Best practice & research. Clinical gastroenterology
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Coeliac plexus neurolysis (CPN) has been performed for nearly 100 years to try and control pancreatic pain. In recent years endoscopic ultrasound (EUS)-guided CPN has become the preferred technique for this procedure yet relatively little data exists to support its superiority over other methods. Recent studies have demonstrated the potential for direct EUS-guided injection into coeliac ganglia as a means to improve efficacy of CPN. This article describes the technique of EUS-CPN, the evidence supporting its use and recent advances in this procedure.
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Best Pract Res Clin Gastroenterol · Jan 2009
ReviewDrug-related damage of the ageing gastrointestinal tract.
Drug use increases with age and the elderly is at increased risk of adverse drug reactions. Gastrointestinal adverse effects are one of the most often reported. Serious event are mostly caused by NSAIDs and/or aspirin which are the most widely prescribed medications in the world. ⋯ At-risk patients should be on prevention strategies including the use of the lowest effective dose, co-therapy with a gastroprotective agents or use of a COX-2 selective agent. Treatment of Helicobacter pylori infection is beneficial in patients starting therapy with these agents, especially in the presence of ulcer history. The best strategy to prevent lower GI complications has yet to be defined.
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Best Pract Res Clin Gastroenterol · Jan 2009
ReviewEndoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology - An overview.
Endoscopic ultrasound (EUS)-guided biopsies are reliable, safe and effective techniques in obtaining samples for cytological or histological examinations either as a primary procedure or in cases where other biopsy techniques have failed. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA), as well as endoscopic ultrasound-guided trucut biopsy (EUS-TCB), has proven to be of significant value in the diagnostic evaluation of benign and malignant diseases, as well as in staging of the malignant tumours of the gastrointestinal tract and of adjacent organs. The diagnostic yield of EUS-guided biopsies depends on site, size and characteristics of target tissues as well as technical and procedural factors (type of needle, biopsy technique and material processing). ⋯ There are numerous challenges and pitfalls in the differential diagnostic classification of benign and malignant lesions. These problems are related to the characteristics of samples obtained by EUS-guided biopsy, as well as to the multiple diagnoses with similar or overlapping cytological or histological characteristics. The high prognostic and therapeutic relevance of the cytopathological diagnoses resulting from EUS-guided biopsy calls for a shared responsibility of an endosonographer and a cytopathologist.