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At least 343 records · Page 19Linked to original sources
PubMed1996

[Biliary fistula, following partial hepatectomy, treated by endoscopic papillotomy (atypical indication for endoscopic sphincterotomy)].

The authors present the case of a 33 y old male patient. The young farmer suffered of a large Echinococcus (hydatid) cyst in the right lobe of his liver. The solution of the problem was a practically atypical right lobectomy. On the 5th postoperative day there was manifested a marked external bile fistula through the drain inserted at laparotomy, and the leakage continued until the 38th postoperative day, when after an endoscopic papillotomy the leak nearly immediately has closed. According to the authors, and some literary data published since, in cases of a postoperative external bile fistula the method of choice seems to be the EST.

Adult↗
PubMed1994

A multipurpose cerebral endoscope and reflections on technique and instrumentation in endoscopic neurosurgery.

We discuss our experiences concerning our cerebral endoscope with reflections on various techniques used since 1986. During this time we have had experience with four prototypes. This minimal invasive procedure has been successful to a certain extent both in paediatric and adult patients, stereotactically and by freehand method or both. Further modification for flexibility and manipulation of the optic element is under development.

Adult↗
PubMed2002

Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography imaging for pancreaticobiliary pathology: the gastroenterologist's perspective.

With advances in noninvasive radiologic technology, additional adjunctive techniques are developing, and the roles for ERCP and EUS are continuously changing. In a diagnostic setting, ERCP is currently best reserved for patients with a high likelihood of needing endoscopic therapy, and EUS is especially useful for cases in which other imaging techniques have been inconclusive or are of inferior diagnostic capability. In a therapeutic setting, ERCP and EUS retain important roles in the management of both benign and malignant pancreatic and biliary disease. Certainly, technological advances also directly affect these modalities and expanded applications for ERCP and EUS for the pancreas and biliary tract are anticipated.

Biliary Tract Diseases↗
PubMed1990

Effectiveness of endoscopic drainage for pancreas divisum: endoscopic and surgical results in 31 patients.

Thirty-one patients with symptomatic pancreatitis and pancreas divisum were treated prospectively by inserting an endoprosthesis into the dorsal pancreatic duct for drainage. Pain was a feature characteristic of all 31 patients; of these 92% had an improvement in their subjective complaints of pain after sphincterotomy and insertion of a prosthesis in the minor papilla. During a two-year follow-up period, 84% (26/31) of the group showed improvement in all the signs and symptoms associated with their pancreatitis, and this improvement was sustained in all patients for at least several months. A group of twenty-six patients subsequently underwent pancreatic surgery for recurrent symptoms. Those patients who had improved with endoscopic drainage did significantly better following surgical drainage than those who had shown little or no improvement with an endoprosthesis. On the basis of the above preliminary results, we recommend preoperative insertion of an endoprosthesis into the dorsal duct as a therapeutic predictor of eventual surgical outcome.

Adolescent↗
PubMed2004

Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: results of a retrospective, single center study between 1996-2002.

AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients undergoing preoperative ERCP (< or =90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (> or =8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP. RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%, for three 72.5%, for four or more 91.4%. CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients). Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g. skill of the endoscopist, other diagnostic tools).

Bile Ducts↗
PubMedDate not supplied

Percutaneous and endoscopic management of bile leak following endoscopic stone retrieval--a case report.

Endoscopic sphincterotomy with stone removal is the method of choice for the treatment of choledocholithiasis. The main complications of this procedure are bleeding, pancreatitis, intestinal perforation and cholangitis. Herein, we report on a case of bile peritonitis in a patient who underwent sphincterotomy and stone retrieval. The literature regarding the etiology and management of bile peritonitis is also reviewed.

Aged↗
PubMed1992

Endoscopic approaches in the diagnosis of obstructive jaundice--with special reference to endoscopic retrograde cholangiopancreatography.

Duodenofiberscopy with endoscopic retrograde cholangiopancreatography (ERCP) was performed in 102 patients with obstructive jaundice. Peritoneoscopy and peritoneoscopic cholecystocholangiography were done in patients whose ERCP was inconclusive. The causes of obstructive jaundice were carcinoma of the pancreas in 14 cases, carcinoma of the papilla of Vater in 12 cases, choledocholithiasis in 37 cases, carcinoma of the common bile duct in seven cases, hepatocellular carcinoma (HCC) in seven cases, intrahepatic cholestasis in three cases and miscellaneous causes in eight cases. No final diagnosis was made in 14 patients. The duodenofiberscopic examination with biopsy revealed the cause of obstructive jaundice directly in eight cases, when carcinoma of the pancreas or papilla of Vater extended to the duodenal mucosal surface. In 34 of the 37 patients with choledocholithiasis, ERCP alone was successful in making the diagnosis. Percutaneous transhepatic cholangiography and ERCP were used together to reach a diagnosis in the remaining three patients. We propose a classification for HCC on ERCP which may be useful for the study of icteric type HCC.

Ampulla of Vater↗
PubMed1991

[Endonasal, endoscopic-microscopic control of the decompression of the optic nerve. An anatomic endoscopic presentation of the operation].

The indication for decompression of the optic nerve after indirect trauma is made both by the ophthalmologist and the ENT-surgeon. The ENT-surgeon usually reaches and decompresses the optic canal by a transethmoidal-transsphenoidal route. The majority of authors prefer the transfacial approach to the ethmoid including resection of the crossing plane comprising the frontal process of the maxilla, the ethmoid, the lacrimal and the frontal bone. Hitherto we have knowledge of only one author utilising an endonasal approach to decompress the optic nerve. At the university hospital of Göttingen, the ENT-surgeons gathered experience with the endonasal, endoscopically and microscopically controlled operation method, which is less traumatic to the patient and avoids postoperative mucoceles of the frontal sinus. This surgical procedure is described by surgical-anatomical specimens.

Endoscopes↗
PubMed1984

Endoscopic balloon tamponade for conservative management of severe hemorrhage following endoscopic sphincterotomy.

We report on two patients in whom balloon tamponade was applied for management of severe hemorrhage following endoscopic sphincterotomy (EST). In both patients after EST severe hemorrhage from the papillary orifice was treated by immediate introduction of a special balloon catheter (balloon catheter, model Mainz, Vygon, Aachen). In both patients after 10 minutes no further bleeding was visualized. We conclude that this simple procedure should be taken into account for the conservative treatment of severe hemorrhage following EST.

Ampulla of Vater↗
PubMedDate not supplied

Prospective comparison of catheter-based endoscopic sonography versus standard endoscopic sonography: evaluation of gastrointestinal-wall abnormalities and staging of gastrointestinal malignancies.

PURPOSE: Endoscopic sonography (EUS) is an important imaging modality for evaluating benign and malignant luminal gastrointestinal-tract abnormalities. The objectives of this study were to evaluate the feasibility of catheter-based EUS (C-EUS) during standard upper and lower endoscopy in patients with malignancies and other abnormalities of the gastrointestinal-tract lumen, to assess the image quality obtained with the 12.5-MHz catheter-based ultrasound transducer, and to prospectively compare the interpretations of C-EUS images with those of the standard EUS (S-EUS) images. METHODS: One hundred thirty-seven consecutive patients referred for EUS were evaluated with C-EUS followed by S-EUS. The patients were assigned to 1 of 2 groups: group A, patients with intramural masses or intestinal wall thickening, with biopsies negative for malignancy; and group B, patients with esophageal, gastric, duodenal, or rectal cancer referred for staging. The results of C-EUS and S-EUS were compared for each group. RESULTS: C-EUS was completed in 134 patients: 81 patients with 83 lesions in group A and 53 patients in group B. For group A, C-EUS image interpretation concurred with that of S-EUS in 74 (89%) of 83 lesions. For group B, C-EUS concurred with S-EUS for tumor depth (T) and nodal (N) classifications in 19 cases (36%) and 26 cases (49%), respectively. The depth of invasion was underestimated by C-EUS in all 34 cases in which the T classifications by C-EUS and S-EUS were discordant. In 1 of 6 patients with stenotic cancer that was nontraversable by S-EUS, C-EUS identified lymphadenopathy (incorrectly classified as N0 by S-EUS). CONCLUSIONS: C-EUS was easily performed, and the C-EUS images were comparable to the S-EUS images in assessing mucosal and intramural lesions. The limited depth of penetration of the catheter-based transducer resulted in understaging the extent of tumor invasion and underestimating the nodal spread.

Adult↗
PubMed1982

Endoscopic diagnosis of early gastric cancer by the endoscopic Congo red-methylene blue test.

The endoscopic Congo red test combined with dyeing with methylene blue was performed in 85 patients with early gastric cancer (94 lesions). Results revealed that gastric cancer bleached the Congo red and methylene blue sprayed over their surface and this appeared in sharp contrast to the red-colored mucosa of unaffected areas. Grossly, polypoid and flat types, and histologically differentiated adenocarcinomas bleached the dyes more frequently and more intensely than depressed and undifferentiated adenocarcinomas. Thus the spread of cancerous growth could be judged rather accurately and so the target area could be reached by biopsy in cases where there were few if any visual signs of abnormality.

Adenocarcinoma↗
PubMed2007

The role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in distinguishing pancreatic cystic lesions.

Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed. Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.

Adult↗
PubMed1989

Evaluation of endoscopic ultrasonography for gastric tumors and presentation of three-dimensional display of endoscopic ultrasonography.

We have studied the usefulness of endoscopic ultrasonography (EUS) for: (1) differentiation between extragastric mural compression (EGMC) and submucosal tumors (SMT); (2) qualitative assessment of these lesions; (3) diagnosis of serosal invasion by malignant gastric tumors; (4) presentation of three-dimensional display of EUS findings. A total of 103 patients with submucosal lesions protruding into the gastric lumen on endoscopy were examined. Differentiation between EGMC and SMT could be made by EUS in all cases. Qualitative assessment of these lesions was made by observing their EUS findings, i.e. their internal and marginal echo pattern and their location in the gastric layers. The correct diagnosis was made in 88% (23/26) of EGMC. Of 50 patients with SMT, comprising myogenic tumor (32), aberrant pancreas (8), lipoma (3), gastric cyst (4) and malignant lymphoma (elevated type; 3), differentiation between malignant and benign myogenic tumors was impossible by EUS alone. In addition, 48 patients with advanced gastric cancer and malignant lymphoma were examined. Invasion to the serosal surface was diagnosed as interruption of the fifth layer of the gastric wall. Invasion to other organs was diagnosed by interruption and fusion of the fifth layer into the border of the adjacent structure. Serosal invasion was diagnosed accurately in 65% of 48 patients. Microscopic invasion was difficult to diagnose, and gastric stenosis by tumor was an obstacle to adequate scanning. EUS can be valuable in the differential diagnosis between EGMC and SMT and in the qualitative diagnosis of gastric lesions. It is also effective in detecting serosal invasion by gastric malignant tumors. Three-dimensional display of pathological lesions is new in EUS.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Graphics↗
PubMed1977

Assessment of endoscopic aspiration cytology and endoscopic retrograde cholangi-pancreatography (ERCP) in patients with cancer of the pancreas. Part I.

This report is concerned with studies on duodenofiberscopic examinations with aspiration cytology endoscopic retrograde cholangio-pancreatography (ERCP) in 44 patients with cancer of the pancreas. Aspiration cytology alone was diagnostic in 91% of cancer of the head of the pancreas, 55% of cancer the body and tail of the pancreas and 100% of cancer of the whole pancreas. ERCP alone was diagnostic in 59% of cancer of the head of the pancreas, 75% of cancer of the body and tail of the pancreas and 100% of cancer of the whole pancreas. By combining these two approach a diagnostic result was obtained in 95% of cancer of the head of the pancreas and 90% of cancer of body and tail of the pancreas. It is concluded that the combined diagnostic approach has enhanced diagnostic accuracy of malignant lesions of the pancreas and that it has not yet led to an improvement resectability and mortality.

Ampulla of Vater↗
PubMed1977

Assessment of endoscopic aspiration cytology and endoscopic retrograde cholangio-pancreatography in patients with cancer of the hepato-biliary tract. Part II.

Aspiration cytology and ERCP were evaluated in 66 patients with cancer of the hepato-biliary tract. Cytology was diagnostic in 100% of ampullary cancer, 83% of cancer of extrahepatic bile duct, 0% of cancer of intrahepatic bile duct, 25% of cancer of gall bladder and 0% of cancer of liver. ERCP was diagnostic in 65% of ampullary cancer, 90% of cancer of extrahepatic bile duct, 100% of cancer of intrahepatic bile duct, 25% of cancer of gall bladder and 25% of cancer of liver. Endoscopic findings was diagnostic in 77% of cancer of ampullary region. By combining these approaches, a diagnostic result was obtained in 100% of ampullary cancer, 96.5% of cancer of extrahepatic bile duct, 100% of cancer of intrahepatic bile duct, 50% of cancer of gall bladder and 25% of cancer of liver. It is concluded that the combined diagnostic approach has enhanced the diagnostic accuracy of malignant lesions of the hepato-biliary tract and that it has not yet led to an improvement in resectability and mortality.

Ampulla of Vater↗
PubMed1991

Variceal bleeding after endoscopic injection sclerotherapy: an analysis of 108 subjects undergoing endoscopic injection sclerotherapy.

Among 108 cases of endoscopic injection sclerotherapy (EIS) performed from January 1984 through September 1989, post-EIS variceal bleeding occurred in 38 case (35%). Death was significantly more frequent among the post-EIS bleeders than non-bleeders (55% v. 27%). Background factors were analyzed for failure to prevent bleeding. The curve of the cumulative non-bleeding rate following emergency EIS (21 cases) was significantly lower (P less than 0.01) than that following elective EIS (22 cases), and there was more frequent rebleeding (13/21 v. 7/22) within a shorter mean period of time (4.9 months v. 14.1 months) in the former; association of hepatocellular carcinoma was also more frequent (13/21 v. 3/22). Continuation of drinking showed no difference between post-EIS bleeders (5/38) and non-bleeders (9/70). After complete variceal eradication the curve of the cumulative non-bleeding rate was significantly higher than after incomplete eradication (P less than 0.001). Following prophylactic EIS (65 cases) there was significantly less frequent bleeding (P less than 0.01) than following EIS performed after variceal rupture (43 cases). The risk of variceal bleeding after EIS can be minimized by complete eradication of varices at the initial EIS. Prophylactic EIS was suggested to contribute to reducing the frequency of post-EIS bleeding.

Emergencies↗
PubMed2002

Is the success rate of endoscopic third ventriculostomy age-dependent? An analysis of the results of endoscopic third ventriculostomy in young children.

INTRODUCTION: Different opinions exist in the literature about the effectiveness of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus in young children. Therefore we made a retrospective evaluation of our own success rates of performing ETVs in children less than 2 years of age. MATERIALS AND METHODS: In a series of 275 ETVs 66 procedures were performed in children less than 2 years of age. RESULTS: The overall success rate in this young age group was 53%, lower than the success rates of ETVs reported in literature (72-92%). But further analysis of these results and a comparison of the results in subgroups with different etiologies of the hydrocephalus showed that the success rates varied between 20 and 88%. CONCLUSION: We conclude that the success of ETV depends mainly on the etiology of the hydrocephalus and not on the age of the patient alone.

Age Factors↗