Surgical management of type 2 diabetes mellitus and metabolic syndrome: Available procedures and clinical data
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
The LSG was initially performed as the first part of a two-stage operation for patients who were at excessive risk for a complete BPD (Figure 55.2). Substantial weight loss was noted with the sleeve gastrectomy alone, and it has now become widely accepted as a stand-alone operation with excellent weight loss. The operation entails dividing the gastrocolic omentum up to the angle of His superiorly and down to the antrum, along the greater curvature of the stomach, just proximal to the pylorus. Sequential firings of the linear endoscopic stapler begin approximately 5 cm proximal to the pylorus. The stapler is fired parallel to a 34–40 Fr bougie, which is used to calibrate the diameter of the tubularized stomach. Many surgeons choose to oversew or imbricate the staple line to decrease the risk of bleeding or leak. The excised portion of the stomach is then removed. Intraoperative esophagogastroduodenoscopy may be performed to assess the patency of the sleeve, ensure intraluminal hemostasis, and rule out a leak from the staple line.
The Digestive (Gastrointestinal) System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Ultrasound (US) and computed tomography (CT) can provide visualization of the pancreas as well as complement barium studies. They are most useful in examination of the solid organs. The liver-spleen scan demonstrates mass lesions; the 99mTc-HIDA liver scan reveals cystic duct obstruction, and the 99mTc-RBC scan shows the approximate location of intermittently bleeding lesions. Magnetic resonance imaging (MRI), oral cholecystography (OCG), percutaneous transhepatic cholangiogram (PTC), endoscopic retrograde cholangiopancreatography (ERCP), esophagogastroduodenoscopy, sigmoidoscopy, colonoscopy, and laparoscopy are additional radiographic and endoscopic procedures employed in the diagnosis of disorders of the digestive system. The names of most of these procedures are self-explanatory to the pharmacist who knows the basic roots; esophagogastroduodenoscopy, for example, merely combines roots for the esophagus, stomach, and duodenum with-oscopy, visualization with a fiber-optic scope.
Regional Therapy of Liver Metastases: A Surgeon’s View
Neville Willmott, John Daly in Microspheres and Regional Cancer Therapy, 2020
Patients are followed up with serial visits every 2 weeks when their pump is filled and they are asked about symptoms or side effects of therapy, such as weakness and abdominal pain. Liver function tests and complete blood counts are performed at each visit and plasma CEA levels are taken at alternate visits. An abdominal CT scan is performed at 2 months and thereafter as necessary. Esophagogastroduodenoscopy is performed for patients who describe epigastric pain, fullness, or vomiting.
Association of Candida esophagitis with acute esophageal necrosis
Published in Baylor University Medical Center Proceedings, 2022
Muhammad Sheharyar Warraich, Bashar Attar, Shazaq Khalid, Muhammad Ali Khaqan
AEN is exceedingly rare, with an incidence of 0.01% to 0.28%.3 It was first described in 1914 by Brekke et al but did not get its current name until 1990.2,4 Some commonly described risk factors associated with this condition include renal insufficiency, diabetes mellitus, hypertension, atherosclerotic vascular disease, sepsis, and hypothermia.5 Mucosal barrier dysfunction seems to be the common endpoint of the different theories that have attempted to explain the pathogenesis of AEN. AEN typically occurs in critically ill patients who have multiple chronic conditions. It usually presents with upper gastrointestinal bleeding, but patients may display other symptoms like nausea, vomiting, dysphagia, and abdominal pain. Diagnosis is made on direct visualization during esophagogastroduodenoscopy. Biopsy is associated with a small risk of perforation and is supportive but not required for the diagnosis. It can help rule out infections and some other similar-appearing conditions like melanosis, melanoma, and acanthosis nigricans. Treatment is mostly supportive and includes aggressive hydration, proton pump inhibitors, and antimicrobials for cases that have a histologically confirmed infection. Total parenteral nutrition is a consideration for such patients due to the risk of perforation associated with the use of enteral tubes. Surgical management is necessary for the subset of patients whose disease is complicated by perforation or mediastinal disease. AEN is known to have a high mortality rate, with one study suggesting a rate up to 28%.6
Appropriate endoscopic treatment selection and surveillance for superficial non-ampullary duodenal epithelial tumors
Published in Scandinavian Journal of Gastroenterology, 2021
Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Chiko Sato, Ryosuke Ikeda, Masafumi Nishio, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Masataka Taguri, Shin Maeda
No deaths were attributed to mucosal neoplasms. In our study, 185 of the 189 enrolled patients underwent a scheduled esophagogastroduodenoscopy. Our results demonstrated that no cases that underwent complete resection experienced local recurrence across all the ER modalities. Local recurrence only occurred in cases of incomplete resections. Besides, all cases with local recurrence were handled with repeat ER. Importantly, given that the time from the day of ER to local recurrence ranged from 385 to 1727 days, a minimum of 3 years of endoscopic surveillance is advised. Although this study excluded patients with familial polyposis syndrome, three patients with a metachronous incidence of small bowel neoplasms were noted. Notably, one case had an advanced ileal carcinoma 5 years after the initial endoscopic treatment of a submucosal invasive duodenal carcinoma triggered by an increase in serum CEA level. Because there have been no reports dealing with the significance of the whole intestine examination for patients with duodenal neoplasms, further studies using video capsule endoscopy may be needed.
Prevalence of digestive manifestations in patients with amyloidosis
Published in Amyloid, 2019
María Belén Sánchez, María Dolores Matoso, María Adela Aguirre, Elsa Mercedes Nucifora, Sebastián Marciano, Jesica Cepeda, Santiago Rinaudo, Fernando Binder, María Lourdes Posadas Martinez, Bruno Rafael Boietti, Mariano Marcolongo
We analysed 138 patients with amyloidosis, 84 (60.8%) were men, with a median age of 65 years (ICR 51–73). The proportion of different subtypes of amyloidosis was: AL 43.4%, ATTRwt 16.6%, localized 14.4%, AA 10.1%, undefined 8.6% and TTR 6.5%. The prevalence of digestive manifestations was 49.2% (n 68 patients, CI 95% 41–58%), being the most frequent: chronic diarrhoea (36.6%), constipation (29.4%), dyspepsia (22%) and evident bleeding (20.6%). Out of 138 patients, 33.3% (46 patients) underwent esophagogastroduodenoscopy. In 73.9% of them (34), findings were linked to infiltration and to neuropathic involvement, others were nonspecific. The most frequent findings were: esophagitis, erosive gastropathy, gastric evacuation delay, congestion and friability of the mucosa. Out of 138 patients with amyloidosis 36.9% (51 patients) underwent videocolonoscopy and 30 (58.8%) presented abnormal findings. Among the most frequent, are polyps and diverticula, followed by compatible lesions, ischemic colitis and congestion with diffuse friability of the mucosa and rectal ulcers. Biopsies were performed in 32 patients (23.2%) and at least one Congo Red (CR) organ was positive in 14 (43.7%). The organ with the highest proportion of positive CR samples was the duodenum (9 of 20 patients biopsied, 45%), followed by colon-rectum (6/16, 37.5%) and stomach (7/20, 35%).
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