Further investigation into the societal cost of cognitive dysfunc

Further investigation into the societal cost of cognitive dysfunction in cirrhosis is PLX3397 important to encourage routine diagnosis and therapy of MHE beyond the research setting. “
“See article in J. Gastroenterol. Hepatol. 2010; 25: 1416–1419. Drainage is needed for symptomatic or infected intraabdominal/pelvic fluid collections. The options are surgical, imaging-guided and endoscopic drainage. The surgical approach allows greater access, facilitates more thorough drainage and debridement,

and may address the predisposing condition at the same setting, but at the expense of being more invasive and associated with greater morbidity.1 An imaging-guided approach using computer tomography and ultrasound VX-809 mw by the interventional radiologist is less invasive than surgical drainage. However, access for drainage may be limited by interposed organs, blood vessels, nerves and bony structures. There is also the possibility of inadvertent puncture of undetected interposed organs and vessels. Furthermore there is a need to insert an external indwelling drainage catheter for a prolonged period of time which can be uncomfortable for patients; the catheter may also be prone to slippage. Endoscopic transenteric drainage is less invasive than surgery, and may be able to access collections not possible with the imaging-guided approach. In addition, it does away with the need for an indwelling external drainage catheter because an internal

transenteric stent can be inserted, thus improving patient comfort. In the past, before the introduction of endoscopic ultrasound (EUS), endoscopic transenteric drainage was performed by puncturing the endoscopically visible intraluminal bulge caused by the fluid collection, after which guidewire and transenteric

stent insertion were performed under fluoroscopic guidance. Increasingly endoscopic drainage is being performed under real time EUS guidance.1 The difference between EUS and non-EUS guided endoscopic drainage is that during EUS-guided drainage, EUS is used to visualize the fluid collection and guide the initial puncture and guidewire insertion. All subsequent steps such as balloon dilatation of the puncture tract and stent insertion are similar between both approaches, and usually performed with fluoroscopic find more monitoring. EUS has made it possible for endoscopic drainage to be performed even in the absence of endoscopic bulging, because the collection can now be visualized directly, thus extending the spectrum of cases that are treatable endoscopically.2,3 With the use of colour Doppler ultrasound during EUS-guided drainage, EUS may potentially decrease the risk of puncturing interposed blood vessels.4 Most published data for EUS-guided drainage are in the context of pancreatic fluid collections, although drainage of liver and subphrenic abscesses has been reported.1,5 There are limited data concerning EUS-guided drainage of pelvic abscesses.

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