Medical treatment for sphincter of oddi dysfunction:Can it replace endoscopic sphincterotomy?

AIM:To report the results of a medical management of sphincter of oddi dysfunction(SOD) after an intermediate follow-up period.METHODS:A total of 59 patients with SOD(2 men and 57 women,mean age 51 years old) were included in this prospective study.After medical treatment for one year,the patients were clinically re-evaluated after an average period of 30 mo.RESULTS:The distribution of the patients according to the Milwaukee's classification was the following:11 patients were type 1,34 were type 2 and 14 were type 3.Fourteen patients underwent an endoscopic sphincterotomy(ES) after one year of medical treatment.The median intermediate follow-up period was 29.8 ± 3 mo(3-72 mo).The initial effectiveness of the medical treatment was complete,partial and poor among 50.8%,13.5% and 35%,respectively,of the patients.At the end of the follow-up period,37 patients(62.7%) showed more than 50% improvement.The rate of improvement in patients who required ES was not significantly different compared with the patients treated conservatively(64.2% vs 62.2%,respectively).CONCLUSION:Our study confirms that conservative medical treatment could be an alternative to endoscopic sphincterotomy because,after an intermediate follow-up period,the two treatments show the same success rates.

Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

AIM:To evaluate the feasibility and the outcome of endoscopic mucosal resection(EMR)for large colorectal tumors exceeding 4 cm(LCRT)undergoing piecemeal resection. METHODS:From January 2005 to April 2008,146 digestive tumors larger than 2 cm were removed with the EMR technique in our department.Of these,34 tumors were larger than 4 cm and piecemeal resection was carried out on 26 colorectal tumors.The mean age of the patients was 71 years.The mean follow-up duration was 12 mo. RESULTS:LCRTs were located in the rectum,left colon,transverse colon and right colon in 58%,15%, 4%and 23%of cases,respectively.All were sessile tumors larger than 4 cm with a mean size of 4.9 cm (4-10 cm).According to the Paris classification,34%of the tumors were typeⅠs,58%typeⅡa,4%typeⅡb and 4%typeⅡc.Pathological examination showed tubulous adenoma in 31%,tubulo-villous adenoma in 27%,villous adenoma in 42%,high-grade dysplasia in38%,in situ carcinoma in 19%of the cases and mucosal carcinoma(m2)in 8%of the cases.The two cases(7.7%)of procedural bleeding that occurred were managed endoscopically and one small perforation was treated with clips.During follow-up,recurrence of the tumor occurred in three patients(12%),three of whom received endoscopic treatment. CONCLUSION:EMR for tumors larger than 4 cm is a safe and effective procedure that could compete with endoscopic submucosal dissection,despite providing incomplete histological assessment.