Subject(s)
Adenoma, Villous/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Common Bile Duct Neoplasms/surgery , Common Bile Duct/surgery , Adenoma, Villous/diagnosis , Aged, 80 and over , Common Bile Duct/diagnostic imaging , Common Bile Duct Neoplasms/diagnosis , Endosonography , Female , HumansABSTRACT
AIM: To evaluate the rate of adverse events (AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS: Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after the procedure. RESULTS: 308 patients were included and a single polypectomy was performed in 205. Only 36 (11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm (5-60) and in 294 cases (95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219 (71.1%) patients. Nine patients presented AEs (2.9%), and 6 of them were bleeding (n = 6, 1.9%) (in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding. CONCLUSION: Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.
Subject(s)
Duodenal Diseases/surgery , Endoscopy, Gastrointestinal/adverse effects , Microsurgery/adverse effects , Polyps/surgery , Postoperative Hemorrhage/epidemiology , Stomach Diseases/surgery , Adult , Aged , Aged, 80 and over , Duodenum/pathology , Duodenum/surgery , Endoscopy, Gastrointestinal/methods , Female , Humans , Incidence , Male , Microsurgery/methods , Middle Aged , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/therapy , Prospective Studies , Risk Factors , Spain , Stomach/pathology , Stomach/surgery , Young AdultABSTRACT
BACKGROUND AND AIMS: Stenosis is one of the most frequent local complications in Crohn's disease (CD). Surgery is not the ideal treatment because of the high rate of postoperative recurrence. Endoscopic balloon dilation (EBD) currently is the current treatment of choice for short strictures amenable to the procedure. However, it is not applicable or effective in all the cases, and it is not without related complications. Our goal was to summarize the published information regarding the use and the role of the stents in the treatment of CD stricture. A Medline search was performed on the terms "stricture," "stenosis," "stent" and "Crohn's disease." RESULTS: a total of 19 publications met our search criteria for an overall number of 65 patients. Placing a self-expanding metal stent (SEMS) may be a safe and effective alternative to EBD and/or surgical intervention in the treatment of short stenosis in patients with CD. Indications are the same as those for EBD. In addition, SEMS may be useful in stenosis refractory to EBD and may be suitable in the treatment of longer or more complex strictures that cannot be treated by EBD. With the current information, it seems that the best treatment option is the placement of a fully covered stent for a mean time of 4 weeks. Regarding the use of biodegradable stents, the information is limited and showing poor results. CONCLUSIONS: the use of stents in the treatment of strictures in CD should be taken into account either as a first endoscopic therapy or in case of EBD failure.
