9 research outputs found
Outcomes and adverse factors for endoscopic mucosal resection (EMR) of colorectal polyps in elderly patients.
IntroductionEndoscopic mucosal resection (EMR) is an invaluable technique, however it is associated with significant risks. In the elderly in particular, the long-term survival benefits of polyp resection with EMR are unknown. The aim of this study was to determine the long-term outcomes in elderly patients who had undergone EMR and to identify any adverse factors.MethodA retrospective observational study on patients of 75 years of age or greater, who underwent EMR of colorectal polyps, in a single tertiary centre, from 2005 to 2014. Demographics of the patients, including Charlson Comorbidity Index (CCI), endoscopic and histological data, were reviewed to identify potential factors predicting outcomes.ResultsThe patients' median age was 80 years. In total 239 procedures were performed in 206 unique patients. The complication rate was 1.6%. Mean overall survival was 6.7 years with only one patient dying from metastatic colorectal cancer (0.5%) and 49 dying from non-colorectal cancer conditions (24%). Age more than 79 years and CCI more than 2 were independent predictors of significantly shorter survival (p=ConclusionEMR of colonic polyps is safe even for elderly patients. However, the decision to proceed to complex endoscopic therapy should be individualised considering the patients' age and comorbidities. CCI can help to objectively assess the comorbid state of a patient prior to such decisions
Yield of Combined Impedance-pH Monitoring for Refractory Reflux Symptoms in Clinical Practice
Background/Aims
In patients with gastroesophageal reflux disease, persistent symptoms on
proton pump inhibitor (PPI) therapy may be due to residual acid or
non-acid reflux. Combined impedance-pH has been suggested to be superior
to pH alone in the management of refractory patients to PPI. The utility
of implementation of this technique in every day clinical practice is
still unknown. The aim of this study was to investigate the outcomes of
patients studied with combined impedance-pH and to evaluate the yield of
additional impedance monitoring over pH alone in patients with
persistent gastroesophageal reflux disease symptoms.
Methods
Seventy-one patients (31 men; mean age, 49.1 +/- 15.5 years) on PPI
therapy underwent combined impedance-pH for persistent typical (76%) or
atypical (49%) symptoms.
Results
During impedance-pH study, 44 (62%) patients reported symptoms. A
positive symptom index (SI) was found in 21(48%) patients: 8 (18.2%)
had a positive SI for acid reflux, 9 (20.5%) for non-acid reflux and 4
(9.1%) for mixed reflux. Addition of impedance allowed association
between reflux and symptoms in 20.5% of patients who would have been
missed by pH study alone. Heartburn was the most prevalent symptom
associated with acid reflux, whereas regurgitation and ear, nose and
throat symptoms were associated with non-acid reflux.
Conclusions
The use of combined impedance-pH monitoring substantially increased the
diagnostic yield compared to pH alone. With SI analysis, 20.5% of
patients received a diagnosis that could not have been achieved with pH
testing alone
Bravo 48-hour Wireless pH Monitoring in Patients With Non-cardiac Chest Pain. Objective Gastroesophageal Reflux Disease Parameters Predict the Responses to Proton Pump Inhibitors
Background/Aims
In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux
disease (GERD) is the commonest cause and ambulatory pH is of great
value in identifying these patients. However, parameters in the context
of predicting therapeutic response are still unknown. By extending the
monitoring period, we could better evaluate the best evidence for GERD
association. Our aims were (1) to compare the outcomes of 48-hour pH
monitoring to 24-hour and (2) to determine whether objective parameters
could predict the treatment success in patients with NCCP using Bravo pH
system.
Methods
Pathological esophageal acid reflux (PEAR) and positive symptom index
(SI) were calculated after 24-hour and compared to the 48-hour study.
Evidence suggestive of GERD diagnosis was considered if PEAR and/or SI
(+) were present on each different day. After pH study, all patients
received proton pump inhibitor twice a day for 4 weeks. Treatment
success was determined at the end of therapy.
Results
Thirty-two patients with NCCP participated. GERD was identified in 20
(62.5%) patients; 17 (53.1%) had PEAR, 3 (9.4%) SI (+) and 7 (22%)
both. Twelve (41%) patients exhibited PEAR values on day 1, while 17
after 2 days; a 12.1 % gain. SI (+) was found in 6 patients (18.8%) on
day 1 and in 4 more on day 2, a gain of 12.5%. Significantly higher
proportion of patients with GERD indicators showed improvement compared
to those without (90% vs 16.7%, P < 0.005).
Conclusions
In patients with NCCP, 48-hour pH measurement identified GERD as the
cause of NCCP with an increased yield by almost 12% compared to 12
hours. Objective GERD parameters could predict response to antireflux
therapy