Gastrointestinal endoscopy
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Gastrointest. Endosc. · Jun 2010
Comparative StudyEUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer.
Stereotactic body radiotherapy (SBRT) has been approved for the treatment of locally advanced pancreatic cancer. Placement of gold fiducials is required for real-time tracking and delivery of a high-dose therapeutic beam of radiation to the tumor. Traditionally, fiducials have been placed either intraoperatively or percutaneously. Recently, EUS-guided fiducial placement has been reported, but the safety and feasibility of this approach is not well defined. ⋯ EUS-guided fiducial placement for SBRT in locally advanced and recurrent pancreatic cancer is safe and feasible. Successful placement was achieved in 90% of patients, with a low complication rate (2%). Furthermore, 91% of patients successfully completed SBRT after EUS-guided fiducial delivery. Although fiducials can spontaneously migrate from the initial injection site, the rate of migration is relatively low (7%), and no migration-related complications occurred over the course of this study. Limitations to EUS-guided fiducial placement may include surgically altered anatomy (pancreaticoduodenectomy) in patients with recurrent pancreatic cancer.
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Gastrointest. Endosc. · Jun 2010
Comparative StudyWhen do we miss synchronous gastric neoplasms with endoscopy?
Accurate detection of synchronous multifocal gastric cancer is mandatory for the successful management of stomach cancer. ⋯ The entire stomach should be examined with particular care during endoscopy procedures, especially when endoscopic resections of tumors are to be performed. Further, to improve detection, the approaches used to evaluate patients for multifocal tumors need to be improved. A large-scale prospective study is necessary to follow up on our findings.
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Gastrointest. Endosc. · Jun 2010
Comparative StudyComparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage.
The need for therapeutic endoscopy in patients with upper GI hemorrhage is important in determining the risk and disposition of these patients. Pre-endoscopic risk scores may be helpful in predicting this need. ⋯ The Blatchford score is more useful for predicting low-risk patients who do not need therapeutic endoscopy and who may be suitable for outpatient management. A threshold of 0 for low risk should be used. The Rockall score is not helpful in predicting the presence of low-risk lesions.
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Gastrointest. Endosc. · Jun 2010
Comparative StudyPersistent snoring under conscious sedation during colonoscopy is a predictor of obstructive sleep apnea.
Obstructive sleep apnea (OSA) is characterized by cessation of breathing during sleep. Conscious sedation (CS) induces sleep and may uncover sleep-related breathing disorders. ⋯ Snoring during CS is a strong predictor of OSA. Given the medical and financial burden of undiagnosed OSA, these patients should be carefully identified and referred for sleep medication evaluation.