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N Soehendra

Publications and source records attributed to N Soehendra.

At least 73 records · Page 4Linked to original sources
PubMed1998

Endoscopic management of huge bezoars.

BACKGROUND AND STUDY AIMS: After the first gastroscopic removal of a bezoar by McKechne in 1972, different endoscopic methods have been reported including a water jet, forceps, snare, and basket. Huge and solid bezoars, however, are still a problem. We report on our experience in fragmenting huge, solid bezoars using a modified needle-knife (bezotome) and a modified mechanical lithotriptor (bezotriptor). PATIENTS AND METHODS: Over a period of 14 months (October 1994 to December 1995), a total of 15 patients (ten male, five female, median age 41 years) with 17 gastric bezoars and one esophageal bezoar, treated endoscopically, were included in the study. A monopolar diathermy knife with a 15 mm needle (bezotome) was used for trichobezoars. For diospyrobezoars we need a bezotriptor. RESULTS: All 18 bezoars, from 4 x 3 x 3 cm to 10 x 8 x 8 cm in size, were successfully fragmented, ten in one session and eight in two sessions. Complete clearance of the upper digestive tract was achieved at the latest three days after the treatment. There were no complications. CONCLUSIONS: Bezotome and bezotriptor are useful endoscopic devices to disintegrate huge, hard bezoars and achieve complete clearance.

Adolescent↗
PubMed1998

Improved endoscopic stenting for malignant dysphagia using Tygon plastic prostheses.

BACKGROUND AND STUDY AIMS: Endoscopic palliative treatment of malignant esophageal stenosis using conventional plastic stents has been reported to be associated with a considerable risk of perforation. Stenoses with a distance of less than 2cm from the upper esophageal sphincter (UES) have generally been excluded from treatment. Using self-expandable metal stents, procedure-related complications are rare. However, the rates of late complications necessitating retreatment appear to be as high as those of plastic stents. This study describes our stent placement technique and our results using a modified Tygon plastic stent. PATIENTS AND METHODS: Over a two-year period, 71 consecutive patients with incurable malignant esophageal stenosis were prospectively studied. Tygon plastic stents of diameter 9-14 mm were individually tailored according to length and location of the stenosis. Prior to stenting, stepwise bougienage was performed, if necessary over several sessions. After endoscopic placement of a guide wire, the stent was inserted over a bougie without fluoroscopic monitoring. RESULTS: A total of 71 patients (54 men and 17 women, median age 69, range 34-93), were treated with Tygon plastic stents (14 mm: 19 patients; 12 mm: 50 patients; 9 mm: 2 patients). Median length of the strictures and of the stents were 7 (range 2-18) and 10 (range 6-25) cm, respectively. Four patients had an associated esophago-respiratory fistula. After a median of 2 (range 1-5) bougienage sessions, stent insertion was technically successful in all patients. Forty-one stents were placed across the cardia, 13 were positioned 0.5-1 cm below the UES. Three patients had to undergo retreatment within 24 hours because of pain or stent migration and the stents were repositioned or exchanged. No procedure-related perforation, hemorrhage or respiratory problems were observed. During a median follow-up of 63 (range 2-388) days, 82% of the patients died. Improvement or stabilization of dysphagia allowing for oral nutrition could be achieved in 89%. Dislocation occurred in eight patients, bolus obstruction in five patients and tumor overgrowth in four patients. Three of the four fistulas could be covered by the stent. In one patient with a fistula located at the level of the UES, a stent was placed but migrated after 5 days. Overall, 27 patients (38%) required reinterventions, mainly for dysphagia or nutritional problems. CONCLUSIONS: In our experience, Tygon plastic stents with a diameter of 9-14 mm can be safely placed after stepwise, less extensive bougienage. Effective palliation is possible even for lesions located close to the UES. Perforation can be avoided. Reintervention rates seem to be comparable to those seen with self-expanding metal stents.

Aged↗
PubMed1998

Endoscopic therapy of pancreatic strictures.

Over the past decade, endoscopic therapy has been increasingly used as a less invasive alternative to surgery for the treatment of pancreatic duct strictures. The therapeutic goal has been the palliative relief of severe pain associated with chronic pancreatitis. Studies from several centers have shown that endoscopic stenting results in pain relief for a high percentage of patients. Future investigation needs to focus on the refinement and standardization of basic techniques, and different strategies need to be compared in well-designed trials.

Catheterization↗
PubMed1997

[Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study].

Drainage and resection are the principles of surgery in chronic pancreatitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Beger and Frey combine both to different degrees. In a prospective randomized trial both procedures were compared: 74 patients were randomly allocated to either Beger's (n = 38) or Frey's, (n = 36) group. In addition to routine pancreatic diagnostic work-up a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Assessment of endocrine and exocrine function included oral glucose tolerance test, serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl test. The mean interval between symptoms and surgery was 5.1 years (1-12 years). The median follow-up was 30 months. There was no mortality. Overall morbidity was 27% (32% Beger, 22% Frey). Complications from adjacent organs were definitively resolved in 91% (92% Beger, 91% Frey). A decrease in pain score of 95% and 93% after Beger's and Frey's procedure, respectively, and an increase of 67% in the overall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between the two groups. Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and control of complications affecting adjacent organs. Neither procedure leads to further deterioration of endocrine and exocrine pancreatic function.

Adult↗
PubMed1997

Is sclerotherapy out?

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed1997

Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer.

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection of early esophageal cancer has increasingly proved to be an effective treatment modality, especially if the tumor has not invaded the muscularis mucosae. Different techniques have been introduced, using an overtube, double-channel endoscope, or suction cap. We have not found that these devices are required for snare resection in the esophagus. PATIENTS AND METHODS: Over a period of two years (1994-1996), seven patients (five men and two women, age range 59-88) with early esophageal cancer defined by endosonography (3 cm or less in size, limited to the submucosal layer) were treated using a simplified technique of endoscopic snare resection using a monopolar diathermic polypectomy snare made of monofilament steel wire. The snare was positioned around the lesion, and then closed while pressing the snare against the mucosa and applying suction to draw the lesion into the snare. Pure coagulation current was used for resection. If necessary, a piecemeal technique was used to achieve complete removal. RESULTS: Complete removal was achieved in one session in all seven cases. No complications were observed. Two patients underwent radical surgery with no tumor remnant or metastatic lymph node in the resected specimen. All patients have remained free of recurrence during a median follow-up period of seven months (range 3-22 months). Two patients died of cardiovascular disease four and eight months after endoscopic mucosal resection. CONCLUSION: Small early esophageal cancer can be safely removed with a simplified method of endoscopic snare resection using a standard monofilament polypectomy snare.

Adenocarcinoma↗
PubMed1997

Endosonography-guided fine-needle biopsy of indurated pancreatic lesions using an automated biopsy device.

BACKGROUND AND STUDY AIMS: We have designed and evaluated a prototype automated spring-loaded biopsy needle for endoscopic ultrasonography (EUS)-guided tissue sampling of indurated lesions in which sampling using conventional aspiration needles has failed. PATIENTS AND METHODS: EUS-guided fine-needle biopsy using the new device was performed in four patients (two men, two women, mean age 65 years) with indurated pancreatic lesions that could not be penetrated with a conventional manually operated aspiration needle. The lesions were located in the head of the pancreas in two patients, in the genu in one, and in the body in one. RESULTS: The automatic biopsy needle allowed penetration of the pancreatic lesions in all cases. The biopsy route was transduodenal in two patients, and transgastric in the other two. The biopsies provided a core specimen for histological and cytological diagnosis in all cases. No complications occurred. CONCLUSION: The spring-loaded biopsy needle allows tissue sampling of indurated pancreatic lesions that cannot be penetrated with conventional aspiration needles. Further studies are warranted to determine whether this device can improve the results of EUS-guided fine-needle aspiration biopsy.

Adenocarcinoma↗
PubMed1997

Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis.

BACKGROUND: In chronic pancreatitis, compression of the splenic vein and superior mesenteric vein (SMV) by an inflammatory mass may cause segmental portal hypertension. Drainage and resection are the principles of surgery for chronic pancreatitis. This study was devised to evaluate the effect of drainage and resection on venous splanchnic blood flow in patients with non-occlusive segmental portal hypertension. METHODS: In 14 of 30 patients with chronic pancreatitis predominantly involving the pancreatic head, segmental portal hypertension due to compression of the splenic vein and SMV was detected by means of indirect splenomesentericoportography and Doppler ultrasonography. None of these 14 patients had symptomatic gastric fundic varices. They were allocated randomly to surgical drainage or resection. Median follow-up was 30 (range 12-48) months. RESULTS: In the resection group, mean(s.d.) splenic vein blood flow increased from 316(46) ml/min before operation to 396(57) ml/min at follow-up (P < 0.01). In the drainage group, preoperative splenic vein blood flow (318(37) ml/min) was not increased after operation (322(37) ml/min). Mean(s.d.) SMV flow increased from 292(42) ml/min before operation to 436(64) ml/min at follow-up (P < 0.01) in the resection group. In the drainage group mean(s.d.) SMV blood flow was 296(32) ml/min before operation and 314(34) ml/min at follow-up. No patient developed fundic gastric varices during follow-up. CONCLUSION: In non-occlusive segmental portal hypertension due to chronic pancreatitis, resection, but not drainage, restores normal venous splanchnic blood flow.

Adult↗
PubMed1997

[Endoscopic prosthesis implantation in stenoses and fistulas of the proximal cervical esophagus].

Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for esophageal carcinoma. However, the treatment of high cervical tumors using commercially available plastic prostheses is problematic. We modified the design and implantation techniques of the Celestin prosthesis to accommodate high cervical tumors and report our results in 38 patients. Over a 7 year period 42 modified Celestin prostheses were implanted in 38 patients with high cervical esophageal tumors. 15 had stenosis only, 22 had a stenosis and fistula, and one had a fistula without stenosis. Graduated bouginage up to 38 Fr or 42 Fr for large prostheses was performed prior to stent placement in an average of 2.3 sessions. There were no procedure-related complications. Only in one case the prosthesis had to be withdrawn after reimplantation because of intolerable painful foreign body sensation. Improvement of dysphagia was achieved in 34 patients. The fistulas could be adequately bridged and sealed in 17 of 23 patients. Prostheses migrated in 11 cases (proximally, n = 6; distally, n = 5). Mean patient survival in 28 patients followed until death was 86 days (range 5-338 days).

Adult↗
PubMed1997

Nonvariceal upper gastrointestinal bleeding. New and alternative hemostatic techniques.

In upper gastrointestinal bleeding, endoscopic management does reduce rates of rebleeding, surgery, and mortality. In active bleeding, however, early recurrence still occurs in around 20% despite successful initial hemostasis. Several new techniques or modifications of endoscopic hemostatic methods have been invented to improve the results. They include ligating devices, biological injection agents, argon plasma coagulation, and hemoclips. Hemoclips and injection therapy using fibrin glue do not cause relevant tissue damage and appear to have better results in terms of lower rebleeding rates. Fibrin glue seems to be effective only if injected repeatedly. Due to limited experience, no final conclusion can be made at this stage. Further clinical investigation is warranted.

Clinical Trials as Topic↗
PubMed1996

Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation.

BACKGROUND: Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation falls have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. PATIENTS AND METHODS: Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm. RESULTS: Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-pre-cut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (pre-cut, 2.4%, non-pre-cut, 3.9%; p > 0.05). CONCLUSION: Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.

Aged↗
PubMed1996

Endoscopic snare excision of "giant" colorectal polyps.

BACKGROUND: Endoscopic treatment of giant colorectal polyps remains controversial because of concerns regarding coexistent malignancy, incomplete resection, and safety. METHODS: We reviewed the clinical course after removal of 176 benign-appearing large (>3 cm) colorectal polyps, which were removed by endoscopic snare resection in 170 patients. These were termed "giant" polyps. Sessile polyps (n = 129) were removed piecemeal and pedunculated polyps (n = 47) transected at the stalk. RESULTS: Bleeding was the only complication in 24% of polypectomy procedures (procedural in 58, immediate in 3, delayed in 6 patients). Except for one conservatively treated delayed bleed, all bleeds were treated endoscopically. Histology of resected polyps showed coexistent malignancy in 12%. Eight patients had malignant polyps that met "unfavorable" criteria and underwent surgery. Following complete endoscopic resection, 16 patients were lost to follow-up and 124 patients had follow-up of at least 6 months (117 benign and 7 "favorable" malignant polyps). Nineteen patients with benign polyps developed recurrences (18 benign, 1 malignant); one patient with a favorable malignant polyp had a malignant recurrence and underwent surgery. CONCLUSION: Endoscopic resection of benign-appearing giant colorectal polyps is feasible and safe. Complete excision is possible in patients with benign and favorable malignant polyps, but recurrence rates are high. Close surveillance to detect and treat recurrence is required.

Adolescent↗
PubMed1996

A new guide wire papillotome for patients with Billroth II gastrectomy.

BACKGROUND AND STUDY AIMS: Guide wire-assisted papillotomy is a well-established technique in conventional biliary endoscopy, but has not been previously employed in Billroth II patients, due to the lack of an appropriate papillotome that can accommodate a guide wire. We therefore designed a Billroth II papillotome that can be inserted over a guide wire. PATIENTS AND METHODS: Over a 12-month period, 24 patients (18 males, six females, median age 72 years), who had previously undergone a Billroth II gastrectomy and who were referred to our department for therapeutic biliary endoscopic procedures, were included in this study. RESULTS: The papilla could be reached in 22 patients, but the procedure failed in two due to an excessively long afferent loop. Cannulation of the bile duct with the standard Billroth II papillotome was possible in 11 patients; the remaining 11 patients, in whom free cannulation failed, underwent cannulation over the guide wire. Diagnostic endoscopic retrograde cholangiography revealed bile duct stones in 17 patients, and malignant-appearing common bile duct stenoses in five patients. Papillotomy was successfully performed using the guide wire Billroth II papillotome in all patients, without complications. CONCLUSION: The Billroth II papillotome is effective and safe in patients in whom free cannulation has failed using the standard Billroth II papillotome.

Aged↗
PubMed1996

[Therapy splitting: are intra-operative cholangiography and surgical bile duct revision still indicated?].

The role of therapeutic splitting in cases of cholecystolithiasis and choledocholithiasis has to be reviewed since laparoscopic bile duct exploration might be an alternative. To assess the need of the new approach we evaluated our results of the therapeutic splitting. Between 1988-1992 a cholecystectomy was performed in 577 cases either as an open (n = 274) or laparoscopic (n = 277) procedure. Pre- or postoperative endoscopic retrograde cholangiopancreatography (ERC/P) was performed if the clinical presentation, laboratory findings or ultrasound showed signs of choledocholithiasis. In the laparoscopic cases no intraoperative cholangiography was carried out. The patient follow-up was evaluated by a questionnaire. 128 patients were suggested to have a common bile duct (CBD) stone and had a preoperative ERC/P. In 68 cases stones were extracted. After cholecystectomy 19 ERC/P's were performed. In 4 patients residual stones after preoperative ERC/P were detected. So far occult stones were found in 5 cases. Intraoperative cholangiography was performed additionally in the patients with open cholecystectomy n = 207¿, of whom two demonstrated choledocholithiasis. Endoscopic clearance of the common bile duct was achieved in all patients. Minor complications occurred after ERC/P in 1.5%. Within a median follow-up time of 48 months patients with endoscopic papillotomy did not develop further CBD stones or a cholangitis. The therapeutical splitting facilitates in all patients with cholecysto- or choledocholithiasis a successful clearance of the CBD. Intraoperative cholangiography is not necessary according to our experience. With an experienced endoscopic team the therapeutic splitting should be the preferred treatment modality compared to the laparoscopic bile duct exploration, which will probably lead to a high complication rate if performed outside specialized centers.

Adolescent↗
PubMed1996

Frontiers of biliary endoscopy.

Endoscopic techniques have contributed considerably in the diagnosis and management of patients with biliary problems. Several challenges remain. Techniques can certainly be improved to facilitate procedures and to reduce their risk. The main challenges now are to evaluate outcomes more objectively and to develop the interface between endoscopy and other related techniques, particularly radiology and surgery. State-of-the-art patient management demands a multidisciplinary team approach. None of these techniques can be applied appropriately and optimally without adequate specialist training.

Biliary Tract Diseases↗