Endoscopic management of Kock pouch dysfunction: case report of a method to establish wire-guided pouch access for catheterization.
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Catheterization↗
Biomedical subjects
Klaus Mergener
Publications and source records attributed to Klaus Mergener.
Mini-laparoscopically guided percutaneous gastrostomy and jejunostomy.
BACKGROUND: Percutaneous endoscopic tube placement can be problematic under certain circumstances: absence of transillumination of the abdominal wall, percutaneous jejunostomy in patients with a PEG tube and recurrent aspiration, enteral feeding access after gastrectomy, and obstruction of the upper GI tract. As an alternative in these problematic situations, a technique was developed for placing feeding tubes under visual control by using mini-laparoscopy. METHODS: Placement of a feeding tube with mini-laparoscopy with the patient under conscious sedation was considered for 17 patients in whom standard PEG placement was impossible. Techniques used were the following: combined mini-laparoscopy/endoscopy for placement of a percutaneous gastrostomy or jejunostomy, and mini-laparoscopic-guided direct tube placement in cases of obstruction of the upper GI tract. OBSERVATIONS: In 13 patients, mini-laparoscopic-assisted tube placement was successful. In 4 patients, adhesions or peritoneal carcinomatosis prevented laparoscopic visualization of the stomach or small bowel. The combined mini-laparoscopic/endoscopic approach allowed a successful insertion of gastric tubes in 6 patients and jejunal tubes in 4 patients. Direct insertion of a percutaneous endoscopic jejunostomy tube without enteroscopy was feasible in all 3 patients with obstruction of the upper GI tract. No complication occurred. CONCLUSIONS: Mini-laparoscopy-assisted tube placement is a simple and safe alternative when endoscopic percutaneous tube placement is problematic or not feasible.
Adult↗
Intraoperative transjejunal ERCP: case reports.
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Adult↗
Stenting of the gastrointestinal tract.
Self-expandable metal stents are being increasingly used to palliate malignant stenoses of the gastrointestinal tract. These prostheses have made it possible to reestablish luminal continuity in patients with malignant obstruction of esophagus, gastric outlet, small bowel, or colon who are at high risk of surgical intervention. Despite technologic refinements in the stents and their delivery systems, and an increasing number of studies related to self-expandable metal stents, data regarding their long-term efficacy, side effect profile, and true cost efficacy in comparison with other treatment modalities remain incomplete. This article reviews the available technology, placement techniques, indications, and outcomes relating to the use of self-expandable metal stents in esophagus, stomach, small bowel, and colon.
Colonic Diseases↗