Gastrointestinal

Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.

ABSTRAK
Sekolah Tinggi Ilmu Kesehatan Mandala Waluya Kendari
Program Studi Farmasi
Skripsi Penelitian,  September 2020
BORIS YASIN (F201601082)
“UJI EFEKTIVITAS GASTROPROTEKTIF EKSTRAK DAUN LABU KUNING (Cucurbita moschata) PADA TIKUS (Rattus norvegicus) YANG DIINDUKSI ASPIRIN”
Pembimbing I : apt. Jastria Pusmarani, S.Farm. M.Sc.
Pembimbing II : apt. Citra Dewi, S.Farm. M.Farm.
(xii + 86 Halaman + 5 Gambar + 6 Tabel + 9 Lampiran)

Di Indonesia Angka kejadian gastritis menurut World Health Organization (WHO) tahun 2017 cukup tinggi yaitu 274.396 kasus dari 283.452.952 jiwa penduduk. Efek samping dari penggunaan obat antiinflamasi non steroid (OAINS) menjadi 20% penyebab dari ulkus peptikum dan akan meningkat seiring bertambahnya usia. Pengobatan ulkus peptikum hingga saat ini menggunakan obat sintetik yang memiliki beberapa efek samping sehingga diperlukan pengobatan alternatif seperti pengobatan herbal. Daun labu kuning (Cucurbita moschata) mengandung senyawa flavonoid, saponin, tanin, alkaloid yang mampu melindungi mukosa lambung. Tujuan dilakukan penelitian ini adalah untuk mengetahui efektifitas gastroprotektif ekstrak daun labu kuning (Cucurbita moschata) pada tikus (Rattus norvegicus) yang  diinduksi aspirin.
Penelitian ini merupakan penelitian analitik laboratorium. Sampel diekstraksi menggunakan metode maserasi. Pengujian efek gastroprotektif menggunakan 18 ekor tikus yang dibagi menjadi 6 kelompok yaitu kelompok kontrol normal (Na.CMC 0,5%), kelompok kontrol positif (Omeprazole 20 mg/kgBB), kelompok kontrol induksi (Aspirin 300 mg/kgBB), kelompok (Dosis ekstrak 100 mg/kgBB), kelompok (Dosis ekstrak 200 mg/kgBB), dan kelompok (Dosis ekstrak 300 mg/kgBB). Analisis data menggunakan uji Kruskall Wallis dan Mann Whitney untuk mengetahui perbedaan tiap kelompok.
Hasil penelitian menunjukan adanya efek gastroprotektif ekstrak daun labu kuning (Cucurbita moschata) pada Dosis ekstrak 300 mg/kgBB dengan nilai P signifikan 0,037  <  0,05 yang sebanding dengan kelompok kontrol positif.

Kata Kunci : Gastroprotektif, Aspirin, Daun labu kuning (Cucurbita moschata).
Daftar Pustaka : 33 (2001-2018)

BACKGROUND: Traditionally, tube feedings have been delayed after percutaneous endoscopic gastrostomy (PEG) placement to the next day and up to 24 h postprocedure. However, results from various randomized controlled trials (RCTs) indicate earlier feeding may be an option. We conducted a meta-analysis to analyze the effect of early feedings (≤4 h) after PEG placement.

Background: No objective measure of the level of sedation is universally accepted. However, bispectral index monitoring is currently used to objectively measure sedation levels in several clinical settings. This study compares the temporal relationship of bispectral index levels versus the Observer's Assessment of Alertness/Sedation (OAA/S) scale for sedation during endoscopy and proposes a functional bispectral index range for endoscopic procedures. Methods: Fifty consecutive adults undergoing endoscopic retrograde cholangiopancreatography, colonoscopy, or esophagogastroduodenoscopy by a single endoscopist were studied. Intravenous sedation was achieved with diazepam and meperidine. Bispectral index levels (0 to 100) and OAA/S scores (1 to 5) were recorded every 3 minutes by a single trained observer. Results: There were significant temporal correlations between bispectral index levels and OAA/S scores (r = 0.59, p < 0.0001). Bispectral index levels and OAA/S scores corresponded with the need for additional sedation as determined clinically by the endoscopist. An OAA/S score of 3 corresponded to a bispectral index level of 81.49 ± 9.78. Conclusions: Bispectral index monitoring temporally correlates with the OAA/S scale and therefore provides an objective measure of sedation during endoscopy. This preliminary, observational study suggests that a bispectral index level near 82 corresponds with sufficient and functional sedation levels for endoscopy. (Gastrointest Endosc 2000;52:192-6.)

... Elliot B. Tapper &amp;amp;amp; Diego Martin &amp;amp;amp; N. Volkan Adsay &amp;amp;amp; Bobby Kalb &amp;amp;amp; David Kooby &amp;amp;amp; Juan M. Sarmiento ... 3. Tohme-Noun C, Cazals D, Noun R, Menassa L, Valla D, Vilgrain V. Multiple biliary hamartomas: magnetic resonance features with histopathologic correlation. ...

An 81-year-old man presented with rectal discharge, tenesmus, and a 10-kg weight loss over a period of 4 weeks. His medical history was significant for an early signet-ring-cell gastric adenocarcinoma (T1N0M0), for which he underwent a partial gastrectomy 6 years earlier. Digital rectal examination demonstrated a hard, concentric stenosis 4 cm from the anal verge. Laboratory data revealed mild anemia, with a hemoglobin level of 11.4 g/dL (reference range 12.3-14.5 g/dL). Sigmoidoscopy revealed a concentric, nontraversable stenosis at 4 cm from the dentate line ( ). Histology demonstrated a nonspecific chronic colitis. CT of the abdomen and pelvis showed a circumferential stenosis of the distal rectum . The perirectal fat appeared fibrosed, but there was no evidence of tumor infiltration into the pelvic musculature. No lymphadenopathy could be identified. Because of the high clinical suspicion of a rectal tumor, a surgical transrectal biopsy was performed. Pathology results revealed a signet-ring-cell cancer compatible with metastatic gastric cancer. EGD disclosed a large anastomotic tumor. Histology confirmed the recurrence of the signet-ring-cell gastric cancer.

Background: Gastrointestinal disorders (GIDs) are among the most common problems in health care. Among these GIDS, functional dyspepsia (FD), gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastric cancer, and colorectal cancer. Objective: A significant number of GIDs may present different oral manifestations and require a special attitude from the dental practitioner. The main objective of this article is to review these GIDs and their oral repercussion. Methods: symptoms, pathogenesis, epidemiology, oral manifestations and management in dentistry of GIDs are reviewed. Discussion: A significant number of GIDs may induce oral manifestations. Among these are GERD, IBD, and celiac disease. Conclusion: Dental practitioner must be aware of GIDs oral manifestations and be prepared when their clinical signs and symptoms occur.

Background: Biliary leakage is a problematic complication of hepatobiliary surgery. A novel alternative method is described that can obviate the need for reoperation for refractory biliary fistula. Methods: Nine patients with large biliary leaks unresponsive to endoscopic drainage underwent N-butyl-2cyanoacrylate glue occlusion at ERCP. Results: In 7 patients, occlusion was successful with prompt control of the fistula in a single session, averting reoperation. In 1 patient there was a partial response and in another the treatment was unsuccessful. No procedure-related complication occurred over a median follow-up of 35 months (range: 1.6-160 months). Conclusion: N-butyl-2-cyanoacrylate glue occlusion is a safe and effective endoscopic method for control of refractory bile leaks that eliminates the need for surgical reintervention.

Background and Objective: Overuse injuries of the hand, wrist, forearm, and shoulder are common among endoscopists and may be from repetitive pinching and gripping forces or awkward posturing. In this pilot study, we evaluated distal upper-extremity musculoskeletal load during colonoscopy (1) to confirm the feasibility of performing ergonomic measurements in endoscopists and (2) to identify tasks that may contribute to overuse injuries.

Background: Pathologic diagnosis and therapeutic interventions on the small bowel have been difficult and challenging for gastroenterologists. In the last few years, significant advances have been made in this direction. New diagnostic and therapeutic modalities for visualizing the small bowel have been introduced. Furthermore, increased indications for small-bowel imaging and therapeutics have been recognized. However, the currently available methods have limitations, and development of newer, rapid, minimally invasive, safe, and readily available techniques is needed.

Radionuclide imaging using (111)In, (99m)Tc and (153)Sm is commonly undertaken for the clinical investigation of gastric emptying, intestinal motility and whole gut transit. However the documented evidence concerning internal radiation dosimetry for such studies is not readily available. This communication documents the internal radiation dosimetry for whole gastrointestinal transit studies using (111)In, (99m)Tc and (153)Sm labeled formulations. The findings were compared to the diagnostic reference levels recommended by the United Kingdom Administration of Radioactive Substances Advisory Committee, for gastrointestinal transit studies.

INTRODUCTION: The omentum is acknowledged to have diverse functions in the pathophysiology of intra-abdominal disease. Its angiogenic properties act as a natural defense mechanism in peritonitis and intra-abdominal sepsis. With advancing technology the omentum is revealing itself as a new player in the field of molecular surgery with special reference to cancer, obesity and tissue reconstruction. MATERIALS AND METHODS: This article reviews the existing and potential surgical applications of the omentum.

To promote the appropriate use of new or emerging endoscopic technologies and those technologies that have an impact on endoscopic practice, the ASGE Technology Committee presents relevant information to practicing physicians in the form of technology reviews. Evidence-based methodology is employed wherein a MEDLINE literature search is performed to identify pertinent clinical studies on the topic, a MAUDE (Food and Drug Administration Center for Devices and Radiological Health) database search is performed to identify the reported complications of a given technology, and both are supplemented by accessing the ''related articles'' feature of PubMed and by scrutiny of pertinent references cited in the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized controlled trials are lacking; in such cases, large case series, preliminary clinical studies, and expert opinion are utilized. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Reviews are drafted by 1 or 2 committee members, reviewed in significant detail by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is appropriate, the most recent coding data and list prices at the time of publication are provided. For this review the MEDLINE database was searched through October 2005 for articles related to endoscopic clipping by using the keywords ''endoscopic clips'' and ''gastrointestinal endoscopy'' plus ''clip application'' and ''hemoclip.'' Practitioners should continue to monitor the medical literature for subsequent data about the efficacy, safety, and socioeconomic aspects of these technologies.

Background: Distinguishing malignant from benign biliary strictures remains a challenge. This prospective study assessed intraductal US as an adjunct to endoscopic retrograde cholangiography and tissue sampling for diagnosis of malignant and benign biliary strictures. Methods: Sixty-two patients were enrolled who had biliary strictures suspected to be malignant but with negative tissue sampling by endoscopic retrograde cholangiography, or suspected biliary strictures

Background: Transpapillary stents are used to treat malignant biliary strictures. However, there are different stent types and data are controversial in respect to success and complications. Recently, completely covered self-expandable metal stents (CSEMS) have become available. The aim of this study is to present a consecutive series of CSEMS placed to decompress the bile duct in malignant stenosis due to pancreatic carcinoma and to evaluate the effectiveness, complication rate and extractability of these devices.

Statements are prepared by a nonadvocate, non-Federal panel of experts, based on (1) presentations by investigators working in areas relevant to the questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the National Institutes of Health (NIH) or the Federal Government. The statement reflects the panel's assessment of medical knowledge available at the time the statement was written. Thus, it provides a "snapshot in time" of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.

87%); in 15 patients the bleeding stopped completely, whereas in 11 patients symptoms improved significantly. All patients with mild and 9/11 (patients with moderate RP were successfully treated (mean 2.0 sessions). A mean of 3.5 sessions was required in 2/5 (40%) patients with severe RP in whom APC was proved successful; in one patient bleeding was controlled after 8 sessions. All APC sessions were well tolerated, and there were no cases of perforation. Conclusions: APC is a safe, effective, and well-tolerated treatment in patients with mild and moderate RP. However, in the presence of severe RP several sessions of APC are usually required and less than 50% of patients were treated successfully.

The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidencebased methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such situations, large case series, preliminary clinical studies, and expert opinions are used.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most commonly performed endoscopic procedures. It provides the treating physician with both diagnostic and therapeutic options. The recent shift towards interventional uses of ERCP is largely due to the emergence of advanced imaging techniques, including magnetic resonance cholangiopancreatography and ultrasonography. With over 500,000 ERCP procedures performed yearly in the United States alone, it is important that all medical and surgical practitioners be well versed in indications, contraindications, potential complications, benefits, and alternatives to ERCP. The authors present an in-depth review of ERCP-related complications (pancreatitis, bleeding, perforation, etc) as well as special topics related to ERCP (periprocedural antibiotic use, performance of intraoperative ERCP, performance of ERCP during pregnancy, etc).

An 81-year-old man presented with rectal discharge, tenesmus, and a 10-kg weight loss over a period of 4 weeks. His medical history was significant for an early signet-ring-cell gastric adenocarcinoma (T1N0M0), for which he underwent a partial gastrectomy 6 years earlier. Digital rectal examination demonstrated a hard, concentric stenosis 4 cm from the anal verge. Laboratory data revealed mild anemia, with a hemoglobin level of 11.4 g/dL (reference range 12.3-14.5 g/dL). Sigmoidoscopy revealed a concentric, nontraversable stenosis at 4 cm from the dentate line ( ). Histology demonstrated a nonspecific chronic colitis. CT of the abdomen and pelvis showed a circumferential stenosis of the distal rectum . The perirectal fat appeared fibrosed, but there was no evidence of tumor infiltration into the pelvic musculature. No lymphadenopathy could be identified. Because of the high clinical suspicion of a rectal tumor, a surgical transrectal biopsy was performed. Pathology results revealed a signet-ring-cell cancer compatible with metastatic gastric cancer. EGD disclosed a large anastomotic tumor. Histology confirmed the recurrence of the signet-ring-cell gastric cancer.

Enterobius vermicular is a parasite can lead to inflammation and symptoms
in rare cases however it can manifest as ulceration in colon which may mimic
tubercular ulcer. A 40-year-oldman presented with pain abdomen. The
pathologic findings confirmed the diagnosis of E. vermicularis in the colonic
biopsy. It is important to be aware of this resemblance to avoid unnecessary
surgical intervention and simple treatment measures which can cure the
patient.

Background: There has been recent public concern regarding the adequacy of current practices for flexible endoscope reprocessing. High-level disinfection is defined by the Food and Drug Administration (FDA) as a minimum of 6-log reduction of mycobacteria under a worst-case scenario. Several agents are currently approved by the FDA, but published data on their relative efficacies against mycobacteria are lacking. The objective of this study was to determine the efficacy of these agents for high-level disinfection. Methods: In simulated-use testing, video endoscopes (5 colonoscopes and 5 duodenoscopes) were each inoculated with 9.0 × 10 7 colony-forming units of Mycobacterium chelonae. Cleaning was performed by using a standardized protocol. Each endoscope was then subjected to chemical disinfection with Cidex (2.0% glutaraldehyde) at 20°C for 20 minutes, Sporox (7.5% hydrogen peroxide) at 20°for 30 minutes, and Steris 20 (0.2% peracetic acid) at 50°C to 56°C for 12 minutes using the Steris System 1 processor. Although not FDA-approved, tests were also conducted by using 70% isopropyl alcohol at 20°C for 20 minutes. These results were compared with disinfection with ethylene oxide gas. All channels were sampled for M chelonae before and after manual cleaning and after disinfection. Results: Cleaning alone resulted in an average log reduction of 3. Cidex, Sporox, Steris 20, ethylene oxide gas, and isopropyl alcohol, in combination with manual cleaning, each achieved a 6-log or greater reduction of the mycobacterial inoculum. No organisms were recovered from any channel after reprocessing with ethylene oxide and Steris 20. Conclusions: Commercially available high-level disinfectants are equally efficacious for reprocessing flexible GI endoscopes when used in conjunction with cleaning and in accordance with recommended guidelines. (Gastrointest Endosc 2001;53:456-62.) 456 GASTROINTESTINAL ENDOSCOPY

Percutaneous endoscopic gastrostomy (PEG) has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. Although generally considered safe, PEG tube placement can be associated with many potential complications. This review describes a variety of PEG tube related complications as well as strategies for complication avoidance. In addition, the reader is presented with a brief discussion of procedures, techniques, alternatives to PEG tubes, and related issues. Special topics covered in this review include PEG tube placement following previous surgery and PEG tube use in pregnancy.

Introduction Management of severe secondary peritonitis (SSP) may require intestinal resections and bowel exteriorization due to an unacceptable high risk for anastomotic dehiscence (AD). Bowel exteriorization can be achieved through loop or ...

Background: Working parties of the American Society for Gastrointestinal Endoscopy (ASGE) Quality Committee recently published a proposed new lexicon for adverse events and a separate extensive review of risk factors. The complexity of procedures also affects outcomes.

Joint hypermobility syndrome/Hypermobile Ehlers-Danlos Syndrome (JHS/hEDS) is a heritable connective tissue disorder affecting virtually every bodily system [Grahame, 2013; Castori et al, 2012]. Over the past 18 years there has been an explosion in the literature relating JHS/hEDS to gastrointestinal symptoms [Castori et al, 2015], with patients enduring symptoms from mouth to anus [Castori et al, 2015]. It would seem that the defective connective tissue and tissue laxity in JHS/HEDS causes GI symptoms in this patient cohort [Castori et al, 2015; Farmer & Aziz, 2010; Firkee et al, 2014; Zarate et al, 2010]. This leads to considerable stress in patients with JHS/hEDS, and a long catalogue of problems for which the need for narrative medicine becomes invaluable [Knight, 2015]. In this article, narrative medicine, where science meets humanities [Charon, 2006], is used as a way for the patient story to be seen and heard at the helm of a long and complex history of GI problems in relation to having JHS/hEDS, including highlighting awareness of the condition Anterior Cutaneous Nerve Entrapment Syndrome [ACNES] [Applegate, 2002, Koop et al, 2016].

Background: There are various emerging scientific evidences based on research trials and therapeutic practices that 'Synbiotics' (probiotics and prebiotics) play an important role in animal health and nutrition. There has been a significant increase in the characterization and verification of potential health benefits associated with the use of probiotics and prebiotics.
Objective: The primary clinical effects for the application of probiotics have been reported as the ability to modulate the balance and activities of the gastrointestinal (GI) microbiota, treatment of infectious diseases including viral, bacterial and antibiotic associated diarrhea, cellular immune-modulation, lowering of serum cholesterol, improvement in lactose digestion, allevia-tion of allergy related disorders, reducing the risk of colon cancer and imparting the coloniza-tion resistance effect on intestinal microbiota.
Results: The probiotic therapy also known as the microbial interference therapy (MIT) has in particular drawn the interest of animal clinicians, in the treatment of enteric infections of neonatal farm and food animals eliminating the entero-pathogens selectively while building up the normal intestinal flora to flourish. This cannot be achieved by the use of gut-active antibiotics , which lack the ability to discriminate between its friends and foes. The probiotic therapy in food animals has embarked upon establishing a new non-antibiotic arena in the treatment of their several infections, which ultimately not only eliminates the possibility of development of drug resistance but also render the food animals and their produce free from xenobiotic residual effects, which enter the human food chain.
Conclusion: In this review, the current knowledge on the contribution of the gut microbiota to the host well-being has been discussed. Moreover, the available information on probiotics and prebiotics and their application in animal health, production and nutrition has been reviewed.