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Biomedical subjects

N Soehendra

Publications and source records attributed to N Soehendra.

232 records · Page 13Linked to original sources
PubMedDate not supplied

Malignant jaundice: results of diagnostic and therapeutic endoscopy.

Direct cholangiography plays an important role in the diagnosis of malignant obstructive jaundice. Endoscopic retrograde cholangiopancreatography is gradually gaining ground over percutaneous transhepatic cholangiography. Endoscopy can determine the exact location and extent of the obstruction. Typical changes of the ducts are often helpful in interpreting the causes of obstructive jaundice. Representation of the bile and pancreatic duct systems is successful in 95% of cases in the hands of an expert. Acute pancreatitis is a complication occurring in about 1% of cases. Immediate drainage can usually prevent septic complications. Endoscopic drainage is a palliative measure for inoperable patients. Compared to biliodigestive anastomoses, catheters are subject to clogging in the less-risky, nonsurgical method. Blockage causes late cholangitis which can only be recognized and remedied by regular after-care of the patient. Endoscopic placement of the prosthesis has an 85% rate of success. The rate of complications related to the procedure is 2%. The mortality rate is 1%.

Adolescent↗
PubMedDate not supplied

Endoscopic therapy for biliary obstruction.

Endoscopic management of biliary obstruction is feasible in most patients and has emerged as standard treatment. Aside from the removal of bile duct stones, placement of a biliary stent is the most commonly employed modality of management. In experienced hands, this is successful in over 90% of patients. Lower procedure-related complications and the relative non-invasive nature of endoscopic treatment has relegated surgical management to a subsidiary role. Hospitalization time rarely exceeds 1-2 days. In most patients with advanced malignant disease and short life expectancy, stenting affords effective palliation. For the majority of patients endoscopic management is preferable to the percutaneous transhepatic approach due to lower overall mortality and morbidity. Stent occlusion necessitating replacement remains a problem, but improvements in this area can be expected. New plastic stent designs are undergoing investigation. Expandable metallic stents are promising but controlled comparative trials with conventional plastic prostheses are needed. Use of expandable stents should be judicious since these cannot be removed. In the future we can look forward to advances in peroral cholangioscopic technology which may permit targeted treatment of intraductal biliary malignancies.

Biliary Tract Neoplasms↗
PubMedDate not supplied

Endoscopic snare excision of benign adenomas of the papilla of Vater.

Over a 5-year period (1985 to 1990), 25 patients (11 men and 14 women, median age 68) with adenomatous tumors of the papilla of Vater judged to be benign by endoscopic appearance and forceps biopsy were included in this study. All patients had de novo tumors except for two patients who had recurrent adenomas after local surgical excision. Presenting symptoms included pain (19 patients), jaundice (9 patients), and pancreatitis (4 patients). ERCP showed bile and pancreatic duct dilation in 20 patients (6 with stones) and 2 patients, respectively. The adenoma and the papilla of Vater were excised using a standard polypectomy snare (snare papillectomy). Procedure-related complications included bleeding in two patients and acute pancreatitis in three patients. No deaths occurred. Histologic analysis showed benign adenoma with mild to moderate dysplasia in 18 patients and severe dysplasia in 1 patient. Two patients with evidence for intraductal tumor extension on ERCP were referred for surgery. Six patients had recurrences at a median follow-up of 37 months (range, 7 to 79 months), of whom one had intraductal tumor spread and underwent pancreatoduodenectomy. Five patients were re-treated endoscopically; one ultimately required surgery.

Adenoma↗
PubMedDate not supplied

Endoscopic treatment of Mirizzi's syndrome.

Electrohydraulic lithotripsy has been shown to be an effective non-surgical treatment for common bile duct and intrahepatic duct stones. This technique was applied via the endoscopic retrograde route in 14 patients (mean age, 70) with the Mirizzi syndrome, all of whom were at high risk for surgery. The procedure was performed under strict cholangioscopic guidance. Twelve patients had a single stone and two had multiple stones impacted in the cystic duct. Stone diameter was 1.5 cm in one patient, 2 to 3 cm in nine patients, and greater than 3 cm in four patients. Insertion of the babyscope and stone fragmentation were successful in all patients. Complete stone clearance required one session in 12 patients and two sessions in two patients (both with multiple stones). In one patient post-procedural leakage of contrast medium from the cystic duct into the peritoneal cavity was noted. This was attributed to pressure necrosis induced by the impacted stone. The patient had an uneventful course of recovery, and leakage resolved with conservative management. Mortality was zero. Endoscopic treatment of the Mirizzi syndrome with electrohydraulic lithotripsy seems to be an effective and relatively safe alternative to surgery.

Adult↗
PubMedDate not supplied

Asymptomatic esophageal varices should be endoscopically treated.

Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

Cost-Benefit Analysis↗