Category Archives: Gastroenterology

Management of enterocutaneous fistulas

Posted on by
2

Owen RM, Love TP, Perez SD, Srinivasan JK, Sharma J, Pollock JD, Haack CI, Sweeney JF, Galloway JR. Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience. JAMA Surg. 2013 Feb;148(2):118-26.

Full-text for Emory users.

Figure 1. Causes of enterocutaneous fistula between 1987 and 2010. IBD indicates inflammatory bowel disease; other includes radiation, neoplasm, and trauma. Percentages may total more than 100% owing to the fact that some patients’ ECFs were secondary to multiple causes.

Continue reading →

Challenges of Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks

Posted on by
Reply

Anastomotic leaks after digestive surgery have an important impact on surgical outcome. They represent a real therapeutic challenge because of the high morbidity and mortality rates. Multiple treatment options exist, often combining interventional radiology and endoscopy and even redo surgery. To improve patient outcomes, it is of the utmost importance to provide an individualized patient-tailored treatment plan after multidisciplinary discussion. EVT is nowadays recognized as an effective and useful endoscopic approach to treat leaks or perforations in both the upper and lower gastrointestinal tract. Moreover, it has become one of the most effective treatment options overall with a very good safety profile. However, it is a time-consuming endeavour requiring engagement from the endoscopist and understanding from the patient.

Supplementary Materials: The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/life13061412/s1, Video S1: Procedure of EVT in a patient with anastomotic leak after oesophagectomy.

Continue reading →

Prophylactic angiographic embolisation after endoscopic control of bleeding

Posted on by
Reply

“Acute upper gastrointestinal bleeding (AUGIB) is one of the most common emergencies in gastroenterology. Despite major improvements in its management, AUGIB continues to be associated with significant morbidity and mortality. Bleeding peptic ulcers are one of the principal causes of AUGIB. Endoscopic therapy to bleeding ulcers reduces further bleeding and improves patients’ outcomes.”

Continue reading →

Prophylactic arterial embolization in patients with bleeding peptic ulcers

Posted on by
Reply

“Upper gastrointestinal bleeding is a common emergency in people. With a hospitalization rate of 67 per 100,000 in the USA and an in-hospital mortality of 1.9 per 100 cases, it is a severe condition. The most common cause of upper gastrointestinal bleeding is a peptic ulcer in the stomach or duodenum. The aetiology of peptic ulcers is complex, but known risk factors for complications of peptic ulcers are Helicobacter pylori infection, and the use of non-steroidal anti-inflammatory drugs (NSAIDs). The definition of a peptic ulcer is a loss of tissue from the mucosa. The bleeding is often from the arteries in the submucosa or tunica muscularis, but there can be erosions of larger arteries, such as the gastroduodenal, right gastric, or left gastric arteries.”

Continue reading →

Prognosis following NACT for esophageal cancer

Posted on by
Reply

“Neoadjuvant chemoradiotherapy followed by surgery is currently considered an important multimodality treatment option for patients with locally advanced esophageal or gastroesophageal junction cancer. Perioperative chemotherapy is an alternative multimodality treatment option for locally advanced gastroesophageal junction
adenocarcinoma.”

Continue reading →

Validation of a diagnostic score for gastriclinitis plastica

Posted on by
Reply

“In this retrospective study, all patients who had gastrectomy for cancer between 2007 and 2017 in French tertiary centers were included. The outcome was a diagnosis of GLP based on pathological review of the surgical specimen. The diagnostic score was created by using variables that were most frequently associated with GLP using penalized logistic
regression on multiply imputed datasets. We used discrimination measures to assess the performances of the score. Internal validation was performed using bootstrapping methods to correct for over-optimism.”

Continue reading →

Is Linitis Plastica a Contraindication for Surgical Resection?

Posted on by
Reply

“The diagnosis of LP carries significant controversy regarding its surgical management.
Lymph node involvement is almost always present at the time of diagnosis, and due to its
diffuse nature, microscopic disease is often found at the resection margins. Peritoneal
dissemination is frequently encountered at the time of surgery or as the main site of
recurrence. As such, curative resection is possible in less than half of patients and early
recurrence is common, leading to a dismal median survival, ranging from 6 to 12 months,
and 5-year survival between 8 and 13 %.”

Continue reading →