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At least 37 records · Page 2Linked to original sources
PubMed1982

Duodenoscopic sphincterotomy for removal of bile duct stones in patients with gallbladders.

Duodenoscopic sphincterotomy was attempted in 71 elderly patients with gallbladders who presented with acute symptoms caused by common bile duct stones. Sphincterotomy was possible in all but one patient, and duct clearance was achieved in 61 (86%); failures were usually due to the size of the stones. Two patients required blood transfusions for immediate bleeding, and two underwent cholecystectomy for acute cholecystitis developing within 7 days of sphincterotomy. One patient with a retained stone was judged to be unfit for surgery and died 6 weeks after sphincterotomy. Eleven patients had elective cholecystectomy. Forty-eight patients (mean age 75 years) were discharged with their gallbladders in place; clinical follow-up (mean 19 months) had been possible in 44. None have suffered cholangitis or jaundice, and only five have so far needed cholecystectomy for recurrent biliary pains. Duodenoscopic sphincterotomy is recommended for acutely ill patients with symptoms caused by duct stones, even patients with gallbladders. Longer follow-up is required to judge the indications for subsequent cholecystectomy, but present evidence suggests that it is reasonable to postpone cholecystectomy indefinitely for many elderly and frail patients.

Adult↗
PubMed1977

Duodenoscopic sphincterotomy and gallstone removal.

Duodenoscopic sphincterotomy was attempted in 265 patients. The procedure was successful in 243 patients (92%). Indications for sphincterotomy were: 185 patients with choledocholithiasis, 52 patients with papillary stenosis, and 6 patients with ampullary carcinoma. The clinical and biochemical evidence of cholestasis resolved in 222 of the 243 successful patients (91%). Complications consisting of hemorrhage, perforation, pancreatitis, cholangitis, and instrumental injury resulted in three deaths, an over-all mortality of 1.2%. Emergency laparotomy was required in 6 cases (2.5%). Duodenoscopic sphincterotomy is a relatively safe and effective means of relieving certain instances of extrahepatic cholestasis. The complication and mortality rates appear lower than those with equivalent conventional surgical techniques.

Adult↗
PubMed1999

EUS and K-ras analysis of pure pancreatic juice collected via a duodenoscope after secretin stimulation for diagnosis of pancreatic mass lesion: a prospective study.

BACKGROUND: The early diagnosis of pancreatic cancer remains problematic. This prospective study assessed the utility of a combination of endoscopic ultrasound (EUS) and genetic analysis of pure pancreatic juice in the diagnosis of pancreatic mass lesions. METHODS: One hundred seventy-six patients with suspected pancreatic disease were enrolled and underwent ultrasonography (US), computed tomography (CT), endoscopic retrograde choleangiopancreatography (ERCP), and EUS. Pure pancreatic juice was collected endoscopically after secretin stimulation. K-ras point mutations at codon 12 in the juice were assayed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Thirty-six (20%) patients were found to have solid pancreatic masses including 19 with cancer (7 patients, </= 2 cm) and 17 patients with an inflammatory mass (13 patients, </= 2 cm). US and CT were both less sensitive, particularly in patients with small masses. In 13 patients, small masses (4 cancer and 9 inflammatory masses) were not delineated until EUS. The combination of EUS and K-ras analysis had a high sensitivity (100%; p < 0.05 vs. US) and its accuracy reached 94% (p < 0.01 vs. US). CONCLUSIONS: EUS and K-ras determination in pure pancreatic juice collected via a duodenoscope may be useful for the diagnosis of pancreatic mass lesions.

Adenocarcinoma↗
PubMed1983

Short-channel duodenoscope: innovations in selective biliography.

The selective cannulation of the intrahepatic branches of the biliary system is made possible by the use of torsion-stabilized angiographic catheters passed via short-channel duodenoscopes. Other feasible applications are the endoscopic selective positioning of biliary endoprosthesis, and the cannulation of the gall bladder using a cysto-nasal catheter through which a litholytic fluid can be installed directly into the gall bladder.

Bile Ducts, Intrahepatic↗
PubMed1976

Duodenoscopic papillotomy and gallstone removal.

Using an experimental insulated duodenoscope and a diathermy wire, papillotomy has been performed on 10 patients under diazepam sedation. Seven patients had common bile duct stones (6 following cholecystectomy) and 3 had papillary stenosis. Nine of the patients had severe medical or surgical contraindications to further operative treatment. Papillotomy was successful in all patients, with no significant bleeding or other complications. Repeat endoscopy 6-14 days after papillotomy demonstrated a healed biliary orifice of 7-10 mm diameter. Stones had already passed in 3 of the 7 patients; in 2 others, stones were extracted using balloon catheters or Dormia type baskets. Two larger stones could not be removed; in one of these patients the stone and basket became impacted at the papilla and had to be removed surgically 2 days later. Endoscopic papillotomy is an acceptable alternative to surgery in high risk patients, particularly in the treatment of retained common bile duct stones. If long term results prove satisfactory, the technique will have wider application.

Adult↗
PubMed1981

Nonoperative measurement of pancreatic and common bile duct pressures with a microtransducer catheter and effects of duodenoscopic sphincterotomy.

Duodenoscopic manometry of the pancreatic duct (PD) and common bile duct (CBD) using a microtransducer catheter was distinct advantages over infusion manometry, giving absolute values of in situ intraluminal pressure. Microtransducer manometry was performed without medication in 49 patients with gallbladder stones (10), common bile duct stones (24), hepatic duct stones (6) and common bile duct dilatation (9), and was successful in 42 (86%) for PD and 36 (73%) for CBD. Ductal pressures showed respiration-synchronized biphasic variations superimposed by the arterial pulsation effect. Considerable postural change of the pressure values suggested that the recording posture should be predetermined. The PD-to-duodenum pressure gradient was higher than the CBD-to-duodenum gradient in most cases. Both were lower than those obtained previously by infusion methods. No significant differences were found in pressure profiles of the four disease groups. Endoscopic sphincterotomy significantly reduced not only CBD pressure but also PD pressure.

Adult↗
PubMed1990

Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy.

One hundred sixty-three postcholecystectomy patients with retained or recurrent duct stones under-went successful duodenoscopic sphincterotomy and duct clearance between 1975 and 1980. Follow-up information was obtained on 148 patients in 1982, and on 115 of these in 1986 (at a mean of 8 yr). Fifteen patients (13%) were found to have had further biliary problems, but only 5 were known to have had sphincter stenosis and/or stones, and only 3 had not responded to endoscopic or conservative treatment. One had undergone choledochoduodenostomy for recurrent cholangitis (but continued to have problems), and 1 had died with jaundice, the precise cause of which was unknown. The third continued to have episodes of cholangitis requiring antibiotics despite the apparent lack of biliary obstruction. Bile showed significant bacterial contamination in 60% of 44 patients undergoing check endoscopy, but there was no correlation with symptoms. These long-term results are comparable with those of surgical procedures and justify the continuing use of endoscopic treatment for patients with duct stones.

Bile↗
PubMed1978

Bacteriological efficiency of a standardized cleansing and disinfection technique for duodenoscopes.

Adequate cleansing and disinfection of the endoscopes is desirable to prevent bacteriaemia and septicemia following gastrointestinal endoscopy, especially endoscopic retrograde cholangiopancreatography and duodenoscopic sphincterotomy. A practical method, proved in our department over a period of 12 months, is described. As the result of this standardized cleansing and disinfection technique using the aldehyde derivative Gigasept (succine dialdehyde and 2,5-dimethoxytetrahydrofuran) in a 10% concentration as chemical disinfectant, sterile cultures from the biopsy channel were obtained in 75% of tested instruments. The remaining fiberscopes exhibited only a few bacteria left, resulting in a sufficient success of disinfection according to hygienic standards.

Aldehydes↗
PubMed1977

Duodenoscopic guided biopsy of the biliary and pancreatic duct.

First experiences with duodenoscopic guided biopsy of the biliary and the pancreatic duct on 11 cases using a special designed forceps showed that this method gave good and representative results in the biliary duct and from the papilla. However, in the present stage of development guided biopsy from the pancreatic duct does not aid exact differential diagnosis of benign or malignant lesions. In 3 out of 4 cases with pancreatic cancer the histological diagnosis was false negative. The biopsy specimens are very small and need an exact preparation and great experience of the histologist. Cytologic criteria must be relied on more here as in other areas of the GI-tract. However, the criteria of malignancy rest not in the nature of the individual cell but in the manner of proliferation, namely the infiltration of the deeper layers. This is the advantage of guided biopsy compared to cytological examination. Complications of the method may be avoided by exact guiding of the forceps and by limiting the numbers of specimens.

Aged↗
PubMed1982

The presence of a positive pressure gradient from pancreatic duct to choledochal cyst demonstrated by duodenoscopic microtransducer manometry: clue to pancreaticobiliary reflux.

A case of choledochal cyst is presented. The diagnosis was established by endoscopic retrograde cholangiopancreatography, which also demonstrated that the common bile duct joined the pancreatic duct at an abnormally long distance from the papilla. Duodenoscopic manometry using a microtransducer catheter showed that the pressure in the pancreatic duct was higher than that in the choledochal cyst by 1.1 mmHg. The cyst-to-duodenum pressure gradient of 3.5 mmHg was not different from the common duct-to-duodenum gradient in patients with other common biliary tract diseases, making the presence of a stenosis as an etiology of this entity unlikely. The bile aspirated from the gallbladder had an extremely high amylase content, suggesting influx of the pancreatic juice into the biliary system. The pancreaticobiliary reflux caused by the positive pressure gradient from the pancreatic duct to the choledochal cyst may be related to the development of the disease.

Bile Reflux↗
PubMedDate not supplied

Duodenoscopic sphincterotomy for acute suppurative cholangitis.

Fifteen patients (eight males, seven females; age range: 23-76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1-10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall-bladders in situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile-duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall-bladders in situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3-26 months (mean follow-up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is performed early.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1980

Decompression of malignant biliary obstruction by duodenoscopic intubation of bile duct.

Interest is increasing in non-operative methods of relieving malignant obstruction of the bile duct, and drainage tubes and prostheses may be placed in the bile duct via the percutaneous transhepatic route. Two cases are described, however, in which a duodenoscope was used and the approach was via the papilla of Vater. This method allows temporary or permanent drainage tubes to be placed through malignant strictures. This endoscopic approach is less invasive and should be safer than that by the transhepatic route; furthermore, removing and replacing a blocked endoprosthesis should be easier. Further study is needed, as the procedure is technically more difficult and its role in managing biliary strictures has yet to be defined.

Aged↗
PubMed1985

Percutaneous transhepatic assistance for duodenoscopic sphincterotomy.

Duodenoscopic sphincterotomy is an established method for dealing with common bile duct stones and papillary stenosis. Occasionally even an experienced operator is unable to carry out a sphincterotomy, for instance in the presence of large peri-papillary diverticula or Billroth II gastrectomy. Most of these patients will be offered surgery--a few will refuse or be unfit for operation. One further therapeutic option is a combined approach involving a radiologist and endoscopist, in which percutaneous transhepatic insertion of a guide wire through the papilla, with or without balloon dilatation, is used to facilitate insertion of the sphincterotome by the endoscopist. This has been done successfully in 10 of 11 patients attempted, without significant complication.

Aged↗
PubMed1984

Retroperitoneal perforation during duodenoscopic sphincterotomy.

Perforation into the retroperitoneal space may occur during duodenoscopic sphincterotomy and can be recognized radiographically. While it is potentially serious, most patients should respond to conservative management provided that adequate biliary drainage is achieved. Five cases encountered during approximately 500 sphincterotomies are presented. Radiographs taken 24 hours after 50 additional procedures showed no evidence of perforation.

Adult↗
PubMed1979

Depression of exocrine pancreatic secretion by collection through duodenoscopic catheters.

Two dogs were equipped with gastric and duodenal cannulas permitting quantitative collection of pure pancreatic juice. Two series of experiments were performed: 1) collection through a short catheter, length 35 cm, volume 0.3 ml, and internal diameter 1.0 mm, and 2) collection through a long catheter used for duodenoscopic cannulation in man, length 110 cm, volume 1.7 ml, and internal diameter 1.0 mm at the tip and 1.4 mm in the other part of the catheter. After a basal period of 30 min the secretion was stimulated with secretin in the doses 0.1, 0.5, and 2.0 clinical units/kg/h, each dose being infused over a period of 30 min. With the long catheter the dose-response curve for fluid and bicarbonate was shifted to the right. The basal secretion of fluid was depressed 40%; with increasing secretory rates the depression was less pronounced. No significant depression of the bicarbonate concentration was seen. The protein secretion was insignificantly reduced.

Animals↗
PubMed1975

The diagnosis of necrotizing pancreatic lesions by means of duodenoscopic pancreatography.

Direct demonstration of intrapancreatic abscesses and pseudocysts can be made by means of duodenoscopic retrograde pancreatography. The most important findings are escape of contrast medium from the duct system into a cavity and its visualization, the tryptic perforation of one or more ducts and the concomitant deformity which may be general or limited to the vicinity of the lesion. The differential diagnosis of pancreatic abscess and carcinoma with penetration of contrast medium in the tumor tissue is supported by the fact that the contours of a necrotic cavity are rather well defined, whereas in carcinoma the extraductal opacification is diffuse. As a rule in a necrotic lesion the ductal system is distorted locally or the whole excretory duct system may be involved. In carcinoma the ductal system generally appears normal distally to the tumor. Accurate demonstration of the necrotic lesion, the assessment as to its localization and size are of decisive importance for indication and choice of the surgical procedure.

Abscess↗
PubMedDate not supplied

Duodenoscopic sphincterotomy for common bile duct stones in patients with gallbladder in situ.

Duodenoscopic sphincterotomy (DS) is a well established treatment for common bile duct (CBD) stones in post-cholecystectomy patients, but not in patients with gallbladder in situ. The main argument against the procedure in the latter set of patients has been that by performing it, one is leaving behind the diseased gallbladder which may require further treatment. We have, however, performed 60 DS in 49 patients with gallbladder in situ. The clinical picture of these patients was characterized by abdominal pain in 79.6%, jaundice in 91.8%, history of cholangitis in 46.9%, severe acute cholangitis at the time of DS in 28.6% and a major associated illness in 10.2% of them. Adequate sphincterotomy was performed in 91.8% of the patients with successful stone extractions in 93.3% and an overall CBD clearance in 85.7%. One patient (2%) with severe acute cholangitis, who had presented in a moribund state, died despite adequate DS. Three patients (6%) experienced an exacerbation of acute cholangitis after DS, two of them requiring emergency surgery. During subsequent follow-up, elective cholecystectomy was performed in 26 (54%) patients. Five additional patients are awaiting surgery. Seventeen (36%) patients continue to have their gallbladders in situ and over a mean follow-up period of 12.8 months (range, 4-32 mos) they have remained asymptomatic except for brief episodes of biliary pain in 2 patients. It is concluded that DS relieves the symptoms of CBD stones even in patients with gallbladders in situ and may suffice for patients who are frail, elderly and who have major associated illnesses.

Duodenoscopy↗
PubMed1989

Duodenoscopic sphincterotomy in a northern Indian hospital.

In a 36-month period, 154 duodenoscopic sphincterotomies (DS) were performed on 120 patients in a Northern Indian hospital. The major indication for DS was choledocholithiasis (95.8%), the rest being done for indications like papillary stenosis, periampullary carcinoma and the sump syndrome. Seven patients (5.8%) had significant associated medical illnesses. An adequate sphincterotomy was achieved in 91.6% of patients, with successful stone extraction in 95.3% of them. Overall clearance of the common bile duct (CBD) was thus achieved in 87.5% of the patients subjected to DS. Two patients (1.7%) died after undergoing DS, and six (5%) experienced early complications that necessitated emergency operation in two of them (1.7%). DS appears to be the treatment of choice for the management of choledocholithiasis in the postcholecystectomy patient as well as in the patient with gallbladder in situ who has cholangitis or jaundice or associated medical illness that may constitute a high risk for surgery.

Cholangiopancreatography, Endoscopic Retrograde↗