Role Of Therapeutic Endoscopy Research Articles

Endoscopic Management of Strictures in Crohn's Disease: An Unsolved Case.

Crohn's disease (CD) is a chronic inflammatory disease associated with a significant burden in terms of quality of life and health care costs. It is frequently associated with several complications, including the development of intestinal strictures. Stricturing CD requires a careful multidisciplinary approach involving medical therapy and surgery, still posing a continuous management challenge; in this context, endoscopic treatment represents a valuable, in-between opportunity as a minimally invasive strategy endorsed by extensive yet heterogeneous evidence and evolving research and techniques. This review summarizes current knowledge on the role of therapeutic endoscopy in stricturing CD, focusing on evidence gaps, recent updates, and novel techniques intended for optimizing efficacy, safety, and tailoring of this approach in the view of precision endoscopy.

Role of Therapeutic Endoscopy in Hepatic Hydatid Disease after Surgical Intervention: Case Report

A 79-year-old female diagnosed as hepatic hydatid disease after hepatectomy was referred with jaundice and right hypochondralgia. An endoscopic retrograde cholangiography (ERC) showed a defect in the bile duct. We performed bile duct stenting, but stent occlusion occurred repeatedly. Bile duct stenting was performed 7 times and endoscopic naso-biliary drainage once. Although bile duct stenting was performed repeatedly, ERC provided an excellent diagnostic and therapeutic modality in the present case; thus, it should be considered as a definitive treatment in similar cases, particularly after hepatectomy or if the surgical risk is anticipated to be high.

Management of upper gastrointestinal haemorrhage complicating dual anti-platelet therapy

Upper gastrointestinal haemorrhage is a serious complication of aspirin and clopidogrel (dual) anti-platelet therapy with a high morbidity and mortality. Using an illustrative case this article examines the prognostic significance of gastrointestinal haemorrhage and the risk of stopping anti-platelet therapy. The management of this clinical challenge is reviewed, in the absence of a clinical guideline, with particular reference to the judicious tailoring of anti-platelet therapy, the role of therapeutic endoscopy and the utility of blood transfusion.

INTERVENTIONAL TREATMENT OF ACUTE AND CHRONIC PANCREATITIS: Endoscopic Procedures

The role of therapeutic endoscopy in the treatment of acute and chronic pancreatitis has expanded dramatically over the past 10 years. Drainage of pseudocysts and even organized pancreatic necrosis when localized are becoming commonplace. Other areas in which therapeutic endoscopy has been shown to be efficacious include severe biliary pancreatitis, pancreatic duct disruptions, strictures, and obstructive calculi. Its role in the management of acute recurrent pancreatitis with presumed Oddi's sphincter dysfunction or pancreas divisum continues to be defined. The cost-effectiveness and minimally invasive nature of endoscopic therapy compared with surgery should ensure the continued development of these techniques. More controlled, prospective data are required.

Decrease in a markedly elevated CA19-9 level after stenting of a benign pancreatic ductal stricture

The role of therapeutic endoscopy in the management of pancreatic disease is currently evolving, and at the same time measurement of the CA19-9 tumorassociated antigen appears to have gained acceptance as a useful blood test in the diagnosis and management of patients with pancreatic cancer. A great deal of knowledge has accumulated concerning those conditions, both benign and malignant, that affect CA19-9 levels, i We describe a case of chronic pancreatitis associated with an unusually high level of CA19-9 that decreased dramatically after stenting of a pancreatic ductal s tricture. CASE REPORT An 82-year-old man with a history of chronic recurrent pancreatitis secondary to alcohol consumption was admitted for abdominal pain. The patient drank up to one-half pint of whiskey per week, with his last drink 4 days before admission. He had had several admissions for similar pain in the past, and CT in 1989 revealed changes consistent with chronic pancreatitis and a dilated pancreatic duct. His past medical history was notable for angina and a cholecystectomy for gallstones.

THE SAFETY AND EFFICACY OF GI ENDOSCOPY IN PATIENTS WITH ACUTE-LEUKEMIA - A REVIEW OF 27 CASES

In the course of aggressive treatment for acute leukemia, the ensuing pancytopenia and intensive medical support may be accompanied by severe gastrointestinal (GI) complications. Therefore, to assess the safety and efficacy of GI endoscopy as a means of diagnosis, we analyzed the records of 16 patients undergoing 27 endoscopies a mean (+/-S.D.) of 18.4 +/- 11.9 days post chemotherapy. There were 6 procedures performed in patients with acute lymphocytic, 18 with acute myelogenous, including 3 with acute promyelocytic and 3 with blastic phase chronic myelogenous leukemia. 10/27 procedures were performed in patients with less than 1000 WBC/mm3 and 19/27 had less than 100,000 platelets. 15 patients had 25 upper endoscopies done for: bleeding (twenty-one), abdominal pain (two), and persistent vomiting (two). The principal bleeding sources were: esophagitis (eleven), Mallory Weiss tear (one), gastritis (three), gastric ulcer (one), duodenal ulcer (five). In the non-bleeding cases 2 exams were normal and the others had gastritis (one) and esophagitis (one). 15/25 procedures (64%) resulted in new diagnosis and 20/25 (80%) in additional therapies. 47% of patients undergoing upper GI endoscopy received specific new therapies as a result of that procedure. Nd: YAG laser photocoagulation was effective in stopping bleeding lesions in 4/6 cases. 10/12 bleeding patients had persistent or recurrent bleeding and 2 died from bleeding. None had surgery. Two patients underwent colonoscopy, both for colonic distention. One patient, who had been recently treated for Cl. difficile had submucosal petechiae. The other had non-specific colitis. No biopsies were done and both cases were successfully decompressed..No complications occurred from any GI endoscopy. We conclude that GI endoscopy can be safely performed in patients with acute leukemia, resulting in specific diagnoses and therapies. Esophagitis is a principal cause of GI bleeding in these patients. The role of therapeutic endoscopy in controlling bleeding is promising but requires further evaluation.