BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Sta...BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.展开更多
Fibrolamellar hepatocellular carcinoma(FHCC)is a rare primary malignancy of the liver for which data remain limited.This tumor is more often diagnosed in younger patient populations in the absence of underlying cirrho...Fibrolamellar hepatocellular carcinoma(FHCC)is a rare primary malignancy of the liver for which data remain limited.This tumor is more often diagnosed in younger patient populations in the absence of underlying cirrhosis and hepatitis.These lesions can be diagnosed on computed tomography scan or magnetic resonance imaging with common findings including central calcifications,a central stellate scar,and radiating fibrotic bands.Laboratory markers have not proved useful for diagnosis;however,pathologic analysis can be implemented to aid in diagnosis with findings including ample granular eosinophilic cytoplasm,nuclei with open chromatin and prominent macronuclei,hyaline and pale bodies,and dense lamellar fibrosis that divides the cells into cords or trabeculae.FHCC demonstrates aggressive malignant potential with nodal spread.Treatment patterns have remained mainly surgical;however,systemic therapies have been implemented and are under further investigation with clinical trials.Locoregional therapies and radiation therapies have been trialed sparingly.In this focused review,we discuss the most up-to-date perspective on epidemiology,clinical presentation,diagnostic approach,differential diagnosis,treatment regimens,prognosis,and future directions of FHCC.展开更多
文摘BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.
文摘Fibrolamellar hepatocellular carcinoma(FHCC)is a rare primary malignancy of the liver for which data remain limited.This tumor is more often diagnosed in younger patient populations in the absence of underlying cirrhosis and hepatitis.These lesions can be diagnosed on computed tomography scan or magnetic resonance imaging with common findings including central calcifications,a central stellate scar,and radiating fibrotic bands.Laboratory markers have not proved useful for diagnosis;however,pathologic analysis can be implemented to aid in diagnosis with findings including ample granular eosinophilic cytoplasm,nuclei with open chromatin and prominent macronuclei,hyaline and pale bodies,and dense lamellar fibrosis that divides the cells into cords or trabeculae.FHCC demonstrates aggressive malignant potential with nodal spread.Treatment patterns have remained mainly surgical;however,systemic therapies have been implemented and are under further investigation with clinical trials.Locoregional therapies and radiation therapies have been trialed sparingly.In this focused review,we discuss the most up-to-date perspective on epidemiology,clinical presentation,diagnostic approach,differential diagnosis,treatment regimens,prognosis,and future directions of FHCC.
