS: Laparoscopic gastrectomy after endoscopic resection showed comparable oncologic outcomes to open approach while maintaining benefits of minimally invasive surgery. Thus, laparoscopic gastrectomy can be a treatment of choice for patients previously treated by endoscopic resection.

Endoscopic Management of Cranial Arachnoid Cysts Using Extra-Channel Method

OBJECTIVE: Arachnoid cysts (ACs) can be cured by making the definite and wide communication between the cyst and arachnoid space using endoscopy, but often it is impossible only through the usual working-channel (intra-channel) procedures. We discuss and propose a more valuable endoscopic technique with the presentation of our series of cases. METHODS: We treated 9 patients with cortical AC in various locations with extra-channel endoscopic techniques. The patients ranged in age from 3 years to 60 years (mean age, 37.2 yrs). The follow-up period ranged from 12 to 26 months (mean follow-up duration, 17.2 months). All patients had large AC compressing the adjacent brain with clinical symptoms or signs. The authors performed extensive fenestration via single burr hole with the aid of endoscope. Being bypassed the rigid endoscope, through the space between the shaft of endoscope and guiding cannula (extra-channel method), fenestration procedures were done in the dry fields. RESULTS: Eight (88.9%) patients had been treated successfully with endoscope. One patient required shunt procedure. Among the eight patients who were treated with endoscopic procedure, 6 patients (66.7%) showed cyst reduction, and two (22.2%) showed disappearance of cyst. CONCLUSION: We suggest that extra-channel method will be simple and easy to perform using more valuable instruments with wider working area, and may promise better results compared to the conventional intra-channel endoscopic procedures.

Therapeutic evaluation of endoscopic treatment of acute biliary pancreatitis / 中国普通外科杂志

Objective To evaluate the therapeutic effect of endoscopic treatment for acute biliary pancreatitis. Methods Thirty-six cases of acute biliary pancreatitis were treated in our hospital in recent 4 years. Tweent cases (group E) underwent emergency endoscopic retrograde cholongiopancreatography(ERCP),endoscopic sphincterotomy(EST) and endoscopic naso-biliary drainage (ENBD) within 24h of hospitalization; 16 cases (group C ) were treated conservatively or by operation. Results Successful rate of endoscopic management was 95.24%. There were no severe complications nor mortality in group E. The duration of symptoms and hospitalization in endoscopic group was significantly shorter than those in group C(P0.05). But the serum and urine amylase in group E were significantly lower than those in group C in the second day(P

Endourologic Management of Caliceal Diverticula Containing Calculi / 대한비뇨기과학회지

Caliceal diverticula containing calculi had been managed conventionally by deroofing of the diverticulum, closure of the communication with the collecting system, or partial nephrectomy. To minimize the loss of the renal parenchyme and to treat caliceal diverticulum containing calculi, endoscopic procedure was performed successfully in 6 cases. but failed in 1. Repeated endoscopic procedure was performed in failed case 6 months after first operation and succeeded also. The diverticular neck was dilated with the Amplatz dilator upto 24-30Fr. A 20Fr. nephrostomy catheter was placed for 10-14days, and there was no complications. We evaluated the result of diverticular obliteration with excretory urography 6 months after the operation. In conclusion, endourologic management of caliceal diverticulum containing calculi is a safe. less invasive. successful and parenchyme preserving procedure.