Liver & GIT
Barrett’s esophagus is commonly associated with which one of the following(LQ)
|B||Squamous cell carcinoma|
|D||Gastrointestinal stromal tumor|
3. Benign stricture,
4. Barrett's oesophagus
5. Oeophageal adenocarcinoma
6. Iron deficiency anemia
Extra oesophageal complications
1. Chronic cough
2. Acute laryngitis
4. Dental erosion
A. Documentation of muscle injury.
1. Upper GI endoscopy at endoscopy, Velvety appearance
2. Barium swallow may show hiatus hernia.
B. Documentation of reflux & quantification of reflux.
24h oesophageal pH monitoring ± oesophageal manometry help diagnose GORD when endoscopy is normal.
C. Documentation of pathophysiological factor.
1. Antacids 2. PPI (the most effective drug 3. Prokinetic drugs
Not indicated unless symptoms severe, refractory to medical therapy and there is pH-monitoring evidence of severe reflux. Laparoscopic repairs are gaining favour.
3. Treatment of Barrett’s oesophagus:
1. If premalignant changes i.e. high grade dysplasia seen than do esophageal resection. (Fundoplications)
2. Otherwise high dose of PPI initially, lateral reduce a dose.
3. Photo dynamic treatment
Photodynamic therapy (PDT) involves light. induced activation of an orally administered photosensitizer such as 5-aminolevulinic acid which causes the accumulation of protoporphyrin IX in GI mucosal cells. Local laser light then causes necrosis, which is confirmed by finding squamous re-epithelialization.
4. Repeat endoscopy is must.
Endoscopic biopsy is the gold standard for confirmation of Barrett's esophagus, and for dysplasia or cancer arising in Barrett's mucosa. Endoscopic therapies such as i. endoscopic mucosal resection (EMR), ii. endoscopic submucosal dissection (ESD), iii. photodynamic therapy (PDT), iv. radiofrequency ablation (RFA) are effective modalities for treatment of high-grade dysplasia and intramucosal cancer in Barrett's esophagus.
Natural Orifice Transluminal Endoscopic Surgery (Notes) (H-18th Pg 2411)
NOTES is an evolving collection of endoscopic methods that entail passage of an endoscope or its accessories through the wall of the gastrointestinal tract (e.g., stomach) to perform diagnostic or therapeutic interventions. Some NOTES procedures, such as percutaneous endoscopic gastrostomy (PEG) or endoscopic necronectomy of pancreatic necrosis, are established clinical procedures, others, such as endoscopic appendectomy, cholecystectomy, and tubal ligation, are in development.
Liver & GIT