摘要 :
BACKGROUND: Barrett's surveillance for dysplasia is recommended, but few studies have documented the benefit of endoscopic surveillance for dysplasia or cancer. OBJECTIVES: Using a retrospective study design, we aim to demonstrate...
展开
BACKGROUND: Barrett's surveillance for dysplasia is recommended, but few studies have documented the benefit of endoscopic surveillance for dysplasia or cancer. OBJECTIVES: Using a retrospective study design, we aim to demonstrate the impact of a Barrett's surveillance program on the stage of esophageal adenocarcinoma and identify factors for progression of metaplasia to cancer. SUBJECTS: The Institutional Review Board at Veterans Affairs Connecticut Healthcare approved the study. We report a retrospective review of a prospectively followed Barrett's cohort in a surveillance program and compared their outcome with patients with a new diagnosis of esophageal adenocarcinoma, identified at the same center between 1999 and 2005. RESULTS: There were 248 patients with Barrett's esophagus entered into a surveillance program from 1999 to 2005. During the surveillance period of 987 patient-years, 5 (0.5% patient-year) patients developed esophageal adenocarcinoma. During the same period, 46 patients were diagnosed with new-onset esophageal adenocarcinoma outside of our surveillance program. Only 5% of these patients had a history of gastroesophageal reflux disease. There were 248 patients who underwent a mean number of 2.7+/-1.7 upper endoscopic procedures, with 26 (10%) patients developing dysplasia. Compared with nonsurveillance, more patients had early stage of cancer in the surveillance group (P <.001). All 5 patients with cancer diagnosed from Barrett's esophagus surveillance endoscopy were alive, compared with 20 of 46 (43%) patients with cancer diagnosed outside of the surveillance program. The length of Barrett's segment >3 cm was found to be associated with development of dysplasia, P=.004 (odds ratio 1.2; 95% confidence interval, 1.07-1.34). CONCLUSION: Patients with Barrett's esophagus undergoing endoscopic surveillance benefit from early-stage cancer diagnosis. Progression to adenocarcinoma is low, but long-segment and high-grade dysplasias have an increased risk of cancer. A significant number of patients with newly diagnosed esophageal adenocarcinoma do not complain of gastroesophageal reflux disease and are therefore not investigated for Barrett's esophagus nor entered into surveillance. Patients and physicians can use this information in making a decision about surveillance.
收起
摘要 :
Acute pancreatitis begins as acute pancreatic injury and may generate a systemic inflammatory response that evolves into multiorgan failure, leading to death. Multiple inciting factors such as toxins (alcohol), gallstones, or endo...
展开
Acute pancreatitis begins as acute pancreatic injury and may generate a systemic inflammatory response that evolves into multiorgan failure, leading to death. Multiple inciting factors such as toxins (alcohol), gallstones, or endoscopic retrograde cholangiopancreatography result in a cascade of events beginning with the intra-acinar activation of zymogens and the release of cytokines and other proinflammatory mediators. Their release is a major determinant of the systemic inflammatory response and distant organ failure. Attempts to attenuate the severity of acute pancreatitis by blocking specific inflammatory mediators have had limited success. This review is divided into experimental acute pancreatitis and clinical acute pancreatitis. The distinction is maintained because although animal models of disease have helped define the pathogenesis of acute pancreatitis, they do not completely reproduce the clinical syndrome of human acute pancreatitis or guarantee equal success of therapies in humans. < copyright > 2002 Lippincott Williams & Wilkins, Inc.
收起
摘要 :
PURPOSE OF REVIEW: Acute pancreatitis is associated with a significant morbidity and a mortality as high as 10%. This review summarizes the most relevant articles in the past year that have contributed to understanding and managem...
展开
PURPOSE OF REVIEW: Acute pancreatitis is associated with a significant morbidity and a mortality as high as 10%. This review summarizes the most relevant articles in the past year that have contributed to understanding and management of this disease. RECENT FINDINGS: Pathologic activation of both digestive zymogens and the transcription factor nuclear factor kappaB are early events in acute pancreatitis; these pathologic processes are inhibited in experimental pancreatitis by curcumin and the pH modulator chloroquine. Primary sensory neurons may constitute a final common pathway for pancreatic inflammation. Experimental acute pancreatitis and associated lung injury are attenuated by inhibiting the prostanoid mediators cyclo-oxygenase-2 and 5-lipoxygenase and CC chemokine receptor antagonist Met-RANTES. Endoscopic retrograde cholangiopancreatography-induced acute pancreatitis can be reduced experimentally by intraductal neurokinin-1 receptor antagonist and clinically by use of diclofenac and pancreatic duct stenting. MRI in the setting of acute pancreatitis is a reliable method of staging disease severity. Distinct patterns of cytokine response are observed in acute pancreatitis. SUMMARY: Early events within the acinar cell and the regulation of inflammation by transcription factors continue to be elucidated. Although experimental acute pancreatitis can be successfully ameliorated by use of cytokine and inflammatory inhibitors, this has not been demonstrated in clinical disease. The finding of a compartmentalization of the inflammatory response in acute pancreatitis may be important for planning therapeutic interventions. Pancreatic duct stenting reduces the risk of developing postendoscopic retrograde cholangiopancreatography pancreatitis in high-risk people.
收起
摘要 :
The indications for ERCP utilization have changed significantly since its initial description. Over the past 40 years, the procedure has evolved from a diagnostic to a predominately therapeutic procedure. Although widely available...
展开
The indications for ERCP utilization have changed significantly since its initial description. Over the past 40 years, the procedure has evolved from a diagnostic to a predominately therapeutic procedure. Although widely available, ERCP is technically challenging and is associated with the highest rate of severe complications among gastroentero-logic procedures. To evaluate and compare the clinical appropriateness of ERCP in a variety of practice settings, it is important to have a thorough understanding of its utilization, success rate, and complications. Such data are important to establish benchmarks, improve safety, and develop guidelines to assist the practicing gastroenterology community.
收起
摘要 :
The indications for ERCP utilization have changed significantly since its initial description. Over the past 40 years, the procedure has evolved from a diagnostic to a predominately therapeutic procedure. Although widely available...
展开
The indications for ERCP utilization have changed significantly since its initial description. Over the past 40 years, the procedure has evolved from a diagnostic to a predominately therapeutic procedure. Although widely available, ERCP is technically challenging and is associated with the highest rate of severe complications among gastroentero-logic procedures. To evaluate and compare the clinical appropriateness of ERCP in a variety of practice settings, it is important to have a thorough understanding of its utilization, success rate, and complications. Such data are important to establish benchmarks, improve safety, and develop guidelines to assist the practicing gastroenterology community.
收起
原文获取