To investigate the outcome of flexible endoscopic myotomy performed with the Hook knife in patients with symptomatic Zenker’s diverticulum (ZD). METHODSAll consecutive patients treated for ZD at our institution betwe...To investigate the outcome of flexible endoscopic myotomy performed with the Hook knife in patients with symptomatic Zenker’s diverticulum (ZD). METHODSAll consecutive patients treated for ZD at our institution between 7/2012 and 12/2016 were included. The flexible endoscopic soft diverticuloscope-assisted technique with endoclips placement and Hook knife myotomy were performed in all patients. Here we report a retrospective review of prospectively collected data. Demographics, dysphagia score (Dakkak and Bennett), associated symptoms and adverse events were collected pre-procedure, at 2 and 6 mo post-procedure, and at the end of the follow-up period. Clinical success was defined as at least 1-point improvement in dysphagia score and a residual dysphagia score ≤ 1, with no need for reintervention. Dysphagia scores were compared before treatment and at end-of-follow-up using the Wilcoxon test. RESULTSTwenty-four patients were included. Mean size of ZD was 3.0 cm (range 2-8 cm). Mean number of sessions was 1.17/patient (range 1-3 sessions). Overall clinical success was 91.7%. Two adverse events (8.3%) occurred, and both were managed conservatively. No bleeding or perforation was reported. Mild pain was reported by 9 patients (37.5%). Median hospital stay was 1 d (range 1-6). Median follow-up was 19.5 mo (range 6-53). Mean ± SD dysphagia score was 2.25 ± 0.89 before treatment and decreased to 0.41 ± 0.92 at end-of-follow-up (P < 0.001). Regurgitation and cough dropped from 91.7% and 50% to 12.5% and 0% at the end of follow-up, respectively. Recurrence was observed in 3 patients, and all 3 were symptom-free after one more session. CONCLUSIONThe Hook knife, used in the soft diverticuloscope-assisted technique setting, is efficient and safe for treatment of ZD.展开更多
AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy(SBCE). METHODS: Retrospective single ce...AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy(SBCE). METHODS: Retrospective single center study. One hundred lesions selected from forty-nine consecutive conventional white light SBCE(SBCE-WL) examinations were included. Lesions were reviewed at three Flexible Spectral Imaging Color Enhancement(FICE) settings and Blue Filter(BF) by two gastroenterologists with ex-perience in SBCE, blinded to each other's findings, whoranked the quality of delineation as better, equivalent or worse than conventional SBCE-WL. Inter-observer percentage of agreement was determined and analyzed with Fleiss Kappa(k) coefficient. Lesions selected for the study included angioectasias(n = 39), ulcers/ero-sions(n = 49) and villous edema/atrophy(n = 12). RESULTS: Overall, the delineation of lesions was im-proved in 77% of cases with FICE 1, 74% with FICE 2, 41% with FICE 3 and 39% with the BF, with a percent-age of agreement between investigators of 89%(k = 0.833), 85%(k = 0.764), 66%(k = 0.486) and 79%(k = 0.593), respectively. FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy with a percentage of agreement of 97.4%(k = 0.910), 81.6%(k = 0.714) and 91.7%(k = 0.815), respectively. FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy, with a percentage of agreement of 89.7%(k = 0.802), 79,6%(k = 0.703) and 91.7%(k = 0.815), respectively. FICE 3 improved the delineation of 46.2% of angioecta-sias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy, with a percentage of agreement of 53.8% [k = not available(NA)], 75.5%(k = NA) and 66.7%(k = 0.304), respectively. The BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25% of villous edema/atrophy, with a per-centage of agreement of 76.9%(k = 0.558), 81.6%(k = 0.570) and 25.0%(k = NA), respectively.CONCLUSION: Virtual chromoendoscopy can improve the delineation of angioectasias, ulcers/erosions and villous edema/atrophy detected by SBCE, with almost perfect interobserver agreement for FICE 1.展开更多
BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological pro...BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children,as it can help in the development of more effective,safe and personalized preventive and therapeutic strategies.AIM To define the profile of children seeking emergency care due to FB impaction in the esophagus,analyze factors associated with complications,and evaluate the effectiveness of rigid(RE)and flexible endoscopes(FE).METHODS A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy(FE=84 vs RE=82)at the Dr.JoséFrota Institute was performed.The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications.The secondary outcomes were age group,gender,symptoms,length of hospital stay,and location of the FB.RESULTS Boys(66.9%),preschoolers(43.4%),FB>24 hours(62.7%),cervical esophagus(60.8%),coin ingestion(57.2%)and complaints of dysphagia(24.9%)and sialorrhea(23.1%)were the predominant findings.Endoscopy was successful(90.4%)with sedation(89.1%).A total of 97%of patients were discharged from the hospital,while 3%died.The average hospital stay length was 2.6 days.Most patients did not experience complications predominated(64.5%).Esophageal perforations were more frequent after RE(11%vs 4.8%),while FE was more effective(95.2%vs 85.4%).Theχ2 test or Fisher's exact test was used to compare categorical variables.For continuous variables,the Kruskal-Wallis test or analysis of variance was used.Statistical analyses were performed in R®software(version 1.3.1093).CONCLUSION Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys.Risk factors for complications due to esophageal FB include battery ingestion,delayed removal(>48 hours)and lodging in the thoracic esophagus.FE was generally more effective than RE for removing FBs;both procedures are safe.展开更多
The minimally invasive surgery through natural orifices has revolutionized the laparoscopic surgery for abdominal procedures. The use of the vaginal approach is not new for gynecologists but it is a new concept for th...The minimally invasive surgery through natural orifices has revolutionized the laparoscopic surgery for abdominal procedures. The use of the vaginal approach is not new for gynecologists but it is a new concept for the non-gynecological laparoscopic surgeons. The use of this new approach has been used to perform some procedures and to extract specimens after a laparoscopic surgery, but we don’t know exactly the number of procedures performed until today. There are few papers with clinical experience and a lot of philosophical papers about NOTES. Our aim is to know how and how often we are using this new approach for non-gynecological abdominal minimally invasive procedures. With the revision of the PubMed publications we obtained a total of 268 articles, of which 125 were included in the analysis (46.64%). Cholecystectomy was the procedure more usually performed: there is a large clinical experience with a total of 2432 transvaginal cholecystectomies. Bariatric surgery, colectomy and appendectomy have been other surgical procedures with some clinical experience in the use of the transvaginal approach. Analyzing the publications on transvaginal approach, we observed that the use of the vaginal route for non-gynecological abdominal surgery was not anecdotal, with accumulative experience of more than 3000 patients reported in published studies. The use of the vaginal route has shown its safety, obtaining some additional benefits such as the aesthetic and the faster functional recovery. Dyspareunia, one of the most feared, has not been reported in studies as a concern to consider.展开更多
文摘To investigate the outcome of flexible endoscopic myotomy performed with the Hook knife in patients with symptomatic Zenker’s diverticulum (ZD). METHODSAll consecutive patients treated for ZD at our institution between 7/2012 and 12/2016 were included. The flexible endoscopic soft diverticuloscope-assisted technique with endoclips placement and Hook knife myotomy were performed in all patients. Here we report a retrospective review of prospectively collected data. Demographics, dysphagia score (Dakkak and Bennett), associated symptoms and adverse events were collected pre-procedure, at 2 and 6 mo post-procedure, and at the end of the follow-up period. Clinical success was defined as at least 1-point improvement in dysphagia score and a residual dysphagia score ≤ 1, with no need for reintervention. Dysphagia scores were compared before treatment and at end-of-follow-up using the Wilcoxon test. RESULTSTwenty-four patients were included. Mean size of ZD was 3.0 cm (range 2-8 cm). Mean number of sessions was 1.17/patient (range 1-3 sessions). Overall clinical success was 91.7%. Two adverse events (8.3%) occurred, and both were managed conservatively. No bleeding or perforation was reported. Mild pain was reported by 9 patients (37.5%). Median hospital stay was 1 d (range 1-6). Median follow-up was 19.5 mo (range 6-53). Mean ± SD dysphagia score was 2.25 ± 0.89 before treatment and decreased to 0.41 ± 0.92 at end-of-follow-up (P < 0.001). Regurgitation and cough dropped from 91.7% and 50% to 12.5% and 0% at the end of follow-up, respectively. Recurrence was observed in 3 patients, and all 3 were symptom-free after one more session. CONCLUSIONThe Hook knife, used in the soft diverticuloscope-assisted technique setting, is efficient and safe for treatment of ZD.
文摘AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy(SBCE). METHODS: Retrospective single center study. One hundred lesions selected from forty-nine consecutive conventional white light SBCE(SBCE-WL) examinations were included. Lesions were reviewed at three Flexible Spectral Imaging Color Enhancement(FICE) settings and Blue Filter(BF) by two gastroenterologists with ex-perience in SBCE, blinded to each other's findings, whoranked the quality of delineation as better, equivalent or worse than conventional SBCE-WL. Inter-observer percentage of agreement was determined and analyzed with Fleiss Kappa(k) coefficient. Lesions selected for the study included angioectasias(n = 39), ulcers/ero-sions(n = 49) and villous edema/atrophy(n = 12). RESULTS: Overall, the delineation of lesions was im-proved in 77% of cases with FICE 1, 74% with FICE 2, 41% with FICE 3 and 39% with the BF, with a percent-age of agreement between investigators of 89%(k = 0.833), 85%(k = 0.764), 66%(k = 0.486) and 79%(k = 0.593), respectively. FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy with a percentage of agreement of 97.4%(k = 0.910), 81.6%(k = 0.714) and 91.7%(k = 0.815), respectively. FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy, with a percentage of agreement of 89.7%(k = 0.802), 79,6%(k = 0.703) and 91.7%(k = 0.815), respectively. FICE 3 improved the delineation of 46.2% of angioecta-sias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy, with a percentage of agreement of 53.8% [k = not available(NA)], 75.5%(k = NA) and 66.7%(k = 0.304), respectively. The BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25% of villous edema/atrophy, with a per-centage of agreement of 76.9%(k = 0.558), 81.6%(k = 0.570) and 25.0%(k = NA), respectively.CONCLUSION: Virtual chromoendoscopy can improve the delineation of angioectasias, ulcers/erosions and villous edema/atrophy detected by SBCE, with almost perfect interobserver agreement for FICE 1.
基金the Institutional Research Ethics Board(number 6.886.384)Brazil platform system(Approval with CAAE number 79007324.1.0000.5047).
文摘BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children,as it can help in the development of more effective,safe and personalized preventive and therapeutic strategies.AIM To define the profile of children seeking emergency care due to FB impaction in the esophagus,analyze factors associated with complications,and evaluate the effectiveness of rigid(RE)and flexible endoscopes(FE).METHODS A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy(FE=84 vs RE=82)at the Dr.JoséFrota Institute was performed.The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications.The secondary outcomes were age group,gender,symptoms,length of hospital stay,and location of the FB.RESULTS Boys(66.9%),preschoolers(43.4%),FB>24 hours(62.7%),cervical esophagus(60.8%),coin ingestion(57.2%)and complaints of dysphagia(24.9%)and sialorrhea(23.1%)were the predominant findings.Endoscopy was successful(90.4%)with sedation(89.1%).A total of 97%of patients were discharged from the hospital,while 3%died.The average hospital stay length was 2.6 days.Most patients did not experience complications predominated(64.5%).Esophageal perforations were more frequent after RE(11%vs 4.8%),while FE was more effective(95.2%vs 85.4%).Theχ2 test or Fisher's exact test was used to compare categorical variables.For continuous variables,the Kruskal-Wallis test or analysis of variance was used.Statistical analyses were performed in R®software(version 1.3.1093).CONCLUSION Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys.Risk factors for complications due to esophageal FB include battery ingestion,delayed removal(>48 hours)and lodging in the thoracic esophagus.FE was generally more effective than RE for removing FBs;both procedures are safe.
文摘The minimally invasive surgery through natural orifices has revolutionized the laparoscopic surgery for abdominal procedures. The use of the vaginal approach is not new for gynecologists but it is a new concept for the non-gynecological laparoscopic surgeons. The use of this new approach has been used to perform some procedures and to extract specimens after a laparoscopic surgery, but we don’t know exactly the number of procedures performed until today. There are few papers with clinical experience and a lot of philosophical papers about NOTES. Our aim is to know how and how often we are using this new approach for non-gynecological abdominal minimally invasive procedures. With the revision of the PubMed publications we obtained a total of 268 articles, of which 125 were included in the analysis (46.64%). Cholecystectomy was the procedure more usually performed: there is a large clinical experience with a total of 2432 transvaginal cholecystectomies. Bariatric surgery, colectomy and appendectomy have been other surgical procedures with some clinical experience in the use of the transvaginal approach. Analyzing the publications on transvaginal approach, we observed that the use of the vaginal route for non-gynecological abdominal surgery was not anecdotal, with accumulative experience of more than 3000 patients reported in published studies. The use of the vaginal route has shown its safety, obtaining some additional benefits such as the aesthetic and the faster functional recovery. Dyspareunia, one of the most feared, has not been reported in studies as a concern to consider.
