Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Endoscopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed2006

Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage.

BACKGROUND AND STUDY AIMS: Pancreatic pseudocysts are a complication in up to 20% of patients with pancreatitis. Endoscopic management of pseudocysts by a conventional transenteric technique, i. e. conventional transmural drainage (CTD), or by endoscopic ultrasound-guided drainage (EUD), is well described. Our aim was to prospectively compare the short-term and long-term results of CTD and EUD in the management of pseudocysts. PATIENTS AND METHODS: A total of 99 consecutive patients underwent endoscopic management of pancreatic pseudocysts according to this predetermined treatment algorithm: patients with bulging lesions without obvious portal hypertension underwent CTD; all remaining patients underwent EUD. Patients were followed prospectively, with cross-sectional imaging during clinic visits. We compared short-term and long-term results (effectiveness and complications) at 1 and 6 months post procedure. RESULTS: 46 patients (37 men) underwent EUD and 53 patients (39 men) had CTD. The mean age of the entire group was 50 +/- 13 years. There were no significant differences between the two groups regarding short-term success (93% vs. 94%) or long-term success (84% vs. 91%); 68 of the 99 patients completed 6 months of follow-up. Complications occurred in 19% of EUD vs. 18% of CTD patients, and consisted of bleeding in three, infection of the collection in eight, stent migration into the pseudocyst in three, and pneumoperitoneum in five. All complications but one could be managed conservatively. CONCLUSIONS: No clear differences in efficacy or safety were observed between conventional and EUS-guided cystenterostomy. The choice of technique is likely best predicated by individual patient presentation and local expertise.

Adult↗
PubMed2006

A novel double-channel therapeutic endoscope ("R-scope") facilitates endoscopic submucosal dissection of superficial gastric neoplasms.

BACKGROUND AND STUDY AIM: Endoscopic submucosal dissection (ESD) is a new and radical treatment for superficial gastrointestinal neoplasms that provides high rates of en bloc resection compared with treatment by conventional mucosal resection. However, ESD is a complex procedure that is associated with long operating times and a higher complication rate. This feasibility study assessed the use of a novel double-channel therapeutic endoscope for performing en-bloc ESD in order to assess whether the procedure time could be shortened. PATIENTS AND METHODS: The therapeutic endoscope we used (the "R-scope") is equipped with a multibending system and has two movable instrument channels: one moves a grasping forceps vertically for lesion countertraction; the other swings a cutting knife horizontally for dissection. Twenty consecutive patients (18 men, 2 women; mean age 63 years, range 54 - 80 years) with superficial gastric neoplasms in the distal two-thirds of the stomach underwent resection of their tumor by ESD using the R-scope. Forty size- and location-matched gastric neoplasms resected by conventional ESD were reviewed retrospectively for the purposes of comparison. RESULTS: The rates of curative en-bloc resection, complications, and local recurrence using the two ESD methods were comparable. The mean +/- SD operating time was significantly shorter for ESD using the R-scope than for conventional ESD (57.9 +/- 29.7 minutes vs. 92.8 +/- 58.9 minutes, P = 0.016). CONCLUSION: The R-scope appears to shorten the operating time of ESD with comparable efficacy and complication rates.

Aged↗
PubMed2006

Same-day endoscopic retrograde cholangiopancreatography after transduodenal endoscopic ultrasound-guided needle aspiration: do we need to be cautious?

Patients who are undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for suspected pancreatic tumors frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) for palliation of their symptoms. Performing EUS-FNA and ERCP in tandem may be cost-effective and may reduce procedure time, but the potential risks associated with this approach have not been clearly defined in the literature. We report two patients who underwent same-day therapeutic ERCP after transduodenal EUS-FNA for pancreatic tumors. Endoscopic biliary manipulation during ERCP aggravated an inadvertent and subclinical needle puncture injury to the bile duct sustained during the preceding EUS-FNA. This resulted in leakage of bile into the retroperitoneal space, and both patients required laparotomy and surgical drainage. Additional clinical evidence is needed to clarify these issues and to determine whether it would be prudent to perform therapeutic ERCP prior to diagnostic transduodenal EUS-FNA when these two procedures are planned as sequential or same-day procedures.

Bile↗
PubMed2001

A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy.

BACKGROUND: A prior Billroth II gastrectomy renders endoscopic sphincterotomy (EST) more difficult in patients with bile duct stones. Endoscopic balloon dilation (EBD) is a relatively easy procedure that potentially reduces the risk of bleeding and perforation. METHODS: Thirty-four patients with bile duct stones and a previous Billroth II gastrectomy were randomized to EST or EBD. Complications were graded in a blinded fashion. Results were compared with those for a group of 180 patients with normal anatomy from a previously reported randomized trial of EBD versus EST. RESULTS: All stones were removed in 1 endoscopic retrograde cholangiopancreatography in 14 of 16 patients who underwent EBD versus 14 of 18 who had EST (p = 1.00). Mechanical lithotripsy was used in 3 EBD procedures versus 4 EST procedures (p = 1.00). Early complications occurred in 3 patients who had EBD versus 7 who underwent EST (p = 0.27). Three patients had bleeding after EST; 1 patient had mild pancreatitis after EBD. The median time required for stone removal was 30 minutes in both groups. Compared with patients with a normal anatomy, patients with a previous Billroth II gastrectomy had a significantly increased risk of bleeding after EST (17% vs. 2%, relative risk = 7.25, p < 0.05). CONCLUSIONS: A prior Billroth II gastrectomy renders EST more difficult and increases the risk of a complication. EBD in these patients is easy to perform and is not associated with an increased need for mechanical lithotripsy or a longer procedure time. The risk of bleeding is virtually absent after EBD and the risk of pancreatitis after EBD seems not significantly increased in these patients.

Adult↗
PubMed2004

Cost-effectiveness of endoscopic ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in patients suspected of pancreaticobiliary disease.

BACKGROUND: It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163 patients. The effectiveness of an investigation was defined as the percentage of patients with no need for further evaluation after the investigation in question had been performed. Costs were assumed from the budget-holder's point of view. RESULTS: MRCP, EUS and ERCP had a total accuracy of 0.91, 0.93 and 0.92, respectively. Eighty-four (52%) patients needed endoscopic therapy in combination with ERCP, giving an effectiveness of MRCP, EUS, and ERCP of 0.44, 0.45 and 0.92, respectively. The cost-effectiveness of MRCP, EUS, and ERCP was 6622, 7353 and 4246 Danish Kroner (DKK) per fully investigated and treated patient (1 DKK=0.14 EUR). CONCLUSION: Within a patient population with a probability of therapeutic ERCP in 50% of the patients, ERCP was the most cost-effective strategy.

Adult↗
PubMed1996

Endoscopic retrograde cholangiography in the diagnosis and endoscopic management of biliary complications after liver transplantation.

OBJECTIVE: Biliary reconstruction in orthotopic liver transplantation is increasingly being performed without T tube drainage. This increases the difficulty of diagnosing subsequent biliary tract problems, with a greater reliance placed on endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of biliary tract complications. The usefulness of ERCP was evaluated in patients who underwent liver transplant where biliary reconstruction was not done with T tube drainage. DESIGN AND PARTICIPANTS: A retrospective study of the case notes of 90 patients who underwent liver transplantation, and in whom the biliary reconstruction was by end to end choledochocholedochostomy without T tube splintage. RESULTS: ERCP was performed as the primary procedure to investigate a suspected biliary complication in 30 patients (33%). The procedure was successful in 26 patients (87%), and showed a biliary stricture in 12 patients and a bile leak in six patients. ERCP was normal in seven patients and demonstrated dilated ducts alone in one patient. Six of the biliary strictures were successfully dilated endoscopically (50%), but none of the bile leaks resolved with endoscopic drainage. CONCLUSION: This study confirms the diagnostic role of ERCP post liver transplant. The therapeutic role requires clearer evaluation with a controlled trial.

Adolescent↗
PubMed1997

Endoscopic bile duct stent placement as a predictor of outcome following endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction.

OBJECTIVES: To determine whether symptomatic improvement following placement of endoscopic stent across the biliary sphincter could predict the longer-term clinical outcome after endoscopic sphincterotomy (ES). METHODS: Twenty-three post-cholecystectomy patients with suspected sphincter of Oddi dysfunction underwent, sequentially, sphincter of Oddi manometry, endoscopic stent placement, ES, and follow-up for a further 6-12 months. RESULTS: Eight (35%) patients either did not respond (n = 5), did not tolerate the stent (n = 1) or relapsed during stenting (n = 2). Only the patient who did not tolerate the stent from the outset (12%) improved after ES. Of five patients who responded to stenting and had ES within 8 weeks, only two (40%) remained asymptomatic. In contrast, of 10 patients who were pain-free during 12-14 weeks of stenting, nine (90%) continued to be asymptomatic after ES. All seven patients with an elevated sphincter of Oddi pressure responded to stenting and six benefited from sphincter ablation. Five (31%) of 16 patients who had normal sphincter pressure and had improvement after 12-14 weeks of stenting remained free from pain following ES. ES resulted in long-term freedom from pain in 12 of the 23 patients: six of the seven patients with elevated sphincter of Oddi pressure and six of the 16 subjects with normal manometry (P < 0.05). CONCLUSION: Freedom from symptoms during at least 12 weeks of stenting predicted a favourable outcome after ES, irrespective of sphincter of Oddi pressure. Patients who failed to improve or showed improvement only with short-term stenting were less likely to benefit.

Adult↗
PubMed1999

Selection criteria for pre-operative endoscopic retrograde cholangiography and endoscopic-laparoscopic treatment of biliary stones.

OBJECTIVE: Pre-operative endoscopic retrograde cholangiography (ERCP) prior to laparoscopic cholecystectomy (LC) is the most common treatment of gallbladder and common bile duct (CBD) stones. In this study we evaluate our selection criteria for pre-operative ERCP and the results of endoscopic-laparoscopic treatment in patients with CBD stones. DESIGN: Consecutive adult patients admitted to the department of surgery because of symptomatic cholelithiasis were included in a prospective open trial. PARTICIPANTS: Between January 1996 and December 1996, 841 patients underwent LC at our hospital. ERCP pre-LC was performed in 95 of the 841 patients, on the basis of our selection criteria. INTERVENTIONS: The indication to perform ERCP was suggested by a dilatated CBD (> 10 mm) or ductal stones, abnormal serum liver tests, persisting for more than 3 days, jaundice, cholangitis or pancreatitis. Twelve months after surgery, all patients were contacted by telephone to exclude symptoms related to residual stones. RESULTS: Cannulation of the CBD was successful in 94 of 95 patients submitted to pre-LC ERCP. CBD stones were found in 87 patients (95.6%) in 22 of whom (25.2%) they were in the form of small stones or sludge. In only three of 94 patients (3.2%) no alterations of the CBD or papilla were found. Complications occurred in eight of 98 patients (in five after endoscopic sphincterotomy (ES), and in three after LC). CONCLUSIONS: Pre-operative ES in selected patients with coexisting gallbladder and CBD stones has been a good approach and the criteria that we used for selection of patients to be submitted to pre-operative ERCP/ES seem to be effective.

Adolescent↗
PubMedDate not supplied

T-tube access for endoscopic sphincterotomy: a variant of combined percutaneous and endoscopic approach.

Selective deep cannulation of the common bile duct (CBD), which is essential for successful endoscopic sphincterotomy, may not be possible in all patients. Three patients with retained CBD stones with T-tube in situ in whom selective deep cannulation failed, underwent successful sphincterotomy using a combined percutaneous and endoscopic procedure through the T-tube. CBD stones were then extracted with a Dormia basket. In situ T-tube can provide percutaneous access for combined approach in patients with retained CBD stones in whom endoscopic cannulation is not successful.

Catheterization↗
PubMed2006

Does the advent of endoscopic ultrasound (EUS) sound the death knell for endoscopic retrograde cholangiopancreatography (ERCP)?

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) has been the premier diagnostic and therapeutic endoscopic procedure in the management of pancreatic and biliary diseases (PBD). The use of endoscopic ultrasound (EUS), including EUS-guided fine needle aspiration (FNA), of pancreatic and biliary tumours has become more widely available in the last decade and has gradually replaced diagnostic ERCP. Together with EUS, other imaging modalities like magnetic resonance cholangiopancreatography (MRCP) have resulted in a decrease in the number of ERCPs. With the advent of interventional EUS, ERCP is at risk of being completely eclipsed. METHODS: A search of all relevant articles on EUS and ERCP from Medline and peer-reviewed journals. RESULTS: This review article examines the exact place of ERCP and EUS and their relative contributions in the management algorithm of PBD. CONCLUSION: Although diagnostic EUS, including EUS-guided FNA, is well established in the evaluation of PBD, interventional EUS is still in its infancy and its true potential is unknown. Therefore, therapeutic ERCP still has a vital, albeit smaller role to play in the treatment of pancreatic and biliary diseases.

Biliary Tract Diseases↗
PubMed1989

[The results of bile culture after selective sampling of the main biliary tract via endoscopic catheterization. The relation of the microbes isolated, the anatomicopathologic picture and the possibility of septic complications following endoscopic cholangiopancreatography (ERCP)].

Selective sampling from the main bile way using endoscopic catheterization was used in the attempt to establish parameters capable of identifying patients at risk of septic complications following endoscopic cholangiopancreatography. The results obtained evidenced a significant relationship between neoplastic type obstructions of the main bile way, age of patient and positive bile culture with increased risk of septic complications. The advisability of using local and/or systemic antibiotic prophylaxis in elderly patients with suspected neoplastic obstruction of the bile way and thus candidates for endoscopic cholangiopancreatography is considered.

Adult↗
PubMed1998

Acute biliary pancreatitis: the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography.

BACKGROUND: Acute biliary pancreatitis, particularly severe pancreatitis, necessitates urgent diagnosis and treatment of common bile duct (CBD) stones. The roles of urgent endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary pancreatitis were prospectively studied. METHODS: Thirty-five consecutive patients with suspected acute biliary pancreatitis underwent urgent ultrasonography, computed tomography (CT), EUS, and ERCP. Endoscopic sphincterotomy (ES) was performed for CBD stones. We investigated (1) imaging diagnostic results of CBD stones and intrapancreatic and extrapancreatic pathology and (2) the outcome of ERCP. RESULTS: Imaging studies established a biliary origin in 24 patients, 15 with and 9 without CBD stones. According to Acute Physiology and Chronic Health Evaluation II scores, 6 had severe and 18 had mild pancreatitis. EUS (100%) and ERCP (100%) were significantly more sensitive for CBD stones than were ultrasonography (47%) and CT (47%). EUS detected pancreatic necrosis (100%), as well as inflammation in the lesser sac (100%) and retroperitoneum (81%), which CT confirmed. No complications related to ERCP occurred. After ES, rates of morbidity and mortality related to pancreatitis were 8% and 0%, respectively. CONCLUSIONS: EUS, an accurate and minimally invasive modality, may limit ERCP to therapeutic use in biliary pancreatitis. EUS is recommended if ultrasonography and CT have failed to detect CBD stones. CBD stones should be treated with urgent ES.

Acute Disease↗
PubMedDate not supplied

Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy.

Measurements of variceal pressure with a noninvasive endoscopic pressure gauge and by direct variceal puncture were performed in 20 cirrhotic patients with portal hypertension in the course of the first session of therapeutic sclerotherapy following an episode of variceal bleeding. Endoscopic gauge measurements of the pressure of esophageal varices gave similar values (15.5 +/- 2.7 mm Hg) than measurements by variceal puncture (15.4 +/- 2.4 mm Hg; not statistically significant), and there was a highly significant linear correlation between both measurements (r = 0.9, p less than 0.001). Azygos blood flow, that was markedly increased in these patients (852 +/- 399 ml per min), was directly related to variceal pressure (r = 0.73, p less than 0.01). Variceal pressure was significantly lower than portal pressure (18.8 +/- 5.0 mm Hg) (p less than 0.05), indicating that measurements of variceal pressure cannot substitute measurements of portal pressure. The study demonstrates that the noninvasive endoscopic gauge technique allows an accurate estimation of variceal pressure in patients with portal hypertension. This technique may provide additional useful information in the evaluation of portal hypertension as well as on the mechanism of variceal bleeding.

Adult↗
PubMed1998

Non-radiological technique for 3D imaging of intestinal endoscopes: computerised graphical 3D representation of endoscope and skeleton.

Colorectal cancer is a common malignancy but as yet there is no agreement regarding the optimal method for screening. Colonoscopy is theoretically the investigation of choice. The examination can, however, be difficult to perform and the average trainee requires at least 200 supervised examinations to become proficient. Colonoscopy takes on average about half an hour per patient and sedation is normally required because of painful instrument looping. The authors previously developed a non-radiological method of visualising the path of the endoscope using magnetic drive coils under the patient and a chain of sensors in the biopsy channel of the instrument. The computer-generated grey-scale images produced in real time were deemed unsatisfactory and the anatomical markers confusing. A new computer graphics system is described in which a much more realistic endoscope and, if necessary, skeleton can be produced. The wire-frame octagonal representation should help in the detailed analysis of colonoscopy using existing endoscopes and aid in future computer design and testing of novel instruments incorporating worm or snake-like properties.

Colonoscopy↗
PubMed2006

Endoscopic lateral approach thyroid lobectomy: safe evolution from endoscopic parathyroidectomy.

INTRODUCTION: Endoscopic thyroid surgery has been shown to be feasible. Most minimal access procedures have been performed via a midline approach. Based on our experience of more than 500 endoscopic parathyroidectomies via a lateral approach we have used the same method for thyroid lobectomy. METHODS: We present our experience of endoscopic thyroid lobectomy via a lateral approach (ETLA) and review of the results over a 1-year period (2004). Inclusion criteria for ETLA were (1) solitary nodule with atypical/suspicious fine-needle biopsy (FNB) or solitary toxic nodule; (2) lesions with a diameter of < 3 cm. Patients with a history of previous neck surgery or radiation exposure were excluded. All patients underwent postoperative vocal cord checks and plasma calcium evaluation. RESULTS: A total of 742 thyroid procedures were performed during 2004. Among them, 38 patients (5.1%) underwent ETLA. Indications for surgery were suspicious FNB results (36 patients) and a toxic nodule (2 patients). Mean nodule size was 19.2 mm. Mean +/- SD operating time was 102 +/- 27 minutes. All recurrent laryngeal nerves were identified (including one that was nonrecurrent). Of the 38 patients, the superior parathyroid gland was identified in 36 and the inferior parathyroid gland in 33. There were two conversions due to difficulty with the dissection. Two operations were converted because malignancy was diagnosed on frozen section examination. Two patients underwent a delayed completion thyroidectomy when definitive histology necessitated it. There were no permanent operative complications, and all patients were discharged on the first postoperative day. CONCLUSIONS: ETLA offers excellent intraoperative visualization of the vital structures and is a safe alternative to conventional thyroid lobectomy in selected cases.

Adult↗
PubMed2003

A prospective endoscopic study of retropubic vascular anatomy in 121 patients undergoing endoscopic extraperitoneal inguinal hernioplasty.

BACKGROUND: A sound knowledge of retropubic pelvic vascular anatomy is pivotal to the successful performance of endoscopic total extraperitoneal (TEP) inguinal hernioplasty. The objective of the current study was to evaluate the incidence and anatomy of iliopubic and aberrant obturator vessels. METHODS: Between July 2001 and March 2002, a prospective endoscopic evaluation of retropubic vascular anatomy was performed on patients who underwent TEP. Endoscopic photographs of the vasculature overlying the superior pubic ramus in the recruited patients were captured on a computer. RESULTS: The retropubic vascular anatomy of 121 patients, who underwent either unilateral (n = 100) or bilateral (n = 21) TEP was examined. The iliopubic artery and vein were invariably present in every patient, and traversed along the iliopubic tract toward the pubic symphysis. The aberrant obturator artery was present in 31 pelvic halves, giving an overall incidence of 22%. The aberrant obturator vein existed between the external iliac and obturator venous system in 27% (n = 38) of the 141 pelvic halves examined. The overall incidence of corona mortis, in the form of either an aberrant obturator vein or artery, was 40% (n = 56). CONCLUSIONS: Iliopubic vein and artery are universal findings in every patient. Both aberrant obturator artery and vein cross the superior pubic rami, and are therefore susceptible to injuries during dissection of the Bogros space and stapling of the mesh onto Cooper's ligament. Awareness of these aberrant vessels will help to reduce bleeding and subsequent morbidity. Tracing along the aberrant vessel can easily identify the obturator foramen, which is an anatomic landmark that indicates an adequate inferior dissection of the preperitoneal space.

Aged↗
PubMed2005

Endoscopic resection of gastrointestinal submucosal tumors assisted by endoscopic ultrasonography.

BACKGROUND: The resection and histologic examination of the lesions is generally considered the treatment of choice in order to achieve diagnosis in gastrointestinal submucosal tumors. Moreover, the degree of malignancy of the tumor depends on certain features that can only be studied on the entire resected piece. METHODS: We revised the cases of patients who underwent endoscopic resection of gastrointestinal submucosal tumors in the period from 1997 through 2002. RESULTS: Fifty submucosal lesions were resected in 45 patients (64.4% men). Patient mean age was 55.31 years. Of the lesions, 52% were gastric tumors and 88% were located in the second layer. Mean size was 12.34 mm, and 54% were smaller than 10 mm. Resection with submucosal injection of saline solution and diluted adrenaline was performed on 46% of the lesions, and standard resection using polypectomy snare on 48%. Ligation was used in three cases. Resection was successful in 98% and major complications were observed in 4% (two cases of bleeding, endoscopically resolved). CONCLUSIONS: The endoscopic resection of submucosal tumors is a safe and efficient technique: It has few associated complications and allows diagnosis in all the cases and cure of the lesion in the great majority of cases.

Adult↗