Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder.
Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder. Clin Endosc. 2020 Mar 16;: Authors: Kim D, Cho B, Choi JW, Kim KB, Park SM Abstract Picosulfate solution is widely used as a small volume bowel cleansing agent and is considered to be effective and relatively safe. A case of a 75-year-old woman ingested picosulfate powder and drank a small volume of water, subsequently experienced severe burning pain in the chest. Endoscopy was performed and showed a submucosal hemorrhage and exudative ulcers at the mid to lower esophagus. At 2 weeks, her symptoms improved with conservative treatment. However, liquid food dysphagia developed 11 weeks after ingestion. A follow-up endoscopy revealed multiple esophageal strictures, which were treated with a fully covered metal stent and esophageal balloon dilation. Consequently, the esophageal strictures improved after one year. As this case demonstrates, detailed information about picosulfate powder ingestion after dissolving it in more than 200 mL of water should be presented to patients to avoid esophageal injury. PMID: 32176843 [PubMed - as supplied by publisher]
Conclusion: A unique case of a coexistence of primary hepatic neuroendocrine carcinoma and a distal cholangiocarcinoma, which had invaded the pancreas. No treatment guidelines are established for the treatment of the unique case.
ConclusionsOur study of published trials indicates that using low, as opposed to standard, IAP during laparoscopic cholecystectomy may reduce patients ’ post-operative pain, including shoulder pain, and length of hospital stay. Heterogeneity in the pooled estimates and high risk of bias of the included trials suggest the need for high-quality, adequately powered RCTs to confirm these findings.
Esophagogastric junction outflow obstruction (EGJOO) is a rare but increasingly recognized, newly described disorder typically presenting with dysphagia and chest pain. On manometry it is characterized by failure of the lower esophageal sphincter (LES) to relax with wet swallow reflected by an elevated integrated relaxation pressure (IRP), yet with some preserved esophageal peristalsis, thus not fulfilling the diagnostic criteria for achalasia. At present there is no well-defined management algorithm thus pharmacotherapy, botulinum toxin injection, pneumatic dilation, and surgical myotomy are all used in everyday care with mixed results.
Walled-off necrosis (WON) can occur in up to 20% of severe acute pancreatitis (AP) cases and is associated with a mortality rate that varies between 8% and 39%. Drainage is indicated in cases of infection, biliary obstruction, gastric outlet obstruction (GOO) and abdominal pain. Endoscopic ultrasound (EUS)-guided transmural drainage of WON has replaced surgical interventions, given that it has been associated with lower morbidity. Luminal-apposing metal stents (LAMS) have been rapidly replacing plastic stents (PS).
CONCLUSION: GFs are rare, occult and potentially life-threatening complications in CD. US is one of the first-line modalities to evaluate CD and its complications. OA-CEUS, a novel technique of US for gut, may be helpful in reducing the possibility of a missed diagnosis of GF. PMID: 32536779 [PubMed - in process]
Achalasia is an uncommon primary motor disorder of the esophagus, characterized by disorganized peristalsis and insufficient relaxation of the lower esophageal sphincter (LES).1 These abnormalities impede food passage across the LES into the stomach, causing symptoms that include dysphagia, regurgitation, and/or chest pain. Treatment targeting disruption of the LES leads to improvement or resolution of symptoms in the vast majority of patients.2 Currently, 3 main LES-directed treatments are offered to patients with achalasia: pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and peroral endoscopic myotomy (POEM).
AbstractBackgroundEnhanced recovery after surgery (ERAS) protocols have been extensively proven in lower gastrointestinal surgery to decrease postoperative physiologic stress and length of stay (LOS). ERAS in bariatric surgery (ERABS) varies immensely from each program with inconsistent results with a predominant goal of reducing LOS. Our focus in implementing enhanced recovery after bariatric surgery (ERABS) protocols is aimed at reducing postoperative pain and opioid use.MethodsThis is a retrospective review of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG) at a single hig...
CONCLUSIONS: Our findings suggest a general high diagnostic yield for EGD in pediatric patients, stemming mainly from patients in whom a specific condition was suspected a priori. However, the role of the procedure in the diagnosis and management of non-specific gastrointestinal complaints was minor suggesting that EGD may be superfluous for some of these patients. PMID: 32147981 [PubMed - in process]
ConclusionsThe majority of endoscopists who perform ERCPs suffer from a musculoskeletal pain symptom, and almost half report a musculoskeletal injury. Further investigation regarding risk factors and preventative strategies is warranted. This information can then be incorporated into ergonomics education which only a small proportion of advanced endoscopists report having received any training in.
ConclusionsAggressive hydration with lactated Ringer solution was a protective factor in reducing the overall incidence of PEP, hyperamylasemia and risk of abdominal pain.