Gastric mucus and air bubbles are frequent sources of artifacts during endoscopic ultrasonography (EUS). To reduce these artifacts, we prepared a mucolytic-antifoam solution consisting of simethicone, acetylcysteine, and sodium bicarbonate and performed a prospective randomized and controlled trial comparing this solution (21 patients) to a placebo (22 patients) during EUS. Eight patients in the drug group received a perfect score for both mucolytic and antifoam effect compared with none in the placebo group (p less than 0.001). For overall rating, the drug group received a total of 10 excellents and 9 goods compared with 9 goods, 10 satisfactories, and 1 unacceptable in the placebo group (p less than 0.001). There were no complications associated with the solution. In conclusion, a mucolytic-antifoam solution improved endoscopic visualization and reduced artifacts during EUS study. Its routine use during EUS procedures is therefore recommended.

Acetylcysteine↗

PubMedDate not supplied

Large gastric folds: a diagnostic approach using endoscopic ultrasonography.

The evaluation of large gastric folds poses a difficult diagnostic problem. Exploratory laparotomy with full-thickness gastric biopsy is frequently required in order to rule out malignancy. To examine the utility of endoscopic ultrasonography in the diagnostic evaluation of large gastric folds, 28 consecutive patients with endoscopically or radiographically diagnosed large gastric folds were studied; in most of these patients endoscopic biopsies had been inconclusive for malignancy. Sixteen subjects were women and 12 were men, with a mean age of 57 years (range, 23 to 84). All patients underwent endoscopic ultrasonography to determine the anatomic wall layer of enlargement; large-forceps biopsy with histopathologic review was then performed when appropriate. Endoscopic ultrasonography demonstrated enlargement of layer 2 only (deep mucosa) in 64% (18/28) of patients, primarily of layer 3 (submucosa) in 14% (4/28), and of layer 4 (muscularis propria) in 21% (6/28). Large-forceps endoscopic biopsy performed immediately after ultrasonography in 86% (24/28) revealed acute or chronic inflammation in 67% (16/24), malignancy in 16% (4/24), and Ménétrier's disease in 4% (1/24). The biopsy results of 3 patients (13%) were negative for malignancy, but because of ultrasonographic findings of wall thickening involving layers 3 and 4 (submucosa and muscularis propria), they underwent laparotomy, which revealed primary gastric adenocarcinoma. Endoscopic ultrasonography demonstrated gastric varices in 4 patients; biopsy specimens were not taken. One patient with gastric lymphoma had only a layer 2 abnormality, but the correct diagnosis was made by endoscopic biopsy. Malignancy did not develop in any of the patients with gastric wall thickening limited to layer 2 and negative biopsy results during a mean follow-up period of 35 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Radiographic appearances of esophageal stents.

Among patients with esophageal carcinoma and associated dysphagia, more than 60% have unresectable disease at presentation. In such cases, the goal of treatment is primarily palliation of the dysphagia; treatment options include surgery, radiation therapy, laser ablation, and placement of stents. Beginning with the first stent-made of boxwood and silver in 1885-evolution in design led to the creation of large-diameter, rigid plastic stents placed at laparotomy and eventually placed by means of endoscopy. However, complications such as perforation, hemorrhage, dislodgment, pressure necrosis, and occlusion were frequently encountered with these stents. The development of small-diameter, expandable metal stents eliminated some of these complications. Metal stents have greatly reduced procedure-related morbidity and mortality, but complications such as perforation, malposition, migration, tumor ingrowth and overgrowth, food obstruction, and tracheoesophageal fistula persist. An efficacious and increasingly used method of treating malignant dysphagia, esophageal stent placement must undergo further improvements to reduce the frequency of complications, particularly migration and tumor ingrowth.

Contraindications↗

PubMedDate not supplied

Skin-level gastrostomies and jejunostomies for long-term enteral feeding.

Skin level gastrostomies and jejunostomies were used in 17 patients for long-term enteral feeding. These devices offer greater comfort to the patient and less potential complications and dysfunction compared to tube gastrostomies and jejunostomies. Placement of the skin level devices requires "mature" gastrocutaneous and jejunocutaneous fistulas. These fistulas can be created by initial placement of percutaneous endoscopic gastrostomies and jejunostomies.

Adult↗

PubMedDate not supplied

Recurrent deletions involving chromosomes 1, 5, 17, and 18 in colorectal carcinoma: possible role in biological and clinical behavior of tumors.

We have employed cytogenetic and restriction fragment length polymorphism (RFLP) analysis to identify a full spectrum of cytogenetic and molecular alterations associated with initiation and progression of "sporadic" colorectal cancer and also to correlate the alterations with biological and clinical behavior of the tumors. The study series included 63 colorectal cancers, 47 primary and 16 metastatic recurrences. Cytogenetic analysis was successful in 48 tumors (76%) of which 44 (91%) were abnormal. Of these 44 tumors, clonal abnormalities were identified in 43, whereas chromosomes from one tumor were unsuitable for complete analysis. Each of these abnormal tumors displayed heterogeneity with regard to extent and complexity of recurrent chromosomal abnormalities. Numerical losses of chromosomes 17 and 18 (20-34%) and gains of chromosome 7 (28%) were significantly higher. The four most frequent structural rearrangements on the other hand, involved specific regions of chromosomes 1p, 5q, 17p, and 18q. The shortest regions of overlap of these rearrangements or losses were located at 1p36, 5q21-22, 17p13 and 18q21- > ter. RFLP analysis directed at 1p, 5q, 17p and 18q identified allelic deletions of these regions in 39 tumors (64%) which included 17 normal and 11 cytogenetic failures. Of all the informative tumors, 32%, 37%, 31%, and 63% showed allelic losses at chromosomes 1p, 5q, 17p and 18q respectively. The two methods of analysis (cytogenetics and RFLP) employed to identify genetic alterations were complementary; probes for chromosome 1 and 18 showed the greatest degree of concordance, whereas probes for chromosomes 5 and 17 provided relatively higher rate of discordance with cytogenetic results. These differences could be attributed mainly to three reasons: 1) a limited number of probes used for RFLP analysis; 2) contamination of tumor cells with normal cells, and 3) either mutational inactivation or deletion of specific alleles not closely linked to the probes used. Regardless of these limitations, however, the combined use of cytogenetic and RFLP identified genetic alterations in a large number of tumors and help elucidate the role of hyperdiploidy and/or relative deficiency of a given chromosomal segment in expression of recessive mutations. In addition, alterations of either chromosomes 1 or 17 predicted poorer survival for the patients with primary colorectal cancer (p = 0.03).

Blotting, Southern↗