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At least 613 records · Page 34Linked to original sources
PubMed2003

Prospective evaluation of 4-mm diameter endoscopes for esophagoscopy in sedated and unsedated patients.

BACKGROUND: Unsedated esophagoscopy with small-diameter endoscopes is generally well tolerated but of limited sensitivity for the diagnosis of esophageal mucosal disease. This study evaluated the sensitivity of esophagoscopy performed with new 4-mm diameter prototype battery-powered and video endoscopes. Patient tolerance for an unsedated examination with the 4-mm endoscopes was assessed and the performance characteristics of the battery-powered and video 4-mm endoscopes were compared. METHODS: Patients referred for EGD were recruited to undergo an additional examination with a 4-mm endoscope. A prototype 60-cm long, 4-mm diameter battery-powered fiberoptic esophagoscope was used in the first 24 patients and a prototype 60-cm long, 4-mm diameter video esophagoscope in the next 27 patients. Examiners who were unaware of patient history and procedure indications recorded esophageal findings, ease of intubation, optical quality (5-point visual scale), and time for examination of the esophagus and then recorded esophageal findings after the standard EGD. RESULTS: The sensitivity, specificity, and accuracy for identification of Barrett's esophagus was 100%; overall sensitivity, accuracy, and specificity for detecting esophageal lesions were, respectively, 91%, 98%, and 99%. Patient tolerance (assessed by symptom scores for choking, pain, and discomfort) and acceptability of unsedated esophagoscopy with the 4-mm diameter instruments were significantly better than in a historical group of patients examined with a 3-mm diameter endoscope. The optical quality of video endoscope was rated as superior to that of battery-powered endoscope, and esophageal examination was performed significantly quicker with the video versus the battery-powered endoscope (68 vs. 137 seconds; p = 0.001). CONCLUSIONS: Unsedated esophagoscopy with 4-mm diameter endoscopes may be an alternative to EGD for screening for Barrett's esophagus. Given the current state of endoscopic technology, a minimum diameter of 4 mm is required for satisfactory esophageal imaging.

Barrett Esophagus↗
PubMed2003

Endoscopic placement of direct percutaneous jejunostomy tubes in patients with complications after esophagectomy.

BACKGROUND: Complications after esophagectomy may prevent oral intake, lead to dependence on total parenteral nutrition, and lengthen hospital stay. Direct percutaneous endoscopic placement of a jejunostomy tube allows enteral feeding in the presence of postoperative complications and eliminates the need for total parenteral nutrition. METHODS: A total parenteral nutrition database was used to identify patients who received total parenteral nutrition because of complications after esophagectomy. Records of all patients subsequently referred for percutaneous endoscopic jejunostomy placement were reviewed. RESULTS: Twenty-five patients with postesophagectomy complications were referred for percutaneous endoscopic jejunostomy placement. A percutaneous endoscopic jejunostomy was successfully placed in 21 patients (84%), all of whom were weaned off total parenteral nutrition. Six patients (29%) in whom percutaneous endoscopic jejunostomy placement was successful died during hospitalization at a mean of 20 days (range 5-40 days) after the procedure for reasons unrelated to percutaneous endoscopic jejunostomy tube insertion. The remaining 15 patients were discharged while receiving nutrition by means of the percutaneous endoscopic jejunostomy. Ten of them had subsequent removal of the percutaneous endoscopic jejunostomy at a mean of 131 days (range 20-281 days). There were no major percutaneous endoscopic jejunostomy-related complications. Minor complications occurred in 4 patients (19%). CONCLUSION: Percutaneous endoscopic jejunostomy placement may be considered in patients with complications after esophagectomy. In these patients, percutaneous endoscopic jejunostomy placement avoids the need for total parenteral nutrition.

Aged↗
PubMed1998

Endoscope-assisted brain surgery: part 2--analysis of 380 procedures.

OBJECTIVES: Microsurgical techniques and instruments that help to reduce intraoperative retraction of normal intracranial neuronal and vascular structures contribute to improved postoperative results. To achieve sufficient control of the operating field without retraction of neurovascular components, the resection of dura and bone edges is frequently required, which, on the other hand, increases operating time and operation-related trauma. The use of endoscopes may help to reduce retraction and, at the same time, may help to avoid additional dura and bone resection. The aim of this study is to describe the principles on which the technique of endoscope-assisted brain surgery is based, to give an impression of possible indications for endoscope-assisted microsurgical procedures, and, with illustrative cases, to delineate the advantages of endoscopes used as surgical instruments during microsurgical approaches to intracranial lesions. METHODS: During a period of 4.5 years, 380 microsurgical procedures were performed as endoscope-assisted microneurosurgical operations. This surgical series was analyzed for time of surgery, usefulness of intraoperative endoscopy, and complication rates. Lens scopes with viewing angles of 0 to 110 degrees and with diameters of 2.0 to 5.0 mm as well as newly designed "viewing dissectors" (curved, rigid fiberscopes) with diameters of 1.0 to 1.5 mm connected to a video unit were used as microsurgical instruments. The positioning of the endoscopes was achieved by retractor arms fixed to the Mayfield headholder. Thus, the surgeon was able to perform customary microsurgical manipulations with both hands under simultaneous endoscopic and microscopic control. RESULTS: The lesions treated with endoscope-assisted microsurgery comprised 205 tumors, 53 aneurysms, 86 cysts, and 36 neurovascular compression syndromes. Eighty-nine of these lesions were localized in the ventricular system, 242 in the subarachnoid space or intracerebral, and 49 in the sella. Endoscope-assisted microsurgery was advantageous to reduce the size and the operation-related tissue trauma of approaches to lesions within the ventricular system, in the brain tissue as well as in the subarachnoid space at the base of the brain. Using less retraction during tumor removal, the visual control of retrosellar, endosellar, retroclival, and infratentorial structures was improved. Video-endoscope instrumentation was especially helpful during procedures in the posterior cranial fossa and at the craniocervical junction. It allowed for inspection of channels and hidden structures (e.g., the internal auditory meatus, the ventral surface of the brain stem, the ventral aspect of root entry zones of cranial nerves, the content of the foramen magnum, and the upper cervical canal), both without retraction and without resection of dura and bone edges. Endoscope instrumentation during surgery for large or giant aneurysms was useful to dissect perforators on the back side of the aneurysms and to control the completeness of clipping. CONCLUSION: Although the results reported herein cannot be compared directly with those of exclusive microsurgical procedures performed during the same period of time, videoendoscope-assisted microsurgery can be recommended as a time-saving, trauma-reducing procedure apt to improve postoperative outcomes.

Adolescent↗
PubMed2002

Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note.

OBJECTIVE: Endoscopes have been commonly used in transsphenoidal surgery to treat pituitary tumors, to compensate for the narrow surgical field. Although many navigation systems have been introduced for neurosurgical procedures, there have been few reports of navigation systems for endoscopic operations. This report presents our recently developed, endoscopic, augmented reality (AR) navigation system. METHODS: The technology is based on the principles of AR environment technology. The system consisted of a rigid endoscope with light-emitting diodes, an optical tracking system, and a controller. The operation of the optical tracking system was based on two sets of infrared light-emitting diodes, which measured the position and orientation of the endoscope relative to the patient's head. We used the system during endonasal transsphenoidal operations to treat pituitary tumors in 12 recent cases. RESULTS: Anatomic, "real," three-dimensional, virtual images of the tumor and nearby anatomic structures (including the internal carotid arteries, sphenoid sinuses, and optic nerves) were superimposed on real- time endoscopic live images. The system also indicated the positions and directions of the endoscope and the endoscopic beam in three-dimensional magnetic resonance imaging or computed tomographic planes. Furthermore, the colors of the wire-frame images of the tumor changed according to the distance between the tip of the endoscope and the tumor. These features were superior to those of conventional navigation systems, which are available only for operating microscopes. CONCLUSION: The endoscopic AR navigation system allows surgeons to perform accurate, safe, endoscope-assisted operations to treat pituitary tumors; it is particularly useful for reoperations, in which midline landmarks may be absent. We consider the AR navigation system to be a promising tool for safe, minimally invasive, endonasal, transsphenoidal surgery to treat pituitary tumors.

Endoscopy↗
PubMed2003

Anterior endoscopic discectomy and fusion for adolescent idiopathic scoliosis.

STUDY DESIGN: A review of adolescent patients with idiopathic scoliosis undergoing endoscopic release and spinal fusion. OBJECTIVE: To describe the indications, techniques, results, and complications of thoracic anterior endoscopic scoliosis surgery. SUMMARY OF BACKGROUND DATA: Anterior endoscopic treatment of thoracic adolescent idiopathic scoliosis has become an alternative method of surgical treatment. METHODS: Twenty-one patients with adolescent idiopathic scoliosis have undergone a thoracic anterior endoscopic release and fusion followed by posterior instrumentation and fusion. Indications for the endoscopic fusion were large curve magnitude, skeletal immaturity, and/or thoracic hyperkyphosis. Eleven patients have undergone anterior endoscopic instrumentation and fusion for thoracic scoliosis curves between 45 degrees and 70 degrees, using a single screw/single rod construct and autogenous rib bone graft. RESULTS: Results from the anterior endoscopic release and fusion procedures followed by a posterior instrumentation and fusion had an average preoperative curve of 82 degrees (range, 41 degrees -125 degrees ), with postoperative correction to 28 degrees (range, 5 degrees -60 degrees ) showing 70% correction. For patients undergoing an anterior endoscopic instrumentation and fusion, the average preoperative Cobb measurement of 53 degrees (range, 44 degrees -62 degrees ) was corrected to an average 26 degrees (range, 18 degrees -38 degrees ) for an average correction rate of 51%. One patient undergoing an anterior endoscopic release was converted to an open procedure for end plate bony bleeding without sequelae. One patient with an anterior endoscopic instrumentation and fusion had revision anterior surgery for a distal set screw dislodgment and subsequent posterior instrumentation and fusion for pseudarthrosis. CONCLUSIONS: The use of both anterior endoscopic release and fusion combined with either anterior instrumentation or separate posterior instrumentation and fusion continues to evolve. Surgeons treating patients with these techniques must understand that there are specific indications for them and many technique options available to optimize surgical results.

Adolescent↗
PubMed2004

Abnormal gastroesophageal flap valve is highly associated with endoscopic reflux esophagitis after Helicobacter pylori eradication.

BACKGROUND: Whether or not eradicating Helicobacter pylori worsens reflux esophagitis remains controversial. We investigated the relationship between gastroesophageal flap valve grading and endoscopic reflux esophagitis (in patients with peptic ulcer and gastritis) before and after H. pylori eradication in a case controlled study. Whether endoscopic assessment of the gastroesophageal flap valve allows prediction of endoscopic reflux esophagitis development or exacerbation was also assessed. MATERIALS AND METHODS: A total of 220 patients with peptic ulcer or chronic gastritis, who received H. pylori eradication therapy, were followed for at least 6 months (range, 6-34 months) for endoscopic changes. Another 88 age- and disease-matched H. pylori-positive controls, without eradication therapy, were also enrolled. Gastroesophageal flap valve grade (I-IV) was assessed using the Hill classification. RESULTS: Endoscopic reflux esophagitis incidence was significantly (p < .01) higher in abnormal gastroesophageal flap valve (grades III and IV) than in normal gastroesophageal flap valve (grades I and II) cases in both H. pylori eradication and control groups. The rate of new endoscopic reflux esophagitis after eradication was significantly (p < .01) higher in the abnormal than in the normal gastroesophageal flap valve group (54.5% vs. 9.1%). By contrast, the endoscopic reflux esophagitis exacerbation rate in patients with endoscopic reflux esophagitis before eradication was low (4.5%) and endoscopic reflux esophagitis improvement was observed in 40.9% of these patients. CONCLUSIONS: These results suggest gastroesophageal flap valve grading by endoscopy to be useful for predicting the risk of newly developing endoscopic reflux esophagitis after H. pylori eradication, in addition to predicting the presence of endoscopic reflux esophagitis.

Adult↗
PubMed2004

Endoscopic balloon dilation of ileal pouch strictures.

BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in patients with ulcerative colitis. Strictures can occur at the inlet and outlet of the pouch. Endoscopic balloon dilation has been successfully used in patients with Crohn's strictures at the small intestine and colon. There are no published trials on endoscopic balloon therapy of ileal pouch strictures. AIM: To evaluate outpatient endoscopic balloon dilation of strictures in ileal pouches. METHODS: Patients underwent nonfluoroscopy-guided, nonsedated, outpatient endoscopic dilations with an 8.6-mm upper endoscope and through-the-scope balloons (size: 11-18 mm). Pre- and posttreatment Pouchitis Disease Activity Index symptom scores (range: 0-6), endoscopic stricture scores based on resistance in passing the endoscope (range: 0-4), and Cleveland Global Quality of Life were compared. RESULTS: Nineteen patients with pouch strictures who had concurrent Crohn's disease of the pouch (n = 11), cuffitis (n = 5), and pouchitis (n = 3), including 14 inlet and 14 outlet strictures, were enrolled. The mean number of strictures for each patient was 1.61 +/- 0.78. All strictures were successfully dilated with the through-the-scope balloon, with a mean of 1.74 +/- 1.19 (range: 1-5) sessions for each patient. Nine patients had a second endoscopy at 8 wk and five patients had a third pouch endoscopy at 16 wk after the initial endoscopic dilation. Endoscopic stricture scores immediately (0.30 +/- 0.47), 8 wk (0.40 +/- 0.51), and 16 wk (0.44 +/- 0.76) after the dilation were significantly improved compared to the predilation stricture scores (2.67 +/- 0.78). The symptom scores and quality-of-life (QOL) scores improved at week 8 and 16 following dilation, with a mean follow-up of 6.10 +/- 5.83 months (2-25 months). No complications were experienced with the procedure. One patient with CD who failed endoscopic and medical therapy underwent pouch resection. CONCLUSION: In conjunction with medical therapy, outpatient endoscopic balloon dilation appears safe and effective in treating pouch inlet and outlet strictures, by relieving symptoms, restoring pouch patency, and improving QOL in the majority of patients.

Adult↗
PubMed1993

Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.

To define the role of two-portal endoscopic carpal-tunnel release as a method for the treatment of compression of the median nerve at the wrist, a prospective, randomized, multicenter study was performed on 169 hands in 145 patients. Either open or endoscopic carpal-tunnel release was performed in all of the patients who had clinical signs and symptoms consistent with carpal tunnel syndrome, had not responded to or had refused non-operative management, and had had electrodiagnostic studies consistent with carpal tunnel syndrome. Follow-up evaluations were performed at twenty-one, forty-two, and eighty-four days. At the end of the follow-up period, both the open and endoscopic methods had resulted in high levels of achievement of the primary outcomes (relief of pain and paresthesias). The numbness and paresthesias were relieved in eighty (98 per cent) of eighty-two hands in the open-release group compared with seventy-seven (99 per cent) of seventy-eight hands in the endoscopic-release group. This parameter was not recorded for three hands in the open-release group or six hands in the endoscopic-release group. The satisfaction of the patients with the procedure, graded on a scale of 0 to 100 per cent, averaged 84 per cent in the open-release group compared with 89 per cent in the group that had had endoscopic release. We found no significant differences between the two groups with regard to the secondary quantitative-outcome measurements, including two-point discrimination, postoperative interstitial-pressure data for the carpal canal, Semmes-Weinstein monofilament testing, and motor strength. The open technique resulted in more tenderness of the scar than did the endoscopic method. Thirty-two (39 per cent) of eighty-two hands in the open-release group and fifty (64 per cent) of seventy-eight hands in the endoscopic-release group were not tender at eighty-four days. This parameter was not recorded for three hands in the open-release group and six hands in the endoscopic-release group. The open method also resulted in a longer interval until the patient could return to work (median, twenty-eight days, compared with fourteen days for the open-release and endoscopic-release groups). Four complications occurred in the endoscopic carpal-tunnel release group: one partial transection of the superficial palmar arch, one digital-nerve contusion, one ulnar-nerve neuropraxia, and one wound hematoma.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed1994

[Trigonoplasty for vesicoureteral reflux--from open surgery to endoscopic surgery].

To evaluate endoscopic trigonoplasty compared to open trigonoplasty for vesicoureteral reflux, we analyzed clinical results, complications, the use of analgesics for postoperative pain and bladder irritability and postoperative length of hospitalization. One of six patients undergoing endoscopic trigonoplasty subsequently underwent open trigonoplasty due to failure of trocar placement, therefore, 7 patients having vesicoureteral refluxy renoureteral units underwent open trigonoplasty and 5 patients with vesicoureteral reflux 7 renoureteral units underwent endoscopic trigonoplasty. Mean operative time was 143 +/- 48 minutes for open surgery and 185 +/- 54 minutes for endoscopic surgery. Vesicoureteral reflux disappeared in 8 renoureteral units but was worse in one unit after open trigonoplasty, while vesicoureteral reflux subsided in 6 units and improved in one unit from grade II to grade I after endoscopic trigonoplasty. There were no intraoperative complications after open surgery, while one patient had pneumoperitoneum due to inadequate placement of a trocar during endoscopic surgery. There were no early postoperative complications after endoscopic surgery. However, 2 patients developed hematuria after open surgery. The degree of postoperative pain and irritability following endoscopic trigonoplasty was lower than that after open trigonoplasty and analgesics were used less frequently after endoscopic surgery. The mean postoperative hospital stay was 16.7 +/- 3.2 days for open surgery and 14.4 +/- 2.9 days for endoscopic surgery. These results indicate that endoscopic trigonoplasty is a useful procedure for vesicoureteral reflux because it is minimally invasive.

Adolescent↗
PubMedDate not supplied

Endoscopic diagnosis of intestinal metaplasia of stomach--accuracy judged by histology.

BACKGROUND/AIMS: To testify proposed endoscopic criteria in surveying intestinal metaplasia (IM), we conducted a prospective study to assess the accuracy of endoscopic diagnosis of IM correlated with histology. METHODOLOGY: Between January 1996 and July 1997, 87 subjects undergoing endoscopic examination as part of a health check-up were enrolled. Subjects whose endoscopic features showed whitish color change with plaques, patches or homogeneous discoloration on gastric mucosa were diagnosed as IM and enrolled in group A, while subjects without any of these endoscopic features were enrolled in group B. Endoscopic biopsies were taken from areas with whitish changes and normal-looking mucosae for histological correlation. RESULTS: There were 8 subjects with whitish plaques, 29 subjects with whitish patches, and 8 subjects with homogeneous whitish discoloration enrolled in group A. In contrast, 42 subjects without any endoscopic features of IM were enrolled in group B. After verification by endoscopic biopsy with histologic examination, 30 and 10 subjects were histologically confirmed to have IM in groups A and B, respectively. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic diagnosis was 75%, 68.1%, 66.7%, 76.2%, and 71.3%, respectively. There was a positive relationship between age and sensitivity, and tendency of an inverse relationship between age and specificity. CONCLUSIONS: The proposed endoscopic criteria are valuable in detecting three-fourths of IM patients during routine endoscopic examination. It was more effective to detect IM in elderly patients and to exclude IM in younger subjects by these criteria.

Adult↗
PubMed1987

A study of the correlation between endoscopic and histological diagnoses in gastroduodenitis.

Serial histological specimens from 14 patients with the endoscopic diagnosis of erosive gastritis and/or duodenitis were examined for correlation between endoscopic and histological findings. All patients were symptomatic outpatients without history of alcoholism or usage of aspirin or nonsteroidal antiinflammatory drugs. After the initial diagnosis, the patients underwent follow-up endoscopy until healing of erosions at 1, 4, and 8 wk. Pairs of biopsies from the gastric fundus, body, and antrum, and the duodenum were obtained at each endoscopy. Agreement between histological and endoscopic findings occurred in only 56% of the 161 sites studied. The best correlation occurred in the duodenum when there was endoscopic disease (89%) and was worst in the stomach at all sites regardless of endoscopic findings (46%). A normal histology in the face of abnormal endoscopic changes was seen in only 16% of all biopsies. Histological inflammation occurred in 27% of all biopsies with a normal endoscopic appearance and in 55% of the normal endoscopic areas in the stomach. Histological appearances at each biopsy site remained constant in individual patients throughout the study. The specific histological findings, such as activity and severity, did not correlate with the endoscopic severity of inflammation or with any specific endoscopic appearances, such as erosions, petechiae, or nodules. In conclusion, the histological and endoscopic findings in the stomach from patients with symptomatic erosive gastroduodenitis correlate poorly while good correlation occurs in the duodenum.

Adolescent↗
PubMed1995

A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy.

Results from studies evaluating needle-knife papillotomy are conflicting. The aim of this prospective trial was to assess the safety and efficacy of needle-knife papillotomy and compare the results with those of standard endoscopic sphincterotomy. During a period of 6 years, ERCP was performed 1680 times. Four hundred fifty-six patients had biliary obstruction and were candidates for endoscopic sphincterotomy. Cholangiography was successful in 414 subjects (91%). These individuals underwent endoscopic sphincterotomy, which was successful in 395; overall success rate for endoscopic sphincterotomy was 87% (395 of 456). Forty complications occurred (9.7%), but only 21 (5.1%) were serious. No procedure-related mortality occurred. Fifty-two of 456 patients (11%) were managed by needle-knife papillotomy. In 42 of these subjects, cholangiograms had failed or were incomplete, and endoscopic sphincterotomy was not attempted; in 10 individuals endoscopic sphincterotomy had failed. Needle-knife papillotomy was successful in 47 of 52 patients (90%). Three complications occurred (5.7%), only 2 of which (3.8%) were serious. Morbidity rates for needle-knife papillotomy and endoscopic sphincterotomy were not significantly different. No procedure-related mortality occurred. Needle-knife papillotomy increased the overall success rate for endoscopic management with sphincterotomy from 87% (success rate for endoscopic sphincterotomy alone) to 97% (success rate for endoscopic sphincterotomy and needle-knife papillotomy).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

[The development of the endoscopic treatment].

With development and improvement of the endoscope equipment, the role of the digestive system endoscope is developing to the application from the pickup of mere lesion to precise diagnosis and endoscopic treatment. The range of the digestive system endoscopic treatment tends to also expand year by year. From the viewpoint of the medicine side, the update of the digestive system endoscope is reported this time. Digestive system endoscopic treatment can be divided roughly into the digestive tract region and the bile pancreas region. There are foreign body extraction, hemostasis methods(peptic ulcer, esophageal varix), excision for the tumor, dilatation methods for the stenosis, etc. as endoscopic treatment in the digestive tract region. In the bile pancreas region, there are endoscopic sphincterotomy, calculus removal of bile duct and ductus pancreaticus, drainage, dilatation methods for the stenosis, etc. The endoscopic treatment develops more and more on both regions with development of together various equipment and improvement in the technique. The invasion to the patient is less than the surgery for the endoscopic treatment, and it is possible to position with the therapy that it retained the function of the organ and was excellent concerning the QOL. It is anticipated with that the effort with the aim of further low invasion will advance in future too.

Catheterization↗
PubMed2006

Endoscopic resection of benign tumors of the papilla of vater.

Most benign papillary tumors are adenomas which can potentially undergo the adenoma-carcinoma-sequence making complete removal mandatory for curative therapy. Endoscopic resection (papillectomy) of these lesions is being increasingly performed as a less traumatic alternative to surgery. Available data shows endoscopic papillectomy to be effective and safe in experienced hands with usually little morbidity and virtually no mortality. Success rates are around 80 % for lesions without intraductal involvement. Selected cases of limited distal intraductal involvement accessible after sphincterotomy may also be managed curatively by endoscopic resection. Endoscopic snare resection of entire lesions should be primarily regarded as a diagnostic procedure. It allows for an accurate histological diagnosis based on examination of the entire specimen rather than forceps biopsies and thus a reliable assessment of the need for surgical therapy. Subsequent surgery in operable patients is not precluded by previous endoscopic resection. Surgery is indicated in case of incomplete removal and if malignancy is present. The curative role of endoscopic papillectomy for early invasive carcinoma needs to be established. Histological features and individual risk for surgery are factors to be considered. Inoperable patients may still benefit from palliative endoscopic stenting. After endoscopic papillectomy has been completed, regular follow-up examinations including biopsies are warranted because of the risk of local recurrence. For benign looking papillary tumors, endoscopic papillectomy serves as a diagnostic tool and should be considered as first line procedure regardless of age. The following article details the approach to patients with benign papillary tumor and the technique of endoscopic papillectomy.

Ampulla of Vater↗
PubMed1995

Endoscopic incision of Zenker's diverticula.

BACKGROUND AND STUDY AIMS: The endoscopic treatment of symptomatic pharyngoesophageal diverticula (PED) with rigid instruments involves the incision of the septum between the diverticulum and the esophageal lumen, within which the cricopharyngeal muscle is present. The aim of this study is to report on the feasibility and efficacy of our method using flexible endoscopy and an electro-surgery system with minimal trauma to the patients. PATIENTS AND METHODS: Forty-two patients (13 female, 29 male) with symptomatic pharyngoesophageal diverticula underwent endoscopic treatment. The average age of the patients was 68.4 years (range 46 to 102 years) and 26 of them (61%) had concomitant cardiopulmonary diseases. The procedure consisted of endoscopic incision of the septum with a needle knife, using cutting/coagulation current. It was performed under preparation for routine endoscopic examination. All patients were clinically and endoscopically evaluated at two and four weeks, and afterwards followed clinically at 12, 24, and 60 months after the procedure. RESULTS: The endoscopic incision was performed in one to live sessions (mean of 1.8 session per patient). Two complications (one cervical emphysema, and one hemorrhage) were managed clinically. Dysphagia disappeared in all patients soon after the treatment, although the post-operative radiological and endoscopic controls revealed the presence of a remaining diverticulum. Manometric findings disclosed a significant reduction in upper esophageal sphincter pressures in all five patients after endoscopic incision. Mean follow-up was 38 months. There was recurrence of dysphagia in three patients (7.1%) at 12, 22, and 60 months after the procedure. They experienced relief of dysphagia after a repeated endoscopic incision. CONCLUSIONS: Endoscopic incision of PED using flexible equipment proved to be a highly efficient and safe method of treating symptomatic disease. It should be considered as an alternative therapy for Zenker's diverticula, especially for patients at a high surgical risk.

Adult↗
PubMed1998

Endoscopic application in aesthetic and reconstructive facial bone surgery.

Twenty-three cases of endoscopically assisted facial bone surgery were performed over the past 3 years. Our series is consistent with 16 cases of aesthetic contouring surgery and 12 treatments of facial bone fracture, including three cases for recontouring of frontal bone, three cases for recontouring of zygoma, endoscopically assisted correction of three zygomatic and blowout fractures, four cases for rhinoplasty and septoplasty for deviated nose, and three cases for mandible contouring surgery. To accomplish this technique, a rigid 4-mm, 30-degree down-angled endoscope was used. The frontal bone or zygomatic arch was approached endoscopically through two or three small incisions on the frontal or temporoparietal scalp. All endoscopic instruments were then manipulated through these incisions. The approach for endoscopically assisted rhinoplasty is the same as with standard rhinoplasty procedures. The approach for zygoma complex and maxillary sinus needs an intraoral incision. Recontouring of zygoma, mandible, and nasal dorsum by an air-driven burr and rasp was performed with endoscopic visual assistance. A plate and screw fixation for zygomatic arch fracture requires an additional small skin incision over the plate for the trocar method. The duration of follow-up ranged from 6 months to 30 months. The postoperative course was satisfactory with a few complications. The extra time needed for the endoscopic procedures was less than 1 hour. Endoscopically assisted facial bone surgery can be performed with adequate visualization and direct manipulation of all facial bones. Complications usually associated with extensive incisions in the bicoronal approach may be avoided. Poor visualization in the conventional approach for operation of orbit, nose, maxillae, and mandible may be avoided by use of the endoscope. This technique may prove to be ideal for aesthetic surgery for facial skeleton with smaller scar and less morbidity.

Adolescent↗
PubMed2002

Automatic fusion of freehand endoscopic brain images to three-dimensional surfaces: creating stereoscopic panoramas.

A major limitation of the use of endoscopes in minimally invasive surgery is the lack of relative context between the endoscope and its surroundings. The purpose of this work was to fuse images obtained from a tracked endoscope to surfaces derived from three-dimensional (3-D) preoperative magnetic resonance or computed tomography (CT) data, for assistance in surgical planning, training and guidance. We extracted polygonal surfaces from preoperative CT images of a standard brain phantom and digitized endoscopic video images from a tracked neuro-endoscope. The optical properties of the endoscope were characterized using a simple calibration procedure. Registration of the phantom (physical space) and CT images (preoperative image space) was accomplished using fiducial markers that could be identified both on the phantom and within the images. The endoscopic images were corrected for radial lens distortion and then mapped onto the extracted surfaces via a two-dimensional 2-D to 3-D mapping algorithm. The optical tracker has an accuracy of about 0.3 mm at its centroid, which allows the endoscope tip to be localized to within 1.0 mm. The mapping operation allows multiple endoscopic images to be "painted" onto the 3-D brain surfaces, as they are acquired, in the correct anatomical position. This allows panoramic and stereoscopic visualization, as well as navigation of the 3-D surface, painted with multiple endoscopic views, from arbitrary perspectives.

Algorithms↗
PubMed1993

Endoscopic extraction of bile duct stones: management related to stone size.

Endoscopic sphincterotomy has become the first line treatment for patients with common bile duct (CBD) stones. This technique may fail, however, due to difficult anatomy, previous surgery, periampullary diverticula or the presence of a large stone. The importance of stone size to the success of endoscopic sphincterotomy has not been fully assessed. A prospective study was carried out over the period January 1987 to December 1989 on 100 patients (45 male, 55 female, median age 69 years, range 19-97) with CBD stones in which a policy of early duct clearance was followed. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and the stone size and number recorded from the cholangiograms and corrected for magnification. Sphincterotomy was performed using a diathermy unit with a cutting current and stones were extracted using a balloon catheter or a Dormia basket. Of the 100 patients with CBD stones receiving ERCP, successful clearance of the biliary tree was possible in seven without endoscopic sphincterotomy and five were felt to be unsuitable for endoscopic sphincterotomy. Of the remaining 88 patients endoscopic sphincterotomy was successful in 75 (85%). Of the 75 patients having endoscopic sphincterotomy stone clearance was successful in 44 (59%). There were no deaths and only four complications, which rapidly resolved on conservative treatment (two acute pancreatitis, two bleeding). The number of CBD stones present was similar in those patients with successful endoscopic sphincterotomy and duct clearance (median 1, range 1-10, n = 44) as in those in whom it failed (median 2, range 1-6, n = 31). In contrast there was a highly significant difference when stone size was analysed (successful clearance median stone size 10 mm, range 3-27 mm; unsuccessful: median 18 mm, range 10-42, p<0.001). Stones less than 10 mm in diameter (n=21) were all removed successfully whereas in patients with stones over 15 mm (n=25) only three were removed endoscopically (12%). All patients with evidence of residual stones had additional treatment. Of these 31 patients, 10 had surgery, 11 had insertion of an endoprosthesis, and 10 had dissolution treatment with methyl-tert-butyl ether through a nasobiliary catheter. This study shows the importance of stone size to the success rate of endoscopic removal of bile duct stones.

Adult↗