Clinical Update最新文献

Commentary: There now are a wide variety of self-expandable metal stents (SEMS) available to the endoscopist for treatment of biliary obstruction. Furthermore, there is increasing availability of stents with different designs and configurations; stents that are fully covered, uncovered, or partially covered; and several methods of stent deployment. Also, the clinical indications for use of SEMS are expanding to potentially include benign biliary tract disease as well as preoperative usage in potentially resectable malignant disease. In this Clinical Update, Dr Todd H. Baron reviews this topic, focusing on comparative clinical outcome studies of metal vs plastic stents for treatment of biliary obstruction. In addition, Dr Baron discusses possible complications of SEMS and how to manage them.

– Richard C. K. Wong, MD, FASGE, Editor

University Hospitals Case Medical Center, Cleveland, OH

Commentary: Rectal bleeding from internal hemorrhoids occurs commonly and is a frequent indication to visit a physician. Some patients may present with severe bleeding and anemia that require hospital admission and/or blood transfusion. Although medical therapy is usually effective for the majority of outpatients, some patients with frequent and/or severe bleeding may require therapy by endoscopy or surgery. In this Clinical Update, Dr Rome Jutabha reviews the indications and contraindications to endoscopic therapy of symptomatic internal hemorrhoids. In addition, Dr Jutabha discusses the relative risks and benefits of the various commercially available endoscopic treatments.

– Richard C. K. Wong, MD, FASGE, Editor

University Hospitals Case Medical Center, Cleveland, OH

As the prevalence of obesity and its devastating complications continue to increase, bariatric surgery has become an attractive long-term solution for many patients. In this comprehensive review, the authors discuss the role of endoscopy in patients who had undergone bariatric surgery. It is emphasized that before any endoscopic procedure, endoscopists should become familiarized with the new postsurgical anatomy. Bariatric surgery is associated with various complications that may require endoscopic intervention. Each type of surgical procedure provides different challenges for endoscopic evaluation and treatment. Because bariatric surgery is here to stay, endoscopists should start to get acquainted with the potential adverse events of the procedure and the indications for diagnostic and therapeutic endoscopy.

— Ronnie Fass, MD, Editor

Commentary: In the recent past, evaluation of the small bowel was limited to various radiographic techniques, red-blood-cell scintigraphy, angiography, and push enteroscopy. Overall, the success of these tests in identifying small-bowel lesions was variable and commonly unsatisfactory. The introduction of the wireless capsule endoscopy allowed complete visualization of the small intestine, but wireless capsule endoscopy lacks the ability to provide diagnostic sampling or therapeutic maneuvers. In this review, Dr Haluszka provides an excellent summary on double-balloon enteroscopy (DBE), the first technique to provide both complete diagnostic examination of the small bowel and a full range of therapeutic maneuvers and diagnostic sampling. Still, despite its clear advantage, DBE remains largely restricted to tertiary-referral centers. The review also presents other novel methods to evaluate the small bowel, such as the single-balloon enteroscope.

– Ronnie Fass, MD, Editor

Commentary: Indications for endoscopy in patients with inflammatory bowel disease (IBD) are diverse and are commonly prompted by acute events or the need for colorectal cancer screening. In this article, Dr Charles Bernstein provides a critical review of the value and yield of an endoscopy in various clinical scenarios where an endoscopy is commonly entertained in patients with IBD. The author emphasizes that an endoscopy should not routinely be used to evaluate disease activity in patients who are doing well and are in remission. A summary table (Table 1) provides 10 valuable tips about how to integrate an endoscopy into the management of patients with IBD.

– Ronnie Fass, MD, Editor

Commentary

Endoscopic enteral access for enteral nutrition in patients who are unable to maintain an oral intake is an important palliative procedure that is within the gastroenterologist's armamentarium. Many new developments and improvements in this area have been introduced in the last decade. In this review, Dr DeLegge provides a detailed description of several bedside techniques of nasogastric-tube placements. In addition, different percutaneous endoscopic procedures for establishing enteral access are described. Importantly, proper usage of these modalities and potential complications are also presented. In the end, Dr DeLegge recognizes that endoscopists should be well trained in these endoscopic techniques, understand their advantages and disadvantages, and use proper clinical judgment when offering them to patients.

– Ronnie Fass, MD, Editor