[Obscure bile duct stenosis: diagnostic management].
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Bile Duct Neoplasms↗
Biomedical subjects
U Weickert
Publications and source records attributed to U Weickert.
[Diagnosis of biliary tract carcinoma].
There are several diagnostic tools available in the diagnosis of bile duct cancer. Tumors of the middle and distal part of the extrahepatic bile duct are accessible to endosonography. Endoscopic retrograde cholangiopancreatography (ERC) and percutaneous transhepatic cholangiography (PTC) are the most invasive procedures for diagnosis of bile duct cancer. However, they offer the opportunity to obtain material for cytological or histological investigation. Moreover, bile flow can be assured by inserting endoprostheses during the procedure. Cholangioscopy and/or intraductal ultrasonography can be performed during ERC. They confer to the diagnosis of a malignant bile duct tumor and are the most accurate methods to diagnose the extent of longitudinal spread. Magnetic resonance imaging-cholangiography is an efficient diagnostic procedure which should be used first, if the bile duct tumor is located in the hilar region.
Bile Ducts↗
Lasso technique for retrieval of a dislocated and impacted esophageal stent.
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Deglutition Disorders↗
Successful treatment of pancreatobiliary fistula by endoscopic stenting.
An unusual pancreatobiliary fistula occurred as a complication of chronic pancreatitis. Endoscopic papillotomy was performed and a plastic endoprosthesis was inserted into the main pancreatic duct. The pancreatic stenting led to the closure of the fistula and no additional surgical treatment was necessary.
Biliary Fistula↗
[Endoscopic drainage of symptomatic pancreatic pseudocysts. An efficient and safe therapy in the clinical routine?].
BACKGROUND AND OBJECTIVE: Clinical studies have demonstrated excellent success and low complication rates of endoscopic therapy of pancreatic pseudocysts. But it is not known, if these results can be reached in gastroenterological centers outside clinical studies. PATIENTS AND METHODS: We investigated the outcome of endoscopic therapy in 21 patients (15 male, 6 female, age 40 - 81) with pancreatic pseudocysts treated in our clinic between 1997 and 2002. A follow-up examination was included. RESULTS: Similar to the results of reported clinical studies the initial clinical success rate was 18/21 with symptomatic recurrences in two patients. All therapy-induced complications were successfully treated conservatively. CONCLUSION: Excellent results of endoscopic therapy of pancreatic pseudocysts can be reached in a gastroenterological center. Surgical treatment can be reserved for cases, when endoscopic therapy fails.
Adult↗
[Cholangioscopy after successful treatment of complicated choledocholithiasis. Is stone free really stone free?].
BACKGROUND AND OBJECTIVE: After successful percutaneous or endoscopic therapy of complicated choledocholithiasis (requiring more than one therapeutic intervention or lithotripsy), radiological visualization of the bile duct is the standard to determine if any stone fragments are left. It is unknown how often stone fragments, which might be the cause for another period of symptomatic choledocholithiasis, are missed. PATIENTS AND METHODS: We performed cholangioscopy in 31 consecutive patients (age 42 - 85; 14 male, 17 female) with complicated choledocholithiasis after successful therapy when there were no stone fragments left radiographically. RESULTS: Cholangioscopy revealed retained stone fragments in four female patients. Two of these had a benign stricture of the common bile duct. CONCLUSIONS: Cholangioscopy after successful endoscopic or percutaneous therapy of complicated choledocholithiasis seems to be useful, because in bile ducts radiographically free of stones, cholangioscopy detects stone fragments in some patients. Further studies are needed to demonstrate if cholangioscopy can reduce the rate of symptomatic relapse after treatment of complicated choledocholithiasis.
Adult↗
Capsule endoscopy versus push enteroscopy in patients with occult gastrointestinal bleeding.
BACKGROUND: Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of capsule endoscopy compared with push enteroscopy in patients with occult gastrointestinal bleeding. METHODS: Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using capsule endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using capsule endoscopy and push enteroscopy. RESULTS: On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-120) months. The lowest haemoglobin level was 6.5 +/- 1.6 g/dl (2.3-9.6) and on average 9 +/- 10 (0-50) blood units were transfused. Each patient underwent 4 +/- 2 (1-10) hospitalisations, with a mean 9 +/- 4 (5-17) diagnostic procedures before capsule endoscopy was used. Definitive bleeding sites were diagnosed by push enteroscopy in 7 patients (angiodysplasia [n = 5], ulcers [n = 1], multiple jejunal diverticula [n = 1]). Capsule endoscopy showed a bleeding source in 25 cases (76 %) (angiodysplasias [n = 15], Meckel's diverticulum [n = 1], ulcers [n = 7], ileum diverticulosis [n = 1], B-cell lymphoma [n = 1]). Push enteroscopy localised an additional bleeding source in comparison with capsule endoscopy (multiple jejunal diverticula) in one patient. Both methods of examination were safe and showed no complications. DISCUSSION: The present study shows that capsule endoscopy had the highest diagnostic yield and was superior to push enteroscopy in patients with chronic gastrointestinal bleeding. By using the capsule at an early stage the subsequent therapeutic procedure could be considerably shortened and diagnostic processes could possibly be optimised.
Adolescent↗
[Mirizzi Syndrome without Cholecystolithiasis].
BACKGROUND: Mirizzi syndrome is a rare cause of biliary symptoms and jaundice. It describes an obstruction of the common hepatic bile duct by external compression caused by an impacted gallstone in the gallbladder neck or cystic duct. This setting is usually associated with cholecystolithiasis. CASE REPORT: A 64-year-old caucasian woman with intermittent abdominal pain and newly diagnosed jaundice was admitted to our clinic. An ERC was performed a few weeks earlier because of similar complaints without jaundice. At that time there was no evidence of choledocholithiasis. Now ERC surprisingly showed a gallstone impacted in the cystic duct, leading to an external compression of the common hepatic bile duct (Mirizzi syndrome). Since an endoscopic stone extraction failed, surgical intervention was performed. A laparoscopic cholecystectomy was performed without trans-cystic stone removal. After removal of the bile duct drainage it became evident that the impacted stone was still located in the remaining part of the cystic duct. After successful endoscopic extraction of the impacted stone the patient remained free of symptoms without recurrent jaundice. CONCLUSION: In rare cases Mirizzi syndrome without cholecystolithiasis can cause biliary symptoms. A close interdisciplinary cooperation is necessary in order to guarantee an excellent therapeutic management.
Bile Duct Diseases↗
Why do bilioduodenal plastic stents become occluded? A clinical and pathological investigation on 100 consecutive patients.
BACKGROUND AND STUDY AIMS: The main complication associated with biliary stenting is stent occlusion. This study tested the hypothesis that bilioduodenal reflux may play a crucial role in stent clogging. PATIENTS AND METHODS: Plastic stents in 100 consecutive patients with various biliary disorders were investigated macroscopically and cytologically. RESULTS: In 37 patients with elective stent extraction, the only risk factor for stent occlusion was the duration of stenting. Plant material was found as a consequence of duodenobiliary reflux in 38 of the 89 stents with any stent content. In patients who had two stents, the stent content was identical in eight of 14 cases. CONCLUSIONS: In addition to other mechanisms of biliary stent occlusion, duodenobiliary reflux appears to play an important role. A stent design capable of at least partly preventing this type of reflux might be of clinical benefit.
Adult↗
Long-term results after successful extracorporeal gallstone lithotripsy: outcome of the first 120 stone-free patients.
BACKGROUND: Long-term results after successful extracorporeal shock wave lithotripsy (ESWL) of symptomatic gallbladder stones are determined by stone and complaint recurrence. The long-term outcomes of the first successfully treated patients of our Department are presented. METHODS: The first consecutive 120 patients with symptomatic gallbladder stones who became stone-free after ESWL plus oral bile acids in the years 1986 and 1987 were included in this study. They were followed up at 1-to 2-year intervals clinically and by ultrasonography until April 1998. Recurrence of stones and biliary symptoms and subsequent treatment were recorded. The effect of various factors on recurrence was analyzed. RESULTS: Median follow-up time was 6.0 years for all patients and 8.8 years for patients without recurrence (range, 0-11.2 years for both). Actuarial recurrence probability was 1.9%-16.6% per year reaching 60.2% (49.9%, 70.3%) (95% confidence interval) after 10 years. Patients with stone recurrence revealed significantly more stones before ESWL than patients without recurrence (P < 0.03). Other factors were not significantly different. The majority of stone recurrences were symptomatic requiring retreatment, mostly cholecystectomy. CONCLUSION: The probability of gallbladder stone recurrence after successful ESWL remains high during a decade of follow-up. Many patients require repeated nonsurgical treatment or cholecystectomy. Thus long-term results are unsatisfactory and ESWL should be offered only exceptionally.
Adult↗
[Dilatation of pancreatic duct stenoses with the ring coagulator--initial experiences].
Stenoses of the main pancreatic duct in chronic pancreatitis should be treated by interventional endoscopy. If mechanical dilatation was unsuccessful, a thermodilator has been in use in our clinic since September 1998. From September 1998 to March 1999 dilation of pancreatic duct stenoses was done by the thermodilator in six patients. An asymptomatic elevation of amylase and lipase was noticed in one patient. There were no further complications. The termodilator is a promising instrument for dilatation of difficult stenoses of the main pancreatic duct. Before general use, however, evaluation of the success and complication rates in a greater number of patients is needed.
Adult↗
[The holmium-YAG laser: a suitable instrument for stone fragmentation in choledocholithiasis. The assessment of the results of its use under babyscopic control].
BACKGROUND AND OBJECTIVE: Stone fragmentation is required in ca. 5% of patients with choledocholithiasis to free the patients of stones. Several extra- and intracorporal methods of stone fragmentation (lithotripsy) have been available. We here report our experience with the recently available holmium-YAG laser, used under babyscopic monitoring. PATIENTS AND METHODS: Between September 1997 and May 1998 lithotripsy was performed by holmium-YAG laser under monitoring in 20 patients with choledocholithiasis in whom conventional methods had failed to achieve stone fragmentation. RESULTS: All stones were cleared in 19 of the 20 patients. A second session was necessary in four patients, three sessions in one. There was no serious complication and no death during a 30-day follow-up. CONCLUSION: Holmium-YAG laser lithotripsy under babyscopic monitoring has been shown to be a suitable method in patients with choledocholithiasis in whom previous treatment has failed it is complementary to current methods of stone fragmentation.
Aged↗
The thermodilator: an effective instrument in the palliative therapy concept of malignant bile duct stenosis.
BACKGROUND AND METHODS: In the case of incurable malignant bile duct stenosis the aim of therapy is to secure the bile flow. Sometimes dilation of the stenosis is necessary to enable the introduction of a biliary duodenal stent or the replacement of a small-bore stent by a large-bore one. The previously most commonly used methods - bougienage and balloon dilation - can be unsuccessful with severe stenoses, which means that an extension of the endoscopic therapeutic instrumentarium is desirable. We examined the success rates and complications of a thermodilator which can be used to dilate bile duct stenoses. RESULTS AND CONCLUSIONS: In 21 out of 24 applications the therapeutic objective was achieved. In one case we observed an endoscopically controllable bile duct hemorrhage. The thermodilator is therefore a valuable addition to the endoscopic treatment possibilities of malignant bile duct stenosis.
Aged↗
[Placenta morphology and Doppler ultrasound of umbilical cord vessels in premature infants].
OBJECTIVE: There is a raised morbidity and mortality in fetuses with pathological waveforms in the umbilical arteries. Less differentiation of the placental villi could (partly) explain this finding. MATERIALS AND METHODS: We examined a total of 51 placentas (28th to 35th week of gestation) as to a correlation between dopplersonographical findings in the umbilical arteries and placenta morphometry. RESULTS: In the groups with pathological waveforms there was not only a reduction in the weight of the placenta and child, but also less differentiation of the placental villi. The occurrence of so-called sprouts did not correlate with the dopplersonographical findings. CONCLUSIONS: The raised fetal morbidity and mortality in premature infants with pathological waveforms in the umbilical arteries can at least partly be explained less differentiation of the placental villi. We found no correlation with the occurrence of sprouts.
Adult↗
Intimal sarcoma of the left iliac artery.
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Aged↗
[Myocardial pump failure in dilated cardiomyopathy and pheochromocytoma].
Progressive dyspnoea developed in a 37-year-old woman over a period of 2 months. A chest x-ray and echocardiography revealed a massive dilatation of the heart with thrombi in both ventricles. The endomyocardial biopsy was classified as myocarditis in two different departments of pathology. The patient developed thromboembolic events and an untreatable heart failure which led to the patient's death. The necropsy revealed a dilated 600-gram-heart and thrombi in both ventricles. On histological and immunohistological examination of the heart, the original diagnosis was corrected to catecholamine-induced dilated cardiomyopathy.
Adrenal Gland Neoplasms↗
[A rare cause of recurrent upper gastrointestinal hemorrhage: aortoesophageal fistula in aneurysma spurium of the descending aorta].
An aneurysma of the distal thoracic aorta developed in an 65 year old man. Several weeks later, the man was admitted to hospital because of upper gastrointestinal bleeding. The diagnosis of an aortoesophageal fistula was made not until several endoscopic investigations. The patient died from a major bleeding soon after. The aneurysm proved to be an aneurysma spurium.
Aged↗
[Placental morphometry in pregnancies with reversed enddiastolic flow in the umbilical artery or fetal aorta].
BACKGROUND: Fetuses with a reversed enddiastolic flow in the umbilical artery and/or aorta are at risk pregnancies and show a higher incidence of perinatal morbidity and mortality. The aim of this study was to evaluate the pathological changes in the terminal villous tree in fetuses with a reverse flow in the fetal aorta or umbilical artery. MATERIALS AND METHODS: In this retrospective study, 16 cases with a reverse flow in the fetal aorta or umbilical artery (Gr. 1) were compared with gestational age matched 16 healthy pregnant women (Gr. 2). The following morphometric parameters were evaluated in 50 sections in each placenta (1600 measurements): mean vessel diameter, volume density of the villous tissue, stem villi and terminal villi. Measurements were performed using a computerized Video Image Analysis system. RESULTS: The mean gestational age at birth was similar in both groups (30 + 4 weeks gestation vs. 30 + 6 weeks gestation, respectively, for Gr. 1 and Gr. 2). The birth weights (985 g vs. 1780 g) and the placental weights (216 g vs. 385 g) were significantly lower in the reverse flow group. There was a significant reduction in the proportion of total villous tissue (19 % versus 45 %) and in the diameter of tissue at the terminal villi (2.1 % versus 7.6 %) in the reverse flow group. Although the mean number of vessels at the terminal villi was lower than the control group (4.1 versus 5.6), the mean and total areas of the vessels were not different. CONCLUSION: Our observations showed a significant association between the placental morphometric parameters and reversed enddiastolic flow in the umbilical artery or fetal aorta. The reduced number of functional placental units is responsible for the diminished exchange function of the placental vessels in "reverse flow" cases. This could partially explain the adverse outcome in this clinical situation.
Adult↗