Vishny M L, Blades E W, Creger R J, Lazarus H M
Ireland Cancer Center, Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106.
Cancer Invest. 1994;12(4):384-9. doi: 10.3109/07357909409038227.
We reviewed our upper endoscopy (esophagogastroduodenoscopy, EGD) experience in a group of 65 consecutive patients receiving carmustine (BCNU) 600 mg/m2, cisplatin 200 mg/m2, VP-16 2400 mg/m2, and autologous bone marrow transplantation (BMT) for relapsed or refractory non-Hodgkin's lymphoma or Hodgkin's disease. Forty-one patients (33 with chest irradiation) underwent 48 EGDs for the following symptoms: upper gastrointestinal bleeding (melena and/or hematemesis) (12/48); persistent nausea and vomiting (7/48); odynophagia (25/48); and dysphagia (14/48). All patients who had dysphagia or odynophagia had endoscopic evidence of severe esophagitis, with confluent erosions or ulcerations. Gastrointestinal bleeding, which presented as melena or hematemesis, was caused by severe esophagitis in 11 of 12 patients. Yeasts were detected in 11/42 histological, or cytological specimens and were isolated in 4/26 cultures. No bleeding or infectious complications occurred in any patient as a result of the EGD procedure. We conclude that severe esophagitis documented by EGD is common in lymphoma patients receiving autologous BMT. Use of EGD, however, did not affect the decision to initiate empirical therapy with amphotericin B for persistent fever.
我们回顾了一组连续65例接受卡莫司汀（BCNU）600mg/m²、顺铂200mg/m²、依托泊苷（VP-16）2400mg/m²及自体骨髓移植（BMT）治疗复发或难治性非霍奇金淋巴瘤或霍奇金病患者的上消化道内镜检查（食管胃十二指肠镜检查，EGD）经验。41例患者（33例曾接受胸部放疗）因以下症状接受了48次EGD检查：上消化道出血（黑便和/或呕血）（12/48）；持续性恶心和呕吐（7/48）；吞咽痛（25/48）；吞咽困难（14/48）。所有有吞咽困难或吞咽痛的患者内镜检查均有严重食管炎的证据，表现为融合性糜烂或溃疡。12例表现为黑便或呕血的上消化道出血患者中，11例由严重食管炎引起。42份组织学或细胞学标本中有11份检测到酵母，26份培养物中有4份分离出酵母。EGD检查未导致任何患者出现出血或感染并发症。我们得出结论，EGD记录的严重食管炎在接受自体BMT的淋巴瘤患者中很常见。然而，EGD的应用并未影响对持续发热开始使用两性霉素B进行经验性治疗的决策。
