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At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

[Difficult endoscopic extraction: pneumomediastinum and bilateral pneumothorax after attempted endoscopic extraction of needle incarcerated in hiatal hernia].

From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.

Adult↗
PubMedDate not supplied

Endoscopic anatomy of the sphenopalatine and posterior nasal arteries: implications for the endoscopic management of epistaxis.

BACKGROUND: Refractory posterior epistaxis is a challenge for otolaryngologists. Most algorithms for managing this condition ultimately call for interrupting the arterial blood supply to the nasal mucosa. Traditionally, this was accomplished either by transantral arterial ligation or by arteriographic-guided embolization. More recently, the endonasal endoscopic approach has also been described. Because the primary blood supply to the posterior nasal cavity is derived from the terminal branches of the sphenopalatine and the posterior nasal arteries, we conducted this anatomic study to examine and describe the anatomic relationship of these two arteries as they exit the pterygopalatine fossa and enter the nasal cavity. METHODS: We performed endoscopic dissections of this anatomic region in nine fresh and one formalin-preserved cadaver specimens. A total of 19 sides were examined. RESULTS: In 3 of 19 specimens (16%), the sphenopalatine artery branched from the sphenopalatine artery within the sphenopalatine canal, allowing the two arteries to exit together. In 8 of the 19 specimens (42%), the sphenopalatine artery exited much more posteriorly, yet from within a shared posteriorly elongated sphenopalatine foramen. In the remaining eight specimens (42%), the sphenopalatine artery exited through a distinct foramen directly posterior to the larger sphenopalatine foramen. CONCLUSION: Understanding this anatomic relationship is important in performing endoscopic arterial ligation. If the sphenopalatine artery is not specifically identified and ligated, an important component of the posterior nasal circulation will not be addressed adequately by this surgical approach.

Cadaver↗
PubMed1989

[1-step endoscopic laser papillosphincterotomy with endoscopic biliary drainage].

Two patients with obstructive jaundice are presented. They had cancer of the large duodenal papilla and choledocholithiasis with edema and deformity of the papilla. Endoscopic laser papillosphincterotomy with "Nd-YAG" laser and one-step endoscopic biliary drainage--endoprosthesis of the common bile duct and naso-labial drainage, respectively--were performed. The importance of laser papillotomy in patients, in whom electropapillotomy can not be accomplished or will not give satisfactory results, is emphasized. Analysis is made of the periodic medical literature on this problem. Report is made for the first time on combining two endoscopic methods--laser photocoagulation and endoprosthesis in benign and in malignant stenoses of the papilla, realized in one act.

Aged↗
PubMed1988

[Radical endoscopic treatment of early gastric cancer-indication for and evaluation of endoscopic resection].

In the endoscopic treatment of early gastric cancer, it is absolutely necessary to adapt a radical approach. The indication for this technique in 545 surgically resected cases of single gastric cancer was studied and technical evaluation was made of endoscopic resection (ER) in 98 of early gastric cancer lesions. Except for 2 special lesions of early gastric cancer, invasion depth m and sm minute invasion [sm(+)] cancer did not show lymph node metastasis [n(+)], but this was recognized in sm(++) cancer showing more than moderate invasion and which was deeper than pm cancers. The applicable lesions were selected excluding the n(+)-risk group with invasion deeper than sm(++) based on histological type, macroscopic type, size and the presence or absence of ulcers(Ul). These were differentiated type II a less than 2 cm in size, differentiated type Ul(-) II c of less than 1 cm and undifferentiated type Ul(-) II c of less than 5 mm in areas excluding the fundic gland mucosa. Our method of ER is endoscopic double snare polypectomy. II a or II c lesion is artificially squeezed into a pedunculated form. The cutting snare is placed over the peduncle, the grasping forceps are replaced with another snare to grasp the tumor firmly. Then cutting snare is applied to include sufficient normal mucosa surrounding the lesion and coagulating current is passed through to slowly resect the ared. The 1st-ER healing ratio, remnant ratio and recurrence ratio of standard ER in 55 II a and 30 II c lesions were 83.5, 12.9 and 3.5% respectively. The recurrent cases were retrospectively found originals in the remnant. Among remnant and recurrences, the 2nd-ER healing ratio was 43% (6/14) and surgically treated cases were 8 (6 inapplicable cases), the final ER healing ratio being 90.6% and satisfactory. Most of the remnant lesions were II a of more than 2 cm, and II c of more than 1 cm for differentiated type and II c for undifferentiated type. As ER could not be applied to these lesions, its indication was confirmed to be technically satisfactory.

Gastroscopy↗
PubMed1995

[Endoscopic placement of self-expandable metallic stents (Wallstent) for malignant biliary stenosis, with special reference to preventive endoscopic nasal bile drainage against acute obstruction after stenting].

From December 1993 to December 1994, we inserted 14 biliary endoprostheses (Wallstent) endoscopically in 12 consecutive patients (5 men and 7 women; 55-91 years [mean 69.8 years] of age) with malignant biliary stenosis. Successful placement of Wallstent was achieved in all 12 patients. Procedure related death was encountered in one patient (8.3%) who was complicated with emphysematous cholecystitis, combined with a slipping migration of the stent. In 11 of the 12 patients, serum bilirubin levels reduced to less than 2.0 mg/dl. Acute obstruction, which was defined as the obstruction of the stent within 24 hours after the stent placement, occurred in 2 patients (16.7%). Endoscopic nasal bile drainage (ENBD) following stent placement was performed in 4 patients and acute obstruction was not developed in these cases. After endoprosthesis 8 patients were discharged with 6-47 hospital days and the average hospitalized period excluding a case with cerebral infarction was 12.7 days. Excluding one procedure related death, 6 patients died of primary malignancy 39-189 days (average 90.7 days) after endoprosthesis and in 2 cases recurrence of jaundice was observed. The other 4 patients have been alive for 60-174 days (average 102.5 days) without jaundice. The survival rate of the all patients was 64% for 3 months and 32% for 6 months, respectively. In conclusion, we suggested that the endoscopic Wallstent placement would contribute to the improvement of the quality of life for patients with malignant biliary stenosis. However, acute obstruction may be developed in some cases. For the purpose of managing acute obstruction, we recommend ENBD for a few days following the placement of a Wallstent.

Acute Disease↗
PubMedDate not supplied

Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques--clinical results of 65 procedures.

The authors have developed two endoscopic techniques that, in their opinion, are minimally traumatic and achieve superior clinical results when compared with traditional types of heel spur surgery. From the original development of the one-portal system for endoscopic plantar fasciotomy, a two-portal system has been developed (patent pending) that provides significant advantages over the one-portal system. Postoperative morbidity was decreased with both endoscopic techniques when compared with traditional types of open heel spur surgery. Both groups of patients returned to normal activity sooner than would patients who have had their heel spur syndrome/plantar fasciitis treated with open, traditional surgery.

Adult↗
PubMed1996

[Endoscopic treatment in colorectal lesions--especially on endoscopic mucosal resection].

Protruded polyps can usually be treated with conventional polypectomy technique. Slightly elevated lesions without malignant findings are treated with hot biopsy method if they are small enough (less than 5 mm). In order to treat flat or slightly depressed lesions or slightly elevated lesions larger than 5 mm, endoscopic mucosal resection (EMR) technique has been invented. Cancers confined to the mucosa or those only minimally invading the submucosa can be completely removed with this method. However, if histological analysis of the resected specimen shows that the cancer invades the submucosa massively or permeating the vessels, surgical treatment should be added, because otherwise there would be risk of cancer residue or metastasis. When a lesion is suspected to be a submucosal cancer by endoscopic findings and pit pattern analysis from the beginning, then surgical resection is the treatment of choice. Laterally spreading tumors, especially the homogeneous granular type, are good indication for EMR or endoscopic piecemeal mucosal resection (EPMR). It is important to remove the lesion completely confirming that the resection margin is covered with normal pits.

Colectomy↗
PubMed1997

Successful endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate following the recurrence of bleeding soon after endoscopic ligation for ruptured duodenal varices.

Bleeding from duodenal varices in a 63-yr-old man with alcoholic cirrhosis of the liver was found at endoscopy, and ligation surgery was carried out. Ten months after the operation, bleeding from the duodenal varices occurred and was treated by endoscopic ligation. However, after performing this procedure, bleeding again occurred 1 week later. Hemostasis was finally achieved by endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate. For the 22 months since the injection, the patient has been free from further bleeding. These results suggest that endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate was effective in bringing about immediate cessation of the bleeding in duodenal varices and that long-term hemostasis can be expected.

Duodenoscopy↗
PubMed1999

Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group.

BACKGROUND: Same-day discharge after endoscopic biliary sphincterotomy (ES) is a common clinical practice, but there have been few data to guide appropriate selection of patients. Using a prospective, multicenter database of complications, we examined outcomes after same-day discharge as it was practiced by a variety of endoscopists and evaluated the ability of a multivariate risk factor analysis to predict which patients would require readmission for complications. METHODS: A 150-variable database was prospectively collected at time of ES, before discharge and again at 30 days in consecutive patients undergoing ES at 17 centers. Complications were defined by consensus criteria and included all specific adverse events directly or indirectly related to ES requiring more than 1 night of hospitalization. RESULTS: Six hundred fourteen (26%) of 2347 patients undergoing ES were discharged on the same day as the procedure, ranging from none at 6 centers to about 50% at 2 centers. After initial observation and release, readmission to the hospital for complications occurred in 35 (5.7%) of 614 same-day discharge patients (20 pancreatitis and 15 other complications, 3 severe). Of the same-day discharge patients, readmission was required for 14 (12.2%) of 115 who had at least one independently significant multivariate risk factor for overall complications (suspected sphincter of Oddi dysfunction, cirrhosis, difficult bile duct cannulation, precut sphincterotomy, or combined percutaneous-endoscopic procedure) versus 21 (4.2%) of 499 without a risk factor (odds ratio 3.1: 95% confidence interval [1.6, 6.3], p < 0.001). Of complications presenting within 24 hours after ES, only 44% presented within the first 2 hours, but 79% presented within 6 hours. CONCLUSIONS: Same-day discharge is widely utilized and relatively safe but results in a significant number of readmissions for complications. For patients at higher risk of complications, as indicated by the presence of at least one of five independent predictors, observation for 6 hours or overnight may reduce the need for readmission.

Adult↗
PubMed2004

Influence of endoscopic papillary balloon dilation and endoscopic sphincterotomy on sphincter of oddi function: a randomized controlled trial.

BACKGROUND AND STUDY AIM: Endoscopic papillary balloon dilation (EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function, there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. PATIENTS AND METHODS: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. RESULTS: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure, there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1 year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST. When the pancreatic enzyme levels of the two groups were directly compared, there was no significant difference at 1 year after the procedure, but the EPBD group had significantly higher levels at 1 week following the procedure. CONCLUSION: In this study it was found that in patients with CBD stones both EPBD and EST preserve sphincter of Oddi function.

Adult↗
PubMed1999

Metaanalysis of randomized controlled trials of endoscopic retrograde cholangiography and endoscopic sphincterotomy for the treatment of acute biliary pancreatitis.

OBJECTIVE: Endoscopic retrograde cholangiography with endoscopic sphincterotomy (ERC+ES) has been advocated for the management of acute biliary pancreatitis. However, it is also viewed as dangerous. Our objective was to review published randomized, controlled trials (RCTs) of ERC+ES in patients with acute biliary pancreatitis and, by metaanalysis, to estimate the overall efficacy and safety of this approach. METHODS: We performed a fully recursive literature search for published RCTs of ERC+ES in gallstone-related acute pancreatitis. RCTs were pooled. Individual and overall mortality and complication rates were calculated, together with their 95% confidence intervals (CI), absolute risk reduction (ARR), relative risk reduction (RRR), and numbers needed to treat (NNT) for avoidance of complications or death. RESULTS: Four published RCTs had a numerically lower complication rate, and three had a numerically lower mortality rate, in the treated groups than in controls. After pooling, there were 460 treated patients and 374 controls. Complications occurred in 115 (25.0%) treated patients and 143 (38.2%) controls (z = 4.10; p < 0.001). Twenty-four treated patients (5.2%) and 34 controls (9.1%) died (z = 2.15; p < 0.05). ERC+ES had a 34.6% RRR for complications and a 42.9% RRR for death; ARR for complications and death was 13.2% (95% CI: 6.9-19.5%) and 3.9% (95% CI: 0.35-7.45%), respectively. The NNT for avoidance of complications and death was 7.6 and 25.6, respectively. CONCLUSIONS: ERC+ES reduces morbidity and mortality in patients with acute biliary pancreatitis. Treating 26 such patients with ERC+ES is predicted to save one life.

Acute Disease↗
PubMed1993

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy: experience in the Sudan.

Over a 5 year period 626 endoscopic retrograde cholangiopancreatography (ERCP) examinations were attempted in Khartoum, Sudan. The relevant duct was successfully cannulated and visualized in 94% of cases of biliary tract disease and in 73% of cases of pancreatic disease. This was due to the large number of cases with advanced pancreatic cancer. The commonest abnormal finding was stones in the biliary tree in 214 cases (35% of all cases). Cholangiocarcinoma was seen in 18 cases, pancreatic cancer in 64 cases, chronic pancreatitis in 48 cases and periampullary carcinoma in 20 cases. ERCP was considered normal in 100 cases. Endoscopic sphincterotomy (EST) was performed in 48 cases; 44 had common duct stones. ERCP and EST are feasible and useful procedures in a developing country. However they are expensive and should be carried out in referral centres.

Adult↗
PubMed1986

Endoscopic retrograde cholangiopancreatography and endoscopic papillotomy in recurrent pyogenic cholangitis.

In recurrent pyogenic cholangitis (RPC), there is primary bacterial cholangitis resulting in the formation of strictures and stones in the intrahepatic as well as the extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) is a very useful investigation in the study of RPC. The location of stones and strictures and the morphology of the bile ducts are well delineated. Moreover, cholangitis liver abscesses and biliary-enteric fistulas, which are frequently encountered in RPC, are demonstrated. ERCP can also be used to differentiate RPC from ascariasis, clonorchiasis, hepatocellular carcinoma and cholangiocarcinoma, which sometimes have quite similar clinical pictures and can be confused with RPC. ERCP should be performed in every patient with RPC in order to plan surgical treatment. Endoscopic papillotomy (EPT) is indicated in RPC patients with residual common bile duct stones or papillary stenosis, and as primary treatment in selected high-risk patients. More studies are necessary to establish additional indications for EPT.

Ampulla of Vater↗
PubMed1993

Techniques for endoscopic and non-endoscopic intracorporeal laser applications.

This article deals with various designs of CO2 and Nd:YAG lasers currently used in surgery. It is discussed how their wavelength and beampath characteristics can be utilized in either the contact or the non-contact method to achieve specific clinical aims. These may concern endoscopic procedures, e.g. palliative tumour destruction or haemangioma or cystic membrane coagulation, or non-endoscopic procedures, as exemplified by two case reports on treatment for a congenital vascular disorder and varicosis, respectively. As there is a certain overlap of laser and high-frequency applications, their respective advantages and drawbacks are compared in detail. The main safety concern in HF surgery is that of errant currents in the patient, whereas in laser applications the main hazard is to the operators' eyes. This hazard can be safely eliminated.

Adult↗
PubMed1987

Tissue sampling from the common bile duct through endoscopic retrograde cholangiopancreatography, endoscopic papillo(sphinctero)tomy and drainage in juxtapapillary malignancies.

In 22 patients with radiological evidence of a malignant stricture or an obstruction of the common bile duct, endobiliary tissue specimens were obtained through endoscopic retrograde cholangiopancreatography. An endoscopic papillo(sphinctero)tomy was necessary in 9 of the 22 patients. The following techniques were employed: (1) forceps biopsy of the papillary infundibulum and/or of the common bile duct; (2) brush cytology in the same sites as above; (3) biliary juice cytology obtained by a nasobiliary drainage tube. In 8 patients, two different sampling techniques were used. The final diagnosis was established by means of pathological evaluation of surgical or necroscopic material. The diagnostic adequacy was 100% for biopsy, 88% for brush cytology, and 62% for bile cytology. The sensitivity was 100%, 66%, and 25%, respectively, for the above techniques. From 6 cases without biliary cancer, the specificity was 100%. These data show that biopsy specimens alone provide a definitive preoperative diagnosis in most cases, provided adequate samples are obtained.

Aged↗
PubMed2002

[Endoscopically controlled stabilization of humerus shaft fractures. The endoscope as an aid in minimally invasive osteosynthesis].

This study describes the anatomical basis of direct visualization of the radial nerve and of fracture reduction in humeral shaft nailing and reports first clinical results. Fourteen cadavers were random selected and dissected in order to determine the exact course of the radial nerve in relationship to anatomical landmarks. In individuals with a total humeral length between 25-33 cm the radial nerve was found to cross the humeral shaft exactly in the middle of the long axis of the humeral shaft. The average distance from the lateral epicondyle to the point were the radial nerve penetrates the lateral intermuscular septum was 11.9 +/- 1.0 cm, the distance from the posterior tip of the acromion to the crossing of the nerve with the medial border of the humeral shaft was 12.9 +/- 1.5 cm. Using these landmarks in six clinical cases fracture reduction, visualization of the radial nerve and intramedullary nailing could be achieved with endoscopic control. There were no surgical complications such as secondary radial nerve palsy, hematomas or wound healing problems. With the use of the endoscope the number of secondary radial nerve palsies associated with intramedullary humeral shaft nailing might be reduced in the future.

Adult↗
PubMed1984

Pancreas divisum and its association with choledochal sphincter stenosis. Diagnosis by endoscopic retrograde cholangiopancreatography and endoscopic biliary manometry.

Choledochal sphincter stenosis was demonstrated in 37 of 90 patients with pancreas divisum. In 21 of the patients, stenosis was diagnosed during ERCP by endoscopic calibration of the choledochal sphincter, delayed drainage of contrast material from the bile duct, or a dilated common duct with or without elevation of the serum alkaline phosphatase level. In 12 patients, stenosis was diagnosed during endoscopic manometry with the demonstration of elevated basal choledochal sphincter pressures. Stenosis was initially diagnosed during surgery in four patients. Common duct diameters were normal in all patients who had not had cholecystectomy. Choledochal sphincter stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. The surgical approach to patients with pancreas divisum and intractable obstructive pain should include sphincteroplasty of both the major and minor sphincters rather than the minor sphincter alone.

Adolescent↗