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At least 289 records · Page 16Linked to original sources
PubMed1994

Systemic iodine absorption during endoscopic application of radiographic contrast agents for endoscopic retrograde cholangiopancreaticography.

Hyperthyroidism induced by contrast agents in a major problem in patients with pre-existing thyroid disease, particularly in patients with functional thyroid autonomy. The present study was undertaken to evaluate whether contrast media applied during endoscopic retrograde cholangiopancreaticography (ERCP) may result in a significant increase of serum iodine levels and thus may be associated with the risk of iodine-induced hyperthyroidism. The courses of serum concentrations of total iodine and free iodide, as well as of urinary iodine excretion, were measured in 15 patients before and up to 21 days after ERCP. During ERCP, the non-ionic contrast medium iopamidol was instilled in amounts resulting in a total iodine load of 57.4 +/- 22.8 mmol (7.3 +/- 2.9 g). In all patients, ERCP resulted in a highly significant increase in serum levels of total iodine from 0.8 +/- 0.5 to 85.2 +/- 116.9 mumol/l 4 h after application of the contrast agent. In parallel, serum iodide levels were raised from 0.06 +/- 0.04 to 5.42 +/- 6.09 mumol/l and urinary iodine excretion from 71.1 +/- 35.7 mumol/mol creatinine to 621,620.9 +/- 636,492.2 mumol/mol creatinine. Peak concentrations of serum iodine are well related to the total amount of iodine applied (p < 0.05). During follow-up, iodine levels returned to pre-exposure levels within 2-3 weeks. Levels of thyrotropin, free thyroxine, and free triiodothyronine remained unchanged during the follow-up period. In conclusion, endoscopic application of iodinated contrast agents during ERCP leads to significant increases of serum levels of total iodine and free iodide and of urinary iodine excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed2000

[Percutaneous endoscopic gastrotomy (GEP): designed reusable (NAGEP) for one time endoscopic technique. Experimental study in dogs].

INTRODUCTION: This aim of our experimental study was to demonstrate the versatility of our designed reusable device for PEG and its future application in humans. MATERIALS AND METHODS: 20 mongrel dogs received enteral nutrition by a Foley tube placed by a single endoscopic technique using a reusable stainless steel designed device, three reusable stainless steel designed device, three reusable stainless steel dilators, an Olympus XQ20 video gastrointestinal endoscope, basic surgical equipment and surgical material. RESULTS: The procedure was successfully performed in all dogs under general anaesthesia. The duration of the whole procedure ranged from 10 to 18 min. The complications regardless by the PEG procedure were minimal. The Foley tube was retained by 15 days. CONCLUSIONS: The application of the stainless steel reusable designed device for the PEG is safe, and presents several advantages. This technique for PEG placement could be used in the future due the characteristics of the designed device: durable and reusable for unlimited number of procedures.

Animals↗
PubMedDate not supplied

The accuracy of endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, computed tomography, and transabdominal ultrasound in the detection and staging of primary ampullary tumors.

BACKGROUND/AIMS: To compare the accuracy between EUS (endoscopic ultrasound), ERCP (endoscopic retrograde cholangiopancreatography), CT (computed tomography), and transabdominal US (ultrasound) in the detection and staging of primary ampullary tumors. We will also try to discuss the influence of endobiliary stent on EUS in staging ampullary tumors. METHODOLOGY: Twenty-one patients with ampullary tumors were evaluated by EUS, ERCP, CT, and US before operation. The accuracy was assessed with TNM staging and compared with the surgical-pathological findings. RESULTS: EUS was superior to CT and US in detecting ampullary tumors, but EUS and ERCP are of similar sensitivity (EUS 95%, ERCP 95%, CT 19%, US 5%). EUS was superior to CT and US in T staging (EUS 75%, CT 5%, US 0%) and detecting lymph node metastasis (EUS 50%, CT 33%, US 0%) of ampullary tumors. The accuracy of EUS in T and N staging of ampullary tumors tended to be decreased in the presence of endobiliary stent (stenting: T 71%, N 75%; nonstenting T 83%, N 100%), but there was no statistical significance. CONCLUSIONS: EUS was superior to CT and US in assessing primary ampullary tumors, but it was not significantly superior to ERCP in detecting ampullary tumors. The presence of endobiliary stent may decrease the accuracy of EUS in staging ampullary tumors.

Aged↗
PubMed2005

The role of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in diagnosis and treatment of acute pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for diagnosis and therapy in acute and recurrent pancreatitis. While treatment of biliary disorders leading to pancreatitis is common practice, over the past several years many specialized centers have been directing traditional biliary techniques such as sphincterotomy and stenting towards the pancreas. A justifiable fear of pancreatitis and other complications has caused many endoscopists to shy away from pancreatic endotherapy, but refinements in technique, extensive experience, and most notably the routine use of pancreatic stenting to prevent post-ERCP pancreatitis has opened up the field and allowed for endoscopists in specialized centers around the world to perform diagnostic and therapeutic ERCP of the pancreas safely and effectively. In acute gallstone pancreatitis, the benefit of therapeutic ERCP including biliary sphincterotomy has been proven in randomized controlled trials. There are also data to support the role of ERCP directed at the pancreatic sphincters and ducts in treatment of acute relapsing pancreatitis due to pancreas divisum, sphincter of Oddi dysfunction, smoldering pancreatitis, pancreatic ductal disruptions, and perhaps even in evolving pancreatic necrosis. Many causes of apparently idiopathic pancreatitis can be discovered after an extensive evaluation with endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and ERCP with sphincter of Oddi manometry. ERCP often allows treatment of the underlying cause. Because of the inherent risks associated with ERCP, particularly when directed toward the pancreas, the role of ERCP in acute and especially recurrent pancreatitis should be primarily therapeutic with attempts to establish diagnosis whenever possible by less risky techniques including EUS and MRCP. With the added techniques, devices, skill-sets, and experience required, pancreatic endotherapy should preferably be performed in high volume tertiary referral settings. ERCP for diagnosis and treatment of severe or acute relapsing pancreatitis is also best performed using a multidisciplinary approach involving endoscopy, hepatobiliary-pancreatic surgery, and interventional radiology.

Acute Disease↗
PubMed1991

[Disinfection of endoscopes in gastroenterology. Bacteriologic evaluation of the procedure employed in the endoscopic unit at the Mongi Slim Hospital of Tunisia].

An evaluation was made of the incidence of contamination of the endoscopes during gastroscopy and colonoscopy and of the efficacy of the disinfection procedure used in our digestive endoscopy unit. Serial bacteriological samples were made before and after the endoscopy session and also between patient procedures. These samples were taken on the endoscopes and their accessories and also on the walls, examination table, gloves and the uniforms of the staff. Over 60 p. cent of the samples were positive showing that the disinfection technique was not bacteriologicaly satisfactory. Most of the micro-organisms found were opportunists. Firm guidelines regarding adequate disinfection are important and regular micro-biological control of disinfection procedures must be performed.

Disinfection↗
PubMed1991

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy in the management of suspected gallstone pancreatitis.

An approach to suspected gallstone pancreatitis based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCP became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on clinical and biochemical grounds, and further management was based on ERCP findings. If calculi were detected in the common bile duct (13 cases) ES was performed; when calculi were confined to the gallbladder (12 cases) cholecystectomy was advised; and if no calculi were detected on ERCP (4 cases) investigations were continued. ERCP proved to be a reliable guide to management, while ES provided safe and effective symptomatic relief when choledocholithiasis was present, and prevented recurrence of pancreatitis even when the gallbladder remained in situ.

Acute Disease↗
PubMed1990

[Endoscopic study using a superthin endoscope in benign esophageal strictures].

To increase the diagnostic possibilities, the authors suggested a method of endoscopic examination of patients with esophageal strictures by means of a superthin PF-28 fibroscope produced by the Olympus firm (Japan), which was introduced along a string-guide. The examination was successful in 24 of 26 patients. Clinical observations have shown that esophagogastroscopy with a superthin endoscope makes it possible to recognize the exact length of the stenosed segment, detect the second zone of stenosis, and determine the condition of the mucous membrane of the esophago-gastric junction and the proximal part of the stomach.

Adult↗
PubMed1989

[The application of vascular endoscope for the extracranial cerebrovascular occlusive disease: the development of the endoscopic system].

Flexible thin fiber catheter is applied as vascular endoscope for occlusive lesions in the extracranial cerebral arteries. This fiber catheter is introduced transfemorally through 6 or 7 french-sized double lumen balloon catheters. Vascular endoscope clearly demonstrates the internal surface of these vessels by transient occlusion of the proximal side of the vessel through balloon inflation. The occlusive lesions in the subclavian artery or in the proximal vertebral artery were revealed as round smooth-surfaced mass to be treated by the percutaneous transluminal angioplasty.

Aged↗
PubMed1996

Endoscopic variceal ligation versus endoscopic injection sclerotherapy: comparison of hepatic and renal function.

OBJECTIVES: The aim of the present study was to compare the safety of endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) in terms of liver and kidney functions in patients with liver cirrhosis. METHODS: Forty-four patients admitted to Takatsuki General Hospital between February 1991 and March 1993 with esophageal varices due to liver cirrhosis were randomly assigned to receive either EVL or EIS. Serum levels of AST, ALT, total bilirubin (T-bil), direct bilirubin (D-bil), prothrombin time (PT), hepaplastin test (HPT), antithrombin III (ATIII), creatinine (Cr), and blood urea nitrogen (BUN) were measured before and 24 h, 3 days, 7 days, and 14 days after both forms of therapy. RESULTS: Significant elevations of serum T-bil, serum D-bil, and serum ALT and AST levels were observed in the EIS group but not in the EVL group. No significant increases of serum PT, HPT, ATIII, BUN, or Cr levels were observed after treatment in either group. CONCLUSION: EVL should be considered a first choice therapy for eradicating esophageal varices.

Endoscopy↗
PubMed2000

Minilaparotomy and endoscopic techniques for tubal sterilisation.

OBJECTIVES: To evaluate laparoscopic tubal sterilisation, as compared to minilaparotomy in terms of operative morbidity and mortality. Trials comparing laparoscopy or minilaparotomy with culdoscopy were also included in the review. Different methods used to interrupt tubal patency (excision, occlusion and coagulation) and comparison of different forms of anaesthesia will be considered in different reviews. SEARCH STRATEGY: Randomised controlled trials (RCTs) have been identified by using the search strategy of the Cochrane Collaboration. The Cochrane Controlled Trials Register has been searched. Reference lists of identified trials have been searched. SELECTION CRITERIA: All randomised controlled trials comparing laparoscopy, minilaparotomy and/or culdoscopy for tubal sterilisation. Except in one trial [Taner 1994] where 4 women underwent curettage at the same time, all women requested tubal sterilisation as an interval procedure. DATA COLLECTION AND ANALYSIS: Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Data were extracted independently by the reviewers. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes. MAIN RESULTS: Minilaparotomy vs laparoscopy: There was no difference in major morbidity between the 2 groups. Minor morbidity was significantly less in the laparoscopy group (Peto OR 1.89; 95% CI 1.38, 2.59). Duration of operation was about 5 minutes shorter in the laparoscopy group (WMD 5.34; 95% CI 4. 52, 6.16). Minilaparotomy vs culdoscopy: Women undergoing culdoscopy had more major morbidity than women for whom minilaparotomy was performed (Peto OR 0.14; 95% CI 0.02, 0.98). Duration of operation was about 5 minutes shorter in women undergoing culdoscopy (WMD 4. 91; 95% CI 3.82, 6.01). Laparoscopy vs culdoscopy: In the one trial comparing the two interventions there were no significant differences between the groups with regard to major morbidity. Significantly more women suffered from minor morbidities in the culdoscopy group compared to the laparoscopy group (Peto OR 0.20; 95% CI 0.05, 0.77). REVIEWER'S CONCLUSIONS: Major morbidity seems to be a rare outcome for both, laparoscopy and minilaparotomy. The included studies had limited power to demonstrate significant differences especially for the relatively rare but potentially serious outcomes. Personal preference of the woman and/or of the surgeon can guide the choice of technique. Practical aspects (e.g. cost, maintenance, and sterilisation of the instruments) must be taken into account before implementing the more sophisticated endoscopic techniques in settings with limited resources. Culdoscopy is not recommended as it carries a higher complication rate.

Female↗
PubMed1978

Radiation exposure in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic papillotomy.

Radiation exposure was studied in 327 patients undergoing endoscopic retrograde cholangiopancreatography, or endoscopic papillotomy taking into account fluoroscopy time and incident area exposure. The mean fluoroscopy time was 238 +/- 152 seconds and the incident area exposure 3,730 +/- 2,790 R X cm2. These results were compared with standard exposures in upper GI series and colon examinations as found in the literature.

Adult↗
PubMed1995

An endoscopic study on relationship between Helicobacter pylori infection and endoscopic gastric ulcer scars.

A two-year endoscopic follow-up study of 45 gastric ulcer patients was conducted in order to ascertain the relationship between Helicobacter pylori infection, the transformation of ulcer scar patterns, and ulcer relapse during maintenance therapy. Endoscopic findings of gastric ulcer scar patterns, which established the quality of ulcer scars, were classified as follows: Sa, with a central depression, Sb, with a coarse regenerating mucosal pattern up to the center, and Sc, with a fine pattern. The proportion of ulcer relapses was 62% among 29 H. pylori-positive patients and 0% among 16 H. pylori-negative patients. In regard to the relationship between H. pylori infection and scar patterns, 94% of the H. pylori-negative patients displayed Sc scar patterns, while all the H. pylori-positive patients showed various scar patterns, ie, Sa in 38%, Sb in 28%, and Sc in 10%. Ulcer relapses in the H. pylori-positive cases were limited to the Sa and Sb groups (100% and 88%, respectively). In conclusion, our results indicate that H. pylori infection plays an important role in the transformation of the ulcer scar patterns which relate to ulcer relapse.

Cicatrix↗
PubMed1993

Endoscopic balloon sphincteroplasty for benign papillary stenosis--an alternative to surgical or endoscopic papillotomy?

Benign papillary stenosis is an uncommon but well recognised cause of recurrent biliary pain usually in post-cholecystectomy patients characterised by biliary dilatation without bile duct calculi or malignancy. Endoscopic or surgical papillotomy is the recommended treatment but may be associated with a higher complication rate than when performed for bile duct stones. We report 2 cases of papillary stenosis treated by endoscopic balloon dilatation or "sphincteroplasty", as a less traumatic intervention which improved biliary drainage and provided symptomatic relief. Our preliminary experience suggests more widespread evaluation of balloon sphincteroplasty should be considered for papillary stenosis.

Aged↗
PubMedDate not supplied

Percutaneous radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis.

PURPOSE: To compare the results and costs of three different means of achieving direct percutaneous gastroenteric access. METHODS: Three groups of patients received the following procedures: fluoroscopically guided percutaneous gastrostomy/gastrojejunostomy (FPG, n = 42); percutaneous endoscopic gastrostomy/gastrojejunostomy (PEG, n = 45); and surgical endoscopic gastrostomy/gastrojejunostomy (SEG, n = 34). Retrospective review of the medical records was performed to evaluate indications for the procedure, procedure technical success, and outcome. Estimated costs were compared for each of the three procedures, using a combination of charges and materials costs. RESULTS: Technical success was greater for FPG and SEG (100% each) than for PEG (84%, p = 0.008 vs FPG and p = 0.02 vs SEG). All patients (n = 7) who failed PEG subsequently underwent successful FPG. Success in placing a gastrojejunostomy was 91% for FPG, and estimated at 43% for PEG and 0 for SEG. Complications did not differ in frequency among groups. For gastrostomy, the average cost per successful tube was lowest in the PEG group ($1862, p = 0.02); FPG averaged $1985, and SEG $3694. SEG costs significantly more than FPG or PEG (p = 0.0001). For gastrojejunostomy, FPG averaged $2201, PEG $3158, and SEG $3045. CONCLUSION: Technical success for gastrostomy is higher for FPG and SEG than PEG. Though PEG is the least costly procedure, the difference is modest compared with FPG. For gastrojejunostomy, FPG offers the highest technical success rate and lowest cost. Due to high costs associated with the operating room, SEG should be reserved for those patients undergoing a concurrent surgical procedure.

Adult↗
PubMed2001

A new robotic endoscope manipulator. A preliminary trial to evaluate the performance of a voice-operated industrial robot and a human assistant in several simulated and real endoscopic operations.

We report our learning experience in simulated and real surgical tasks with a new voice-controlled robotic endoscope manipulator: an industrial robot with the tool-holder arm modified to support the optic and camera. The manipulator control-card programs have been rewritten to meet the needs of endoscopic surgeons. For this preliminary work, systems engineers with an additional monitor monitored, recorded, and compared the percentage effectiveness and precision of the responses of the robotic and human assistant to successive oral commands during the several different experimental surgical tasks. Simultaneously, to help develop this voice-commanded system for future, more precise robotic manipulation of surgical instruments, they measured the cartesian and spherical coordinates of successive positions of the optic. In unexpectedly difficult experimental conditions, the tireless robot proved more precise and effective than the demonstrably fatigable human: the steadier screen images of the robotic manipulations helped the surgeon tie knots in 7-0 sutures.

Animals↗
PubMed2004

Endoscopic repair of gastrostomy after inadvertent removal of percutaneous endoscopic gastrostomy tube.

Percutaneous endoscopic gastrostomy (PEG) tube placement has become the preferred method of enteral feeding for many patients. Neurologic disease and cancer are the most frequent indications for PEG tube placement. PEG tubes are also becoming more frequent in trauma patients for early initiation of enteral feeding. Inadvertent PEG tube removal is a well-known complication of PEG tubes. Patients undergoing PEG tube placement are frequently malnourished and in poor general medical condition, making them relatively high risk for surgical intervention. In the past, after early inadvertent PEG removal, patients underwent laparotomy for surgical repair of the gastrostomy site. Recently, laparoscopic replacement of the PEG tube has been described. We present a new technique of endoscopic repair of the gastrostomy site with hemoclip placement followed by later PEG tube placement.

Endoscopy, Gastrointestinal↗