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Endoscopic ultrasound (EUS) is the diagnostic modality of choice for various pancreatic pathologies. A recent study has suggested that EUS evaluation during diagnostic workup is a predictor of increased survival in patients with pancreatic cancer owing to improved pancreatic cancer staging and selection of suitable candidates for surgery.
Despite steady improvement in survival after variceal bleeding in patients with cirrhosis, bleeding-related mortality remains high. Current treatment recommendations utilize a step-up strategy, in which only patients who rebleed despite drug and endoscopic therapy undergo TIPS (transjugular intrahepatic portosystemic shunt) implantation; however, in patients who are at high risk of rebleeding, early use of TIPS might greatly reduce mortality.
In a prospective Chinese study in which bismuth was added to standard PPI-based triple therapy, the Helicobacter pylori eradication rate was above 90%. Increased treatment duration was also crucial—a therapeutic gain of 13% was achieved if the quadruple therapy was administered for 14 days instead of 7 days. Clarithromycin resistance was also overcome by the prolonged bismuth-containing quadruple therapy.
Moderate sedation is typically used during lower gastrointestinal endoscopy procedures. Deep sedation with propofol is becoming widespread but carries the risk of cardiorespiratory depression. Nitrous oxide is an inhaled sedative administered routinely in dentistry that might prove to be a safe option for sedation during lower gastrointestinal endoscopy.
Tuberculosis is one of the most important infectious diseases worldwide. Hepatotoxic effects are a serious problem in patients who are undergoing treatment for tuberculosis, as they can cause morbidity and mortality as well interrupt their therapy and limit the efficacy of the antitubercular regimen. In this Review, Senousy and colleagues discuss the hepatotoxic effects of antituberculosis drugs and the management of these effects.
Bowel cleansing is necessary before a colonoscopy or colonic radiological examination, but the procedure is not without risks. This Review describes the safety issues related to the three major osmotically acting cathartics currently in use for bowel cleansing: sodium-phosphate-based products, polyethylene glycol and electrolyte lavage solutions, and magnesium-citrate-based agents. This Review also includes recommendations for the safe use of these agents in bowel cleansing, and discusses which patients are at risk of serious adverse events.
IBS is a common gastrointestinal condition characterized by abdominal pain associated with altered bowel habits. Limited and judicious use of diagnostic testing is recommended, particularly in patients with typical symptoms without alarm signs and symptoms. Management of IBS is multifaceted and is often driven by illness severity, predominant symptoms and patient and practitioner preferences. Sarah Khan and Lin Chang discuss the current evidence-based recommendations for the diagnosis and management of IBS.
A 38-year-old female was evaluated for a 3 year history of postprandial abdominal pain, refractory nausea, vomiting and hematemesis. Her medical history was significant for juvenile polyposis syndrome and Crohn's disease resulting in a total colectomy. Juvenile polyposis syndrome with outlet obstruction of the stomach and excessive hypergastrinemia was diagnosed and treatment started with acid suppressive therapy, prokinetic therapy and total parenteral nutrition. Repetitive endoscopic polypectomy (also known as debulking) was performed twice followed by gastrectomy with duodeoesophageal anastomosis.
