Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present fo...Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic,lung and breast cancer.None of them had recently received antibiotics.One patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous colitis.Two of these three patients had negative stool toxin assays for Clostridium difficile.In the patient presenting with perforation,an emergency left hemicolectomy was performed and the pathological findings in the colon were acute inflammation and ischemic necrosis;the other three patients were treated with oral vancomycin and/or oral or intravenous metronidazole leading to complete resolution of the symptoms.Apart from pseudomembranous colitis,we describe patients presenting with neutropenic enterocolitis as well as ischemic colitis after docetaxel use.These cases provide some insight into the spectrum and varied clinical presentations of severe colitis associated with taxane-based chemotherapy.展开更多
BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enterosco...BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.展开更多
文摘Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic,lung and breast cancer.None of them had recently received antibiotics.One patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous colitis.Two of these three patients had negative stool toxin assays for Clostridium difficile.In the patient presenting with perforation,an emergency left hemicolectomy was performed and the pathological findings in the colon were acute inflammation and ischemic necrosis;the other three patients were treated with oral vancomycin and/or oral or intravenous metronidazole leading to complete resolution of the symptoms.Apart from pseudomembranous colitis,we describe patients presenting with neutropenic enterocolitis as well as ischemic colitis after docetaxel use.These cases provide some insight into the spectrum and varied clinical presentations of severe colitis associated with taxane-based chemotherapy.
基金The study was approved by the Texas Tech University Health Sciences Center Institutional Review Board(Approval Number.E14078).
文摘BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.