Is endoscopic ultrasound clinically useful for follow-up of gastric lymphoma?

BACKGROUND: Endoscopic ultrasound (EUS) is considered the best technique for locoregional staging at diagnosis but its role in the follow-up of patients with gastric lymphoma after organ-conserving strategies has not been established. DESIGN AND METHODS: We retrospectively evaluated 23 patients with primary gastric lymphoma treated with a stomach-conservative approach. Sixteen of them were affected by MALT lymphoma and seven by diffuse large-B-cell lymphoma (DLBCL). Five patients were treated with Helicobacter pylori (HP) eradication therapy alone (omeprazole + amoxicillin + clarithromycin); eight patients received a treatment including HP eradication and chemotherapy and the remaining 10 patients were treated with chemotherapy alone. RESULTS: At the end of treatment, a complete remission was documented in 21 (91%) patients by endoscopy with biopsy (E-Bx) but in only seven (30%) patients by EUS. A total of 99 evaluations with both EUS and E-Bx were evaluated and we found concordance between the two methods in 33 occasions (33%) only. No significant difference on the percentage of concordance was recorded between MALT and DLBCL. After a median follow-up of 36.5 months we have not observed any relapse in 12 patients (six DLBCL and six MALT) with a persistent positive EUS but negative E-Bx. CONCLUSIONS: Although the length of follow-up cannot exclude late relapse, we think that in restaging and follow-up of gastric lymphoma, EUS seems not to be a reliable tool if it is abnormal and E-Bx still remains the gold standard. Therefore, after conventional conservative treatment, persistence of EUS abnormality with a negative histology should not be considered as a clinically relevant persistence of disease and should not be a reason for further treatment.

Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children.

BACKGROUND AND OBJECTIVE: Sedation is commonly used to facilitate diagnostic procedures in children. The aim of our study was to investigate sedation in children using propofol alone or combined with fentanyl or midazolam with regard to efficacy, adverse reactions or side-effects related to the drugs, ease of operation for the endoscopist, and time to discharge from the post-anaesthesia care unit. METHODS: We prospectively studied 240 children, aged 1-12 yr of age, undergoing endoscopic procedures of the upper gastrointestinal tract. The patients were given an oral premedication with midazolam (0.5 mg kg(-1)) and were then randomly allocated to one of the three study groups: propofol alone (Group P), propofol with fentanyl 1 mug kg-1 (Group PF) or propofol with midazolam 0.1 mg kg(-1) (Group PM). Additional doses of propofol given during the procedure were recorded. Adequacy of sedation and ease of procedure (easy, adequate, impossible) were evaluated by the endoscopist, who was blinded as to the drugs used. RESULTS: The duration of the procedure and the recovery period were similar in the three groups. The number of patients requiring supplemental doses of propofol to permit safe completion of gastroscopy was 31 in Group P (=39%; eight of these required two additional doses), 14 in Group PM (=18%), and 11 in Group PF (=13%) (P < 0.05). There was a lower incidence of adverse events in Group PM and in Group PF than in Group P (P < 0.05). CONCLUSIONS: Propofol in combination with fentanyl or midazolam gives better sedation and ease of endoscopy than propofol alone.

Esophacoil for palliation of recurrent malignant esophago-jejunal anastomotic stricture. Case reports.

Recurrent malignancy at esophagojejunal anastomosis represents an incurable stage of disease. Treatment options are limited. Surgery presents a high rate of morbidity and mortality and frequently fails to alleviate symptoms. Radiochemotherapy relieves dysphagia slowly and offers disappointing clinical results. The use of Self Expanding Metallic Stent (SEMS) has shown to be effective, safe and offers a good quality of residual life. We herein report three cases of malignant esophagojejunal anastomotic strictures successfully treated with metallic coil stent (Esophacoil).

EsophaCoil for palliation of dysphagia in unresectable oesophageal carcinoma: short- and long-term results.

BACKGROUND AND AIM: Few reports have shown that EsophaCoil is an effective and safe prosthesis for palliation of malignant oesophageal dysphagia. A single centre experience using this type of prosthesis is reported. PATIENTS AND METHODS: Between January 1995 and September 2000, 42 consecutive patients, 41 with unresectable oesophageal cancer and one with oesophageal stenosis secondary to lung cancer, were treated with 44 EsophaCoils (2 patients received 2 stents). Tumours were located in lower third of oesophagus and/or gastric cardia in 22 cases, in middle third in 18 and in upper third in 2. Mean stricture length was 5.3 cm. Implantation was performed on hospitalized patients. RESULTS: EsophaCoil placement was successful all 44 times and was followed by complete expansion of the prostheses. There were no major procedure-related complications or deaths. Dysphagia score improved from mean of 2.9 to 1.3 within 24 hours of stent implantation. Median hospital stay was 2.7 days. Late complications occurred in 14 patients (34.2%): 3 migrations into stomach, 7 tissue overgrowth, 2 late perforations and 2 food impactions. Mean survival time was 4.2 months (range 1-10). CONCLUSIONS: In our experience, full expansion of EsophaCoil was achieved in all cases. This result, was associated with high incidence of retrosternal pain. Relief of dysphagia score was identical to that obtained with other types of Self-Expanding Metal Stent. Coil design prevented tumour ingrowth and allowed retrieval of three migrated stents. Mean survival time was similar to that reported in larger series using different types of Self-Expanding Metal Stent.

[Campylobacter pylori (C. pylori): an occasional finding or a constant pathogenetic factor in peptic and inflammatory gastroduodenal pathology? Personal observations]. / Campylobacter pilori (C. pylori): un reperto occasionale o un fattore patogenetico costante nella patologia peptica ed infiammatoria gastroduodenale? Considerazioni personali.

The detection of CP in the mucosa of the gastric antrum had led to the supposition of this bacterium's potential pathogenetic role in the onset and continuation of peptic ulcer and/or inflammatory gastroduodenal disease. After reviewing the literature, the Authors report the incidence rate of the presence of C.P. in the mucosa of the gastric antrum in 110 symptomatic patients. Endoscopic examination revealed a negative diagnosis, or the presence of gastric and/or duodenal ulcer, or aspecific inflammatory disease. C.P. was detected using the quick urea test and histomorphological analysis after modified Giemsa staining on bioptic endoscopic specimens. C.P. were present in 86.6% of duodenal ulcers, 94.8% of gastro-duodenal inflammation, and 29.4% of endoscopical normal patients. These results confirm that C.P. should not be considered an occasional finding but almost a constant factors. The importance of performing the quick urea test during endoscopic examination is underlined, since if positive an appropriate therapeutic protocol can be started as soon as possible.

Endoscopic ultrasonography in a case of gastric leiomyoblastoma.

Endoscopic ultrasonographic diagnosis of a gastric leiomyoblastoma stemming from the gastric wall is reported. Transparietal echography and CT had indicated that this tumor arose form the right ovary.

[Pathology caused by suture materials in patients with gastric resection. Endoscopic findings]. / La patologia da filo di sutura nel resecato gastrico Rilievi endoscopici.

The authors report the results obtained from an endoscopic study on 131 gastric resected patients, who in 18.3% showed a pathology due to suture thread. The Authors dwell upon the clinical picture shown by these patients, and also consider the cases performed on urgency for hematemesis and/or melaena, and upon the diagnostical role of endoscopy. Moreover, they report the results obtained through the endoscopic therapy, which in 100% of the cases allowed the removal of the suture thread.