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Neuroendocrine tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Sairah R Khan, Kathryn L Wallitt, Adil Al-Nahhas, Tara D Barwick
Optimal technique is essential for the accurate detection of these usually very-small lesions. The patient should be fasted to ensure that the stomach and duodenum are empty. For abdominal CT, patients should arrive around 1.5 h prior to the scan time for filling of the bowel by drinking approximately 800 mL of water (15); 20 mL of contrast medium (CM) may be added to the water if positive CM filling of the lumen is required (e.g. suspected fistulae). However, when gastric or duodenal NET is suspected, water alone (negative oral contrast) is preferable as oral contrast can mask small enhancing lesions. Antiperistaltic agent administration (e.g. butylscopolamine 20 mg IV (intravenously)) to reduce bowel motility is preferable but optional. The details are summarized in Table 24.3 (15).
Acute pain and medical disorders
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Parenteral NSAIDs (ketorolac, tenoxicam, or diclofenac) are at least as effective as parenteral opioids and more effective than anticholinergic smooth muscle relaxants (hyoscine-N-butylbromide) in providing analgesia for biliary colic115[II], 116[II], 117[II], 118[II], 119 [II] and may also prevent progression to cholecystitis.115 [II], 116[II], 119[II] Metamizole is more effective than tramadol or smooth muscle relaxants (butylscopolamine).120[II] Glycopyrronium bromide (glycopyrrolate)121[II] and atropine122[II]) were no more effective than placebo in relieving acute biliary tract pain. Perhaps not surprisingly, these are similar findings to the efficacy of these drugs in the treatment of renal colic. A single RCT demonstrated faster resolution of acute biliary colic and right upper quadrant tenderness in patients who were administered glucagon.123[II]
Intraobserver and interobserver reliability of visible light spectroscopy during upper gastrointestinal endoscopy
Published in Expert Review of Medical Devices, 2018
Louisa J.D. van Dijk, Twan van der Wel, Desirée van Noord, Adriaan Moelker, Hence J.M. Verhagen, Daan Nieboer, Ernst J. Kuipers, Marco J. Bruno
The VLS measurements were performed with a fiber-optic probe (Endoscopic T-Stat Sensor; Spectros, Portola Valley, California, USA) passed through the accessory channel of the endoscope. This probe was placed just above the mucosa (1–5 mm) of the target area, after any bile remnants were removed. The light of the endoscope was switched off and the reading of the mucosal saturation started on the monitor connected with the probe (T-Stat 303 Microvascular Oximeter; Spectros, Portola Valley, California, USA). The reading showed small rapid variations due to true changes in saturation and due to small changes in the position of the probe. A reading was noted if a stable measurement was obtained which is a measurement that recurrences several times during the small rapid variations of a reading. The highest saturation was noted. The probe was repositioned within the measurement site and a new measurement was performed. Three repeated readings per site were noted with fewer than 5% variation and these three readings were averaged reflecting the most accurate mucosal saturation at that site. These saturation measurements were performed at three different locations: the antrum of the stomach, the duodenal bulb, and the descending duodenum since the cutoff values are determined for these three locations [4]. All VLS measurements during this study were performed before any biopsy was executed or any contrast-agent was administered. In case intestinal spasms limited obtaining proper measurements, butylscopolamine (10–20 mg) was intravenously administered. Duration of the first set and second set of VLS measurements was noted.
Colonoscopic observation time as a predictor of stigmata of recent hemorrhage identification in colonic diverticular hemorrhage
Published in Scandinavian Journal of Gastroenterology, 2023
Sho Watanabe, Ayako Sato, Katsumasa Kobayashi, Akihiro Miyakawa, Hitoshi Uchida, Tomoyo Machida, Kenichiro Kobashi, Tsunehito Yauchi
The baseline characteristics of the 392 patients (249 men and 143 women) included in the study are presented in Supplementary Table 1. The mean age ± SD was 71.3 ± 12.8 years. Extravasation on CT was detected in 60 patients (25.1%). The mean time from visit to endoscopy was 26.7 ± 28.4 h. Polyethylene glycol preparation was performed in 364 patients (92.8%). For the antispasmodic, butylscopolamine and glucagon were used in 231 and 120 patients (65.1% and 33.8%), respectively. Soft cap and water-jet scope were used in 351 and 247 patients (89.5% and 96.9%), respectively. The mean BBPS was 7.3 ± 2.0, and the mean observation time was 25.9 ± 18.5 min.
‘Underwater endoscopic mucosal resection with submucosal injection and marking’ for superficial non-ampullary duodenal epithelial tumors to achieve R0 resection: a single-center case series
Published in Scandinavian Journal of Gastroenterology, 2023
Keiichi Hashiguchi, Naoyuki Yamaguchi, Junya Shiota, Taro Akashi, Kumi Ogihara, Maiko Tabuchi, Moto Kitayama, Kayoko Matsushima, Yuko Akazawa, Ken Ohnita, Kazuhiko Nakao
All endoscopic procedures were performed under CO2 insufflation. Most cases were performed using a therapeutic gastroscope with a water-jet function (GIF-Q260J; Olympus Medical Systems, Tokyo, Japan). A therapeutic pediatric colonoscope with a water-jet function (PCF-H290TI; Olympus Medical Systems) has been used since 2020 to obtain a broader range of down-angulation compared with the gastroscope. All endoscopic procedures were performed using a forward-viewing endoscope with a transparent cap on the tip. The location of the papilla and the relation of the SNADETs to the papilla were identified using the cap-assisted method [3]. Eight endoscopists (KH, NY, JS, TA, K Ogihara, MT, MK, and K Ohnita) who had experienced more than 300 colonic CEMRs performed all the endoscopic procedures in this study. Antiperistaltic agents, such as butylscopolamine or glucagon, were used during the procedures in the absence of contraindications. Diazepam and pethidine hydrochloride were administered as intravenous sedative and analgesic agents. The lesion size was estimated by referring to the endoscopic appearance or comparing the opened snare (10–25 mm) at resection. For CEMR procedures, a submucosal injection was first performed under the lesion. Subsequently, the lesion was captured by a 10–25-mm electrosurgical snare (Captivator II, Boston Scientific Co., Natick, MA, USA, or Snare Master, Olympus Medical Systems) under CO2-inflated conditions. The lesion was removed electrosurgically (Endo-cut Q mode, effect 3, duration 1, and interval 6; VIO 300 D; ERBE Elektromedizin, Tübingen, Germany). The resected specimens were immediately collected from the duodenum. After confirming that there were no residual lesions, the mucosal defect was closed using endoclips (EZ Clip; Olympus Medical Systems). If residual lesions were suspected, additional resection was performed. The submucosal injection agent was 10% glycerin solution (Glycereb®, Terumo Co, Ltd, Tokyo, Japan) mixed with indigo carmine and epinephrine at a dilution ratio of 1:200. The type of electrosurgical snare was determined based on the endoscopist’s preferences. In some cases of CEMR before UEMR-SIM was introduced, procedures were performed with marking when the lesion was difficult to capture without doing so. Four to six marking dots were made around the lesion using the tip of an electrosurgical snare with an electrosurgical unit (soft coagulation mode, effect 5, 70 W; VIO 300 D) at the beginning of the procedure.