RESUMO
Esophageal capsule endoscopy (ECE) is considered to be an alternative to conventional esophagogastroduodenoscopy (EGD); however, its indications continue to expand. This report presents results from the use of ECE in patients with hemophilia at a tertiary referral academic center over a 7-year period. A total of 16 patients with hemophilia, who were all at risk of new-variant Creutzfeldt-Jakob disease due to previous treatment with UK plasma-derived pooled blood products, underwent a total of 28 ECE examinations. Main outcomes were the diagnostic yield of ECE, requirement for subsequent conventional EGD, and any variceal bleeding episodes during the follow-up period. The overall diagnostic yield was 67.8â% (19â/28 ECEs). Only one patient underwent conventional EGD, for esophageal biopsies. There were no variceal hemorrhage events in any of the patients on variceal screening follow-up.âECE is a useful and acceptable alternative to conventional endoscopy in selected patient groups (i.âe. patients with hemophilia). In this group, ECE can eliminate the need for prior administration of clotting factors.
Assuntos
Endoscopia por Cápsula/métodos , Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/prevenção & controle , Hemofilia A/complicações , Adulto , Idoso , Varizes Esofágicas e Gástricas/complicações , Esofagoscopia/efeitos adversos , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: The aim of this study was to compare cognition following coronary artery bypass grafting (CABG) surgery with or without cardiopulmonary bypass (CPB) (on- or off-pump). DESIGN: Systematic review and meta-analysis of randomized control trials comparing cognitive outcome in patients undergoing CABG surgery on- or off-pump as assessed by continuous measures from a battery of 7 psychometric tests. SETTING: Multi-institutional centers performing CABG surgery. PARTICIPANTS: Patients with coronary artery disease requiring CABG surgery. INTERVENTIONS: CABG surgery with or without CPB. MEASUREMENTS AND MAIN RESULTS: A structured literature search identified 13 randomized control trials that included a total of 2,405 patients. Results from 7 psychometric tests were grouped into early (≤3 months) and late (6-12 months) postoperative periods. No significant differences were found between on- and off-pump groups in any of the 7 psychometric tests in either the early (p range 0.21-0.78) or late (p range 0.09-0.93) postoperative period. CONCLUSION: The results suggested that CPB may not be associated with cognitive decline that is associated with CABG surgery.
