AIM： To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophagogastric junction （EGJ） associated with Barrett＇s esophagus （BE） with low-grade dysplasia （LGD）, by endoscopic r...AIM： To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophagogastric junction （EGJ） associated with Barrett＇s esophagus （BE） with low-grade dysplasia （LGD）, by endoscopic rnucosal resection （EMR）. METHODS： Cap fitted EMR （EMR-C） was performed in 3 patients with hyperplastic-inflammatory polyps （HIPs） and BE. RESULTS： The polyps were successfully removed in the 3 patients. In two patients, with short segment BE （SSBE） （≤ 3 cm）, the metaplastic tissue was completely excised. A 2 cm circumferential EMR was performed in one patient with a polyp involving the whole EGJ. A simultaneous EMR-C of a BE-associated polypoid dysplastic lesion measuring 1 cm × 10 cm, was also carried out. In the two patients, histologic assessment detected LGD in BE. No complications occurred. Complete neosquamous reepithelialization occurred in the two patients with SSBE. An esophageal recurrence occurred in the remaining one and was successfully retreated by EMR. CONCLUSION： EMR-C appears to be a safe and effective method for treating benign esophageal mucosal lesions, allowing also the complete removal of SSBE.展开更多
Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occ...Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018.Results:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours.Abdominal pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms.Endoscopic treatment often fails and surgery is effective when performed early.展开更多
文摘AIM： To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophagogastric junction （EGJ） associated with Barrett＇s esophagus （BE） with low-grade dysplasia （LGD）, by endoscopic rnucosal resection （EMR）. METHODS： Cap fitted EMR （EMR-C） was performed in 3 patients with hyperplastic-inflammatory polyps （HIPs） and BE. RESULTS： The polyps were successfully removed in the 3 patients. In two patients, with short segment BE （SSBE） （≤ 3 cm）, the metaplastic tissue was completely excised. A 2 cm circumferential EMR was performed in one patient with a polyp involving the whole EGJ. A simultaneous EMR-C of a BE-associated polypoid dysplastic lesion measuring 1 cm × 10 cm, was also carried out. In the two patients, histologic assessment detected LGD in BE. No complications occurred. Complete neosquamous reepithelialization occurred in the two patients with SSBE. An esophageal recurrence occurred in the remaining one and was successfully retreated by EMR. CONCLUSION： EMR-C appears to be a safe and effective method for treating benign esophageal mucosal lesions, allowing also the complete removal of SSBE.
基金No source of funding has been declared by the authors.The guidelines of the PRISMA 2009 statement were adopted.
文摘Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018.Results:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours.Abdominal pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms.Endoscopic treatment often fails and surgery is effective when performed early.
