Esophageal overtube facilitation of transesophageal echocardiography in patients with previously difficult esophageal intubation.

Background: In upper endoscopy, overtubes protect the hypopharynx and esophagus in patients requiring multiple esophageal intubations. Transesophageal echocardiography (TEE) is frequently used in general cardiology practice to provide high-resolution, real-time images of cardiac structures that are often not visualized by transthoracic imaging alone. Patients with a history of esophageal disorders or difficult esophageal intubations may have increased risk for complications from the echoprobe.

A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease.

Objectives: Capsule endoscopy (CE) allows for direct evaluation of the small bowel mucosa in patients with Crohn's disease (CD). A number of studies have revealed significantly improved yield for CE over other modalities for the diagnosis of CD, but as sample sizes have been small, the true degree of benefit is uncertain. Additionally, it is not clear whether patients with a suspected initial presentation of CD and those with suspected recurrent disease are equally likely to benefit from CE.

Capsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn's disease.

In this study, CE was superior to push enteroscopy and small bowel radiography for diagnosing small bowel pathology in patients who had OGIB, and its yield may be comparable to intraoperative endoscopy. Incremental yield of CE over push enteroscopy and barium radiography is greater than 30% for clinically significant findings, primarily because visualization of additional vascular and inflammatory lesions is possible by CE.CE was also found to be superior to small bowel barium radiography, colonoscopy with ileoscopy, CT enterography, and push enteroscopy for diagnosing nonstricturing small bowel CD.

Colonic perforation after computed tomographic colonography in a patient with fibrostenosing Crohn's disease.

Computed tomographic colonography (CTC) offers great promise in the management of patients with disorders of the colon. Few complications have been reported with its use thus far. We describe herein a case of colonic perforation during CTC in a patient with active stenosing ileocolonic Crohn's disease.

A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.

Objectives: Due to its superior ability to examine the entire small bowel mucosa, capsule endoscopy (CE) has broadened the diagnostic evaluation of patients with obscure gastrointestinal bleeding (OGIB). Published studies have revealed a numerically superior performance of CE in determining a source of OGIB compared with other modalities, but due to small sample sizes, the overall magnitude of benefit is unknown. Additionally, the types of lesions more likely to be found by CE versus alternate modalities are also unknown.

Development of macro-aspartate aminotransferase in a patient undergoing specific allergen injection immunotherapy.

Macro-aspartate aminotransferase (macro-AST), a complex between normal AST and an immunoglobulin, is recognized as a cause of isolated elevation of AST. Though its pathogenesis is unknown, previous reports have been suggestive of an autoimmune process. We describe a case of macro-AST formation in a patient with previously normal liver enzymes in whom an isolated AST elevation was discovered after initiation of specific allergen injection immunotherapy (SIT) for allergic rhinitis.

Prognostic factors in acute pancreatitis.

The assessment of the severity of acute pancreatitis (AP) is a critical early step in its management, as severity of AP predicts prognosis. A range of options are available for assessment of severity in AP, including clinical evaluation, standardized prognostic criteria, computed tomography (CT), and biochemical markers. Clinical assessment has limited accuracy for predicting severity early in the course of AP.