The American journal of gastroenterology
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Am. J. Gastroenterol. · Dec 2010
Comparative StudyA comparison of optical colonoscopy and CT colonography screening strategies in the detection and recovery of subcentimeter adenomas.
Evidence has shown that computerized tomographic colonography (CTC) and optical colonoscopy (OC) can detect advanced adenomas at an equal rate; however, a comparison of the subcentimeter adenoma detection has not been performed. The objective of this study is to compare CTC and OC screening programs, with a focus on the detection and recovery of subcentimeter adenomas. ⋯ (i) An OC screening program detects and recovers a significant four and a half fold greater number of non-advanced adenomas compared with a CTC screening program. (ii) The primary difference between screening with OC and CTC is the recovery and management of the subcentimeter adenoma.
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Am. J. Gastroenterol. · Dec 2010
EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle.
Endoscopic ultrasonography (EUS)-guided celiac plexus neurolysis (EUS-CPN) is safe and effective but not beneficial for some patients with extended abdominal cancer. We compared the effectiveness of standard EUS-CPN and EUS-guided broad plexus neurolysis (EUS-BPN) that extends over the superior mesenteric artery (SMA) using a 25-gauge needle. ⋯ Our preliminary data suggested that EUS-BPN using a 25-gauge needle provides patients with advanced abdominal cancer with better pain relief than standard EUS-CPN, and without incurring serious complications. Moreover, it seems that broad neurolysis over the SMA may provide superior analgesia.
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Am. J. Gastroenterol. · Dec 2010
Editorial CommentEditorial: Neurolysis for pancreatic cancer pain: same song, different verse?
Since Kappis first performed percutaneous neurolysis in 1914, investigators have employed innumerable technical variations in an effort to enhance the efficacy. Similar efforts have been underway by endosonographers since Wiersema performed the first endoscopic ultrasound (EUS)-guided celiac plexus neurolysis in 1996. ⋯ Sakamoto et al. present a new method of EUS-guided neurolysis in an attempt to improve the outcomes. Although their data are promising, we eagerly await rigorously designed studies that may validate their findings.
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Am. J. Gastroenterol. · Dec 2010
Editorial CommentEditorial: Detection of small polyps: much ado about nothing?
Computed tomographic (CT) colonography (CTC) represents an alternative to optical colonoscopy for colorectal cancer screening. However, diminutive polyps (≤ 5 mm) are not routinely reported for CTC. ⋯ Although the study was not randomized, the results highlight the difference between the two screening strategies. Because of incomplete understanding of the natural history of diminutive adenomas, further study is needed to determine the long-term impact of the use of CTC for colorectal cancer screening.