Abstract
Barrett's esophagus (BE) is a premalignant condition that progresses to esophageal adenocarcinoma through an intermediate stage known as dysplasia. Current guidelines recommend that individuals with BE undergo periodic endoscopic surveillance with white-light endoscopy-WLE and random, four-quadrant biopsies to identify and treat dysplasia. However, this surveillance strategy is limited by random sampling error and low sensitivity. Surveillance with random biopsies can miss up to 43-57% of early neoplasia. This review will discuss the current role of two advanced imaging techniques i.e. Confocal Laser Endomicroscopy (CLE) and Volumetric Laser Endoscopy (VLE) in screening and surveillance for BE. CLE has the highest accuracy of any endoscopic technique and increases the diagnostic yield and sensitivity for dysplasia and
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CLE can be used for the endoscopic evaluation of BE and for the accurate estimation of lesions’ extent and lateral margins to guide endoscopic treatment. CLE is not helpful in assessing the depth of invasion of early neoplastic lesions or in endoscopic surveillance after ablative or resective therapy. VLE is a new imaging modality with limited studies. However, early experience suggests that VLE appears to be a valuable imaging modality in its ability to identify sub-squamous Barrett’s esophagus and buried Barrett’s glands after mucosal ablation. Overall, CLE and VLE have not been adopted widely due to limited availability, high cost and need for specific operator training. The major limitation of all studies assessing the the role of CLE and VLE in screening and surveillance for BE is that they were all performed by expert endoscopists in tertiary referral centers with a population enriched in regard to the proportion of patients with dysplasia. Despite developments in advanced imaging techniques, these techniques are not included in standard surveillance guidelines and WLE with random biopsies remains the gold standard for BE
Acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) appears to be the most frequent major complication, occurring in 1-10% of patients overall, with a mortality rate ranging from 0.2-0.6% and an annual healthcare expenditure cost reaching $150 million in USA alone (1) (2). Several risk factors have been reported to play a role in ERCP-induced pancreatitis; some are patient-related (i.e. sphincter of Oddi dysfunction (SOD), female gender, history of pancreatitis, pancreatic acinar opacification), while others are procedure-related (i.e. precut or needle-knife endoscopic sphincterotomy, repeated pancreatic duct injection, difficult cannulation), and this may be useful in stratifying patients into low-risk or and high-risk categories (3).
Gastrointestinal tract (GIT) is the portal through which nutritive substances; vitamins, minerals and fluids enter the body. The digestive tract is more than 10 metres long from one end to the other. It is continuous starting from the mouth, passing through the pharynx and the oesophagus, to the stomach, the small and large intestines, ending in the rectum, and finally into the anus. The GI tract is divided into two main sections: the upper GI tract and the lower GI tract. Upper GIT includes the mouth, pharynx, oesophagus and stomach. The lower GI tract includes the small and large intestines and anus. The accessory organs of digestions are the gallbladder, liver and pancreas. Diseases that may occur in upper and lower GIT can be divided as oesophageal diseases, gastric diseases and intestinal diseases.
After obtaining vital signs, a physical assessment would include inspection, auscultation, percussion and palpation of the abdomen. Inspection consists of visual examination of the abdomen noting its shape, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration (Walker, 1990). Abnormalities detected on inspection combined with the patient’s history provide clues to intra-abdominal pathology (Diekmann, n.d). Auscultation of the abdomen is performed before percussion and palpation which can alter bowel motility (Jensen, 2015). Auscultation allows detection of altered bowel sounds, rubs, or vascular bruits. Normal peristalsis creates bowel sounds that may be altered or absent by disease. Percussion is performed to identify organ size and detect the presence of fluid, gas or masses. Palpation includes both light and deep techniques (Jensen, 2015). Light palpation detects areas of tenderness, distention, ascites, presence of masses, and bladder distention; whereas deep palpation, an advanced skill assesses
Colon cancer develops in the part of the gastrointestinal tract that absorbs water and minerals before waste products are disposed via the rectum. In women endometrial cancer is related to colon cancer. This type of cancer is the second leading cause of death due to cancer in the United States. Over one-hundred fifty thousand individuals will be diagnosed this year and this cancer will probably be responsible for about 47,900 deaths in 1999 (http://www.cancer.org). Most colon cancers are adenocarcinomas that develop from the glandular cells. Ninety percent of all colon cancer cases will develop in individuals after 50 years of age. Ninety percent of all tumors arise from polyps that are commonly found in people older than 50. Prevention includes regular exercise and a diet high in fiber. The most important risk factor is age. Medical screening includes a yearly blood occult test after age 50 and a colonoscopy every 3 years after age 50. Regular screening detects polyps that have become precancerous. If regular screening is not done, the cancer is not detected until blood is found in the...
This is extremely important, especially for individuals who are experiencing pain and/or discomfort. The only way an individual can benefit from treatment is with an accurate diagnosis.
Upper gastrointestinal endoscopy, UGI, is a procedure that allows surgeons to look at the inside lining of the esophagus, stomach, and duodenum. The tip of the endoscope is inserted through the mouth and moved down the throat into the esophagus, stomach, and duodenum. An UGI may be performed to find: inflammation of the esophagus, ulcers, cancer, hiatal hernia, or a narrowing of the esophagus. It may be done in a doctor’s office, clinic, or hospital
This assignment will endeavour to demonstrate the map of medicine as followed within the National Health Service for the diagnosis, treatment and follow-up of abdominal aortic aneurysms (AAA). It shall discuss the current AAA screening programme being implemented across the United Kingdom to include the use of Ultrasound and Computed Tomography (CT) as imaging modalities in the demonstration of AAAs. Both the advantages and disadvantages of the modalities used during the diagnosis and treatment of AAA will be shown.
Etheric JS. Clark DS; Slater ED (2014) Disease Screening. In Esherherick J.S. Clark D.S. Slater
Over the years barium sulfate has proven to be a successful contrast agent for examination of the gastrointestinal tract. Though the road to discovery was long and relentless at times, when it finally found its niche in medicine it was only to the advantage of the physicians and patients today. There are many new diagnostic tools in radiology today that have led to the questioning of barium studies’ place in medicine and whether it will remain there long. And to what cost it will take to keep barium around, only time will tell some say. Will it prove to be an obsolete and unnecessary step in viewing, finding and diagnosing pathology or will the scanning technology of the modern radiology day find its diagnostic qualities outdated and pointless compared to its more detailed and less time consuming counterparts.
...h as; gallbladder, liver, pancreas, kidneys, and spleen. These ultrasounds may be performed if the patient has pain in the abdomen, enlarged organs, gallstones, cancer, tumors, and many more conditions.
A hiatal hernia is usually detected using three methods, an upper endoscopy also called esophagogastroduodenoscopy or EGD, a plain chest radiograph, and and upper GI barium series (Kahn, 2008). When using an upper endoscopy to diagnose hiatal hernia, the doctor will insert a small, lighted, flexible tube called an endoscope into the patient's mouth. The endoscope will allow the examination of the stomach, esophagus, and the duodenum including the soft tissues and walls of the upper digestive tract (Gillson, 2008). The patient is typically advised to not to eat anything for at least six hours prior to the procedure. The patient is given a sedative to help them relax and a local anesthetic is sprayed into their throat to suppress any gag reflex they might fe...
Two- four percent of all cancer cases are either caused by or related to drinking alcohol. Alcohol related cancer does not just affect one area of the body it affects a number of areas the esophagus, mouth, la...
The Capsule Endoscopy was one of the most innovative medical advances that happened in years. The Capsule Endoscopy is a small pill that has a camera attached to it, used on patients with problems in their small gastrointestinal tract. Patients are supposed to swallow it and it will take pictures of the small gastrointestinal tract while going through it (Gregorski). The camera on the pill has an own light source and it takes pictures of places in the small gastrointestinal tract, which contains the Duodenum, Jejunum, Ileum (Gregorski). Approaching these places is very difficult by the typical upper and lower endoscopy, and the only other way than the capsule endoscopy is to rip open the stomach and look inside. “Many such
I chose this topic because I a found it as a very interesting thing which I wanted to know more about. I have been CT-scanned when I had concussion after a car accident when I was seven. Also because my father has been under a CT-scanner and a lot of my friends.
“Transesophageal scans done in the operating room provide real-time feedback to the surgeon about the health and functioning of the heart and its valves, so that appropriate choice of surgery required may be made at the time of cardiac surgery (hopkinsmedicine.org n.pag.). TEE is most commonly used in open heart surgeries if the patient will allow. It can also be very common in cardiac procedures such as mitral valve repair. During these type of operations, the transesophageal echocardiogram acts as a monitoring tool for the surgeons. It can be used immediately after procedures to make sure everything went as