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Biomedical subjects

N Soehendra

Publications and source records attributed to N Soehendra.

At least 91 records · Page 5Linked to original sources
PubMed1995

Transpapillary and transmural drainage of pancreatic pseudocysts.

BACKGROUND: Endoscopic drainage of pseudocysts using the transpapillary and transmural approaches has been reported. We evaluated endoscopic drainage in 53 patients with symptomatic pancreatic pseudocysts in whom conservative management had failed. METHODS: After preliminary endoscopic retrograde pancreatography, transpapillary drainage was attempted in 33 patients with pseudocysts that communicated with the main pancreatic duct. Transmural drainage of pseudocysts in contact with the stomach or duodenal wall was attempted in the remaining 20 patients and in 4 patients selected for combined transpapillary and transmural drainage. The cause of pseudocysts was chronic pancreatitis in 92%. The median pseudocyst size was 7.0 cm (range, 2 to 16). RESULTS: Endoscopic drainage was technically successful in 50 patients (94%), of whom 47 had complete pseudocyst resolution. Complications occurred in 11% and included gallbladder puncture (n = 1) and bleeding (n = 2) after transmural drainage, and pancreatitis (n = 1) after transpapillary drainage; stent clogging resulted in abscess formation in 2 patients. Mean follow-up was 22 months (range, 1 to 70); pseudocysts recurred in 11 patients (23%), of whom 7 were successfully re-treated endoscopically. CONCLUSION: Both transpapillary and transmural pseudocyst drainage are highly effective in patients with pseudocysts demonstrating suitable anatomy for these endoscopic techniques.

Adult↗
PubMed1995

Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma.

BACKGROUND: Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas. METHODS: Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the esophagoprobe (features: diameter of 7.9 mm, bougie-shaped tip, no fiber optics, insertion over a guide wire). RESULTS: The esophagoprobe was successfully inserted past the stenosis without complication in all patients. Nine patients (10%) required preliminary bougienage to 33 F. The imaging quality was high and allowed for complete T and N staging in all patients. M staging was indeterminate in 15 patients because of inadequate visualization of the celiac axis region. Histopathologic correlation in 38 patients who underwent surgery showed an overall T stage accuracy rate of 89% (T2 = 80%, T3 = 95%, T4 = 87%), and N and M stage accuracies of 79% (N0 = 44%, N1 = 90%) and 91% (M0 = 94%, M1 = 75%), respectively. CONCLUSIONS: The esophagoprobe enables safe passage of highly stenosing esophageal carcinomas for TNM staging. Accuracy rates are similar to those reported for conventional echoendoscopes.

Adult↗
PubMed1995

Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results.

BACKGROUND AND STUDY AIMS: Endoscopic pancreatic stent drainage has been reported to relieve pain due to chronic pancreatitis in patients with ductal outflow obstruction. However, data regarding the long-term results, as presented here, have hitherto been lacking. PATIENTS AND METHODS: Over a nine-year period, 93 patients (65 males, mean age 49 years) with narcotic-dependent pain due to chronic pancreatitis and with a dominant pancreatic duct stricture visualized by endoscopic retrograde cholangiopancreatography (ERCP), were treated by stent drainage. The duration of pain prior to treatment averaged 5.6 years. The stents were exchanged according to symptoms, and removed if the stricture was judged to be adequately dilated after stenting. RESULTS: Sixty-nine patients (74%) reported complete (n = 46) or partial (n = 23) pain relief at six months. In this group of "early responders", 60 patients experienced sustained improvement during a mean follow-up of 4.9 years (nine had recurrent pain after a mean of 1.2 years). Stents were removed in 49 patients after a mean of 15.7 months; during a mean follow-up of 3.8 years, 36 patients remained pain-free, and 13 had a relapse of pain (11 were retreated by endoscopic drainage and subsequently became pain-free). Complications seen included mild pancreatitis (n = 4) and abscess formation secondary to stent clogging (n = 2). Most patients experienced a regression of the ductal dilation after stenting. CONCLUSION: In selected patients, early responders to pancreatic stent drainage are likely to benefit over the long term. Stent removal after stricture dilation may be associated with continued pain relief.

Adult↗
PubMed1995

H. Joachim Burhenne Lecture. Common areas of interest between interventional biliary radiology and endoscopy.

Therapeutic biliary endoscopy is a more recent subspecialty than interventional biliary radiology, and much has been learned from the pioneering work of interventional radiologists. The areas of interest to biliary radiologists and biliary endoscopists are largely identical. The common bile duct can be approached either by the antegrade percutaneous transhepatic approach or by the retrograde endoscopic transpapillary route. In most cases, endoscopy is the treatment of choice because of its lower risk. A new era in therapeutic endoscopy began with the invention of endoscopic papillotomy in 1973 by Classen and Demling in Germany [1] and Kawai et al. in Japan [2]. This technique made access to the hepatobiliary and pancreatic ductal systems possible, and endoscopic papillotomy has replaced choledochotomy for the treatment of bile duct stones in many centers. Endoscopic or radiologic treatment can entirely replace surgical management. The radiologic approach is advantageous via the endoscopic route when a patient has residual stones in a T tube or intrahepatic stones that lie proximal to a stricture. For patients who have had abdominal surgery and in whom access to the papilla is sometimes impossible because of a long afferent jejunal loop, radiologic therapy is suitable. They also can be treated by the rendezvous approach, whereby the radiologist feeds a guidewire through the papilla into the duodenum and the endoscopist then accesses the bile duct in a retrograde fashion. Calculous disease and ductal stenoses are the main indications for endoscopic therapy; these and other conditions of the biliary tract will be discussed here.

Biliary Tract Diseases↗
PubMed1995

[Occlusive jaundiced caused by liver metastases. Results of endoscopic surgical treatment].

The results of endoscopic drainage treatment in 69 patients with metastases of the liver have been analyzed for the period from 1982 to 1992. Fifty-five patients had follow-up. Criteria for inclusion were: positive diagnosis of liver metastases, jaundice, and primary origin of tumors distant from the pancreaticobiliary system ("distant" primary). Localisations of metastic obstructions were: hilum of the liver (n = 24), commonbile duct (n = 16), and prepapillary region (n = 15). Treatment was performed by transpapillary applications of one or more (n = 3) pig-tail or Tannenbaum stents. Concentrations of mean serum bilirubin could be reduced from 14.5% to 8.8 mg%, 16 patients reached a normal level (less than 1.0 mg%). The median survival time was 76 days ranging vom 4 to 299 days. The most frequent complication was cholangitis in 29% of the cases with mortality in 6 patients. Patients less than 60 years of age and with obstructions in the mid commonbile duct gained most by this kind of treatment. Results were poor in elderly patients with hilar stenosis. Selected patients with known liver metastases may benefit from endoscopic treatment of jaundice.

Adult↗
PubMed1995

The Tannenbaum stent: a new plastic biliary stent without side holes.

OBJECTIVE: Clogging of plastic biliary stents used in malignant biliary obstruction remains a major problem. In vitro studies have shown that side holes, a standard feature of commercially available stents, may contribute to stent clogging. In a pilot study, we designed and prospectively evaluated a new biliary stent without side holes (Tannenbaum stent). METHODS: Over a 12-month period, 55 consecutive patients (mean age 75 yr) with malignant distal common bile duct obstruction and without papillary or duodenal tumor infiltration underwent endoscopic placement of the Tannenbaum stent for the palliative treatment of jaundice. RESULTS: Tannenbaum stent insertion was technically successful on the first attempt in all patients and was accompanied by a significant reduction in mean serum bilirubin levels (10.1-1.6 mg%). Fifty-one patients were followed until death (median survival of 130 days); the symptomatic occlusion rate was 16%, the dislocation rate was 8%, and the median stent patency was 64 wk. Aside from stent clogging, there were no complications. CONCLUSION: The Tannenbaum stent provided effective palliative biliary decompression in all patients. The patency rate was longer than that reported in the literature for conventional plastic stents with side holes and compared favorably with patency rates that have been reported for the metallic expandable biliary stents. The results of this pilot study are encouraging and warrant further studies.

Aged↗
PubMed1995

[Pancreatic pseudocysts: how and when should they be drained?].

Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 50% were of lasting success. The authors' approach is explained with a review of the literature on various drainage techniques. We consider the puncture of a pseudocyst justified only on clinical grounds: the patient's complaints rather than morphological criteria lead to the decision to perform a drainage procedure. Obligatory in the therapeutic concept are ERCP and endosonography. Visualization of a pancreatico-cystic communication leads to the attempt of transpapillary drainage as the therapy of choice. Visualization of anatomic details, namely vessels, lowers the risk of punctures. Direct punctures even in difficult anatomical conditions can be attempted under direct endosonographic control. In our hands, drainage of pseudocysts is a part of the endoscopic treatment concept for chronic pancreatitis and is generally preferred to surgical techniques.

Adult↗
PubMed1995

[Endoscopic therapy in chronic pancreatitis].

In chronic pancreatitis obstruction of the pancreatic ductal system by strictures, stones or pseudocysts seems to play an important part in pathogenesis. Therefore, therapeutic efforts are directed mainly towards reestablishing a free flow of pancreatic secretion. Endoscopic techniques allow decompression of the organ by stenting or stone extraction, as well as evacuation and drainage of pseudocysts. Thus, interventional endoscopy offers safe and long lasting therapy for many patients suffering from chronic pancreatitis. This paper gives a review of the literature and reports on own clinical data.

Calculi↗
PubMed1995

Endoscopic ultrasonography in the diagnosis and treatment of pancreatic pseudocysts.

This article reviews the current diagnostic and therapeutic modalities used in pseudocyst drainage and possible contributions of endoscopic ultrasound to this process. The authors conclude that EUS should improve the ability to reliably differentiate pseudocysts from cystic neoplasms and are excited about the new development that proposes to combine therapy with diagnosis.

Drainage↗
PubMed1994

Prolonged patency with a new-design Teflon biliary prosthesis.

Clogging of biliary endoprosthesis has been a persistent problem faced by endoscopists over many years. Evidence suggests that incorporating sideholes increases the risk of plastic stents clogging. We conducted a prospective, nonrandomized study comparing 10 Fr Teflon pigtail (PT) stents with sideholes to a new design 10Fr Teflon straight stent without sideholes, designated as the "Tannenbaum" (TB) stent. Seventy-four consecutive patients were treated with the PT stent and 55 consecutive patients with the TB stent in two different periods. All patients had malignant distal biliary obstruction with jaundice. Stent insertion was successful in all patients, and a significant reduction in serum bilirubin levels was achieved. All follow-up patients, except one in the TB group, had died at the time of reporting. Median survival in the PT group was 100 days (range: 6-636 days) and 130 days (range: 3-703 days) in the TB group. Median follow-up in the PT group was 104 days (range: 6-636 days) and 141 days (range: 3-537 days) in the TB group. Statistical analysis shows significantly longer patency for the TB stent (p < 0.02). Moreover, the results of the TB stent compared favorably with the published results of metallic self-expandable biliary stents. We believe the TB stent holds great promise for the future of endoscopic biliary stenting. Prospective randomized studies comparing the TB stent with existing plastic and metal stents are, however, necessary.

Aged↗
PubMed1994

Improved endoscopic management of severe upper gastrointestinal hemorrhage using a new wide-channel endoscope.

Problems in emergency endoscopy for upper gastrointestinal bleeding may arise due to blood and food debris preventing proper endoscopic vision and orientation. We present here a new big channel endoscope with a 6 mm suction and drainage channel that achieved complete evacuation of stomach contents in 122 of 123 patients with upper gastrointestinal bleeding, in whom complete gastric cleaning and identification of the bleeding source had proved impossible using standard endoscopes. Gastric emptying using the big-channel endoscope was possible within five minutes in all successful cases. Optimal conditions for therapeutic procedures were therefore provided. The size of the instrumentation channel may open up new indications also for non-emergency endoscopic diagnosis and treatment.

Adult↗
PubMed1994

Prophylactic sclerotherapy for esophageal varices: long-term results of a prospective study.

Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal hemorrhage have given controversial results. We continued a previously reported study and randomly assigned 141 patients with esophageal varices and no prior gastrointestinal bleeding to either prophylactic sclerotherapy (n = 70) or no treatment (n = 71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrent varices were treated with repeat sclerotherapy. The groups were well balanced in terms of demographic and clinical characteristics. Patients in both groups who bled from varices received sclerotherapy whenever possible. During a median follow-up of 56 months, variceal bleeding occurred in 7% in sclerotherapy patients and 44% of control patients (p < 0.01). In the sclerotherapy group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate increased with the severity of liver function impairment. Sclerotherapy was not found to improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or nonalcoholic) or variceal size (low-grade or high-grade). We conclude that sclerotherapy is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does not appear to have an effect on survival.

Adult↗