Gastroenterology clinics of North America
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Gastroenterol. Clin. North Am. · Mar 2006
ReviewEndoscopic approaches for palliation of luminal gastrointestinal obstruction.
Much of the workload of a typical gastroenterologist is devoted to screening patients for gastrointestinal malignancies. Efforts such as colorectal cancer screening via colonoscopy and endoscopic surveillance of patients with Barrett's esophagus are widespread and widely endorsed. In recent years, the armamentarium of endoscopy has broadened considerably and now affords physicians a variety of nonsurgical means to palliate malignant obstruction of the gastrointestinal tract. This article reviews endoscopic techniques to treat malignant esophageal, biliary, small bowel, and colonic obstruction.
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Gastroenterol. Clin. North Am. · Mar 2006
ReviewEndoscopic ultrasound-guided pain control for intra-abdominal cancer.
This article summarizes percutaneous and surgical methods for performing celiac plexus neurolysis and focuses on the technical aspects of endoscopic ultrasound-guided celiac plexus neurolysis. Published literature concerning endoscopic ultrasound-guided celiac plexus neurolysis is reviewed, indications are proposed, and opinions are offered concerning potential future applications and investigational needs as they apply to this technique.
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Gastroenterol. Clin. North Am. · Mar 2006
ReviewPalliative care: a promising philosophical framework for gastroenterology.
Since the 1970s, much has happened to establish palliative care asa health philosophy that will enrich the practice of gastroenterology;conversely, developments in gastroenterology have already improved palliative care. Several recent concepts from the field of gastroenterology such as "the second brain" and "intestinal failure" fit well within the conceptual framework of palliative care. This type of synergy will ultimately encourage the application of this philosophy to a much broader spectrum of patients than those deemed to be at "end of life." This broader spectrum of care can be described as palliative gastroenterology.
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Gastroenterol. Clin. North Am. · Mar 2006
ReviewMedical palliation of the jaundiced patient with pruritus.
Cholestasis secondary to infiltration of the liver by malignant tumors or by obstruction of the biliary tree can be complicated by pruritus. The clinician and ancillary personal must recognize how debilitating pruritus is and identify the treatment of this symptom as a priority. Because robust clinical trials have not been conducted in patients who have pruritus with cholestasis, a network connecting the services that provide care for these patients (eg, hospices) may be useful for disseminating information.