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Esophageal cancer is currently considered the third digestive cancer and among the top ten causes of cancer in the world. Due to lack of screening methods, diagnosis is usually done in advanced stages of the disease, only 60% being candidates for palliative treatment with the survival rate below 20% at 5 years. The aim of this study was to establish the immediate and late complications and the survival rate after stent placement. Methods. This was a retrospective study conducted at Clinical Emergency Hospital Bucharest, Department of Gastroenterology. The study was made on a number of 100 patients with inoperable esophageal cancer in 2012-2014. The main parameters followed were represented by: sex, age, grades of dysphagia, stent diameter and type, immediate and late complications and survival rate. Results. We introduced in the study 100 patients with esophageal cancer. The average age of developing cancer was 63.3±11.1 years with a minimum of 39 and a maximum of 84 years and male sex was the predominant one, 89%. The average survival rate was 14.89±9.3 weeks with a minimum of one week and a maximum of 48 weeks with 11 of the 100 being still alive. Conclusions. Esophageal stenting is a safe and effective procedure technically speaking, but it is limited by the late presentation to the doctor, when the disease is too advanced. The main advantage is the short-term amelioration of the dysphagia, patients benefiting from a better nutrition. [ABSTRACT FROM AUTHOR]

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Dieulafoy's lesion is rare, but with life-threatening potential. It accounts for 1-2% of acute gastrointestinal (GI) bleeding, but often is under-recognised needing repeated endoscopic evaluations. It represents a dilated aberrant submucosal vessel, which erodes the overlying epithelium in the absence of a primary ulcer. Aim. The aim of this study was to identify the problems with diagnosis and difficulties of treatment in patients with Dieulafoy's lesion. Methods. This was a retrospective study of patients with GI bleeding having as cause Dieulafoy's lesion, between 1st January 2012-1st April 2014 in Clinical Emergency Hospital Bucharest. We have reviewed for localization, anticoagulant/antiplatelet use, comorbidities, number of endoscopies for establishing the diagnosis, treatment type (endoscopic or surgical) and final outcome. Results. We had a total of 3400 cases of upper and lower GI bleeding with 33 cases with Dieulafoy's lesion (prevalence of 0.97%). The localization was: 26 cases subcardial (78.7%), 4 duodenal (12,1%), 2 colonic (6%) and 1 esophageal (3%). 2 cases were misdiagnosed at initial endoscopy, being recognized at the following examinations. One case who presented initially with Dieulafoy bleeding duodenal lesion, returned after a few months with GI bleeding from gastric lesion. Treatment was initial done by endoscopic hemostasis (adrenalin injection/hemoclips/electrocoagulation), successful in 28 cases. The rest of 5 cases had surgery, but 2 cases had complications with unfavourable outcome (death). For 2 patients from the 5 surgical cases, reintervention by endoscopy with hemoclips placement was effectively managed. In one of these cases the source of bleeding wasn't diagnosed initially, the patient had surgery with gastrotomy. He rebleed and endoscopic reevaluation by a more experienced endoscopist revealed an esophageal Dieulafoy lesion which was successful treated by hemoclips and adrenalin injection. Colonic Dieulafoy's lesion are very difficult to identify in massive lower GI bleeding. In our two cases, one of them was misdiagnosed as bleeding from colonic polyps, but at reevaluation Dieulafoy's rectal lesion was treated efficacious by hemoclips. Conclusions. Managing active Dieulafoy's lesion poses a diagnostic and therapeutic challenge. Endoscopic reevaluation is necessary in uncertain cases of GI bleeding. Endoscopic therapy, mainly with hemoclips is highly effective and decreases the mortality. Endoscopist's skill and experience are the main factors for establishing the success of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Postpolypectomy bleeding is the most common complication of endoscopic polypectomy, being life threatening in massive hemorrhage. It can be divided in early bleeding which occurs immediately after polypectomy and delayed bleeding which appears after hours to up to 30 days after polypectomy. The aim of this study was to identify the risk factors and the prophylactic management for developing early/delayed postpolypectomy hemorrhage. Methods. This was a retrospective study of patients who developed early or delayed hematochezia after endoscopic polypectomy, between January 2013 - March 2014 in the Clinical Emergency Hospital Bucharest. These cases were retrospectively reviewed regarding risk factors, pathological findings and prophylactic methods or treatment of bleeding. Results. We introduced in the study 71 patients with polypectomies. We had 17 cases (23,94%) with early bleeding, 12 (16,90%) cases with delayed hemorrhage and 42 cases (59,15%) in which we have used prophylactic methods. The risk factors for early bleeding were the size of polyp (median size 2,8 cm), the morphology (thick stalk, sessile). All the bleedings, even the arterial spurting ones were effectively controlled by endoscopic management. Methods included hemoclip placement in all cases and adrenalin injection or electrocoagulation. The patients with delayed bleeding presented in average on the 6th day. The main risk factors were the type of the polyp (sessile), the size (average 10 mm), the old age (more than 60 years), the use of aspirin (even if the guidelines do not contraindicate polypectomy during treatment with aspirin) and early reinitiation of antithrombotic agents. 2 of 12 patients from this group presented with massive bleeding requiring transfusions with packed red blood cells units and urgent colonoscopies. All the cases were successful managed by placing hemoclips and/or injection or thermal probes. We studied a separate group of 42 patients with pedunculated polyps >2 cm / sessile or with aspirin and clopidogrel therapy, in which we had to use prophylactic measures consisting of adrenalin submucosal injection, endoloop placed prior to polypectomy and hemoclips placed prior or after the polypectomy. Only one case of immediate bleeding occurred after endoloop detachment, but it was successfully managed by hemoclips placement. No delayed bleeding occurred after prophylactic measures. Conclusions. Most of postpolypectomy bleedings can be efficiently managed by endoscopic treatment, depending on the endoscopist's technique and availability of hemoclips. In the presence of risk factors (pedunculated polyps >2 cm, sessile polyps, aspirin/clopidogrel use, age >60 years), we recommend prophylactic measures with hemoclips. We recommend the patient to refrain from aspirin for at least 7 days prior to polypectomy if the polyp is larger than 1 cm and the indication is primary prophylaxis, despite the recommendation from the ASGE. [ABSTRACT FROM AUTHOR]

Introduction. The clinical management of the malignant polyp represents one of the biggest dilemmas of gastroenterology. The endoscopic polypectomy is a much discussed therapeutic procedure, as it involves the risk of recurrence and local invasion when the resection is incomplete. The surgical intervention respecting the oncologic resection margins is a radical one, the recurrence risk being very low. Aim. We aimed to determine the advantages and the disadvantages of each intervention, by comparing the histopathological parameters, the evolution, the prognosis and the subsequent complications. Materials and methods. We carried out a retrospective, analytical and transversal type of study, during which we compared 2 groups of 20 patients each, diagnosed with malignant polyp in the period 2007-2014. The first group of patients was followed after endoscopic polypectomy, while the second group suffered the surgical intervention based on the histopathological reports obtained after prior polypectomy. Results. The average age in the follow-up after polypectomy group was higher. This group also presented more comorbidities, higher Charlson scores and a lower estimated 10 years survival rate. The patients in the surgery group presented a higher dimension of the malignant adenoma, a higher frequency of sessile, flat and ulcerated polyps, a lower resection margin, invaded resection margins and vascular invasion. Conclusions. The endoscopic polypectomy is an excellent therapeutic method for the patients with favorable histopathological characteristics of the polyp, being a radical and curative method for these cases. The endoscopic polypectomy is also the election method of treatment for older patients and for patients with comorbidities who present a high surgical risk. The surgical intervention is a curative treatment method for younger patients who present unfavorable histopathological characteristics of the polyp. In our study, there was no difference between the 2 treatment methods regarding the short term prognosis. The short term survival was similar in both groups, the patients in each group presenting a very good post-procedural evolution. [ABSTRACT FROM AUTHOR]

Copyright of Internal Medicine / Medicină Internă is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Universitatis George Bacovia. Juridica is the property of George Bacovia University, Faculty of Sciences Economics, Juridical & Administrative and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)