Background: In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Estab...Background: In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. Objective: Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. Design: A prospective head-to-head comparison was performed. Setting: The study was performed in a tertiary care hospital. Patients: Study patients were 23 adults with subepithelial lesions limited to the submucosa. Intervention: All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy speciments were obtained with large-capacity “jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. Main Outcome Measurement: The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. Results: Twenty-three patients with lesions limited to the submucosa were identi-fied by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) (P = .0001, McNemar test). Conclusion: In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.展开更多
Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correct...Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients.The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence.Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter(IAS)and external anal sphincter(EAS).EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test.Anorectal manometry was performed with a standard water-perfused catheter system.A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test.All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up.Improvement in fecal control was defined as a 25%or greater decrease in continence score.EUS versus manometry were compared with subsequent surgical treatment and outcome.P-values were calculated using Fisher’s exact test.Patients(n = 32;31 females)were followed for a mean 25 months(range 13-46).Sixteen patients had improved symptoms(50%).There was no correlation between EUS or anorectal manometry sphincter findings and outcome.Seven of 14(50%)patients who subsequently underwent surgery versus 9 of 18(50%)without surgery improved(P =.578).In long-term follow-up,approximately half of patients improve regardless of the results of EUS or anorectal manometry,or whether surgery is performed.展开更多
文摘Background: In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. Objective: Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. Design: A prospective head-to-head comparison was performed. Setting: The study was performed in a tertiary care hospital. Patients: Study patients were 23 adults with subepithelial lesions limited to the submucosa. Intervention: All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy speciments were obtained with large-capacity “jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. Main Outcome Measurement: The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. Results: Twenty-three patients with lesions limited to the submucosa were identi-fied by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) (P = .0001, McNemar test). Conclusion: In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.
文摘Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients.The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence.Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter(IAS)and external anal sphincter(EAS).EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test.Anorectal manometry was performed with a standard water-perfused catheter system.A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test.All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up.Improvement in fecal control was defined as a 25%or greater decrease in continence score.EUS versus manometry were compared with subsequent surgical treatment and outcome.P-values were calculated using Fisher’s exact test.Patients(n = 32;31 females)were followed for a mean 25 months(range 13-46).Sixteen patients had improved symptoms(50%).There was no correlation between EUS or anorectal manometry sphincter findings and outcome.Seven of 14(50%)patients who subsequently underwent surgery versus 9 of 18(50%)without surgery improved(P =.578).In long-term follow-up,approximately half of patients improve regardless of the results of EUS or anorectal manometry,or whether surgery is performed.
