Reviews in gastroenterological disorders最新文献

This review focuses on the use of endoscopic techniques in the diagnosis and management of pancreatic disorders. Endoscopic retrograde cholangiopancreatography (ERCP) has been used primarily to evaluate and treat disorders of the biliary tree. Recently, endoscopic techniques have been adapted for pancreatic sphincterotomy, stenting, stricture dilation, treatment of duct leaks, drainage of fluid collections, and stone extraction via the major and minor papillae. In patients with acute and recurrent pancreatitis, ERCP carries a higher than average risk of post-ERCP pancreatitis. This risk can be reduced with the placement of a prophylactic pancreatic stent. Magnetic resonance cholangiopancreatography (MRCP) can establish the anatomy of the biliary and pancreatic ducts, identify pancreas divisum or pancreatic ductal strictures, depict bile duct stones, and demonstrate pancreatic or biliary duct dilation. Endoscopic ultrasound (EUS) provides a safer, less invasive, and often more sensitive measure for evaluating the pancreas and biliary tree, and allows some options for therapy. In acute and recurrent pancreatitis, EUS and MRCP can be used to establish a diagnosis; ERCP can be reserved for therapy.

Patients with inflammatory bowel disease (IBD) are at increased risk for osteoporotic fracture. Bone density testing and osteoporosis management are recommended for IBD patients at greater risk for fracture (ie, postmenopausal women, men aged . 60 years, and those with low body mass indices, glucocorticoid use, family history of osteoporosis, and malabsorption). Patient management includes modification of osteoporosis risk factors, such as calcium and vitamin D supplementation, hormone deficiency correction, and smoking cessation. When indicated, bisphosphonates, such as risedronate and alendronate, have been shown to increase bone mass and reduce fracture risk in patients with glucocorticoid-induced osteoporosis. Infliximab, an anti-tumor necrosis factor a antibody, increases bone mineral density, but this effect has not as yet translated into reduced fracture risk.

In the 1960s, the revolution in the diagnosis and management of gastrointestinal diseases began with the introduction of the first flexible fiber endoscope. Since then, the technologies have evolved greatly. Particularly in recent years, much emphasis has been placed on developing new gastrointestinal endoscopy technologies or techniques in order to provide a precise and even a "real time" endoscopic diagnosis. Magnification and high-resolution endoscopy, chromoendoscopy, and narrow band imaging stand at the forefront of the novel endoscopic techniques for the diagnosis of conditions such as squamous cell carcinoma, Barrett's esophagus, and gastroesophageal reflux disease. This review summarizes the recent advances in esophageal imaging and its practical applications for clinicians.

Recent studies have indicated that the levels of protection against colorectal cancer provided by colonoscopy and polypectomy may be considerably lower than what was once commonly believed. Improvements in colonoscopic detection of neoplasia could be enormously beneficial in reducing the incidence of colorectal cancer related to missed lesions. Factors that interfere with detection of neoplasia during colonoscopy, as well as technologic advances that can improve both neoplasia detection and real-time determination of polyp histology, are reviewed.

Depiction of the small intestine has always been a challenge because of its length and tortuosity. The development of capsule endoscopy has been a significant advance that has allowed for more complete small intestine evaluations. The capsule is disposable, captures 2 images per second, and has a battery life of approximately 8 hours. Images are transmitted to a data recorder via digital radio frequency communication, and downloaded to the workstation computer, where it can be read by a gastroenterologist. One of the complications of use is capsule retention; however, a patency capsule has been developed that indicates whether obstruction is present before capsule endoscopy is performed. Capsule endoscopy has renewed interest in the diagnosis and evaluation of small intestinal diseases, been partly responsible for increased research in this area, and led to the development of newer radiologic and endoscopic techniques to evaluate the small intestine.