137 research outputs found
Value of chromo-magnification endoscopy and targeted biopsies in the diagnosis of celiac disease with previously negative histology: a preliminary study
No full textT1608
Value of Chromo-Magnification Endoscopy and Targeted Biopsies in the Diagnosis of Celiac Disease with Previously Negative Histology: A Preliminary Study
Annalisa Pascariello, Carolina Ciacci, Ilaria Russo, Luca Magno, Giuseppe Galloro, Paola Iovino
Introduction. Chromoendoscopy with magnification has been previously demonstrated to be valuable in assessing the degree of intestinal villous atrophy in patients with suspected celiac disease. Aim and Methods. The aim of this study is to determine the accuracy of these methods in association with targeted biopsies in the diagnosis of suspected celiac disease in cases of positive serology and previous negative histology.13 patients (12 females, range 17-43 years) with a positive/border-line value of anti-tissue transglutaminase antibodies and a previous negative histopathologic evaluation underwent upper endoscopy for the purpose of obtaining duodenal targeted biopsy specimens. In all patients we performed chromoendoscopy with indigo carmine sprayed onto the duodenal mucosa and, thereafter, a full magnification of duodenal mucosa.
A villous pattern score was allocated for each patients at the end of procedure as definitely present = 1, partially present =2, definitely absent = 3. Biopsies were taken from the most abnormal-looking mucosa or apparent normal when present
using rocking biopsy forceps and mounted on filter paper and put into formalin for histological assessment. Three more samples were collected for In Vitro challenge with gluten-derived toxic peptides . Frozen sections of the biopsies were then
evaluated by immunohistochemistry. Results. 76.9%of subject had a positive value of anti-tissue transglutaminase antibodies while 23.1 % had borderline value. The chromoendoscopic results showed normal villous pattern in 46.2%(6 pts), partially
present 15.4%(2 pts ), definitively absent 38.5% (5pts). A significant positive correlation was found between a positive value of anti-tissue transglutaminase antibodies and the endoscopic score of villous pattern (Spearman, r = 0,56, p < 0.05).
In Vitro challenge was positive in 50% of normal villous pattern and in all patients with definitively absent villous pattern.
Conclusions. This preliminary study suggest that chromoendoscopy with magnification may disclose with accuracy severe villous atrophy but it may have a great value in evaluating selected series of patients with doubtful diagnosis of celiac disease
Hemorrhage in the Wirsung's duct caused by aneurysm of the splenic artery in chronic pancreatitis.
No full textTwo cases of haemorrhage from rupture of a splenic artery aneurysm into the pancreatic duct are reported. Both patients suffered from chronic pancreatitis; when haemorrhage appeared both patients experienced abdominal pain. In one patient the melaena was repetitive, in the other one--with a single episode of melaena - the endoscopy showed fresh blood near the papilla. In both patients ultrasonography and computerized tomography (CT) revealed a cystic mass in the pancreatic tail; CT scan also showed a clear contrast enhancement of these lesions after iodinated medium intravenous bolus. Coeliac arteriography confirmed the presence of two large saccular aneurysmal dilatation of the splenic artery. Both patients underwent a laparotomy: distal pancreatectomy with aneurysm resection and splenectomy were successfully performed
Wall injury after colonic polypectomy : comparison between steel and tungsten snares
No full textP0229 WALL INJURY AFTER COLONIC POLYPECTOMY: COMPARISON
BETWEEN STEEL AND TUNGSTEN SNARES
G. Galloro1, L. Magno1, P. Iovino1, S. Ruggiero1, T. Rappa1, C. Meola2,
G.M. Carlomagno2. 1General Surgery and Advanced Technologies, 2Department of
Aerospace Engineering, University of Naples Federico II, Naples, Italy
INTRODUCTION/OBJECTIVES: Electrosurgical current used in polypectomy can
cause thermal injury to digestive wall with complications such as bleeding, postpolypectomy
syndrome, and perforation. To reduce the rate of these complications, we
studied the materials snares are made of. We compared steel and tungsten endoscopic
snares, evaluating the depth of colonic wall injury caused by electrosulgical current
during endoscopic polypectomy on an animal model, using cut, coagulation, and blend
current.
AIMS & METHODS: Polypectomies were performed on a live pig, under general
anesthesia, with a double channel colonoscope. To simulate the polyp stalk, the
colonic mucosa was gathered into the snare by a grasper and the snare closed.
Electrosurgical current was applied 15 times at each of 3 current modes. The procedure
was performed using either a steel or a tungsten snare with same size, shape, and profile
(Innovamedica, Milano, Italy). Colored hemoclips were used to identify the sites. After
polypectomies, the colon was removed and examined by a blind pathologist. To define
the reasons of behaviour of two snares, we reproduced, on an ex-vivo model, the same
conditions of polypectomy described above. Thermal measurements were achieved by
an infra-red thermocamera.
RESULTS: There is significant difference in the depth of tissue injury in the three
different current modes using both steel and tungsten snare. In details, using steel snare,
coagulation provokes significant deeper tissue injury compared to pure cut (p<0.001)
and blend current (p<0.05). Using tungsten snare, there is significant deeper tissue
injury by coagulation compared to pure cut (p<0.01); there is no significant difference
in depth of injury between coagulation and blend. Using both steel and tungsten snares
there is no difference beween cut and blend. Steel snare provokes significant deeper
tissue injury than tungsten snare using pure cut (p<0.05) and blend (p<0.05). There
is no significant difference in depth of tissue injury between steel and tungsten snares
using coagulation. About thermal behaviour of two materials, infra-red thermocamera
findings show a quicker sudden rise and drop in temperature of the tungsten snare,
and a better uniform standard temperature distribution, if compared to steel snare.
CONCLUSION: In tungsten snare, heat is homogeneously distributed and well
concentrated allowing a better and selective cut. Thermal properties of tungsten make
it very well-suited for the manufacturing of electrosurgical devices. Our results suggest
that tungsten should be preferred in the manufacturing of electrosurgical endoscopic
devices thanks to its lower rate of thermal-related complications.
Disclosure of Interest: G. Galloro: No conflict of interest to declare, L. Magno: No
conflict of interest to declare, P. Iovino: No conflict of interest to declare, S. Ruggiero:
No conflict of interest to declare, T. Rappa: None Declared, C. Meola: No conflict of
interest to declare, G. Carlomagno: No conflict of interest to declare.
Endoscopy 2010; 42 (Suppl I) A15
Technical aspects in endoscopic biopsy of lesions in esophageal pemphigus vulgaris.
No full textBackground and aims. Aim of this study is to compare a specific kind of biopsy forceps to a traditional one in providing an adequate specimen of esophageal pemphigus vulgaris lesions that includes the basement membrane for definitive diagnosis.
Patients and methods. Prospective, randomized, blind, single-center study. We performed upper endoscopy with biopsy in 32 patients divided into two groups of 16 each: in group A with a commercially available standard biopsy forceps while in group B with a commercially available rocking biopsy forceps. Hundred-ninety-six biopsy specimens from both groups were blindly evaluated by the same pathologist.
Results. In group A 18.8% of biopsy specimens were adequate (basement membrane included). In group B 87.5% of biopsy specimens were adequate.
The presence of the entire thickness of the mucosa was significantly higher in group B compared to group A. All parameters typically taken into account by pathologist for diagnosis of esophageal pemphigus vulgaris were significantly improved in group B.
Conclusions. The biopsy forceps used in group B permits a rocking motion of the tip on contact with the mucosa, produces a deeper full-thickness mucosal sample up to the basement membrane and assists in the evaluation of histologic features of esophageal pemphigus vulgaris
Aggiornamento sulle strumentazioni per colecistectomia eseguita tramite via transvaginale: attualità e prospettive future della NOTES.
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