Endoscopic sclerotherapy for bleeding esophageal varices secondary to extrahepatic portal vein obstruction.

Portal hypertension and variceal bleeding secondary to extrahepatic portal vein obstruction continue to present a therapeutic challenge. We performed endoscopic injection sclerotherapy in eight patients with extrahepatic portal vein obstruction and bleeding esophageal varices. In contrast to other reported series, all but one of our patients were adults at the time sclerotherapy was initiated. Six had episodes of continued bleeding after a variety of surgical procedures. After sclerotherapy, five had no further bleeding with a mean follow-up of 26 months. Three patients had episodes of bleeding prior to variceal obliteration; two of these patients underwent surgical intervention after emergency sclerosis to stabilize their condition. Transfusion requirements were less after sclerosis (p = 0.035), although the follow-up has been relatively short (mean, 24 months) compared to the duration of bleeding. Our results suggest that endoscopic sclerotherapy is an effective therapeutic alternative, and perhaps the initial treatment of choice, in patients with extrahepatic portal vein obstruction and bleeding esophageal varices.

Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi.

Fifty-one patients who underwent endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi were evaluated retrospectively. The procedure resulted in complete abolition of pain allowing discontinuation of analgesics in 31 of the 46 patients available for follow-up. Patients with a dilated bile duct and delayed drainage of contrast material as demonstrated at endoscopic retrograde cholangiopancreatography (ERCP) had a more favorable response to sphincterotomy than those with normal ductal findings (p = 0.01). There was a higher complication rate in those without ductal dilation and delayed drainage compared to those with these ERCP abnormalities (p = 0.03). Sphincter of Oddi manometry was obtained in 29 patients prior to sphincterotomy; 24 were available for follow-up. A favorable outcome for sphincterotomy did not correlate with manometric assessment, particularly in patients with an abnormal ductal system.

Therapeutic endoscopy for gastrointestinal bleeding.

Patients with variceal or other gastrointestinal hemorrhage require aggressive resuscitative measures and early diagnosis for optimal therapy. A number of nonsurgical endoscopic modalities, such as laser therapy, sclerotherapy, heater probe and electrocoagulation (monopolar or bipolar), are available to arrest and sometimes to prevent hemorrhage. The family physician should be aware of these options so that access to them can be offered to patients if needed.

Pancreatic adenocarcinoma in a patient with Peutz-Jeghers syndrome--a case report and literature review.

A variety of intestinal and extraintestinal neoplasms has been associated with Peutz-Jeghers syndrome, although to our knowledge, there has been no reported case of associated pancreatic neoplasm. We report a 38-yr-old man with Peutz-Jeghers syndrome and pancreatic adenocarcinoma and review current literature regarding a neoplastic diathesis in these patients.

Mesenteric venous thrombosis as a possible complication of endoscopic sclerotherapy: a report of two cases.

Two cases of mesenteric venous thrombosis with bowel infarction occurring after endoscopic sclerotherapy are reported. In neither patient was the diagnosis suspected or recognized until the terminal phase of the illness. Clinicians should be aware of this possible association and complication of endoscopic injection sclerotherapy, as early diagnosis is critical for patient survival.

Alpha 1-antitrypsin deficiency presenting as cryptogenic cirrhosis in adults over 50.

We report cirrhosis and alpha 1-antitrypsin deficiency in two patients over 50 years of age who had an initial diagnosis of cryptogenic cirrhosis. Serum alpha 1-antitrypsin levels were in the homozygous range and a liver biopsy demonstrated cirrhosis with periodic acid-Schiff-positive, diastase-resistant globules in both. Red intracytoplasmic inclusion globules seen on trichrome staining in the first patient, and a decreased alpha-1 fraction on serum protein electrophoresis in the second suggested the diagnosis. We propose that the diagnosis of alpha 1-antitrypsin deficiency be considered in all patients, regardless of age, and that trichrome staining be part of the routine histologic evaluation in all patients with cirrhosis of uncertain etiology.

Endoscopic ultrasonography: a preliminary report.

In order to define normal endoscopic ultrasonographic anatomy with particular emphasis on the pancreas, we studied 25 patients using a prototype ultrasound fiberoptic endoscope (model GF-UM1) and endoscopic ultrasound observation unit (model EU-M1) developed by the Olympus Corporation. We obtained a number of good quality scans of various retroperitoneal structures, and in several cases pancreatic texture and even the pancreatic duct could be appreciated. Differentiation of mucosal from intramural diseases of the hollow gut and from diseases of the retroperitoneal organs can be made by means of endoscopic ultrasonography.

Percutaneous endoscopic gastrostomy: a preferred method of feeding tube gastrostomy.

Percutaneous endoscopic gastrostomy was attempted in 16 patients using local anesthesia and intravenous meperidine and diazepam sedation. The procedure was shown to be safe, easy to perform, and avoided the need for laparotomy. We suggest percutaneous endoscopic gastrostomy be the preferred route of alimentation in those patients requiring feeding gastrostomy.