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P Sakai

Publications and source records attributed to P Sakai.

At least 19 recordsLinked to original sources
PubMed2005

An evaluation of gastric scintigraphy pre- and postpyloroduodenal peptic stenosis dilation.

BACKGROUND: The usual treatment of pyloroduodenal peptic stenosis has been mainly surgical, through pyloroplasty or gastric resection, with or without vagotomy. Since the first description of treatment for this peptic complication by endoscopic balloon dilation perfomed by Benjamin in 1982 [2], this procedure has become a therapeutic option in association with the medical treatment of peptic disease. The aim of this study is to evaluate the results involving clinical, endoscopic, and gastric emptying scintigraphy parameters. METHODS: Between August 1998 and February 2000, 20 patients with pyloroduodenal stenosis refractory to conservative treatment were treated at the Gastrointestinal Endoscopy Unit of the University of São Paulo Medical School. All patients who presented clinical manifestations of pyloroduodenal stenosis underwent upper gastrointestinal endoscopy to confirm peptic stenosis. Biopsy of the narrowing for the confirmation of a benign disease and gastric biopsy for Helicobacter pylori detection were performed. The treatment consisted of dilation of the stenosis with type TTS (Through The Scope) hydrostatic balloon under endoscopic control, treatment of Helicobacter pylori infection, and gastric acid suppression with oral administration of proton pump inhibitor. All patients, except one who was excluded from this study, were submitted to a clinical endoscopic assessment and gastric emptying evaluation by ingestion of (99m)Tc before and after the treatment. Endoscopic evaluation considered the diameter of the stenotic area before and after treatment. A scintigraphic study compared the time of gastric emptying before and after balloon dilation. RESULTS: Nineteen patients completed treatment by hydrostatic balloon dilation. Clinical symptoms such as bloating (p < 0.0001), epigastric pain (p = 0.0159), gastric stasis (p < 0.0001), and weight gain (p = 0.036) showed significant improvement. The diameter of the stenotic area increased significantly (p < 0.01) after the dilation treatment as well as a better gastric emptying of (99m)Tc (p < 0.0001). CONCLUSION: The dilation of the peptic pyloroduodenal stenosis using a hydrostatic balloon is a safe and effective procedure. The evaluation with gastric scintigraphy by ingestion of (99m)Tc is an effective method of assessment for the improvement of gastric function, because its results corresponded to the clinical improvement after endoscopic treatment.

Catheterization↗
PubMed2005

Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope.

BACKGROUND AND STUDY AIMS: Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here. PATIENTS AND METHODS: This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach. RESULTS: The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients. CONCLUSIONS: Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.

Anastomosis, Roux-en-Y↗
PubMed2004

Radial endoscopic ultrasound and spiral computed tomography in the diagnosis and staging of periampullary tumors.

BACKGROUND AND STUDY AIMS: The early detection and accurate staging of pancreatic and ampullary cancer is of utmost importance for the achievement of surgical radical treatment. The aim of this study was to assess prospectively the role of endoscopic ultrasonography (EUS) in detection and staging of pancreatic and ampullary cancer, comparing its results to those obtained with spiral computed tomography (SCT). PATIENTS AND METHODS: Sixty-one patients with suspected pancreatic and ampullary tumors were included, 46 (75, 4%) of whom presented with obstructive jaundice. Patients underwent EUS and SCT within a 7-day period. Examiners were unaware of the previous imaging results, except conventional echography. Image interpretation was compared to surgical and histopathological findings. RESULTS: Fifty-six (91, 8%) patients were surgically explored. Clinical follow-up and/or tissue diagnosis determined the correct diagnosis in the remaining five patients. Pancreatic cancer and ampullary cancer were observed in 29 (47, 6%) and 10 (16, 4%) patients, respectively. Chronic pancreatitis and choledocholithiasis were the most common diagnosis in patients with non-neoplastic disease. EUS was more effective than SCT for the definition of the final diagnosis in patients with obstructive jaundice (87.0 vs. 67.4%, p = 0.04). Both exams were equally effective for detecting pancreatic cancer but EUS predicted more accurately the involvement of portal-mesenteric axis by the tumor (87.0 vs. 67.4%, p = 0.04). EUS was particularly useful in the diagnosis of cancer of papilla of Vater. CONCLUSION: In patients with pancreatic adenocarcinoma without unequivocal signs of distant metastatic disease, EUS is more accurate than SCT to predict venous involvement by the tumor. EUS is superior to SCT to detect ampullary adenocarcinoma. Both methods are equally ineffective to detect nodal involvement in pancreatic and ampullary cancer.

Adolescent↗
PubMed2004

Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study.

BACKGROUND AND STUDY AIMS: There have so far been no prospective studies on the value of flexible endoscopy for removing foreign bodies in the upper gastrointestinal tract. This study presents a clinical analysis of accidents with foreign bodies and prospectively evaluates the effectiveness of flexible endoscopy for removing them. PATIENTS AND METHODS: A total of 105 cases of foreign-body ingestion in the upper gastrointestinal tract were evaluated, 29 (27.6 %) in children and 76 (72.4 %) in adults. Thirty patients (28.5 %) had esophageal strictures. RESULTS: Thirty-nine of the foreign bodies (37.1 %) consisted of food and 66 (62.9 %) were not food-related. The success rate of foreign-body extraction using only a conventional flexible endoscope and accessories for treatment was 98.0 %, and with only a polypectomy snare and rat-toothed forceps it was 91.2 %. Complications at the moment of foreign-body removal occurred in nine patients (8.6 %); there was only one (1 %) esophageal perforation. The incidence of complications related to the duration of foreign-body impaction was six (10.5 %) with foreign bodies impacted for up to 24 h, 13 (52.0 %) for those impacted for 24-48 h, and three (60.0 %) for those impacted for 48-72 h ( P < 0.05). CONCLUSIONS: The flexible endoscope is an effective and safe device for removing foreign bodies from the upper gastrointestinal tract, with a high success rate using only the polypectomy snare and the rat-toothed forceps as accessories. If foreign-body impaction lasts for more than 24 h, there is a significant increase in the incidence of complications.

Adult↗
PubMed2004

Endoscopic ablation of Barrett's esophagus using argon plasma coagulation: a prospective study after fundoplication.

The aim of the prospective clinical study presented here is to test the effectiveness of a multimode approach consisting of argon plasma coagulation combined with laparoscopic fundoplication in the management of Barrett's esophagus. Argon plasma coagulation was performed in 19 patients with Barrett's esophagus who had previously undergone surgical antireflux treatment. The mean follow-up time was 17 months, ranging between 6 and 27 months. Squamous epithelium was completely restored in all patients. In 68.4% of cases two sessions were required. The most frequent complications were chest discomfort and retrosternal pain. In 11 patients the symptoms lasted 3 days and in six cases persisted for a longer period, requiring analgesic medication. Short-term dysphagia and odynophagia were observed in four patients.

Adult↗
PubMed2002

Comparative study of portal hypertensive gastropathy in schistosomiasis and hepatic cirrhosis.

BACKGROUND AND STUDY AIMS: Portal hypertensive gastropathy (PHG) is a common finding in chronic liver disease, but it has not been evaluated in hepatosplenic schistosomiasis, a significant cause of noncirrhotic portal hypertension worldwide. Our study was aimed at comparing cirrhosis with hepatosplenic schistosomiasis with regard to the endoscopic and histological findings of PHG. PATIENTS AND METHODS: We included 43 patients with a history of upper digestive hemorrhage, 22 with cirrhosis and 21 with schistosomiasis, without previous surgical or endoscopic treatment. Upper digestive endoscopies with macrobiopsies of the gastric body were prospectively performed in all cases. RESULTS: The endoscopic signs of PHG were more prevalent in cirrhosis than schistosomiasis (81.8 % vs. 33.3 %; P < 0.05), and the mosaic pattern was the main finding. Histological abnormalities were evenly distributed. CONCLUSIONS: In agreement with other investigations, this study shows a lower prevalence of endoscopic findings of portal hypertensive gastropathy in noncirrhotic diseases. This difference cannot be explained by the underlying microscopic alterations, which were similar in both groups, suggesting that other factors must play a role in its pathogenesis.

Adolescent↗
PubMed2001

Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, and randomized study in Child-Pugh class C patients.

BACKGROUND AND STUDY AIMS: Despite the recognized efficacy of sclerotherapy and elastic band ligation in controlling variceal hemorrhage, the results of endoscopic treatment in Child-Pugh class C patients remain poor. The aim of this prospective, controlled, and randomized study was to compare conventional sclerotherapy with injection of the tissue adhesive N-butyl-2-cyanoacrylate in controlling the first episode of rupturing of esophageal varices. PATIENTS AND METHODS: From January 1994 to June 1997, 36 consecutive Child-Pugh class C cirrhotic patients were admitted with an initial episode of esophageal variceal bleeding. They were randomly assigned to receive sclerotherapy with a 3% ethanolamine oleate solution (group 1, 18 patients) or injection of tissue adhesive (group 2, 18 patients). Episodes of recurrent bleeding were managed after the randomization procedure. After bleeding had been controlled, patients in both groups received weekly sessions of conventional sclerotherapy to eradicate any remaining esophageal veins. RESULTS: The patients in the two treatment groups had similar characteristics on entry into the study. More than 80% of the patients were admitted with moderate or severe hemorrhage. Approximately half of them presented with active bleeding during the index endoscopy. Early recurrent bleeding was observed in ten of the 18 patients in group 1 (55.6%) and in two of the 18 in group 2 (11.1%; P = 0.01). The hospital mortality rates were 72.2% in group I and 33.3% in group II (P = 0.04). CONCLUSION: These findings support the view that cyanoacrylate injection is superior to conventional sclerosis for controlling esophageal variceal bleeding in Child-Pugh class C patients. It is also highly probable that the better bleeding control achieved using the cyanoacrylate tissue adhesive treatment led to a lower hospital mortality rate.

Adult↗
PubMed2001

Endoscopic treatment of Zenker's diverticulum with an oblique-end hood attached to the endoscope.

BACKGROUND: The feasibility and efficacy of incision of the septum between the pharyngoesophageal (Zenker's) diverticulum and the esophagus with a flexible endoscope and needle-knife have been demonstrated. Exposure of the septum remains a critical element of the procedure. This is a report of a technical improvement in this technique: use of a transparent oblique-end hood attached to the tip of the endoscope. METHODS: Ten patients (10 men, age range 67-87 years) with Zenker's diverticulum were treated. With the aid of an oblique-end hood attached to the tip of the endoscope, the septum between the Zenker's diverticulum and esophagus was incised with pure coagulation current. A 10F nasogastric tube was left in place for 48 hours after the procedure to provide nutrition. Thereafter, oral intake was progressively resumed. RESULTS: Complete incision of the septum was achieved in a single session in all cases. Bleeding or perforation did not occur in this small series. Complete relief of dysphagia was reported by all patients during follow-up that ranged from 2 to 12 months. CONCLUSIONS: With the use of the oblique-end hood attached to the tip of the endoscope, incision of Zenker's diverticulum is simplified and can be performed as a single-session procedure.

Aged↗
PubMed2001

[Palliative treatment of advanced esophageal cancer. Comparative study: auto-expandable metal stent and isoperistaltic esophagogastric bypass].

Advanced squamous cell carcinoma of the esophagus (SCCE) is usually a disease of dismal prognosis. Palliation of dysphagia is the main goal of its treatment. This trial compared surgical to endoscopic palliation of dysphagia. Forty patients(32:8a, age 39-79y) suffering from TNM stage III or IV SCCE were divided into two groups: 20 patients were submitted to esophagogastric bypass (surgical group), and 20 patients had an endoscopically placed auto-expandable metal stent (EsophaCoil "In stent", Minnesota, USA)(endoscopic group). Both groups were similar regarding demographic data and nutritional status. The palliation of dysphagia, the incidence of early and late complications, the life quality (Karnofsky Index), the survival, the length of inpatient stay and the costs were evaluated in both groups. There was no difference between surgical and endoscopic groups regarding palliation of dysphagia, frequency of complications, quality of life, and survival. Early and late most common postsurgical complications were anastomotic leak and stenosis, respectively. The most common post-endoscopic complications were both late: benign hyperplasia and tumour overgrowth. None of the surgical or endoscopic complications were related to mortality. Hospital length stay and the costs were significantly higher in the surgical group (15.5 days vs 3 days, P < 0.001; U$ 4.690,45 +/- 1.360,28 vs U$ 2.618,24 +/- 944,98 P < 0.001). In conclusion, the endoscopic placement of an esophageal metal stent for the palliation of malignant dysphagia in patients with irresectable disease is equally effective as surgical bypass at lower costs and reduced length of inpatient stay.

Adult↗
PubMed2000

Esophageal endoscopic aspects after forceful dilation of the gastric cardia in patients with achalasia of Chagas' disease.

The purpose of this study was to evaluate the clinical results and to observe endoscopically the distal esophagus in a series of chagasic adults with incipient megaesophagus and normal endoscopic aspect of the mucosa, who underwent forced hydrostatic dilatation of the cardia, 48 h after the procedure. Twenty patients were submitted to a careful specific pattern of forced dilatation, changing forceful and rapid standardized injection of water to slow distension of the balloon until the patient felt pain. The procedure was repeated three times with the same volume and was maintained each time for 5 min, with intervals of about 3 min. The dysphagia was practically immediately controlled and there were no severe complications or mortality in the series. Five patients complained of pyrosis, mild in two of them. The endoscopic examination revealed mucosal edema in 11 patients (55%), hyperemia in nine (45%) and superficial fissures of the mucosa in six (30%), with seven patients (35%) presenting all the signs simultaneously. These observations characterize 'traumatic esophagitis' due to forced dilatation of the cardia as being frequently asymptomatic. Extreme care with the method can produce effective dilatation of the cardia, avoiding severe complications but not some degree of mucosal injuries.

Cardia↗
PubMed2000

Integrated p53 histopathologic/genetic analysis of premalignant lesions of the esophagus.

UNLABELLED: Esophageal carcinoma frequently occurs in patients with long-standing achalasia. AIM: To examine the role of p53 alterations and PCNA in patients with megaesophagus. METHODS: Sections of four tumors, and corresponding adjacent areas, from patients with achalasia due to Chagas' disease were examined by immunohistochemistry for p53 and PCNA proteins. Furthermore, 128 biopsies from 16 advanced achalasic patients were prospectively collected and evaluated for grades of inflammation, hyperplasia, dysplasia and also for p53 and PCNA proteins. All specimens showing p53 immunoreactivity were topographically genotyped using microdissection, PCR amplification and direct sequencing of p53 exons 5-8. RESULTS: Diffuse strong immunoreactivity of p53 was observed in 2/4 tumors. In one patient, the adjacent mucosa also showed strong p53. In the adjacent mucosa, the same areas showing p53 overexpression also had PCNA positive cells. In the prospective group, 7/16 (43.7%) patients or 53/128 (41.4%) biopsies expressed p53. The grade of inflammation was significantly correlated with the presence of positive p53, in patients, p = 0.004 and in biopsies, p < 0.00001. PCNA expression was found in the basal layer of the mucosa, and increased PCNA was associated with p53 overexpression, p = 0.00018. Genotyping detected mutation in exon 6, codon 213 RG, in one patient (1/16, 6.2%). CONCLUSIONS: (1.) p53 alterations, overexpression and mutational change, are an early event in patients with achalasia; (2.) The inflammation frequently seen in these patients appears to be associated with alterations of the p53 protein; (3.) Expression of the tumor suppressor gene is increased in areas showing proliferation.

Adult↗
PubMed1999

Relationship between persistence of Helicobacter pylori and dysplasia, intestinal metaplasia, atrophy, inflammation, and cell proliferation following partial gastrectomy.

Helicobacter pylori and partial gastric resection are risk factors for gastric cancer. Our aims were to investigate the presence of H. pylori in postgastrectomy patients and to correlate that with alterations in mucosal architecture and cell proliferation. One hundred fifty-one endoscopic biopsies from 22 patients, (15-47 years of age, mean 29.2 years) following partial gastrectomy with Billroth II reconstruction for peptic ulcer disease, were examined for the presence of H. pylori using Giemsa staining. Sections were scored for grade of hyperplasia, intestinal metaplasia, dysplasia, inflammation, and atrophy. Immunohistochemistry for proliferative cell nuclear antigen (PCNA) was used to characterize cell proliferation. H. pylori was observed in 17/22 (77.3%) of patients or in 57/151 (37.7%) of biopsies. Metaplasia was seen in 18/22, chronic atrophic gastritis in 20/22, and cystic glandular dilation in 21/22 patients. The highest type of metaplasia in each patient was: four Type I, five Type IIA and nine Type IIB. Dysplasia was present in 16 biopsies from nine patients. H. pylori was more prevalent in intestinal metaplasia type I (44.8% of biopsies), than in type IIA (32.7%) or type IIB (25%). No H. pylori was detected in regions showing dysplasia or cystic glandular dilation. H. pylori colonization was associated with degree of inflammation (P = 0.00001) and cell proliferation (P = 0.0001). In conclusion, H. pylori is commonly seen many years after gastrectomy, it is associated with an increased epithelial cell proliferation, and it is not present in areas of histologic markers of premalignancy (type IIB metaplasia and dysplasia).

Adolescent↗