Tacoma, WA, United States
Tacoma, WA, United States

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Bertani H.,Nuovo Ospedale Civile S Agostino Estense | Noh K.W.,Tacoma Digestive Disease Center
Digestive and Liver Disease | Year: 2011

Introduction: Doppler transabdominal ultrasound is a validated screening test for chronic mesenteric ischaemia, but gas and obesity are limitations. Endoscopic ultrasound has been proposed as a comprehensive test to evaluate chronic upper abdominal pain and is capable of Doppler measurement. We aim to evaluate the accuracy of Doppler endoscopic ultrasound (D-EUS) as a single screening test to rule out chronic mesenteric ischaemia in patients with abdominal pain and compare it with Doppler transabdominal ultrasound (D-TUS). Methods: We enrolled all patients ≥50 years with chronic upper abdominal pain and vascular risk referred for endoscopic ultrasound. All were scheduled for D-EUS and D-TUS plus a confirmatory test if one of the previous resulted positive. We estimated the accuracy of both techniques comparing them using McNemar test. Results: 68 patients completed the study. Fifty-three (78%) underwent D-EUS, D-TUS, and a confirmatory test. Fifteen (38%) underwent follow-up after negative results. Three (4%) in the D-EUS group and 14 in the D-TUS (21%) were excluded due to artefacts. D-EUS presented a sensitivity of 63%, specificity of 84%, whilst D-TUS presented a sensitivity of 80% and a specificity of 78%. Specificity of D-EUS was not significantly different to D-TUS. Conclusions: These results support the role of Doppler endoscopic ultrasound to exclude chronic mesenteric ischaemia as cause of chronic abdominal pain. © 2011 Editrice Gastroenterologica Italiana S.r.l.

Fleischer D.E.,Mayo Medical School | Overholt B.F.,Gastrointestinal Associates | Sharma V.K.,Mayo Medical School | Reymunde A.,Ponce Gastroenterology | And 9 more authors.
Endoscopy | Year: 2010

Background and study aims: The AIM-II Trial included patients with nondysplastic Barretts esophagus (NDBE) treated with radiofrequency ablation (RFA). Complete eradication of NDBE (complete response-intestinal metaplasia [CR-IM]) was achieved in 98.4% of patients at 2.5 years. We report the proportion of patients demonstrating CR-IM at 5-year follow-up. Patients and methods: Prospective, multicenter US trial (NCT00489268). After endoscopic RFA of NDBE up to 6cm, patients with CR-IM at 2.5 years were eligible for longer-term follow-up. At 5 years, we obtained four-quadrant biopsies from every 1cm of the original extent of Barretts esophagus. All specimens were reviewed by one expert gastrointestinal pathologist, followed by focal RFA and repeat biopsy if NDBE was identified. Primary outcomes were (i) proportion of patients demonstrating CR-IM at 5-year biopsy, and (ii) proportion of patients demonstrating CR-IM at 5-year biopsy or after the single-session focal RFA. Results: Of 60 eligible patients, 50 consented to participate. Of 1473 esophageal specimens obtained at 5 years 85% contained lamina propria or deeper tissue (per patient, mean 30 13, standard deviation [SD] 13). CR-IM was demonstrated in 92% (46/50) of patients, while 8% (4/50) had focal NDBE; focal RFA converted all these to CR-IM. There were no buried glands, dysplasia, strictures, or serious adverse events. Kaplan-Meier CR-IM survival analysis showed probability of maintaining CR-IM for at least 4 years after first durable CR-IM was 0.91 (95% confidence interval [CI] 0.770.97) and mean duration of CR-IM was 4.22 years (standard error [SE] 0.12). Conclusions: In patients with NDBE treated with RFA, CR-IM was demonstrated in the majority of patients (92%) at 5-year follow-up, biopsy depth was adequate to detect recurrence, and all failures (4/4, 100%) were converted to CR-IM with single-session focal RFA. © Georg Thieme Verlag KG Stuttgart.

Odegaard S.,University of Bergen | Nesje L.B.,University of Bergen | Laerum O.D.,Copenhagen University | Laerum O.D.,University of Bergen | Kimmey M.B.,Tacoma Digestive Disease Center
Expert Review of Medical Devices | Year: 2012

The gastrointestinal (GI) tract, with its layered structure, can be imaged by ultrasound using a transabdominal approach or intraluminal high-frequency probes. New ultrasound technology can be used to characterize tissue hardness, study motility in real-time, direct diagnostic and therapeutic intervention, evaluate GI wall perfusion and tissue viability, and perform 3D imaging. Ultrasound is a safe imaging modality, and development of smaller devices has improved its application as a flexible clinical tool, which also can be used bedside. Recently, microbubbles have been injected into the blood stream loaded with contrast agents, or other diagnostic and therapeutic agents. Such bubbles can be destroyed by ultrasound waves, thus releasing their content at a given area of interest. In this article, we present a review of the GI wall anatomy and discuss currently available ultrasound technology for diagnosis and treatment of GI wall disorders. © 2012 Expert Reviews Ltd.

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