OBJECTIVE: Diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Arteriovascular disease, metabolic syndromes, non-steroidal anti-inflammatory drugs (NSAIDs), anti-thrombotics, and anticoagulants have been suggested as risk factors. There is a paucity of studies addressing factors associated with diverticular re-bleeding, especially in the United States. The aim of this study is to evaluate factors associated with colonic diverticular bleeding and re-bleeding in a US community-based hospital. METHODS: We conducted a retrospective case-control study to analyze the factors associated with diverticular bleeding. Between January 2010 and July 2011, 93 patients were admitted to our hospital with a primary diagnosis of acute diverticular bleeding. We compared them to 152 patients who were admitted with a primary diagnosis of diverticulitis in the same period. We collected data from the medical records of each patient in relation to the demographics, comorbidities, medications, social habits, location of diverticulosis, length of stay in the hospital, and re-bleeding rate within 2 years of the first bleeding episode. RESULTS: Factors such as cerebrovascular accident (p=0.009), coronary artery disease (p=0.037), diabetes mellitus (p=0.046), obstructive sleep apnea (p=0.033), NSAIDs (p=0.038), use of anti-thrombotics (p=0.001), anticoagulants (p=0.002) or calcium channel blockers (p=0.009), and bilateral diverticulosis (p=0.001) were significantly associated with diverticular bleeding as compared to diverticulitis. Recurrence of bleeding was noted in 26 out of 93 patients (28%) within 2 years of the first bleeding episode (p=0.001). Bilateral colonic involvement, anticoagulants, and elderly age (≥65 years) were found to have a closer relationship to diverticular re-bleeding, although it was not statistically significant. CONCLUSION: This study reveals that arteriovascular disease, diabetes mellitus, NSAIDs, the use of anti-thrombotics, anticoagulants or calcium channel blockers, and obstructive sleep apnea are factors that are significantly associated with diverticular bleeding. It also shows that bilateral colonic involvement, elderly age, and anticoagulants have a closer relationship to diverticular re-bleeding. More prospective studies in patients with diverticular bleeding should be conducted to shed light on the causality of these factors and the prevalence of diverticulitis.

O divertículo faringo-esofágico (DFE), também conhecido como cricofaríngeo ou de Zenker (DZ), é doença rara, com prevalência estimada entre 0,01% e 0,11%, e que acomete os muito idosos, para os quais tratamentos menos invasivos podem ser úteis, destacando-se o endoscópico. A despeito das inovações com equipamentos e acessórios, hemorragias e perfurações ocorrem em até 10 e 15% dos pacientes, respectivamente. A constatação de divertículo faríngeo em porcos domésticos transformou-se em modelo experimental de grande interesse para fins didáticos e científicos. Pretendeu-se, neste sentido, introduzir inovação técnica e compará-la com o tratamento endoscópico convencional do DFE. O objetivo deste estudo foi comparar, em modelo experimental, a diérese do septo do DFE efetuada através do bisturi harmônico Ultracision &#174; (Grupo U) com a do eletrocautério monopolar (Grupo M). Foram utilizados 20 porcos domésticos com peso médio de 20,2 Kg (&#177;1,35). Os animais foram alocados entre os grupos M e U de forma não aleatorizada. Não houve diferença significativa quanto ao tamanho do divertículo (p=0,0897) ou quanto ao tempo de inserção do diverticuloscópio flexível (p=0,7387). No grupo U, o tempo médio para a incisão do septo e o tempo total do procedimento foram menores (p<0,0001) para as duas comparações. Quanto à extensão da borda seccionada, houve diferença significativa (p=0,0047) entre os grupos, com maior média de tamanho no grupo U. Em relação aos parâmetros microscópicos, apenas a extensão da lesão provocada pela corrente monopolar (Grupo M) foi maior (p<0,0001). Em relação aos parâmetros de profundidade e à presença de inflamação, não houve diferença entre os grupos. Observou-se hemorragia apenas no grupo M (p=0,01), sempre controlada endoscopicamente. Em comparação com a técnica de seção feita com uso de estilete endoscópico e corrente monopolar mista, a diverticulotomia endoscópica experimental com uso de diverticuloscópio flexível e bisturi harmônico se mostrou mais rápida e relacionada com menor dano tecidual / The pharyngoesophageal diverticulum (PED), also known as cricopharyngeal or Zenker diverticulum (ZD), is a rare disease with estimated incidence ranging from 0.01% to 0.11% and more present in elderly patients, for whom a less invasive treatment can be desirable. Despite innovations in endoscopic equipment and accessories, bleeding and perforation occur in up to 10 and 15% of the cases, respectively. The finding of pharyngeal diverticulum in domestic pigs turned into an experimental model of major interest for training and scientific purposes. For this reason, the introduction of a technical innovation and its comparison with PED conventional treatment were focused. Our aim was to compare the diaeresis of the PED septum by the harmonic scalpel Ultracision &#174; monopolar electrocautery (Group M) in an experimental model. Twenty domestic pigs (mean weight 20.2 kg; &#177;1.35) were divided into groups M and U nonrandomly. No significant differences were found related to diverticulum size (p=0.0897) or insertion time of soft diverticuloscope (p=0.7387). In group U, mean time to divide the septum and total procedure time were significantly shorter (p<0.0001) for both comparisons. Regarding incision extension, mean length was significantly higher in group U (p=0.0047). In relation to microscopic parameters, the lateral thermal spread caused by monopolar current (Group M) was found to be more intense (p<0.0001). As for depth and inflammation presence, no differences were verified between the groups. Hemorrhage was exclusively observed in group M (p=0.01) and it was endoscopically managed at all times. When compared to endoscopic incision with needle-knife and monopolar blend current, the experimental endoscopic diverticulostomy using soft diverticuloscope and harmonic scalpel demonstrated to be faster and related to less tissue damage.

O divertículo faringo-esofágico (DFE), também conhecido como cricofaríngeo ou de Zenker (DZ), é doença rara, com prevalência estimada entre 0,01% e 0,11%, e que acomete os muito idosos, para os quais tratamentos menos invasivos podem ser úteis, destacando-se o endoscópico. A despeito das inovações com equipamentos e acessórios, hemorragias e perfurações ocorrem em até 10 e 15% dos pacientes, respectivamente. A constatação de divertículo faríngeo em porcos domésticos transformou-se em modelo experimental de grande interesse para fins didáticos e científicos. Pretendeu-se, neste sentido, introduzir inovação técnica e compará-la com o tratamento endoscópico convencional do DFE. O objetivo deste estudo foi comparar, em modelo experimental, a diérese do septo do DFE efetuada através do bisturi harmônico Ultracision &#174; (Grupo U) com a do eletrocautério monopolar (Grupo M). Foram utilizados 20 porcos domésticos com peso médio de 20,2 Kg (&#177;1,35). Os animais foram alocados entre os grupos M e U de forma não aleatorizada. Não houve diferença significativa quanto ao tamanho do divertículo (p=0,0897) ou quanto ao tempo de inserção do diverticuloscópio flexível (p=0,7387). No grupo U, o tempo médio para a incisão do septo e o tempo total do procedimento foram menores (p<0,0001) para as duas comparações. Quanto à extensão da borda seccionada, houve diferença significativa (p=0,0047) entre os grupos, com maior média de tamanho no grupo U. Em relação aos parâmetros microscópicos, apenas a extensão da lesão provocada pela corrente monopolar (Grupo M) foi maior (p<0,0001). Em relação aos parâmetros de profundidade e à presença de inflamação, não houve diferença entre os grupos. Observou-se hemorragia apenas no grupo M (p=0,01), sempre controlada endoscopicamente. Em comparação com a técnica de seção feita com uso de estilete endoscópico e corrente monopolar mista, a diverticulotomia endoscópica experimental com uso de diverticuloscópio flexível e bisturi harmônico se mostrou mais rápida e relacionada com menor dano tecidual / The pharyngoesophageal diverticulum (PED), also known as cricopharyngeal or Zenker diverticulum (ZD), is a rare disease with estimated incidence ranging from 0.01% to 0.11% and more present in elderly patients, for whom a less invasive treatment can be desirable. Despite innovations in endoscopic equipment and accessories, bleeding and perforation occur in up to 10 and 15% of the cases, respectively. The finding of pharyngeal diverticulum in domestic pigs turned into an experimental model of major interest for training and scientific purposes. For this reason, the introduction of a technical innovation and its comparison with PED conventional treatment were focused. Our aim was to compare the diaeresis of the PED septum by the harmonic scalpel Ultracision &#174; monopolar electrocautery (Group M) in an experimental model. Twenty domestic pigs (mean weight 20.2 kg; &#177;1.35) were divided into groups M and U nonrandomly. No significant differences were found related to diverticulum size (p=0.0897) or insertion time of soft diverticuloscope (p=0.7387). In group U, mean time to divide the septum and total procedure time were significantly shorter (p<0.0001) for both comparisons. Regarding incision extension, mean length was significantly higher in group U (p=0.0047). In relation to microscopic parameters, the lateral thermal spread caused by monopolar current (Group M) was found to be more intense (p<0.0001). As for depth and inflammation presence, no differences were verified between the groups. Hemorrhage was exclusively observed in group M (p=0.01) and it was endoscopically managed at all times. When compared to endoscopic incision with needle-knife and monopolar blend current, the experimental endoscopic diverticulostomy using soft diverticuloscope and harmonic scalpel demonstrated to be faster and related to less tissue damage.

Gastrointestinal (GI) septa are pathological entities whereby a wall of tissue is present in the GItract, resulting in symptoms such as dysphagia and regurgitation. They can be associated withconditions such as esophageal diverticula or upper gastrointestinal duplication, or post-surgicalcomplications such as candy cane syndrome. Current treatments involve interventions by eitherhighly skilled endoscopists or invasive surgery. We suggest the use of compression anastomosis toachieve endoscopic septotomy, relieving the patients of their symptoms. Compression anastomosisusing rings, clips, magnets, and wires or rubber bands (though not named as such for these last two)has previously been described in the literature. We propose the use of a combination of MagneticCompression Anastomosis (MCA) and what we have defined as Wire Compression Cutting (WCC),both involving progressive pressure application to induce ischemia, necrosis, inflammation, andfibrosis with regeneration. This PhD thesis describes the development of a novel medical devicedesigned to achieve the aforementioned process, from initial conception to detailed constructionby a specialized company, based on clinical and technical requirements defined in collaborationwith physicians and from latest regulations. This device, the MAgnetic Gastrointestinal UniversalSeptotome (MAGUS), consists of two magnetic boxes linked by a self-retractable wire. The wire isactivated by a spring coil system located inside the two magnetic boxes. This MAGUS MagneticDevice (MMD) is designed to be used with the MAGUS Delivery System (MDS), a catheter to whichit is attached, enabling the physician to mobilize each magnet independently during the procedure.To assess that the MAGUS meets the technical requirements of the procedure, and to mitigateagainst all possible risks that were identified through Failure Mode and Effects Analysis, verificationtests were performed in combination with animal testing. Clinical trials started in February 2020at Erasme Hospital with good preliminary results. Finally, to make the procedure more accessiblefor less experienced physicians, future improvements on the delivery catheter and procedure areproposed. / En gastroentérologie, un septum est défini comme une paroi de tissu séparant deux cavités. Ce typede structure peut être la cause de symptômes tels que de la dysphasie ou des vomissements. Il estcausé soit par des pathologies, comme les diverticules ou duplications de l’oesophage, soit par descomplications chirurgicales, comme le syndrome dit du "candy cane". Le traitement classique estla chirurgie mais celle-ci est liée à un haut taux de mortalité et morbidité. Ces dernières années,de nouvelles techniques endoscopiques ont été proposées, mais la plupart de celles-ci nécessitentl’intervention de médecins très expérimentés. Le travail développé dans cette thèse propose d’utiliserle concept d’anastomose par compression pour réaliser une découpe de ce septum. L’anastomosepar compression a été abondamment traitée dans la littérature. Cette compression est réalisée pardes anneaux, des clips, des aimants, des élastiques, ou du fil. Afin de réaliser cette septotomie,nous proposons donc de combiner l’anastomose par compression magnétique et ce que nous avonsappelé la découpe par compression par fil (Wire Compression Cutting), qui consiste à appliquer unepression, pour induire de l’ischémie, de la nécrose, de l’inflammation, et enfin de la régénérationcombinée à de la fibrose. Deux cahiers des charges, l’un clinique et l’autre technique, ont été réalisés;ceux-ci se basent sur la littérature sur le sujet, des échanges avec des médecins, et les normeset régulation actuellement d’application. Dans la suite du travail, le développement techniquedu MAGUS (MAgnetic Gastrointestinal Universal Septotome) est décrit, de l’idée à la premièreutilisation sur patients. Ce dispositif permet de réaliser cette compression, à l’aide de deux aimantsreliés par un fil rétractable. Cette solution épurée permet ainsi de découper différentes tailles deseptum, en une seule endoscopie, et sans incisions, réduisant le risque de perforation. Le "MAGUSMagnetic Device" a été conçu avec son outil dédié, le "MAGUS Delivery System", permettant defaciliter la mise en place du dispositif par endoscopie. Afin de vérifier que les caractéristiquestechniques définies au préalable sont bien remplies, et de réduire les dangers identifiés par uneanalyse de risque, des tests de vérifications ont été réalisés, en parallèle d’essais de faisabilité sur descochons. Les premières études cliniques ont commencé en février 2020 à l’Hôpital Erasme, donnantdes résultats préliminaires très encourageants. Ces premiers traitements ont notamment permisde prouver la faisabilité de la découpe par compression par fil. Ce travail est conclu en proposantdes améliorations pour le dispositif de pose, afin de faciliter sa prise en main, ainsi que de futuresnouvelles applications cliniques. / Doctorat en Sciences de l'ingénieur et technologie / info:eu-repo/semantics/nonPublished

Thesis (MSc)--University of Stellenbosch, 1982. / ENGLISH ABSTRACT:This study deals with the development of the ethmoidal region of Ascaphus truei Stejneger with special interest to the development of the nasal sacs, the diverticulum medium and the Jacobson's organ. This is to gather more information regarding the phylogeny of the structures. The opinions concerning the phylogenetical migration of the Jacobson's organ, are corroborated by the development of the organ in Ascaphus. The possible origin of the diverticulum medium from the nasal end of the nasolacrimal duct also is commented on. / No Afrikaans abstract available