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M F Catalano

Publications and source records attributed to M F Catalano.

At least 37 records · Page 2Linked to original sources
PubMed1995

Observer variation and reproducibility of endoscopic ultrasonography.

To investigate interobserver variation and reproducibility of endosonographic findings, both experienced and inexperienced endosonographers evaluated depth of tumor invasion (T stage) and presence of lymph node metastasis (N stage) in 50 patients with nonobstructing esophageal carcinoma. Results were compared with the findings by surgical pathology of the resected specimens. The kappa statistic (kappa) was used to assess interobserver and intraobserver agreement and consistency of accurate interpretation (reproducibility) for the two groups. Agreement between the experienced endosonographers was excellent (kappa = > .75) for T1 and T4 lesions, good (kappa = .61) for T3 lesions, but only poor (kappa = > .46) for T2 lesions. The overall agreement between the experienced endosonographers was equally good for both T and N stages. Agreement between the inexperienced endosonographers was poor for all T stages but was good for lymph node metastasis (kappa = .52). For experienced endosonographers, endosonographic reproducibility of histologically confirmed T4 lesions was excellent, followed closely by T3 and T2 lesions; T1 tumors were frequently interpreted differently by the same endosonographer. Reproducibility of N stage determinations was excellent for N0 lymph nodes and good for N1 nodes. Thus, for experienced endosonographers, interobserver agreement was excellent for all T stages except T2, whereas reproducibility of determination of depth of tumor invasion was good to excellent for T2, T3, and T4 lesions but poor for T1 lesions. As yet poorly defined operator and machine-dependent factors that cause misinterpretation of T1 and T2 tumors will require additional study.

Endoscopy↗
PubMed1995

Postoperative screening for anastomotic recurrence of esophageal carcinoma by endoscopic ultrasonography.

BACKGROUND: The usefulness of endoscopic ultrasonography (EUS) in the preoperative staging of esophageal carcinoma is well established. Alternatively, the role of EUS in the early diagnosis of anastomotic recurrence is less well accepted. METHODS: EUS was used to evaluate 30 asymptomatic and 10 symptomatic patients (i.e., with dysphagia) who had previously undergone resection of esophageal carcinoma. RESULTS: There were 3 (10%) unsuspected anastomotic recurrences in the asymptomatic group. EUS correctly identified locally recurrent cancer in all cases, whereas endoscopy confirmed the presence of only one anastomotic recurrence. Computed tomography was not diagnostic in any of the three recurrences. Sensitivity of EUS for recurrence of esophageal carcinoma was 100% compared with 33% for endoscopic diagnosis while the specificity was 96% for EUS compared with 100% for endoscopic biopsy. There was one false positive diagnosis of recurrence by EUS because of postoperative fibrosis resulting in concentric hypertrophy of the esophageal wall near the surgical anastomosis. Of the 10 symptomatic patients, 4 were diagnosed with tumor recurrence. EUS correctly predicted recurrences in all symptomatic patients (100% sensitivity and specificity), as did upper endoscopy with biopsy. CONCLUSIONS: EUS is more sensitive than upper endoscopy and CT scan for the evaluation of anastomotic recurrence of esophageal carcinoma and should be considered as an adjunctive modality to conventional endoscopy for the postoperative surveillance of these patients.

Aged↗
PubMed1995

Use of corticosteroids in the prevention of post-ERCP pancreatitis.

BACKGROUND: Pancreatitis frequently complicates diagnostic and therapeutic ERCP. A variety of causes have been implicated. A number of different agents have been used, without success, in an attempt to prevent pancreatitis. METHODS: In the current study, 824 patients with a history of iodine sensitivity were given preprocedure corticosteroid therapy (651 oral steroids and 173 intravenous steroids) in an attempt to prevent allergic reactions. These patients were retrospectively studied in an attempt to determine if corticosteroid administration prevents ERCP-related pancreatitis. Two control groups were used for comparison, including 1000 patients during the same study period (Control Group I) and 1954 patients from the Midwest Pancreaticobiliary Group (Control Group II). RESULTS: There was a significant difference in the overall incidence of post-ERCP pancreatitis in the corticosteroid treated group (4.6%) compared with either control group (Control Group I = 7.4% and Control Group II = 9.1%). Of those patients undergoing therapeutic ERCP, results were even more significant in favor of the steroid-treated group (5.2%) compared with Control Group I (9.7%) and Control Group II (11.2%). CONCLUSIONS: These results demonstrate that the administration of corticosteroids prior to ERCP results in a decreased incidence of post-ERCP pancreatitis. A prospective, randomized, controlled trial is warranted.

Acute Disease↗
PubMed1995

Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis.

BACKGROUND: Endoscopic treatment of pancreatic pseudocysts via cystenterostomy has been recognized as a successful treatment option in carefully selected patients. Pancreatic transpapillary stenting as an alternative treatment option in patients with pancreatic pseudocysts directly communicating with the main duct has received little consideration. The aim of the current study was to assess the safety and utility of transpapillary pancreatic endoprosthesis in the treatment of communicating pseudocysts. METHODS: Twenty-one patients underwent placement of 33 transpapillary endoprostheses for the treatment of symptomatic pancreatic pseudocysts. All pseudocysts communicated with the main pancreatic duct and ranged in size from 3 to 9 cm (mean 6 cm). Eight patients had associated pancreatic duct strictures. RESULTS: Stent placement was successful in all cases: 13 directly into the pseudocyst, 8 beyond the stricture but not into the pseudocyst. Initial resolution of pseudocysts was seen in 17 patients, with 16 patients free of pseudocyst recurrence at mean follow-up of 37 months. All patients with associated strictures were treated successfully. Factors predictive of success included presence of strictures, size of pseudocyst greater than or equal to 6 cm, location in the body of the pancreas, and duration of pseudocyst less than 6 months. Complications included one episode of mild pancreatitis. CONCLUSIONS: Endoscopic treatment of symptomatic pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct stenting is a safe, effective modality and should be considered a first line therapy.

Adult↗
PubMed1995

Endoscopic estimation of size: improved accuracy by directed teaching.

Previous studies have demonstrated the inaccuracy of endoscopic estimation of size. Although several devices have been developed to help improve estimation of size, none are convenient for clinical use. We have designed and evaluated a clinical teaching protocol to aid endoscopists in better estimating size. Thirteen "endoscopists" with varying levels of experience (none, less than 1 year, more than 1 year) estimated the size of six steel ball bearings placed into a model colon and viewed with a videoendoscope. They were then taught to compensate for optic distortion and retested immediately after teaching and again 1 month later. The mean error of estimation decreased from 28% before teaching to 8% after teaching (p < .05) and rose to 12% 1 month later (p < .05). Although the indices of mean error decreased immediately after teaching in all groups, only those individuals with less than 1 year of endoscopic experience retained the improvement 1 month after teaching. We conclude that endoscopists can be taught how to compensate for the optic distortion encountered during endoscopy. This teaching is most effective if performed early in the training program.

Colonoscopy↗
PubMed1995

A prospective, double-blind trial of somatostatin analog (octreotide) versus glucagon for the inhibition of small intestinal motility during endoscopic retrograde cholangiopancreatography.

BACKGROUND: Glucagon is effective when used as an antimotility agent during ERCP, but at high doses it may cause nausea and vomiting. Octreotide acetate, a long-acting synthetic analog of somatostatin, inhibits contractility of the small intestine and is generally well tolerated. The purpose of this study was to determine if octreotide given prior to ERCP reduced the requirement for glucagon and enhanced patient tolerance for the procedure. METHODS: Patients undergoing ERCP (n = 100) performed for a variety of indications (but not sphincter of Oddi manometry) were randomly assigned to receive normal saline solution or octreotide at a total dose of 25 micrograms, 50 micrograms, or 100 micrograms diluted in normal saline solution prior to the procedure. Glucagon was subsequently administered (as needed, to inhibit intestinal motility) by endoscopists who were blinded to the test substance given prior to the procedure. RESULTS: For all treatment groups, the dose of glucagon required to inhibit intestinal motility in patients who received octreotide prior to the procedure was not significantly different from the dose administered to patients who received normal saline solution. There was no significant difference in the incidence of nausea and vomiting when individual test groups were compared to the control group. CONCLUSION: Nausea and vomiting after ERCP were uncommon in all treatment groups. Administration of octreotide prior to ERCP did not significantly reduce the dose of glucagon required to inhibit intestinal motility. Tolerance for ERCP was similar for patients given octreotide when compared with those given glucagon to inhibit small intestinal motility.

Adult↗
PubMed1995

Malignant esophageal strictures: staging accuracy of endoscopic ultrasonography.

The prognosis for patients with carcinoma of the esophagus remains poor despite aggressive combination therapies and radical surgical resections. Accuracy of staging esophageal carcinoma by endoscopic ultrasonography is unmatched by that of any other modality. Of patients with esophageal carcinoma, 20% to 36% present with high-grade malignant strictures that preclude passage of the echoendoscope. Aggressive wire-guided dilation followed by complete endoscopic ultrasonographic assessment or endosonography limited to the proximal aspect of the stricture has been used in staging these patients. Of 204 patients with esophageal carcinoma, 51 (25%) presented with high-grade malignant strictures, defined as stenosis precluding passage of the echoendoscope without prior dilation. Thirty-nine of the 51 patients were treated by esophageal resection. Twenty-one of these patients underwent preoperative staging using wire-guided dilation followed by endoscopic ultrasonography, whereas 18 underwent limited endosonographic staging. Correct preoperative assessment of depth of tumor invasion (T stage) was obtained in 33% (7 of 21) of the former group and 28% (5 of 18) of the latter group. Advanced tumor stage (stage III or IV) was present in 90% (35 of 39) of patients presenting with high-grade strictures, indicating a poor prognosis for those patients. The current study demonstrates that (1) approximately 25% of all patients with esophageal carcinoma present with high-grade stricutres that preclude passage of the echoendoscope without prior dilation, (2) the majority of patients with high-grade malignant strictures present with advanced disease (stage III or IV), and (3) because of the low accuracy of endoscopic ultrasonography in staging high-grade strictures, the need to subject such patients to invasive staging studies is questionable.

Carcinoma↗
PubMed1995

Endoscopic retrograde cholangiopancreatography in the orthotopic liver transplant patient.

BACKGROUND AND STUDY AIMS: Diagnostic imaging of the biliary tract is often required in liver transplant recipients, preoperatively to assess extent of biliary tract disease and postoperatively in patients with a suspected biliary complication due to an abnormal postoperative course. PATIENTS AND METHODS: Over a six-year period, 115 patients received 127 liver transplantations at our institution. Twenty-three preoperative ERCPs were performed in 17 patients, while 25 ERCPs were performed on 15 patients after liver transplantation. RESULTS: Preoperative ERCP in seven of 17 patients revealed a dominant biliary stricture as a result of primary sclerosing cholangitis (PSC); five of these patients were managed successfully with the placement of biliary endoprosthesis. An additional nine patients with PSC underwent brush cytology of the extrahepatic bile ducts to rule out coexisting cholangiocarcinoma; there were no positive results, although three were found to have coexisting cholangiocarcinoma after examination of the explanted liver. Postoperatively, nine of 15 patients were found to have biliary tract disease. These included five biliary strictures (three treated successfully by endoscopic dilation and stent therapy), two biliary leaks (treated by biliary endoprosthesis), one biloma (treated by percutaneous drainage) and one intraductal stone (treated successfully by sphincterotomy and stone extraction). The remaining six patients showed no abnormality at ERCP, and were subsequently diagnosed with allograft rejection. CONCLUSIONS: Diagnosis of biliary complications after hepatic transplantation is often problematic. Definitive characterization frequently requires cholangiography. Interventional biliary procedures, both endoscopic and percutaneous, can be used successfully to treat these complications; however, surgical revision and retransplantation are sometimes required.

Adult↗
PubMed1995

Normal structures on endoscopic ultrasonography: visualization measurement data and interobserver variation.

Endoscopic ultrasonography is a highly technical procedure requiring considerable experience and knowledge of human anatomy and its variations. Its use in the assessment of a variety of upper and lower gastrointestinal diseases has been valuable. Measurement of structures by endosonography is routinely accomplished although with uncertain accuracy, reproducibility, and interobserver variation.

Digestive System↗
PubMed1994

Endoscopic treatment of biliary leakage after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is an effective and safe treatment for uncomplicated symptomatic cholelithiasis. However, biliary tract injury may be more common with this procedure than with open cholecystectomy. We have encountered 17 patients with a biliary leak among 465 patients undergoing laparoscopic cholecystectomy, the diagnosis being established by clinical and radiographic parameters. The most common site of leakage was the cystic duct stump. Patients underwent endoscopic sphincterotomy and biliary stent placement, with an overall success rate of 96%. No morbidity or mortality related to the endoscopic procedures was encountered. We conclude that biliary leakage after laparoscopic cholecystectomy is uncommon. When it occurs, it can be treated safely and efficaciously by endoscopic means.

Adult↗
PubMed1994

Training in upper gastrointestinal endoscopy.

Training in upper gastrointestinal endoscopy is a vital portion of the education received by gastroenterology trainees. Proper training involves the acquisition of adequate technical, cognitive, and interpretive skills necessary for good patient care. With the continued technological advancement in endoscopy, advanced training in the form of an additional year of fellowship or hands-on workshops and courses will become essential.

Clinical Competence↗
PubMed1993

High-grade malignant stricture is predictive of esophageal tumor stage. Risks of endosonographic evaluation.

BACKGROUND: Endosonography is very accurate for the preoperative staging of esophageal carcinoma. Approximately 20-38% of patients with esophageal carcinoma present with high-grade malignant strictures that preclude passage of the dedicated echoendoscope. In patients with such strictures, endosonographic staging of esophageal tumors may be performed after aggressive esophageal dilatation. However, aggressive dilatation and passage of the echoendoscope in patients with high-grade malignant strictures is not without risk. A detailed assessment of the tumor stage in patients presenting with high-grade malignant stenoses has not been previously reported to the authors' knowledge. METHODS: Seventy-nine patients with esophageal carcinoma were staged preoperatively using endosonography. The results of preoperative staging were compared with the pathologic stage of the esophagectomy specimen when available or the surgical stage (detection of adjacent organ involvement [Stage T4] or metastatic disease [Stage M1] at the time of surgery). RESULTS: Twenty-one patients (26.6%) presented with high-grade malignant strictures precluding endosonographic examination without prior esophageal dilatation. Nineteen of the 21 patients (91%) with high-grade malignant stricture had Stage III or IV disease by histopathologic examination of the surgical specimen. Five of these 21 patients (24%) sustained an esophageal perforation as a result of either wire-guided dilatation, or as a direct consequence of the endosonographic staging procedure. The discovery of metastatic lymph nodes proximal to the stricture resulted in successful staging (assessment of depth of tumor penetration and lymph node involvement) in only 2 of these 21 patients before esophageal dilatation (incomplete staging). Staging of the proximal aspect of the tumor was obtained in the remaining 19 patients before dilatation; however, the accuracy for such incomplete staging was only 33%. CONCLUSIONS: The majority of patients with esophageal carcinoma presenting with high-grade malignant strictures precluding endoscope passage without prior dilatation have a relatively advanced stage of disease (Stage III or IV) compared with those patients presenting with less severe stenoses. There is a significant risk for esophageal perforation (24%) when patients with high-grade malignant esophageal strictures undergo preoperative staging using endosonography. Patients with high-grade malignant strictures, therefore, present a relative contraindication to endosonography using the dedicated echoendoscope.

Carcinoma↗
PubMed1992

Percutaneous endoscopic gastrostomy with jejunal extension: a new technique.

Percutaneous endoscopic gastrostomies (PEG) with jejunal extensions are placed in patients at risk for aspiration of gastric contents. Current methods used are difficult and often ineffective in preventing aspiration, and frequently result in substantial morbidity and mortality. In this study, a new method of jejunal extension from a PEG was evaluated with regard to efficacy and prevention of aspiration of gastric contents while providing adequate enteral nutrition. Twelve patients with recent aspiration pneumonitis underwent PEG placement with a jejunal extension by this new method. The technique was accomplished rapidly and without difficulty in an average time of 26.2 min (range 17-31 min). In all instances, the jejunal extension remained functional for the first 8 wk after placement, and there were no instances of aspiration of gastric contents while nutritional requirements were met. None of the patients died from complications of the procedure. The method described was effective in preventing aspiration of gastric contents, was easily performed, and was associated with minimal complications.

Enteral Nutrition↗
PubMed1991

Granulocytic sarcoma of the colon.

Granulocytic sarcoma is an extramedullary tumor consisting of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myelogenous leukemia, or acute myelogenous leukemia. This tumor may involve nodes, cervix, bone and periosteum, and infrequently the small intestine. Granulocytic sarcoma rarely occurs in the colon and has not been previously described endoscopically. We encountered a 73-year-old man with myelodysplastic syndrome who presented with fever, diarrhea, and abdominal pain. Colonoscopic evaluation (focal ulceration, friability, and nodularity) was compatible with Crohn's disease, although histology showed a dense myeloid cell infiltrate characteristic of granulocytic sarcoma. In patients with myelodysplastic syndrome or acute or chronic myelogenous leukemia presenting with diarrhea, abdominal pain, and/or fever, colonoscopy and biopsy are indicated to determine if the colon is affected by granulocytic sarcoma.

Aged↗