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Biomedical subjects

A N Kalloo

Publications and source records attributed to A N Kalloo.

At least 19 recordsLinked to original sources
PubMed2001

Efficacy of biliary scintigraphy in suspected sphincter of Oddi dysfunction.

Sphincter of Oddi dysfunction (SOD) can pose diagnostic challenges for the physician. SOD is classified into types I, II, and III, but clinical outcome after sphincterotomy for suspected types II and III SOD has been unpredictable. Therefore, accurate diagnosis of types II and III SOD is important because of the increased risk of sphincterotomy in patients with SOD. Endoscopic sphincter of Oddi manometry (ESOM) is the gold standard for diagnosis of SOD; however, it is associated with significant morbidity and is not an appropriate screening test. Quantitative hepatobiliary scintigraphy (QHBS) has demonstrated good sensitivity as a screening test for SOD in patients following cholecystectomy; however, studies using this methodology are criticized for poor design and patient selection. Recent publications address these criticisms and provide evidence that QHBS and ESOM are comparable diagnostic tools after exclusion of organic biliary obstruction. QHBS can effectively replace invasive ESOM in the diagnostic algorithm of SOD.

Biliary Tract↗
PubMed2001

Enteroscopy.

Explore the source record for details and available documents.

Endoscopy, Gastrointestinal↗
PubMed2001

Gallstones and biliary disease.

Gallstones are common in the US and western countries. This article describes the pathogenesis of gallstone formation and the clinical manifestations and current approaches to diagnosis and treatment of the most common clinical conditions caused by gallstones: biliary colic, acute cholecystitis, choledocholithiasis, and acute gallstone pancreatitis. The role of widely used imaging techniques (transabdominal ultrasound, CT scan, MR imaging, and MRCP) and diagnostic and therapeutic endoscopy (endoscopic ultrasound, ERCP) is emphasized. This article is intended mainly for general practitioners, primary care physicians, and other specialists providing medical care to patients with gallstones and their complications.

Acute Disease↗
PubMed2000

What are the long-term results of endoscopic pancreatic sphincterotomy?

BACKGROUND: Endoscopic pancreatic sphincterotomy has been touted as effective therapy for chronic pancreatitis and unexplained abdominal pain resulting from pancreatic sphincter dysfunction. Although short-term data are encouraging, there are no reports on how these patients fare beyond the first few months. METHODS: We performed a retrospective review of records on all patients who had pancreatic sphincterotomy during a 4-year period between August 1992 and November 1996. Chronic pancreatitis was diagnosed by pancreatography. Patients were evaluated for symptomatic response to pancreatic sphincterotomy and clinical improvement was defined as greater than 50% reduction in the magnitude of pain. RESULTS: Fifty-five patients had pancreatic sphincterotomy including patients with (n = 40) and without (n = 15) chronic pancreatitis. After a median follow-up of 16 months, 60% of all patients reported improvement of pain scores (3.6 +/- 3.4 vs. 8.8 +/- 1.8; p < 0.01) with the best response in patients without evidence of chronic pancreatitis. Complications of pancreatic sphincterotomy included pancreatitis in 5 patients (9%), bleeding in 2 (3.6%) and early stent occlusion in 5 patients (9%). There were no deaths. CONCLUSIONS: In a subgroup of patients with pancreatic sphincter dysfunction, endoscopic pancreatic sphincterotomy results in significant sustained clinical improvement.

Adolescent↗
PubMed1999

Clinical usefulness of 3% hydrogen peroxide in acute upper GI bleeding: a pilot study.

BACKGROUND: A major problem in the endoscopic management of acute upper gastrointestinal (GI) bleeding is the presence of blood and clots overlying the bleeding source, preventing visualization of the lesion. A simple alternative is to alter the characteristics of blood such that it not only becomes easier to remove but also becomes translucent. We report the results of a pilot study on the use of hydrogen peroxide in patients with acute upper GI bleeding. METHODS: Patients with acute upper GI bleeding were studied if the presence of blood or clots obscured the site of bleeding. The potential site of bleeding was initially sprayed with 200 mL water and then with 200 mL 3% hydrogen peroxide mixed with simethicone. RESULTS: In 6 patients with acute upper GI bleeding, hydrogen peroxide spray resulted in good to excellent visualization of the bleeding source. Hemostasis occurred in 2 patients who were actively bleeding. There were no adverse effects or complications. CONCLUSIONS: Hydrogen peroxide significantly enhanced clot dissolution and endoscopic visualization in patients with acute upper GI bleeding.

Acute Disease↗
PubMed1999

Endoscopic cryotherapy: experimental results and first clinical use.

BACKGROUND: Cryotherapy or the application of extreme cold has many potential applications in gastroenterology including tissue destruction and hemostasis but until now its development has been prevented by the lack of a delivery device suitable for use through the endoscope. We report here our experience with prototype devices using both liquid nitrogen driven by a cryosurgical system and cryogenic refrigerants (nitrous oxide and carbon dioxide) at or near ambient temperature. METHODS: Cryotherapy was applied to the distal esophageal mucosa of dogs via a flexible catheter passed through an upper endoscope. In other dogs, cryotherapy was used for hemostasis in a bleeding ulcer model. The procedure was also used for palliation in a 58-year-old man with unresectable adenocarcinoma of the stomach with pyloric channel obstruction. RESULTS: Freezing of the superficial mucosa was nearly instantaneous. All dogs survived the procedure and appeared to thrive. Histologic evaluation revealed significant necrosis of the superficial epithelial layer accompanied by a fibrinocellular infiltrate on the surface. These markers of acute injury subside by the fourth to sixth day and are replaced by regenerating epithelium, a process that is virtually complete by day 10. In the hemostasis experiments, bleeding ceased immediately after cryospraying of the lesions but resumed on thawing in most cases. Application of cryotherapy in the patient resulted in reduction of the pyloric mass with no immediately apparent adverse effects. CONCLUSIONS: These data, although preliminary, demonstrate the feasibility of endoscopic cryotherapy using a simple hand-held device. This device has broad potential for use in gastroenterology including ablation of superficial epithelium, debulking of large tumors and hemostasis.

Adenocarcinoma↗
PubMed1999

Pain: the overlooked symptom in gastroparesis.

OBJECTIVE: Abdominal pain has not been reported generally as a significant feature of the clinical presentation of patients with gastroparesis. METHODS: Using a standardized questionnaire, we analyzed the clinical features of 28 consecutive patients referred with established or suspected gastroparesis over a 4-yr period. The diagnosis of gastroparesis was supported by abnormalities in gastric emptying studies (GES), electrogastrography (EGG), or upper endoscopy (EGD). Diagnostic tests were reviewed. RESULTS: A total of 12 male (mean age 39.5 yr) and 18 female patients (mean age 39.6 yr) were included in this study. These patients had been symptomatic for an average of 37.8 months before their referral to our center. Seven of these patients had insulin-dependent diabetes. Idiopathic gastroparesis was present in more than half of the patients. The symptom profile of the 28 patients was as follows: nausea, 92.9%; abdominal pain, 89.3%; early satiety, 85.7%; and vomiting, 67.9%. The pain was described as burning, vague, or crampy in nature. Only 36% localized to the upper abdomen. In all, 60% of patients complained of postprandial pain, whereas 80% complained of nocturnal pain that interfered with their normal sleeping pattern. In general, pain responded poorly or not at all to prokinetic agents. CONCLUSIONS: Nausea and abdominal pain are the most common complaints of patients with gastroparesis. In 80% of patients, GES and EGG correlated positively.

Abdominal Pain↗
PubMed1998

Effect of local injection of botulinum toxin on sphincter of Oddi cyclic motility in dogs.

To study effects of intrasphincteric injections of botulinum toxin on the sphincter of Oddi cyclic motility and responses to motilin and cholecystokinin, four conscious dogs with duodenal cannula underwent manometry of the common bile duct, sphincter of Oddi, and duodenum. After baseline recording, each dog had intrasphincteric injections of saline or botulinum toxin. The injections of saline had no effect, whereas botulinum toxin significantly reduced mean basal pressure, amplitude, and motility index of the sphincter of Oddi. These effects took place in four to seven days and reached a maximum in seven to 10 days. The basal pressure returned to the baseline level in 28 weeks, but the amplitude and motility index remained low. The pressure parameters of motilin-induced premature phase III-like activity also decreased, but action of cholecystokinin was not affected. These results indicate that the botulinum toxin injections reduce sphincter of Oddi phasic contractile activity for a prolonged period of time.

Animals↗