F. Mondelo

The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage

BACKGROUND Despite different forms of treatment, few studies have been performed on the outcome and prognosis of patients admitted to the hospital because of gastric vascular ectasia (GVE) and upper-GI bleeding (UGIB). There is also little knowledge on the efficacy of argon plasma coagulation (APC) in different subgroups of GVE lesions. OBJECTIVE This study was designed to evaluate the efficacy of APC in patients admitted to the hospital with UGIB because of GVE. DESIGN Prospective evaluation of consecutive cases of UGIB because of GVE. SETTING Tertiary and university-affiliated hospital. PATIENTS AND INTERVENTIONS Twenty-nine patients were included and divided into 3 subgroups: focal vascular ectasia lesions (FVE) (n = 10), portal hypertensive gastropathy (PHG) (n = 11), and gastric antral vascular ectasia (GAVE) (n = 8). Patients were followed at 3 months and every 6 months thereafter during a mean of 23.1 months (range 18-37 months). All patients received intensive APC treatment that was repeated, depending on the endoscopic appearance or clinical evaluation. RESULTS The overall success of APC treatment was 86%, with only one recurrence of UGIB during the follow-up period. The number of APC sessions was 1.2, 2.2, and 2.3, in each subgroup (not significant), with a total number of sessions of 1.9 +/- 1.3. Treatment success was 90% in the FVE group, 81% in the PHG group, and 87.5% in the GAVE group (NS). The rise in hematocrit from baseline values in the overall group and in each subgroup was significant (P > .01). LIMITATIONS A single-center study and small sample. CONCLUSIONS Endoscopic thermal ablation with APC is effective in managing UGIB and in reducing transfusion requirements in patients admitted for GI hemorrhage because of different endoscopic types of GVE.

Prevention of Pancreatic Reactions by Bolus Somatostatin Administration in Patients Undergoing Endoscopic Retrograde Cholangio-Pancreatography and Endoscopic Sphincterotomy

Mild pancreatitis is a common complication of endoscopic retrograde cholangio-pancreatography (ERCP) and endoscopic sphincterotomy. Knowing that a bolus injection of natural somatostatin (SRIF) dramatically reduces pancreatic secretion, a study was conducted in 33 subjects undergoing invasive diagnostic procedures. A placebo (n = 16) or SRIF (n = 17; 4 micrograms/kg) were injected before cannulation. Enzymatic rise was observed in 16 (94%) subjects receiving placebo and in 8 (50%) injected previously with SRIF. In the former group 65% reported abdominal pain whereas only 19% had this complaint in the SRIF series. Results suggest that a bolus injection of SRIF may attenuate pancreatic irritation caused by diagnostic procedures or sphincterotomy.

Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower intestinal endoscopy

BACKGROUND Patients who have prosthetic heart valves, previous history of endocarditis, and surgically constructed systemic-pulmonary shunts or conduits should receive prophylactic antibiotics before colonoscopy. The usefulness of this approach in cirrhotic patients remains unknown. The present study prospectively assesses the incidence of bacteremia in these patients. METHODS Lower intestinal endoscopy was performed in 58 cirrhotic patients. Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 72 hours after endoscopy to detect the development of infectious complications. RESULTS Only 6 cultures from 6 patients were positive. Four were obtained post-endoscopy and the remaining 2 before colonoscopy but the corresponding post-endoscopy samples were negative. All organisms recovered were normal skin flora. All patients, including those with positive cultures, remained asymptomatic during the 72 hours after the procedure. CONCLUSIONS Our findings indicate that lower intestinal endoscopy does not induce bacteremia in cirrhotic patients with or without ascites in the absence of gastrointestinal bleeding and do not support the routine use of prophylactic antibiotics in these patients.

Usefulness of laparoscopy with liver biopsy in the assessment of liver involvement at diagnosis of Hodgkin's and non-Hodgkin's lymphomas ☆ ☆☆ ★

BACKGROUND Staging of lymphoma at diagnosis determines therapeutic strategy and disease prognosis. Hepatic involvement, demonstrated by laparotomy or laparoscopy, is frequent in Hodgkins and non-Hodgkins lymphoma. However, it is unclear whether these procedures are still necessary or whether they should be replaced by less invasive techniques. METHODS Laparoscopy-assisted liver biopsies, as well as laboratory studies, bone marrow biopsy, and thoracic and abdominal computed tomography, were performed as an initial staging evaluation in 112 consecutive patients who were diagnosed with Hodgkins or non-Hodgkins lymphoma. RESULTS Hepatic lymphomatous involvement was demonstrated in 18 patients (16%). It was more frequent in non-Hodgkins (24%) than in Hodgkins (8%) lymphomas (p < 0.04) and among stage III and IV (24%) than stage I and 11 (10%) patients (p < 0.05). The laparoscopic finding of white spots or nodules on the liver surface had a 100% specificity in the diagnosis of lymphomatous liver involvement. Conversely, hepatomegaly on both laparoscopy and computed tomography, as well as laboratory studies, had a low sensitivity and specificity. CONCLUSIONS Laparoscopy-assisted liver biopsy was a useful technique to establish hepatic lymphomatous involvement, which was not identified by either computed tomography or laboratory studies.

3417 Flexible gastrointestinal endoscopes of lasting use. how long should an instrument be used

GI flexible endoscopes are middle term reusable instruments. Despite this statement there is little information on the number of procedures that can be performed with one endoscope. Aim of the study To know the durability of flexible instruments used in GI endoscopy. Material and Methods The total number of procedures performed in a university referral hospital GI Endoscopy Unit from 1972 to 1998 was related to the total number of flexible endoscopes used (Olympus). Replacement was made when the cumulated cost of repair was two-fold the cost of replacement. The analyzed activity included the in/outpatient diagnostic and therapeutic procedures and teaching. Gastroenterologists devoted to GI endoscopy performed 95% of procedures. The rest were emergency procedures(GI-ICU). The total number of the procedures was related to the total number of scopes bought in the period analyzed. The analysis was also performed considering fiveyear periods, with the first five-year period being omitted to avoid the influence of early experience. Electronic scopes were used in the last fiveyear period and their durability was compared to that of the fiberoptic scope periods. (Results table) There were no significant differences in flexible scope duration comparing the periods using fiberscopes and the period using videoscopes. Comments This study provides valuable information for endoscope management in hospital GI endoscopy units but also for private practice, in which the equipment probably lasts longer due to greater care in cleaning and handling, and fewer operators having access to the instruments. Conclusions 1 GI flexible scopes are middle term reusable sets, the duration of which may be related to the number of procedures performed. 2 Endoscopes used for upper GI explorations last twice as long as those used for colonoscopy and three-fold longer than duodenoscopes. 3 Although videoendoscopes seem to provide a greater number of procedures, the difference is not significant when compared to fiberoptic instruments.