27 juillet 2013 ~ 0 Commentaire

Given Imaging Announces Data Confirming PillCam(R) SB Improves Monitoring and Management of Crohn’s Disease

Doctors Use Endoscopy to Place Transpyloric Stent

Doctors Use Endoscopy to Place Transpyloric Stent

Symptoms can include diarrhea, abdominal pain, weight loss and rectal bleeding. Roughly 50% of all cases of Crohn’s disease are diagnosed in the last part of the small intestine (the terminal ileum) and cecum. This area is also known as the ileocecal region. Other cases of Crohn’s may affect one or more of the following: the colon only, the small bowel only (duodenum, jejunum and/or ileum), the stomach or esophagus1. Roughly 500,000 Americans suffer from Crohn’s disease, and about 20% have a direct relative with some form of inflammatory bowel disease (IBD)2. Crohn’s disease affects men and women equally. The cause is unknown; but, the most popular theory is that the immune system is reacting to a virus or bacterium that causes inflammation3. Depending on the severity, treatment options include nutritional supplements, drugs and surgery. There is currently no cure for the disease4. About PillCam SB The PillCam SB video capsule measures 11 mm x 26 mm and weighs less than four grams. Now in its second generation, PillCam SB 2 contains an imaging device and light source and transmits images at a rate of two images per second generating more than 50,000 pictures during the course of the procedure. Initially cleared by the U.S. Food and Drug Administration in 2001, PillCam SB is clinically validated by more than 1,500 peer-reviewed studies. It is an accurate, patient-friendly tool used in patients two years and older by physicians to visualize the small bowel. PillCam SB is the gold standard in small bowel evaluation.

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Complications from endoscopic mucosal resection uncommon in Barrett’s esophagus

Given Imaging Announces Data Confirming PillCam(R) SB Improves Monitoring and Management of Crohn's Disease endoscopy-illustration

Am J Gastroenterol. 2013;doi:10.1038/ajg.2013.187. July 22, 2013 Patients with Barretts esophagus experienced no perforations and low rates of bleeding and strictures when treated with endoscopic mucosal resection in a recent study. Researchers evaluated 681 patients with Barretts esophagus (BE) who underwent 1,388 endoscopic procedures and 2,513 endoscopic mucosal resections (EMRs) at Mayo Clinic in Rochester, Minn., between January 1995 and August 2008, with a median follow-up of 63 months. Photodynamic therapy (PDT) also was performed in 211 cases. Participants mean age was 70 years, and they had a median BE length of 3 cm. A single endoscopist performed 99% of the included EMRs, using the cap and snare technique in 77% of procedures, band and snare in 18% and a variceal band ligation device in 5%. EMR is an accepted technique for the diagnosis and treatment of dysplastic lesions in BE, the researchers wrote. However, the published data regarding EMR-related complications are highly variable and limited to small series. To our knowledge, our study is the largest series reported to date on the complications of EMR in BE. No perforations related to EMR occurred. Post-EMR bleeding was observed in eight patients, none of whom received PDT. Seven of these cases were treated endoscopically, with one patient requiring surgery. Strictures after EMR occurred in seven cases; all treated via a mean of two endoscopic dilations. No participants who developed strictures had also undergone PDT.

find out here http://www.healio.com/gastroenterology/esophagus/news/online/{75B98A12-C808-4E17-A651-31A797DE440C}/Complications-from-endoscopic-mucosal-resection-uncommon-in-Barretts-esophagus

EGD

The pylorus is the part of the stomach that connects to the small bowel. « I think this new technique could play a big role in the treatment of gastroparesis, » says Clarke, who also is clinical director of the Johns Hopkins Center for Neurogastroenterology. « Though it sounds a little bit unconventional, the safety of it may be better than anything else we have out there. » Clarke says recently developed flexible, silicone-covered metal stents have already been approved to treat some gastrointestinal obstructions, but until now have not been used to treat gastroparesis. Typically, patients with gastroparesis don’t get a lot of good news from their physicians. Stomach surgery or risky medications such as erythromycin and metoclopramide have been the go-to treatments for the condition, which can have serious health and quality-of-life consequences. « There are few FDA-approved options for gastroparesis patients, » Clarke says. « The only medicines that are approved have a number of adverse effects associated with them. » The National Institutes of Health estimates that 5 million Americans live with gastroparesis, a condition in which the contents of the stomach empty into the intestine slowly or not at all. Symptoms, including reflux, become chronic. Using an endoscope, Clarke placed a self-expandable, coated metallic stent across the three patients’ pyloric channels, holding the channels open and allowing the patients’ stomachs to empty normally. All three patients showed dramatic reductions in symptoms, Clarke says. One was a 15-year-old boy with chronic nausea and vomiting who had endured unsuccessful trials of erythromycin, metoclopramide, domperidone and promethazine. A second was a 54-year-old man with idiopathic gastroparesis who also didn’t respond to medication, but had complete recovery after his stent placement. In a third patient, the stent migrated out of place and her pain came back, but after replacing it, the pain eased, Clarke reports. All were treated at The Johns Hopkins Hospital. Clarke says the stent placement procedure isn’t difficult. « Technically it’s pretty simple, and the risk appears to be minimal; if it doesn’t work, you just take it out, » he says.

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