Duodenal nodular lymphoid hyperplasia caused by giardiasis infection in a patient who is immunodeficient.
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Adult↗
Biomedical subjects
Nib Soehendra
Publications and source records attributed to Nib Soehendra.
A new radial mechanical puncture echoendoscope: prospective comparison with standard linear and radial echoendoscopes in assessment of focal pancreatic lesions.
BACKGROUND: A new mechanical puncture-echoendoscope was evaluated by comparing it with conventional linear and radial echoendoscopes. The new instrument has a 300 degrees image field parallel to the axis of the echoendoscope, which could potentially improve accuracy and facilitate assessment of suspected pancreatic lesions before needle puncture. METHODS: Twenty consecutive patients with suspected pancreatic lesions were evaluated endosonographically, including fine needle aspiration (FNA). The initial assessment was performed by random selection of either the new instrument or the standard linear echoendoscope. After completing the assessment including FNA, the procedure with FNA was repeated with the other puncture echoendoscope. The findings with these 2 instruments were compared to those with the conventional radial scanning echoendoscope. RESULTS: FNA was performed in 17 patients with pancreatic head lesions. In 3 patients without a visible pancreatic mass lymph, nodes greater than 10 mm in diameter were aspirated. The ability to image the needle, number of punctures, and material obtained were comparable for both puncture echoendoscopes. There were no significant differences with regard to time required for FNA with both puncture echoendoscopes or in the assessment of surrounding structures with all 3 instruments. The results of cytopathologic evaluation of material obtained by FNA were similar in 15 cases. The new instrument could not be passed into the esophagus in 1 patient because of an esophageal stricture. CONCLUSIONS: The performance of the new mechanical puncture echoendoscope was satisfactory for assessment and FNA of pancreatic lesions. The additional use of the conventional radial scanning echoendoscope provided no advantage with regard to any parameter assessed.
Adult↗
Endoscopic treatment of biliary leakage with n-butyl-2 cyanoacrylate.
BACKGROUND: Biliary leakage is a problematic complication of hepatobiliary surgery. A novel alternative method is described that can obviate the need for reoperation for refractory biliary fistula. METHODS: Nine patients with large biliary leaks unresponsive to endoscopic drainage underwent N-butyl-2-cyanoacrylate glue occlusion at ERCP. RESULTS: In 7 patients, occlusion was successful with prompt control of the fistula in a single session, averting reoperation. In 1 patient there was a partial response and in another the treatment was unsuccessful. No procedure-related complication occurred over a median follow-up of 35 months (range: 1.6-160 months). CONCLUSION: N-butyl-2-cyanoacrylate glue occlusion is a safe and effective endoscopic method for control of refractory bile leaks that eliminates the need for surgical reintervention.
Adolescent↗
Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis.
OBJECTIVES: The clinical value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic lesions is uncertain in patients with normal parenchyma and chronic pancreatitis. The aim of this study was to analyze the diagnostic yield and influence of EUS-FNA on the clinical management of patients with pancreatic lesions, in the presence (CP) or absence (NP) of chronic pancreatitis. METHODS: A total of 207 consecutive patients with NP (n = 133) and CP (n = 74) were examined using linear array echo endoscopes for the procedure and 22-gauge needles. RESULTS: Adequate specimens were obtained from 200 lesions. A correct final diagnosis was established at histology (n = 108), bacteriology (n = 9), and clinical follow-up (n = 83). Cytology gave 17 false-negative EUS-FNA results (overall sensitivity: 85%). In patients with NP, 60 solid adenocarcinomas were detected, 32 other malignancies, and 38 benign lesions, with 11 false-negative results (sensitivity: 89%). In patients with CP, only seven of 13 malignancies (all solid adenocarcinomas) were identified using FNA (sensitivity: 54%). Overall, malignancy was identified in 116 patients, 32 of whom (27%) had lesions other than primary solid adenocarcinomas. Management was altered in 25 of these patients, which changed the surgical approach in 21%. EUS-FNA influenced the therapeutic approach in 44% of the total patient group. CONCLUSIONS: EUS-FNA was especially useful in patients with a focal pancreatic lesion with normal parenchyma. Its sensitivity in patients with CP was unacceptably low, and resection of the tumor using standard surgical techniques was still usually required to confirm the correct diagnosis. Diagnostic EUS-FNA influenced clinical management in nearly half of patients.
Adult↗
Endoscopic dilation of esophageal stricture without fluoroscopy is safe and effective.
AIM: Endoscopic dilation of esophageal strictures is a commonly performed procedure in the management of dysphagia. The procedure is usually done with fluoroscopic guidance. The aim of this study was to assess the use of Tracer guide wire in conjunction with Savary-Gilliard dilators in the dilation of tight esophageal strictures without fluoroscopy. METHODS: Fifty-five patients with significant dysphagia from strictures due to a variety of causes were dilated endoscopically. The procedure consisted of two parts. First, a guidewire was passed using endoscopic guidance, and then, dilation was performed without fluoroscopy. A modified Tracer wire was employed and was particularly effective in negotiating very tight esophageal strictures, in which the lumen is less than 6 mm. In general, the "Rule of Three" and "2-3 sessions in 10 days, maximum dilation up to 42 French" rules were followed. 401 dilations in a total of 55 patients(malignant strictures 30, benign 25) in 177 sessions were carried out. RESULTS: The guide wire placement and Savary-Gilliard dilation were successfully performed without fluoroscopy, and improvement of dysphagia was achieved in all patients. Esophageal plastic stent (out diameter 40 French) was placed in five patients with malignant stricture-three of them with tracheo-esophageal fistula. CONCLUSION: Dilation using Tracer guide wire without fluoroscopy is safe and effective in treatment of even very tight esophageal strictures.
Adolescent↗
Endoscopy: current state and future trends in tumor diagnosis.
Gastrointestinal endoscopy has been significantly improved during the last decade. Tumors of less than 5 mm in diameter can now be detected by using high-resolution videoendoscopes. Additional in vivo staining allows better delineation and more precise identification of the lateral spreading of lesions. Today the missing of cancers in early stage is mainly due to lack of screening programs rather than technical limitations. Endoscopic mucosal resection of superficial lesions is primarily a diagnostic procedure to determine the need for surgery. However, it may be curative when histology proves a complete resection. Swallowable endoscopy capsules provide access to the entire small bowel. The capsule takes 2 images/second and transmits them to a recorder. After passage of the small bowel the 50,000 recorded images are reviewed on a computer. The capsule should not be used in patients with suspected intestinal stenosis. Endoscopic ultrasound (EUS) is an established procedure for the T- and N-staging of gastrointestinal tumors. With an accuracy rate of around 90%, this method is helpful for the therapeutic decision e.g. indication for operation. EUS cannot distinguish benign from malignant changes, particularly in focal pancreatic lesions. However, this drawback can be reduced with EUS-guided fine-needle aspiration cytology of the primary lesion or an accessible lymph node. At 7.5-20 MHz the gastrointestinal wall is visualized in 5 and more layers allowing for detailed staging of T1 tumors. 3D-EUS resolution is described to be better than 100 microns. Optical coherence tomography (OCT) with a resolution of 10-20 microns demonstrates tissue micro-architecture. Structures only seen in histology before are visualized real-time in vivo during endoscopy. However, the infiltration depth is only 1 mm and the method is still in the clinical experimental stage. Confocal microscopy has been recently adapted for endoscopy. Images from the first clinical evaluations already show single cells and nuclei. Cellular characteristics become visible and endoscopy is on the way towards optical biopsy.
Endoscopy, Gastrointestinal↗