Search

Conventional endoscopic mucosal resection (CEMR) is the standard modality for removing non-pedunculated colorectal lesions. Underwater endoscopic mucosal resection (UEMR) has emerged as an alternative method. There are few comparative studies between these techniques, especially evaluating recurrence. Then, the purpose of this trial was to compare CEMR and UEMR for the resection of colorectal lesions with respect to efficacy, safety and recurrence rate.Randomized controlled trial of UEMR versus CEMR for naïve and non-pedunculated lesions measuring between 10 and 40 mm. The primary outcome was adenoma recurrence at 6 months after the resection. Secondary outcomes were technical success, en bloc resection and adverse events rates. Block randomization was used to assign patients. Tattooing was performed to facilitate localization of the scars and eventual recurrences. Endoscopic follow-up was scheduled at 6 months after the procedure. The sites of resections were examined with white light, Narrow-Band Imaging and conventional chromoscopy with indigo carmine followed by biopsies.One hundred and five patients with 120 lesions were included, with a mean size of 17.5 ± 7.1 (SD) mm. Sixty-one lesions were resected underwater and 59 by CEMR. The groups were similar at baseline, regarding age, gender, average size, or histological type. Lesions in the proximal colon in the conventional group corresponded to 83% and in the UEMR group to 67.8% (p=0.073). There was no difference between groups regarding success rate (one failure in each group) and en bloc resection rate (60.6% UEMR vs 54.2% CEMR, p = 0.48). Intra-procedure bleeding was observed in five conventional resections (8.5%) and two UEMRs (3.3%) (p = 0.27). There was no perforation or delayed hemorrhage in both groups. Recurrence rate was higher in the CEMR arm (15%) than in UEMR (2%) (p=0.031). Therefore, the relative risk of 6-month recurrence rate in the CEMR group was 7.5 fold higher (95% CI - 0.98 to 58.20) with a NNT of 7.7 (95% CI - 40.33 to 4.22). The higher recurrence rate in CEMR group persisted only for lesions measuring 21-40mm (35.7 vs. 0%, p=0.04).This study demonstrated that UEMR was associated with lower adenoma recurrence rate than CEMR. Both endoscopic techniques are effective and have similar rates of adverse events for the treatment of non-pedunculated colorectal lesions.

Background Although endoscopic vacuum therapy (EVT) has been successfully used to treat postoperative upper gastrointestinal (UGI) wall defects, its use demands special materials and several endoscopic treatment sessions. Herein, we propose a technical modification of EVT using a double tube (tube-in-tube drain) without polyurethane sponges for the drainage element. The tube-in-tube drainage device enables irrigation and application of suction. A flowchart for standardizing the management of postoperative UGI wall defects with this device is presented. Methods An EVT modification was made to achieve frequent fistula cleansing, with 3 % hydrogen peroxide rinsing, and the application of negative pressure. A tube-in-tube drain without polyurethane sponges can be inserted like a nasogastric tube or passed through a previously positioned surgical drain. This was a retrospective two-center observational study, with data collected from 30 consecutive patients. Technical success, clinical success, adverse events, time under therapy, interval time from procedure to fistula diagnosis and treatment start, size of transmural defect, volume of cavity, number of endoscopic treatment sessions, and mortality were reviewed. Results 30 patients with UGI wall defects were treated. The technical and clinical success rates were 100 % and 86.7 %, respectively. Three patients (10 %) had adverse events and three patients (10 %) died. The median time under therapy was of 19 days (range 1–70) and the median number of endoscopic sessions was 3 (range 1–9). Conclusions This standardized approach and EVT modification using a tube-in-tube drain, with frequent fistula cleansing, were successful and safe in a wide variety of UGI wall defects.

INTRODUÇÃO: Constipação na gravidez é sintoma comum, mas para seu diagnóstico são necessários dois ou mais sintomas persistentes, como ritmo intestinal mais lento, dificuldade para evacuar, fezes endurecidas ou sensação de evacuação incompleta. Existem múltiplos fatores envolvidos, hormonais, sedentarismo, ingestão de fibras ou líquidos, uso de medicamentos, etc. OBJETIVO DO ESTUDO: analisar a incidência de constipação em 41 gestantes sadias do Ambulatório de Obstetrícia da Santa Casa de São Paulo. MÉTODO: a pesquisa se fez através do preenchimento de um questionário sobre ritmo intestinal, hábitos de vida, sintomas digestivos antes e após a gravidez. RESULTADOS: observamos que constipação incidiu em 27,6% daquelas que não sofriam sintomas pregressos. CONCLUSÃO: a incidência de constipação na gestação é menor que o usualmente estimado, começa no início da gravidez, e devido ao baixo índice encontrado não há razão para uso indiscriminado de laxativos.BACKGROUND: constipation is a common problem during pregnancy, but for a definitive diagnosis, symptoms such as low motility, defecation difficulties, hard feces and incompletet evacuation should be evaluated. There are a number of factors involved, including hormones, physical activity, water and fiber intake, medication, etc. OBJECTIVE: the objective of the present study was to analyse the occurence of constipation in 41 normal pregnant women from the Ambulatory of Obstetrics and Gynecology Department at Santa Casa Hospital in São Paulo. METHOD: the patients filled a questionnaire with questions related to the frequency of stools, personal habits, symptoms and any other related conditions, before and after pregnancy. RESULTS: the overall incidence of constipation was 27.6%, excluding the subjects with previous history. CONCLUSION: we concluded that the incidence of constipation is lower than expected and generally occurs since the beginning of pregnancy. There seems to be no reason for the prescription of laxatives in most cases in pregnancy.

Endosonography-guided biliary drainage has been used over the last few years as a salvage procedure when endoscopic retrograde cholangiopancreatography fails. Malignant gastric outlet obstruction may also be present in these patients. We report the results of both procedures during the same session in patients with duodenal and biliary obstruction due to malignant disease.A retrospective review from a prospective collected database.Technical success was achieved in all five patients; however, only three patients experienced relief of jaundice and gastric outlet obstruction.Endosonography-guided biliary drainage and duodenal stenting in the same session is feasible. However, severe complications may limit the procedure. This is a challenging procedure and should be done by experts with special attention to patient's selection.