Despite recent advances in medicine,colorectal cancer (CRC)remains one of the greatest hazards for public health worldwide and especially the industrialized world.It has been well documented with concrete data that re...Despite recent advances in medicine,colorectal cancer (CRC)remains one of the greatest hazards for public health worldwide and especially the industrialized world.It has been well documented with concrete data that regular screening colonoscopy aimed at early detection of precancerous polyps can help decrease the incidence of CRC.However,the adherence of the general population to such screening programs has been shown to be lower than that expected,thus allowing CRC to remain a major threat for public health.Various reasons have been suggested to explain the disappointing compliance of the population to CRC screening programs,some of them associated with colonoscopy per se,which is viewed by many people as an unpleasant examination.Governments,medical societies,individual gastroenterologists,as well as the medical industry are working in order to improve endoscopic devices and/or to improve standard colo-noscopy.The aim is to improve the acceptance of the population for this method of CRC screening,by providing a painless and reliable examination of the colon.This review focuses on some of the latest improve-me-nts in this fie-ld.展开更多
Idiopathic achalasia is a rare primary motility disorder of the esophagus. The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in th...Idiopathic achalasia is a rare primary motility disorder of the esophagus. The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in the tubular esophagus. These motor abnormalities lead to dysphagia, stasis, regurgitation, weight loss, or secondary respiratory complications. Although major strides have been made in understanding the pathogenesis of this rare disorder, including a probable autoimmune mediated destruction of inhibitory neurons in response to an unknown insult in genetically susceptible individuals, a definite trigger has not been identified. The diagnosis of achalasia is suggested by clinical features and conf irmed by further diagnostic tests, such as esophagogastroduodenoscopy (EGD), manometry or barium swallow. These studies are not only used to exclude pseudoachalasia, but also might help to categorize the disease by severity or clinical subtype. Recent advances in diagnostic methods, including high resolution manometry (HRM), might allow prediction of treatment responses. The primary treatments for achieving long-term symptom relief are surgery and endoscopic methods. Although limited high-quality data exist, it appears that laparoscopic Heller myotomy with partial fundoplication is superior to endoscopic methods in achieving long-term relief of symptoms in the majority of patients. However, the current clinical approach to achalasia will depend not only on patients' characteristics and clinical subtypes of the disease, but also on local expertise and patient preferences.展开更多
Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the...Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the role of EUS in the clinical management of patients with pancreatic disease. Major indications of EUS are:(1) Detection of common bile duct stones (e.g. in acute pancreatitis); (2) Detection of small exo-and endocrine pancreatic tumours; and (3) Performance of fine needle aspiration in pancreatic masses depending on therapeutic consequences. EUS seems to be less useful in cases of chronic pancreatitis and cystic pan-creatic lesions. Moreover the constant improvement of computed tomography has limited the role of EUS in pancreatic cancer staging. On the other hand,new therapeutic options are available due to EUS,such as pancreatic cyst drainage and celiac plexus neurolysis,offering a new field in which new techniques may arise. So the main goal of this review is to determine the exact role of EUS in a number of pancreatic and biliary diseases.展开更多
文摘Despite recent advances in medicine,colorectal cancer (CRC)remains one of the greatest hazards for public health worldwide and especially the industrialized world.It has been well documented with concrete data that regular screening colonoscopy aimed at early detection of precancerous polyps can help decrease the incidence of CRC.However,the adherence of the general population to such screening programs has been shown to be lower than that expected,thus allowing CRC to remain a major threat for public health.Various reasons have been suggested to explain the disappointing compliance of the population to CRC screening programs,some of them associated with colonoscopy per se,which is viewed by many people as an unpleasant examination.Governments,medical societies,individual gastroenterologists,as well as the medical industry are working in order to improve endoscopic devices and/or to improve standard colo-noscopy.The aim is to improve the acceptance of the population for this method of CRC screening,by providing a painless and reliable examination of the colon.This review focuses on some of the latest improve-me-nts in this fie-ld.
文摘Idiopathic achalasia is a rare primary motility disorder of the esophagus. The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in the tubular esophagus. These motor abnormalities lead to dysphagia, stasis, regurgitation, weight loss, or secondary respiratory complications. Although major strides have been made in understanding the pathogenesis of this rare disorder, including a probable autoimmune mediated destruction of inhibitory neurons in response to an unknown insult in genetically susceptible individuals, a definite trigger has not been identified. The diagnosis of achalasia is suggested by clinical features and conf irmed by further diagnostic tests, such as esophagogastroduodenoscopy (EGD), manometry or barium swallow. These studies are not only used to exclude pseudoachalasia, but also might help to categorize the disease by severity or clinical subtype. Recent advances in diagnostic methods, including high resolution manometry (HRM), might allow prediction of treatment responses. The primary treatments for achieving long-term symptom relief are surgery and endoscopic methods. Although limited high-quality data exist, it appears that laparoscopic Heller myotomy with partial fundoplication is superior to endoscopic methods in achieving long-term relief of symptoms in the majority of patients. However, the current clinical approach to achalasia will depend not only on patients' characteristics and clinical subtypes of the disease, but also on local expertise and patient preferences.
文摘Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the role of EUS in the clinical management of patients with pancreatic disease. Major indications of EUS are:(1) Detection of common bile duct stones (e.g. in acute pancreatitis); (2) Detection of small exo-and endocrine pancreatic tumours; and (3) Performance of fine needle aspiration in pancreatic masses depending on therapeutic consequences. EUS seems to be less useful in cases of chronic pancreatitis and cystic pan-creatic lesions. Moreover the constant improvement of computed tomography has limited the role of EUS in pancreatic cancer staging. On the other hand,new therapeutic options are available due to EUS,such as pancreatic cyst drainage and celiac plexus neurolysis,offering a new field in which new techniques may arise. So the main goal of this review is to determine the exact role of EUS in a number of pancreatic and biliary diseases.
