Home Study Course: Spring 2001

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72408/1/j.1526-0976.2001.005002105.x.pd

The Cystic Duct Remnant: An Unusual Case of a Biliary Intraluminal Filling Defect

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72892/1/j.1572-0241.1988.tb06086.x.pd

Does colonoscopy cause increased ulcerative colitis symptoms?

Background: Ulcerative colitis (UC) patients often report symptom flares after colonoscopy. However, this has not been documented in the literature. Objectives: 1. Determine whether colonoscopy is associated with increased UC symptoms. 2. Determine whether there is a need for escalation of UC medications after colonoscopy. 3. Identify baseline variables associated with increased symptoms after colonoscopy. Methods: Firty-five outpatients with a history of UC, intact colon, and quiescent disease were enrolled in a prospective case-crossover study. Subjects were evaluated with the Simple Clinical Colitis Activity Index (SCCAI) before colonoscopy, 1 week and 4 weeks after colonoscopy. A mixed model analysis was used to accommodate nonindependence of repeated measurements on the same patients. Results: Fifty-one (91%) subjects completed the study. Six subjects had clinical relapse defined by a score of 5 or greater on the SCCAI during the week after colonoscopy. Five subjects increased their 5-aminosalicylic acid (5-ASA) medications immediately postcolonoscopy, two of whom had a SCCAI 5 or greater. Multivariate modeling demonstrated a clear association between the week immediately after colonoscopy preparation and increased disease activity, with the time period being predictive of increased SCCAI (week 1 vs. week 4, P = 0.0127). The baseline SCCAI ( P value < 0.0001) and prednisone use ( P = 0.0120) were predictive of increased SCCAI postcolonoscopy. Thiopurines ( P < 0.001) were protective against increased symptoms. Conclusions: In our study, 1 in 8 subjects had UC relapse by SCCAI immediately postcolonoscopy, and 1 in 10 subjects required an increase in their 5-ASA medications. Clinicians should be cognizant of this effect of colonoscopy in patients with UC. (Inflamm Bowel Dis 2007;13:12–18)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55905/1/20049_ftp.pd

A Study of the Correlation between Endoscopic and Histological Diagnoses in Gastroduodenitis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72433/1/j.1572-0241.1987.tb01777.x.pd

Prolonged Effect of Omeprazole on the 14 C-Urea Breath Test

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73649/1/j.1572-0241.1996.tb08294.x.pd

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas

Preoperative localization of pancreatic neuroendocrine tumors with traditional imaging fails in 40–60% of patients. Endoscopic ultrasound (EUS) is highly sensitive in the detection of these tumors. Previous reports included relatively few patients or required the collaboration of multiple centers. We report the results of EUS evaluation of 82 patients with pancreatic neuroendocrine tumors. METHODS : We prospectively used EUS early in the diagnostic evaluation of patients with biochemical or clinical evidence of neuroendocrine tumors. Patients had surgical confirmation of tumor localization or clinical follow-up of >1 yr. RESULTS : Eighty-two patients underwent 91 examinations (cases). Thirty patients had multiple endocrine neoplasia syndrome type I. One hundred pancreatic tumors were visualized by EUS in 54 different patients. The remaining 28 patients had no pancreatic tumor or an extrapancreatic tumor. Surgical/pathological confirmation was obtained in 75 patients. The mean tumor diameter was 1.51 cm and 71% of the tumors were ≤2.0 cm in diameter. Of the 54 explorations with surgical confirmation of a pancreatic tumor, EUS correctly localized the tumor in 50 patients (93%). Twenty-nine insulinomas, 18 gastrinomas, as well as one glucagonoma, one carcinoid tumor, and one somatostatinoma were localized. The most common site for tumor localization was the pancreatic head (46 patients). Most tumors were hypoechoic, homogenous, and had distinct margins. EUS of the pancreas was correctly negative in 20 of 21 patients (specificity, 95%). EUS was more accurate than angiography with or without stimulation testing (secretin for gastrinoma, calcium for insulinoma), transcutaneous ultrasound, and CT in those patients undergoing further imaging procedures. EUS was not reliable in localizing extrapancreatic tumors. CONCLUSIONS : In this series, the largest single center experience reported to date, EUS had an overall sensitivity and accuracy of 93% for pancreatic neuroendocrine tumors. Our results support the use of EUS as a primary diagnostic modality in the evaluation and management of patients with neuroendocrine tumors of the pancreas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75174/1/j.1572-0241.2000.02480.x.pd

Colonic xanthomatosis

We report two additional cases of colonic xanthomatosis associated with persistent rectal symptoms. Disordered colonic motility in the areas of lipid infiltration was documented in one patient. We conclude these lesions may have a pathophysiologic role in the alteration of intestinal motility which appears to be the cause of our patients' symptoms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44405/1/10620_2005_Article_BF01537008.pd

Campylobacter pylori in Patients with Dyspeptic Symptoms and Endoscopic Evidence of Erosion(s)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73797/1/j.1572-0241.1989.tb02609.x.pd

Long-Term Follow-Up of Helicobacter pylori Treatment in Non-Ulcer Dyspepsia Patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73344/1/j.1572-0241.1995.tb09422.x.pd

Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis

ERCP is the gold standard for pancreaticobiliary evaluation but is associated with complications. Less invasive diagnostic alternatives with similar capabilities may be cost-effective, particularly in situations involving low prevalence of disease. The aim of this study was to compare the performance of endoscopic ultrasound (EUS) with magnetic resonance cholangiopancreatography (MRCP) and ERCP in the same patients with suspected extrahepatic biliary disease. The economic outcomes of EUS-, MRCP-, and ERCP-based diagnostic strategies were evaluated. METHODS : Prospective cohort study of patients referred for ERCP with suspected biliary disease. MRCP and EUS were performed within 24 h before ERCP. The investigators were blinded to the results of the alternative imaging studies. A cost-utility analysis was performed for initial ERCP, MRCP, and EUS strategies for these patients. RESULTS : A total of 30 patients were studied. ERCP cholangiogram failed in one patient, and another patient did not complete MRCP because of claustrophobia. The final diagnoses ( n = 28 ) were CBD stone (mean = 4 mm; range = 3–6 mm) in five patients; biliary stricture in three patients, and normal biliary tree in 20. Two patients had pancreatitis after therapeutic ERCP, one after precut sphincterotomy followed by a normal cholangiogram. EUS was more sensitive than MRCP in the detection of choledocolithiasis (80% vs 40%), with similar specificity. MRCP had a poor specificity and positive predictive value for the diagnosis of biliary stricture (76%/25%) compared to EUS (100%/100%), with similar sensitivity. The overall accuracy of MRCP for any abnormality was 61% (95% CI = 0.41–0.78) compared to 89% (CI = 0.72–0.98) for EUS. Among those patients with a normal biliary tree, the proportion correctly identified with each test was 95% for EUS and 65% for MRCP ( p < 0.02 ). The cost for each strategy per patient evaluated was $1346 for ERCP,$1111 for EUS, and $1145 for MRCP. CONCLUSIONS : In this patient population with a low disease prevalence, EUS was superior to MRCP for choledocholithiasis. EUS was most useful for confirming a normal biliary tree and should be considered a low-risk alternative to ERCP. Although MRCP had the lowest procedural reimbursement, the initial EUS strategy had the greatest cost-utility by avoiding unnecessary ERCP examinations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73885/1/j.1572-0241.2001.04245.x.pd