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  • ISSN: 2373-9487
    Volume 5, Issue 2
    Research Article
    Takahiro Sato*
    Aims: We investigated recent trend of variceal bleeding in patients with portal hypertension and its treatments including ectopic varices.
    Methods: One hundred forty-four patients with variceal bleeding events and portal hypertension were evaluated retrospectively from December 2012 to June 2016.
    Results: Sites of 144 variceal bleeding were as follows; esophageal varices in 67, cardiac varices in 24, fundal varices in 10, and ectopic varices in 43 (29.9%). Ectopic varices were rectal varices in 27, duodenal varices in 4, anastomotic varices after choledochojejunostomy in 2, jejunal varices in 1, gastric body varices in 7 and stomal varices in 2. Endoscopic band ligation (EBL) was successfully performed for 56 esophageal varices and endoscopic injection sclerotherapy (EIS) using 5% ethanolamine oleate (EO) for 6 esophageal varices, and EBL plus EIS for 5 esophageal varices, respectively. EBL was performed successfully for 9 cardiac varices and EIS using EO for 8 cardiac varices, and EBL plus EIS for 7 cardiac varices, respectively. EIS using cyanoacrylate (CA) was successfully performed for 9 fundal varices and EIS using EO for 1 fundal variceal patient. EIS using EO was performed successfully for 21 rectal varices and EBL for 2 rectal varices, and EBL plus EIS for 4 rectal varices, respectively. EIS using CA was successfully performed for 3 duodenal varices and EIS plus balloon-occluded retrograde transvenous obliteration for 1 duodenal variceal patient. EIS using CA was successfully performed for 2 anastomotic varices after choledochojejunostomy, however, jejunal variceal patient who underwent percutaneous transhepatic obliteration (PTO) died 2 days after the treatment due to poor condition. EBL was successfully performed for 6 gastric body varices, and EIS using CA was successfully performed for 1 gastric body varices. Percutaneous injection sclerotherapy using EO was successfully performed for 2 stomal varices. No significant complications were observed.
    Conclusions: Recently, the frequency of ectopic varices has been increasing. Endoscopic treatments and interventional radiology have been performed successfully and safety for variceal bleeding including ectopic varices.
    Case Report
    Daniel Brandao*, Andreia Coelho, Rita Augusto, Armando Mansilha, and Alexandra Canedo
    Chronic mesenteric ischemia is an uncommon disease and its management remains a challenge, especially in patients with severely calcified occlusions of both celiac and superior mesenteric arteries. Endovascular therapy has been increasingly performed to treat this entity due to its favorable outcomes when compared with open surgery. As so, we report three cases of severe chronic mesenteric ischemia with highly calcified occlusion of both celiac and superior mesenteric artery treated by endovascular approach using an innovative triaxial technique.
    Simon Bac* and Dirk Jan Bac
    We present the case of a patient who developed a liver abscess following screening colonoscopy. The patient, a 63-year-old man with no significant medical history, underwent polypectomy of two polyps. Four days afterwards he appeared on our emergency department with fever, nausea and vomiting. He was diagnosed with a Klebsiellapneumoniae liver abscess. The patient was successfully treated with antibiotics for six weeks. This case shows one of the risks of screening colonoscopy. Given the high number of colonoscopy due to the colorectal screening programs, we should be aware of complications in this mostly asymptomatic group of patients.
    Review Article
    Susy Motta Lúcio de Morais, Emy Hiura, Carolina Magri Ferraz, Gracilene Maria Almeida Muniz Braga, Francine Alves Gratival Raposo, Frederico Vieira Froes, Tracy Lacerda, Maria Cristina Valdetaro Rangel, Anderson Rocha Aguiar, Franciele Bosi Rodrigues, Tayna Souza Vargas, Maria Gorett Ramos Rodrigues, and Fabio Ribeiro Braga*
    The objective of the present review was to update the understanding of the types of liver abscesses, namely: pyogenic, amoebic and fungal and relate this pathology with verminosis, in general. Liver abscesses remain a challenge in clinical medicine throughout the world, whether in its diagnosis and or even in its therapy. In “short” it is a serious disease that affects 8-22 individuals per group of 100,000 inhabitants. In recent decades, there have occurred changes in epidemiology, advances in diagnostics and the emergence of new therapeutic alternatives; however some causes for such pathology are still common. Medical literature discusses that parasitism is still a common cause and salutary in the understanding of liver abscess. However, in recent literature it’s been evidenced that the presence of gastrointestinal helminth parasites in preschool aged children has a direct relationship with pyogenic liver abscess. It’s concluded that the pyogenic liver abscess is the most common type and has verminosis as one of its main causes.
    Italo Braghetto* and Juan Carlos Molina
    Sleeve gastrectomy (SG) has been validated as an effective stand - alone bariatric procedure to treat patients with severe and morbid obesity. There are concerns about the development of De Novo gastro esophageal reflux disease after Sleeve Gastrectomy (SG) can occur after. There is no consensus regarding this effect, with several publications showing reduction in Reflux Symptoms and many other showing a significant increase in erosive esophagitis, Reflux Symptoms and esophageal exposure to acid after surgery. There are pathophysiological mechanisms involved as cause of these findings, mainly defective lower esophageal sphincter (LES). In this article we shows the current knowledge about the changes observed on the LES and its possible clinical consequences regarding to postoperative symptoms and appearance os erosive esophagitis and Barrett´ esophagus.
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