Goals: To evaluate efficacy and safety of endoscopic balloon dilation with or without intralesional steroid injection, of symptomatic upper gastrointestinal (UGI) and lower gastrointestinal (LGI) Crohn’s disease (CD)...Goals: To evaluate efficacy and safety of endoscopic balloon dilation with or without intralesional steroid injection, of symptomatic upper gastrointestinal (UGI) and lower gastrointestinal (LGI) Crohn’s disease (CD) strictures. Background: Patients with CD commonly develop obstructive symptoms secondary to gastrointestinal strictures. When these do not resolve with medical management, surgery is usually the only alternative. Limited data are available on the safety and efficacy of endoscopic through-the-scope (TTS) balloon dilation of CD strictures. Study: We performed a retrospective review of TTS balloon dilations done on CD-related UGI and LGI strictures. Postdilation intralesional steroid injections were done at the discretion of the endoscopist. Stricture was defined as luminal stenosis< 10 mm in diameter, through which a scope could not be passed. Technical success was defined as the ability of the scope to traverse the stricture postdilation. Long-term success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilation. Results: Over 4 years, we performed 29 stricture dilations on 17 patients (10 female, 7 male) with 20 strictures. The mean follow-up period was 18.8 months (range, 5-50 months). Stricture locations were as follows: rectal, 5; sigmoid colon, 2; colo-colonic anastomosis, 3; ileocolonic anastomosis, 4; ileum, 1; descending colon, 1; cecum, 1; and distal duodenal bulb, 3 patients. Technical success was achieved in 28 of 29 stricture dilations (96.5%). Ten strictures (34.5%) were dilated to < 15 mm and 19 (65.5%) to ≥15 mm diameter. Long-term success rate in the < 15 mm group was 70%, and in ≥15 mm group was 68.4%. Four quadrant steroid injections were done on 11 strictures. The recurrence rate in this group was 10%and that in the nonsteroid group was 31.3%. The overall long-term success rate was 76.5%by intent-to-treat analysis. Three perforations occurred (all colonic) during 29 stricture dilations, a complication rate of 10%with no mortalities. Conclusion: We report the first series of TTS balloon dilations with or without intralesional steroid injection, of both primary and anastomotic UGI and LGI strictures in CD patients. Long-term success was achieved in 76.5%patients with a complication rate of 10%. This mode of therapy appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory CD-associated GI strictures. Success rates were better in patients who received four quadrant steroid injections. No difference was seen in stricture recurrence rate or complications based on diameter of TTS balloon used.展开更多
Background: Interval colorectal cancer (CRC) occasionally is detected in patie nts who have recently undergone colono- scopy.Systematic evaluation of CRC detected after colonoscopy could identify w ays to improve the ...Background: Interval colorectal cancer (CRC) occasionally is detected in patie nts who have recently undergone colono- scopy.Systematic evaluation of CRC detected after colonoscopy could identify w ays to improve the quality and the outcome of colonoscopy.Methods: This study ex amined cancer diagnoses in the course of the dietary Polyp Prevention Trial, a r andomized study of a dietary intervention on recurrence of adenomatous polyps. A n algorithm was developed to classify each cancer into one of 4 etiologies: (1) incomplete removal (cancer at the site of previous adenoma), (2) failed biopsy d etection (cancer in an area of suspected neoplasia with negative biopsy specimen s),(3)missed cancer (large, advanced stage cancer found at a short interval afte r colonoscopy), or (4) new cancer (sma- ll, early stage cancer after a longer time interval). Results: Of 2079 patient s,13 had cancer detected over 5810 person years of observation(PYO) (2.2 cases/1 000 PYO); 7/13 or 53.8%of patients had either a potentially “avoidable" cancer or one detectable at an earlier time interval because of incomplete removal (4/ 13) or missed cancer (3/13). Conclusions: Interval cancer occurs despite colonos copy. Im- proved quality of colonoscopy may have reduced cancer prev- alence or resulted in earlier cancer detection in over 50%of prevalent cancer s in the dietary Polyp Prevention Trial.展开更多
Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion that is characterized by proliferating fibrous tissue infiltrated by inflammatory cells. The exact etiology of IPT remains unclear. Although the ass...Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion that is characterized by proliferating fibrous tissue infiltrated by inflammatory cells. The exact etiology of IPT remains unclear. Although the association of IPT with systemic inflammatory disorders has been established, a specific link with Crohns disease is rare. We report two cases of IPT associated with Crohns disease. Both patients were elderly males who presented with abdominal pain and jaundice. At the time of presentation, both had active Crohns disease that was undiagnosed. Computed tomography demonstrated a liver mass, and endoscopic retrograde cholangiography revealed biliary strictures in both patients. Given their symptomatic jaundice and concern for cholangiocarcinoma, they underwent abdominal surgical exploration and pathology results revealed IPT. They were subsequently diagnosed with Crohns disease. Following treatment of Crohns disease, there was significant improvement in their overall clinical status. An underlying diagnosis of inflammatory bowel disease should be considered in patients with IPT.展开更多
We evaluated the consequence of different types of fetal arrhythmia in the development of neonatal cholestasis.The charts of 38 children born at St.Justine Hospital between 1993 and 2001 with sustained and hemodynamic...We evaluated the consequence of different types of fetal arrhythmia in the development of neonatal cholestasis.The charts of 38 children born at St.Justine Hospital between 1993 and 2001 with sustained and hemodynamically significant fetal arrhythmias were studied: 19 with supraventricular tachycardia, 14 with atrial flutter, and 5 with atrio-ventricular (AV) block.Six of these 38 children presented with cholestasis.The average duration of arrhythmia was 15.7 days in the noncholestatic group, compared with 40.3 days in the cholestatic group (P<.05).The three infants with supraventricular tachycardia who developed cholestasis survived and resolved their cholestasis, whereas 2 of 3 infants with AV block died.No infant with atrial flutter developed cholestasis.We conclude that newborns who developed tachyarrhythmia during their fetal life can show transient neonatal cholestasis.In patients with AV block, severe and irreversible liver failure could be observed.In addition, extensive collapse of the stroma and the absence of hepatocytes (foie vide) also were observed in a patient with anti-Ro antibodies.展开更多
文摘Goals: To evaluate efficacy and safety of endoscopic balloon dilation with or without intralesional steroid injection, of symptomatic upper gastrointestinal (UGI) and lower gastrointestinal (LGI) Crohn’s disease (CD) strictures. Background: Patients with CD commonly develop obstructive symptoms secondary to gastrointestinal strictures. When these do not resolve with medical management, surgery is usually the only alternative. Limited data are available on the safety and efficacy of endoscopic through-the-scope (TTS) balloon dilation of CD strictures. Study: We performed a retrospective review of TTS balloon dilations done on CD-related UGI and LGI strictures. Postdilation intralesional steroid injections were done at the discretion of the endoscopist. Stricture was defined as luminal stenosis< 10 mm in diameter, through which a scope could not be passed. Technical success was defined as the ability of the scope to traverse the stricture postdilation. Long-term success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilation. Results: Over 4 years, we performed 29 stricture dilations on 17 patients (10 female, 7 male) with 20 strictures. The mean follow-up period was 18.8 months (range, 5-50 months). Stricture locations were as follows: rectal, 5; sigmoid colon, 2; colo-colonic anastomosis, 3; ileocolonic anastomosis, 4; ileum, 1; descending colon, 1; cecum, 1; and distal duodenal bulb, 3 patients. Technical success was achieved in 28 of 29 stricture dilations (96.5%). Ten strictures (34.5%) were dilated to < 15 mm and 19 (65.5%) to ≥15 mm diameter. Long-term success rate in the < 15 mm group was 70%, and in ≥15 mm group was 68.4%. Four quadrant steroid injections were done on 11 strictures. The recurrence rate in this group was 10%and that in the nonsteroid group was 31.3%. The overall long-term success rate was 76.5%by intent-to-treat analysis. Three perforations occurred (all colonic) during 29 stricture dilations, a complication rate of 10%with no mortalities. Conclusion: We report the first series of TTS balloon dilations with or without intralesional steroid injection, of both primary and anastomotic UGI and LGI strictures in CD patients. Long-term success was achieved in 76.5%patients with a complication rate of 10%. This mode of therapy appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory CD-associated GI strictures. Success rates were better in patients who received four quadrant steroid injections. No difference was seen in stricture recurrence rate or complications based on diameter of TTS balloon used.
文摘Background: Interval colorectal cancer (CRC) occasionally is detected in patie nts who have recently undergone colono- scopy.Systematic evaluation of CRC detected after colonoscopy could identify w ays to improve the quality and the outcome of colonoscopy.Methods: This study ex amined cancer diagnoses in the course of the dietary Polyp Prevention Trial, a r andomized study of a dietary intervention on recurrence of adenomatous polyps. A n algorithm was developed to classify each cancer into one of 4 etiologies: (1) incomplete removal (cancer at the site of previous adenoma), (2) failed biopsy d etection (cancer in an area of suspected neoplasia with negative biopsy specimen s),(3)missed cancer (large, advanced stage cancer found at a short interval afte r colonoscopy), or (4) new cancer (sma- ll, early stage cancer after a longer time interval). Results: Of 2079 patient s,13 had cancer detected over 5810 person years of observation(PYO) (2.2 cases/1 000 PYO); 7/13 or 53.8%of patients had either a potentially “avoidable" cancer or one detectable at an earlier time interval because of incomplete removal (4/ 13) or missed cancer (3/13). Conclusions: Interval cancer occurs despite colonos copy. Im- proved quality of colonoscopy may have reduced cancer prev- alence or resulted in earlier cancer detection in over 50%of prevalent cancer s in the dietary Polyp Prevention Trial.
文摘Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion that is characterized by proliferating fibrous tissue infiltrated by inflammatory cells. The exact etiology of IPT remains unclear. Although the association of IPT with systemic inflammatory disorders has been established, a specific link with Crohns disease is rare. We report two cases of IPT associated with Crohns disease. Both patients were elderly males who presented with abdominal pain and jaundice. At the time of presentation, both had active Crohns disease that was undiagnosed. Computed tomography demonstrated a liver mass, and endoscopic retrograde cholangiography revealed biliary strictures in both patients. Given their symptomatic jaundice and concern for cholangiocarcinoma, they underwent abdominal surgical exploration and pathology results revealed IPT. They were subsequently diagnosed with Crohns disease. Following treatment of Crohns disease, there was significant improvement in their overall clinical status. An underlying diagnosis of inflammatory bowel disease should be considered in patients with IPT.
文摘We evaluated the consequence of different types of fetal arrhythmia in the development of neonatal cholestasis.The charts of 38 children born at St.Justine Hospital between 1993 and 2001 with sustained and hemodynamically significant fetal arrhythmias were studied: 19 with supraventricular tachycardia, 14 with atrial flutter, and 5 with atrio-ventricular (AV) block.Six of these 38 children presented with cholestasis.The average duration of arrhythmia was 15.7 days in the noncholestatic group, compared with 40.3 days in the cholestatic group (P<.05).The three infants with supraventricular tachycardia who developed cholestasis survived and resolved their cholestasis, whereas 2 of 3 infants with AV block died.No infant with atrial flutter developed cholestasis.We conclude that newborns who developed tachyarrhythmia during their fetal life can show transient neonatal cholestasis.In patients with AV block, severe and irreversible liver failure could be observed.In addition, extensive collapse of the stroma and the absence of hepatocytes (foie vide) also were observed in a patient with anti-Ro antibodies.
