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Biomedical subjects

Todd H Baron

Publications and source records attributed to Todd H Baron.

At least 19 recordsLinked to original sources
PubMed2003

Percutaneous endoscopic cecostomy: a case series.

BACKGROUND: There are few reports of percutaneous endoscopic cecostomy in adult patients. METHODS: All cases of acute colonic pseudo-obstruction (n = 2) and neurogenic bowel (n = 3) in adults in which percutaneous endoscopic cecostomy was performed were reviewed retrospectively. OBSERVATIONS: Percutaneous endoscopic cecostomy was a definitive treatment. In 1 of the 2 patients with acute colonic pseudo-obstruction, the percutaneous endoscopic cecostomy tube was clamped and subsequently removed 10 weeks after placement; in the other patient with acute colonic pseudo-obstruction, the percutaneous endoscopic cecostomy tube remains in place. In 2 of the 3 patients with neurogenic bowel, the percutaneous endoscopic cecostomy tube continues to function well; the third patient did well for 6 months and then died of underlying comorbid disease. There was no mortality or need for surgical intervention for any patient. Complications occurred in 2 patients; 1 developed transient fever and leukocytosis and 1 had self-limited bleeding during anticoagulation. CONCLUSIONS: Percutaneous endoscopic cecostomy is a safe and effective treatment for both acute colonic pseudo-obstruction and neurogenic bowel when aggressive albeit conservative treatment is unsuccessful.

Acute Disease↗
PubMed2003

Development of a swine model for benign stenosis of the bile duct by endoscopic application of intraluminal thermal injury.

BACKGROUND: A simple animal model is desirable for the study of endoscopic therapies used in the management of biliary strictures. The aim of this study was to identify a method for inducing benign biliary stenoses in a porcine model by using endoscopic techniques. METHODS: Endoscopic retrograde cholangiography was performed in 9 swine. Intraluminal injury was applied to the common hepatic duct with graded applications of either a heat probe or a multipolar probe. Cholangiography was repeated at 7-day intervals. If a stricture was not identified by 28 days, injury was created at another site in the common hepatic duct by using a higher energy dose. After a stricture was identified, the animal was killed and bile duct samples were obtained for histopathologic evaluation. RESULTS: Thirteen thermal injuries were created in the 9 animals. Six of 7 heat probe treatments and 1 of 6 multipolar probe treatments resulted in a stricture (p = 0.025, Fisher exact test). Applications of the heat probe at 10 or 15 J produced a stricture in 6 of 6 cases. All strictures were indistinguishable histopathologically from benign strictures in humans. CONCLUSIONS: The application of intraluminal thermal injury with a heat probe results in a reproducible animal model of benign biliary stenosis.

Animals↗
PubMed2003

Impact on patient outcomes of experience in the performance of endoscopic pancreatic fluid collection drainage.

BACKGROUND: Much attention has been focused on the competence to perform endoscopic procedures. The aim of this study was to determine the impact of procedure experience on patient outcomes after endoscopic pancreatic fluid collection drainage. METHODS: Outcomes for consecutive patients with symptoms from pancreatic fluid collections who were referred for endoscopic transmural and/or transpapillary drainage were analyzed retrospectively. Collections were classified as acute pseudocyst, chronic pseudocyst, and pancreatic necrosis. To assess the impact of endoscopist experience, outcomes for patients who underwent the first 20 procedures were compared with those for patients who had subsequent procedures. RESULTS: In total, 175 patients underwent pancreatic fluid collection drainage; 40 (23%) acute pseudocyst, 78 (44%) chronic pseudocyst, and 57 (33%) pancreatic necrosis. Procedure complication rates, collection recurrence rates, and patient outcomes after acute pseudocyst drainage were independent of endoscopist experience. There was a dramatic improvement in chronic pseudocyst resolution rates after the first 20 procedures versus subsequent procedures (45% vs. 93%; p = 0.0002) and a reduction in days to resolution (50 days, initial 20 procedures vs. 33.5 days, subsequent procedures; p = 0.05). In patients with pancreatic necrosis, there was a decrease in median hospital stay with greater experience (23 days to 15 days; p = 0.04). CONCLUSIONS: Resolution of chronic pseudocyst after endoscopic drainage improves markedly with increasing endoscopist experience. Future prospective studies assessing skill acquisition are required to define the minimum number of collection drainage procedures at which competence can be achieved.

Acute Disease↗
PubMed2002

Safety and outcome of endoscopic snare excision of the major duodenal papilla.

BACKGROUND: The optimal management of adenoma of the major duodenal papilla is not established. Options include surgical excision, endoscopic ablative techniques, snare excision, and observation with periodic biopsies. The aims of this retrospective study were to determine the safety and outcome of snare excision of the papilla. METHODS: Twenty-eight snare excisions of the papilla were performed in 26 patients. Sixteen had familial adenomatous polyposis. In 22 procedures, a minisnare was used, and in 6 cases a prototype snare was designed for excision of the papilla. Pancreatic stents were placed as a prophylactic measure at the discretion of the endoscopist (n = 10). RESULTS: Histopathologically, resected tissue included 25 adenomas, 1 inflammatory polyp, 1 invasive malignancy, and 1 normal papilla. Immediate complications were minor bleeding (n = 2), mild pancreatitis (n = 4) and a duodenal perforation (n = 1). The presence (n = 10) or absence (n = 18) of a pancreatic stent did not correlate with subsequent pancreatitis (2 in each group, p = NS). Follow-up was available for 21 patients (median, 9 months; range, 2-32 months). Pancreatic duct stenosis at the papillectomy site resulted in pancreatitis in 2 patients (17%) at, respectively, 4 months and 24 months. Follow-up endoscopy revealed recurrent/residual adenomatous tissue in 2 (10%). CONCLUSIONS: Snare excision of the major duodenal papilla was well tolerated. Most complications were mild except for a small duodenal perforation. Stenosis of the pancreatic duct orifice with pancreatitis may be a late complication.

Adenomatous Polyposis Coli↗
PubMed2002

Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures.

This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of endoscopic procedures in conjunction with anticoagulation and/or antiplatelet therapy. Guidelines for the appropriate practice of endoscopy are based on critical review of the available data and expert consensus. Controlled clinical studies would be beneficial to clarify some aspects of this statement and revision might be necessary as new data appear. Clinical consideration may justify a course of action at variance from these specific recommendations.

Anticoagulants↗