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PubMed1989

Endoscopic studies on the superficial spreading type of early gastric cancer.

Twenty eight cases out of 230 cases of early gastric cancer showed the superficial spreading type of early gastric cancer. Seventeen stomachs (60.7%) were compatible to the endoscopic finding of spreading cancerous regions, even to macroscopic and microscopic ones. Other 11 cases were not corresponded clinicopathologically to the infiltrated lesions. These 11 cases were studied on the superficial spreading lesions respectively. They were divided into three groups and compared each other micro- and macro-scopically and endoscopically. Group I contained 6 cases, compatible to micro- and macro-scopic findings but not to endoscopic ones. Endoscopic overdiagnosis may be redness and overflow of white fur and underestimate by a few cancer cells superficially in the mucosae, slight difference in height at the margin of II c and cancer without exposure. Group II was similar microscopic and endoscopic findings but not compatible macroscopically. Both cases in group II were overestimated macroscopically at the infiltrated edge because of color change in mucosae but endoscopically diagnosed by changes of color and gastric area. Group III contained 3 cases of microscopic characteristics and not compatible to macroscopic and endoscopic ones. Endoscopic underdiagnosis may be based on a few cancer cells superficially in normal mucosae and on less depressed lesions. These clinicopathological studies might be worthy to clarify the endoscopic and pathologic discrepancies of infiltrating areas by early gastric cancer, and might improve endoscopic techniques of the gastric mucosal observation.

Adult↗
PubMed2001

Effectiveness of endoscopic treatment modalities in complicated hepatic hydatid disease after surgical intervention.

BACKGROUND AND STUDY AIMS: Hepatic hydatid cyst is a common disease in Turkey and the rupture of the cyst into the biliary tract is the most common complication which is difficult to detect and to manage. The aim of this study was to investigate the effectiveness of endoscopic treatment modalities in hydatid cyst patients with biliary complications who had previously undergone surgery. PATIENTS AND METHODS: Over the last 8 years, by means of endoscopic retrograde cholangiopancreatography (ERCP), we have examined 87 patients with postoperative biliary symptoms who had previously undergone surgery for hepatic hydatid disease of the liver. Endoscopic treatment modalities were as follows: endoscopic sphincterotomy (ES) and nasobiliary drainage in patients with biliary fistula; balloon and or bougie dilation and stenting in patients with biliary stricture; and ES and balloon extraction in patients with residual hydatid material within the bile duct. RESULTS: Findings from ERCP included biliary fistula in 55 patients (63.2 %), biliary stricture in 16 (18.4 %), and residual hydatid material within the bile duct in 14 (16.1 %). Two patients had normal findings on ERCP. In total, 85 patients were treated by means of endoscopic modalities. The time to closure of fistula was 17.8 +/- 5 days and the rate of fistula closure was 81 %. Biliary stenting was performed in 13 patients with biliary stricture. Endoscopic removal of hydatid material was achieved in 14 patients. The overall success rate of endoscopic treatment was 86 %, and a second surgical intervention was required only in six patients. No serious complication was encountered after endoscopic procedures. CONCLUSIONS: Endoscopic treatment modalities are safe and helpful methods for the treatment of biliary complications of hepatic hydatid cyst in the postoperative period.

Adolescent↗
PubMed2003

Long-term outcome of endoscopic dual pancreatobiliary sphincterotomy in patients with manometry-documented sphincter of Oddi dysfunction and normal pancreatogram.

BACKGROUND: For patients with sphincter of Oddi dysfunction and abnormal pancreatic basal sphincter pressure, additional pancreatic sphincterotomy has been recommended. The outcome of endoscopic dual pancreatobiliary sphincterotomy in patients with manometry-documented sphincter of Oddi dysfunction was evaluated. METHODS: An ERCP database was searched for data entered from January 1995 to November 2000 on patients with sphincter of Oddi dysfunction who met the following parameters: sphincter of Oddi manometry of both ducts, abnormal pressure for at least 1 sphincter (> or =40 mm Hg), no evidence of chronic pancreatitis, and endoscopic dual pancreatobiliary sphincterotomy. Patients were offered reintervention by repeat ERCP if clinical symptoms were not improved. The frequency of reintervention was analyzed according to ducts with abnormal basal sphincter pressure, previous cholecystectomy, sphincter of Oddi dysfunction type, and endoscopic dual pancreatobiliary sphincterotomy method. RESULTS: A total of 313 patients were followed for a mean of 43.1 months (median, 41.0 months; interquartile range: 29.8-60.0 months). Immediate postendoscopic dual pancreatobiliary sphincterotomy complications occurred in 15% of patients. Reintervention was required in 24.6% of patients at a median follow-up (interquartile range) of 8.0 (5.5-22.5) months. The frequency of reintervention was similar irrespective of ducts with abnormal basal sphincter pressure, previous cholecystectomy, or endoscopic dual pancreatobiliary sphincterotomy method. Of patients with type III sphincter of Oddi dysfunction, 28.3% underwent reintervention compared with 20.4% with combined types I and II sphincter of Oddi dysfunction (p = 0.105). When compared with endoscopic biliary sphincterotomy alone in historical control patients from our unit, endoscopic dual pancreatobiliary sphincterotomy had a lower reintervention rate in patients with pancreatic sphincter of Oddi dysfuntion alone and a comparable outcome in those with sphincter of Oddi dysfunction of both ducts. CONCLUSION: Endoscopic dual pancreatobiliary sphincterotomy is useful in patients with pancreatic sphincter of Oddi dysfunction. Prospective randomized trials of endoscopic biliary sphincterotomy alone versus endoscopic dual pancreatobiliary sphincterotomy based on sphincter of Oddi manometry findings are in progress.

Adolescent↗
PubMed2003

Effect of the angle between the optical axis of the endoscope and the instruments' plane on monitor image and surgical performance.

BACKGROUND: The aim of the study was to examine the effect of the angle between optical axis of the endoscope and the instruments' plane (OAIP) on the monitor display angle (approach angle between the two instruments on a two-dimensional monitor) and endoscopic task performance. METHODS: Two experiments were carried out in the Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) using a standard two-dimensional video endoscopic system. In the first experiment, the monitor display angle was measured during use, with OAIP angles ranging between 0 and 80 degrees (at 10 degrees increments) and manipulation angles varying between 45 and 120 degrees (at 15 degrees increments). In the second experiment, 10 surgeons tied 500 intracorporeal knots with OAIP angles of 0 degrees (optical axis in the same plane as the instruments), +15 degrees and +30 degrees (viewing above the instruments' plane), and -15 and -30 degrees (optical axis looking from below instruments' plane). The end points were the execution time and knot quality score (KQS). RESULTS: In the first experiment, instruments entered the visual field from lateral sides of the monitor with an apparent 180 degrees monitor display angle with a 0 degrees OAIP angle, whereas the monitor display angle approached the actual manipulation angle between the two needle drivers when an 80 degrees OAIP angle was used. In the second experiment, the instruments appeared to enter the image field from the side of the surgeon when the endoscope viewed the instruments from above, whereas instruments entered the field from the opposite side to the surgeon when the endoscope viewed instruments' plane from below. As a result, use of 0 and +15 degrees OATP angles yielded significantly shorter execution times: 70 s compared to 83, 93, and 77 s for +30, -30, and -15 degrees OAIP angles ( p < 0.001), with KQS of 39 degrees and 40 vs 38, 36, and 34%, respectively ( p = 0.257). CONCLUSIONS: The angle between the optical axis of the endoscope and instruments' plane determines how the instruments appear to enter the operative field. The monitor display angle between the instruments is different from the real manipulation angle unless the OAIP angle is near 80 degrees. The apparent entry of instruments into the operative field becomes intuitive for the surgeon only if the endoscope is viewing from above or in the same plane as the instruments. Hence, the best performance for endoscopic knot tying is obtained with this configuration, and execution time increases significantly with viewing from below the instruments' plane.

Endoscopes↗
PubMed2002

Cost comparison of endoscopic stenting vs surgical treatment for unresectable cholangiocarcinoma.

BACKGROUND: Total lifetime costs of endoscopic vs surgical treatment for obstructive jaundice due to cholangiocarcinoma are difficult to assess. The purpose of this study was to compare total costs in these two groups, including all treatment and retreatments. METHODS: This retrospective study identified patients with biopsy-proven cholangiocarcinoma treated this decade with either endoscopic biliary stenting or surgical biliary-enteric bypass with or without resection. Outcomes and hospital charges were recorded. Ten matched control patients were compared from each group. Costs included those for cost of repeat endoscopy in the endoscopic group and for the management of recurrent obstructive jaundice in the surgical group. RESULTS: The groups were similar in age and gender ratio. The surgical approach was frequently for cure; therefore, surgical patients were by and large at an earlier stage of their disease than those in the endoscopic group. Mean survival for the endoscopic group was 19 months vs 16.5 months for the surgical group. The median total lifetime cost for surgical therapy was $60,986 vs $24,251 for endoscopic therapy. CONCLUSION: Endoscopic therapy is an effective palliative therapy for unresectable cholangiocarcinoma. Endoscopic therapy for this entity costs significantly less than surgical treatment. The cost benefit of endoscopic stenting over standard surgical bypass in the management of patients with unresectable cholangiocarcinoma, when considered along with its minimally invasive approach, makes this the procedure of choice for palliative therapy.

Aged↗
PubMedDate not supplied

Diagnosis and treatment control of bleeding colorectal angiodysplasias by endoscopic Doppler sonography: a preliminary study.

The diagnostic accuracy and practical impact of trans-endoscopic Doppler ultrasonography were prospectively investigated in an open preliminary study of patients with hemorrhage from colonic vascular malformations. From January 1, 1991, to December 31, 1992, 437 consecutive patients were seen with lower gastrointestinal bleeding. In 15 cases the source of hemorrhage proved to be colorectal angiodysplasias (3.4%). In all cases bleeding had stopped spontaneously before the endoscopic examination. Upper gastrointestinal causes of bleeding were excluded endoscopically in each patient. To detect the superficial arterial vessels responsible for the hemorrhage a total of 32 lesions were scanned by trans-endoscopic Doppler ultrasonography. Twenty-nine vascular malformations in 12 patients were Doppler-positive (91%) and 3 lesions in 3 patients were Doppler-negative without an arterial signal. All Doppler-positive lesions had injection therapy with epinephrine and polidocanol. Twenty-six of the 29 sclerosed angiodysplasias (90%) in 9 patients could not be found endoscopically 2 weeks later, confirming the success of therapy. Doppler noise was still recorded in 3 visible malformations in the remaining 3 patients, indicating insufficient treatment. Further injections were made into these lesions, and the vascular anomalies were finally eliminated. During 6 months of follow-up, one of the 12 treated patients relapsed with an actively bleeding cecal angiodysplasia. After repeated endoscopic hemostasis, no further hemorrhage was observed in this patient. No bleeding recurred in the 3 patients with Doppler-negative lesions. Endoscopic Doppler sonography may help in the identification of intestinal angiodysplasias. The technically simple method allows objective evaluation of the endoscopic findings and enables monitoring of local endoscopic therapy.

Angiodysplasia↗
PubMed1998

Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review.

BACKGROUND: Endoscopic therapy of biliary tract leaks was uncommon before laparoscopic cholecystectomy. Studies have demonstrated the efficacy of endoscopic drainage by endoscopic sphincterotomy or stent placement. Various endoscopic therapeutic modalities and long-term follow-up of this problem were studied. METHODS: Members of the Midwest Pancreaticobiliary Group reviewed all patients referred for endoscopic therapy of biliary leaks after laparoscopic cholecystectomy from 1990 to 1994. Long-term follow-up was by direct patient contact. RESULTS: Fifty patients were referred for endoscopic therapy of biliary leaks. Abdominal pain was present in 94%. The mean time from laparoscopic cholecystectomy to referral was 6.9 days. Therapy consisted of sphincterotomy only in 6 patients, stent only in 13, and sphincterotomy with stent in 31. Biliary leaks were healed in 44 patients at a mean of 5.4 weeks. A second or third endoscopic procedure was necessary to achieve healing in five patients. Two stent-related complications were noted. Percutaneous or surgical drainage of biliary fluid collections was required in 16 patients. The mean hospital stay for treatment of the leak was 11.1 days after endoscopic therapy. On follow-up (mean 17.5 months), all patients were well except two with mild abdominal discomfort. CONCLUSIONS: Endoscopic sphincterotomy, stent placement, or sphincterotomy with stent are effective in healing biliary leaks after laparoscopic cholecystectomy. Despite prolonged treatment for the leak, patients did well on long-term follow-up.

Bile↗
PubMed2002

Role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of biliary tract complications after orthotopic liver transplantation.

BACKGROUND: Biliary complications are a major drawback of liver transplantation. AIM: To analyse, in a single centre, experience in endoscopic diagnosis and management of biliary complications after liver transplantation. PATIENTS: A total of 147 consecutive liver transplantations performed on 132 patients over a 5-year period. METHODS: Evaluation of the incidence and type of biliary-related complications and analysis of their diagnosis and endoscopic treatment by cholangiopancreatography in terms of success of the endoscopic approach, conversion to surgery and long-term patient and graft survival. RESULTS: Endoscopic retrograde cholangiopancreatography was performed on 30 patients (23%). Overall incidence of biliary complications as confirmed by endoscopic retrograde cholangiopancreatography was 17% (25 cases). Endoscopic retrograde cholangiopancreatography was negative in 5 cases (16%). Biliary complications were successfully treated by endoscopy in 84% of cases (21 out of 25 patients); 4 cases (16%) required a surgical approach (2 choledochojejunostomy, 2 retransplantation) due to failure to correct the problem endoscopically. Stenoses and biliary sludge associated with retained internal stent were almost always successfully managed by endoscopic retrograde cholangiopancreatography, while anastomotic leakage more frequently required a surgical approach. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography is a safe and effective approach for diagnosis and treatment of biliary-related complications after liver transplantation thereby reducing morbidity and mortality related to re-operation which is, however, required in selected cases.

Biliary Tract Diseases↗
PubMed2003

Long-term follow-up of patients with endoscopic treatment of sporadic adenomas of the papilla of vater.

BACKGROUND AND STUDY AIMS: Knowledge about the long-term outcome of patients after endoscopic treatment of ampullary adenomas remains poor, although surgical series have suggested that the initial endoscopic evaluation of these diseases might overlook cancer foci developed in adenomas. The aim of this study was to evaluate retrospectively the long-term outcome in patients with ampullary adenomas treated endoscopically, with a focus on the possible development of cancer. PATIENTS AND METHODS: The study included 24 patients (median age 59 years, range 34 - 84) with macroscopically benign adenomas of the papilla of Vater treated using mainly laser photodestruction between 1983 and 1996. Medical, endoscopic, surgical, and histological reports were reviewed. Patients and general practitioners were contacted to determine patient outcome when endoscopic follow-up had been discontinued. RESULTS: Endoscopic remission (macroscopic and histological) was achieved in 16 patients (66.6 %) with one recurrence (6.2 %) during a mean endoscopic follow-up of 66 months (4-168 months). Endoscopic treatment was discontinued in five (20.8 %) patients (with minimal residual adenoma and advanced age and/or severe unrelated disease), and failed in three patients (12.5 %) (failure of Nd:YAG laser in one case, severe pancreatitis and pancreatic duct ingrowth in one case each). After a mean clinical follow-up of 81 months (8-172 months), two patients (8.3 %) had undergone pancreaticoduodenectomy; eight (33.3 %) had died from unrelated diseases; and 14 (58.3 %) were alive and asymptomatic without any evidence of ampullary cancer. CONCLUSIONS: Long-term follow-up revealed no case of advanced ampullary cancer and suggested that endoscopic treatment was satisfactory for the large majority of patients with ampullary adenomas.

Adenocarcinoma↗
PubMed2006

Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk.

BACKGROUND AND STUDY AIMS: Surgery in elderly patients with acute cholecystitis is quite a high-risk procedure. The recent finding that activated pancreatic enzyme is present in sterile bile from the acutely inflamed gallbladder suggests that obstruction at the level of the common channel is a possible precipitating factor. It was therefore hypothesized that an initial endoscopic sphincterotomy in patients with acute cholecystitis might improve the clinical course. PATIENTS AND METHODS: A prospective unselected series of 105 patients over 65 years of age (52 men, 53 women; mean age 78) suffering from acute cholecystitis were initially treated on a random basis with either conservative methods or endoscopic sphincterotomy. Within the first 72 h after the onset of symptoms, all 52 patients in the endoscopic sphincterotomy group were managed by endoscopic retrograde cholangiopancreatography (ERCP), combined with endoscopic sphincterotomy in 50 cases. The main study parameter was the need for emergency cholecystectomy within the first week after admission. RESULTS: Biliary sepsis requiring emergency surgery occurred in 15 patients in the conservatively treated group, in contrast with none of the 52 patients in the endoscopic sphincterotomy group ( P < 0.001). Iatrogenic complications after endoscopic sphincterotomy occurred in three patients, one of whom required surgery, while two were managed by conservative means. The clinical course improved, avoiding the need for emergency cholecystectomy and other interventions, in 48 patients in the endoscopic sphincterotomy group and in 36 patients in the conservatively treated group ( P < 0.01). CONCLUSIONS: The clinical course after endoscopic sphincterotomy improved in the majority of elderly patients suffering from acute cholecystitis, suggesting that early relief of obstruction at the level of the common channel reduces the risk of developing biliary sepsis. The majority of these patients can undergo surgery electively or can receive further conservative treatment.

Aged↗
PubMed1993

A prospective randomized trial comparing manual and automated endoscope disinfection methods.

OBJECTIVE: To compare the efficacy of endoscope disinfection using automated and manual systems. DESIGN: Prospective randomized trial. SETTING: A 1,000-bed tertiary care referral center. METHODS: All endoscopes underwent a three-stage decontamination process including brushing and cleaning with water and detergent, manual or automated disinfection with 2% glutaraldehyde, and 70% alcohol rinse with forced air drying. Cultures were obtained from endoscopes from both groups before and after alcohol rinse and then after overnight storage. RESULTS: Cultures from 8/30 (27%) automated and 11/30 (37%) manually disinfected (P = 0.58) endoscopes grew gram-negative bacteria and/or nontuberculous mycobacteria before the alcohol rinse. After alcohol rinse, 3 (10%) of 30 automated and 8 (27%) of 30 manually disinfected endoscopes remained contaminated (P = 0.28). Manually disinfected endoscopes were contaminated more frequently with coliform bacteria, whereas endoscopes undergoing automated disinfection were more frequently contaminated with nontuberculous mycobacteria, but the differences were not statistically significant. After alcohol rinse and forced air drying, there was no difference in contamination rates between freshly disinfected endoscopes and those stored overnight (7/30 (23%) versus 4/30 (13%), P = 0.50). Colonoscopes and duodenoscopes were contaminated more often than gastroscopes (P = 0.00001). CONCLUSION: The persistent endoscope contamination after manual and automated disinfection indicates the importance of developing more reliable and effective disinfection methods.

Automation↗
PubMed2005

Laparoscopic evaluation of the contralateral groin in pediatric inguinal hernia patients: a comparison of 70- and 120-degree endoscopes.

BACKGROUND: Transinguinal laparoscopic groin evaluation using a 70-degree endoscope can obviate the need for a second incision when attempting to identify a contralateral patent processus vaginalis (PPV) during open repair of a symptomatic pediatric inguinal hernia. This technique can be technically unsatisfactory when a medial veil of peritoneum obscures adequate visualization of the internal inguinal ring. This study compared 70- degree and 120-degree endoscopes in identification of a contralateral PPV in the same patients. MATERIALS AND METHODS: From September 2000 to October 2003, 81 patients with known inguinal hernias underwent open hernia repair and transinguinal laparoscopic evaluation of the contralateral side. The patients were 62 male, 19 female; mean age 26 months (range, 1 month-10 years); mean weight 11.7 kg (range, 2-33 kg). There were 53 right side hernias and 28 left side. Mean operative time was 43 minutes. Fifty seven patients (70%) had one or more risk factors for developing a contralateral inguinal hernia (49 were younger than 1 year old and 19 were ex-premature). Nineteen patients underwent concurrent procedures (7 circumcisions, 10 hydrocelectomies, 1 orchidopexy, 1 appendectomy). RESULTS: Using the 70-degree endoscope, a medial veil of peritoneum made visualization of the internal inguinal ring impossible in 14 patients (17%) and difficult in an additional 5 patients (6%). Visualization with the 120-degree endoscope was deemed to be superior in 46 (57%), equal in 35 patients (43%), and inferior in none. Overall, contralateral PPVs were detected in 31 patients (38%) with the 120-degree endoscope and in only 23 patients (28%) with the 70-degree endoscope. Had we used only the 70-degree endoscope, 8 PPVs (10%) would have been missed. None of the negative 120-degree endoscope evaluations have developed symptomatic contralateral inguinal hernias. CONCLUSION: In this trial, transinguinal laparoscopic evaluation using the 120-degree endoscope provided superior visualization and identification of contralateral PPVs. This new technique obviates the need for a separate abdominal wall puncture, reduces missed contralateral PPVs, and should be considered for use during pediatric inguinal hernia repair.

Child↗
PubMed2000

Cranial nerve VII region of the traumatized facial skeleton: optimizing fracture repair with the endoscope.

OBJECTIVE: Cranial nerve VII (CN VII) is anatomically positioned adjacent to the condylar neck of the mandible and arch of the midface. Fracture treatment of this region of the facial skeleton remains controversial because of difficult surgical access. Conservative management rarely achieves anatomic fracture repair and can result in irreversible structural deformity and dysfunction. Traditional operative methods require access through very visible facial incisions and risk injury to the facial nerve. We report endoscopic methods of facial fracture repair in the region of CN VII that achieve excellent fracture reduction and stabilization, with minimal risk of facial nerve injury by using hidden incisions. METHODS: A consecutive series of 65 endoscopically assisted facial fracture repairs were analyzed. Endoscopic repairs of the condylar neck (n = 40) of the mandible were performed through an intraoral incision. Endoscopic arch repairs (n = 25) of the midface were performed through a preauricular incision. Outcomes were evaluated by postoperative fracture reduction on radiographs, occlusion, interincisal jaw opening, and facial nerve function. RESULTS: Thirty-seven of 40 condylar neck mandible fractures went on to anatomic bone union, whereas 3 of 40 had either incomplete fracture reduction or re-fracture through the plate. There was one temporary palsy of CN VII that completely resolved spontaneously. Jaw opening exceeded 40 mm by the 8th postoperative week. Computed tomographic images demonstrated anatomic arch repair in all 25 endoscopically repaired cases. Six of seven endoscopically repaired Le Fort III facial fractures went on to restoration of their premorbid occlusion. One of seven had an excellent restoration of the occlusal interface but a cant to the occlusal plane. Two of seven had improved but incomplete restoration of the malar prominence and enopthalmos ipsilateral to the side of endoscopic arch repair. Eight of 25 endoscopic arch repairs developed temporary paralysis of the frontal branch of CN VII that recovered completely by the 10th postoperative week. CONCLUSION: We have developed novel endoscopically assisted techniques to facilitate repair of facial fractures in the region of CN VII. These techniques have been successfully applied to accurately restore the facial skeleton to its preinjury anatomic position in the region of CN VII with minimal risk of facial paralysis by using limited and well-hidden incisions.

Adolescent↗
PubMed2004

Efficacy of electrolyzed acid water in reprocessing patient-used flexible upper endoscopes: Comparison with 2% alkaline glutaraldehyde.

BACKGROUND AND AIM: Two percent glutaraldehyde, the most widely used liquid chemical germicide (LCG), may be hazardous to patients and medical personnel. Alternatives to glutaraldehyde, such as electrolyzed acid water (EAW), are being developed, but data from well-controlled studies with patient-used endoscopes are rare. The purpose of the present paper was to evaluate the high-level disinfection capability of EAW and compare it with glutaraldehyde. METHODS: A random sample of 125 endoscopes was collected immediately after upper endoscopic examination. After careful manual cleaning, endoscopes were divided into a glutaraldehyde and EAW group. After the disinfection procedure, samples from working channel (S-1), insertion tube (S-2), umbilical cord (S-3), and angulation knob (S-4) were taken and cultured. Another twenty endoscopes were experimentally contaminated with hepatitis B virus (HBV) and samples were collected after contamination (T-1), after manual cleaning (T-2), and after final disinfection (T-3). Polymerase chain reaction (PCR) for HBV-DNA was performed. RESULTS: In the EAW group, culture-positive rates were 3.2% in S-1, 9.5% in S-2, 3.2% in S-3, and 27.0% in the S-4 samples. There was no significant difference between the EAW and glutaraldehyde groups for all sampling sites. However, in both groups, disinfection of the angulation knobs (S-4) was less efficient than the others. For the T-1 site, HBV-DNA was detected from all of them, and in 95% (19/20) of T-2. However, HBV-DNA was not detected from T-3 samples. CONCLUSIONS: Electrolyzed acid water is as efficient as glutaraldehyde in eliminating bacteria from patient-used endoscopes. After disinfection procedures using both methods, HBV-DNA was not detected from any endoscopes experimentally contaminated with HBV-positive mixed sera. However, some bacteria may remain on the surface of the endoscopes. Therefore, more careful precleaning of the endoscopes may help achieve high-level disinfection in the clinical setting.

Bacteria↗
PubMed2006

Endoscopic management of biliary complications after adult living donor liver transplantation.

OBJECTIVES: Biliary complications are one of the important issues to be addressed after liver transplantation. Endoscopic management of biliary complications after deceased donor liver transplantation (DDLT) is widely accepted, but it remains to be established in patients after living donor liver transplantation (LDLT). Endoscopic management in LDLT patients is difficult mainly because of the complexity of duct-to-duct reconstruction. METHODS: A total of 174 adult LDLTs with duct-to-duct reconstruction were performed in our institution. Biliary complications developed in 53 patients (30%). Among these, 18 patients were referred for endoscopic management and were the subjects of the present study. Success rate, early morbidity, and outcome were evaluated in these 18 patients. RESULTS: The type of graft was the right liver in six, left liver in eight, and right lateral sector in four patients. Ten out of 18 patients had one biliary anastomosis and the remaining eight had multiple anastomoses. Six patients had a previous history of surgical or percutaneous intervention for biliary complications after LDLT. Seventeen patients had one or more biliary strictures. Biliary casts were found in nine patients, three of whom had concomitant bile leaks. Strictures were successfully treated with endoscopic balloon dilation in 12 (71%) of the 17 patients (nasobiliary catheter placement in eight and stent placement in four patients). Bile leak was successfully managed in two of three patients. Biliary casts were removed by endoscopic papillary balloon dilation in eight of nine patients. Five patients with failed endoscopic therapy were converted to percutaneous or surgical intervention. Endoscopic-procedure-related cholangitis developed in one patient. During follow-up with median periods of 10 months (range 2-20 months), four of nine patients without stent placement developed biliary strictures, and these were relieved by additional endoscopic management. CONCLUSIONS: Endoscopic approach has the potential to be a first-line therapy for the management of biliary complications after LDLT.

Adult↗
PubMed2005

[Endoscopic retrograde cholangiopancreatography can be performed safely in ambulatory centers].

BACKGROUND: Endoscopic retrograde cholangiopancreatography is effective technique to approach various biliary and pancreatic disorders. Safety of endoscopic retrograde cholangiopancreatography on an outpatient basis has been questioned. OBJECTIVES: To evaluate the safety of outpatient endoscopic retrograde cholangiopancreatography and describe procedure complications. PATIENTS/METHOD: We prospectively assessed outpatients endoscopic retrograde cholangiopancreatography during 2001 to 2003 period. Complications were defined according to consensus criteria and all adverse effects related to procedure were included. RESULTS: One hundred and ninety five outpatients endoscopic retrograde cholangiopancreatography were performed, 79 (40.5%) diagnostic and 116 (59.5%) therapeutic. The study group included 112 women, mean age 51 (+/- 18.9) years. The most common diagnoses were: biliary calculi (30.2%), benign stenosis, (13.8%), malignant obstruction (10.2%) and chronic pancreatitis (10.2%). Success was achieved in 88.6% of diagnostic endoscopic retrograde cholangiopancreatography and 78.5% in therapeutic. Complications necessitating observation developed in 10 (5.1%) of 195 endoscopic retrograde cholangiopancreatography, among them, 7 (3.6%) were hospitalized, (2 acute pancreatitis, 2 perforations, 1 bleeding, 1 cardio-respiratory e 1 fever). Among 188 patients initially discharged 8 (4.2%) needed readmission (1 acute pancreatitis, 1 bleeding, 1 perforation, 3 cholangitis, 2 abdominal pain). Comparing the first group where complications were immediately identified to the second, no significant statistical difference concerning to age, sex, diagnoses and procedure difficulty degree was found. CONCLUSION: Sample size and negative statistical results failed to determinate independent risk factors for outpatients endoscopic retrograde cholangiopancreatography complications. However, there were no deaths or bad evolution in patients released after examination, confirming the safety of outpatient endoscopic retrograde cholangiopancreatography.

Adult↗
PubMed1994

Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding. Five years' experience in a central hospital.

BACKGROUND: Despite improved surgical and endoscopic technics, acute bleeding from peptic ulcer is still a serious condition, and management remains controversial. The aim of the study was to evaluate a management policy of aggressive endoscopic and restrictive surgical treatment for acute peptic ulcer bleeding. METHODS: We retrospectively investigated the course of all 341 hospital admissions during 1986 to 1990 caused by bleeding peptic ulceration from the first bleeding episode until 30 days after discharge. RESULTS: Total mortality, in-hospital 30 days' mortality, and operative mortality were 6.3%, 4.4%, and 23.5%, respectively. Risk factors associated with mortality were age and number of concomitant diseases, malignant disease, rebleeding episodes, and surgical complications. No patients without associated illness died. In 73 cases (21%) patients were treated endoscopically one or more times, and altogether 17 patients (5%) were operated on. Rebleeding occurred in 67 cases (23%), and only 23 of these were treated endoscopically at admission. Twenty-six (51%) of the rebleeding patients were treated endoscopically and 13 rebleeding patients were operated on. Two-thirds of patients presenting with arterial bleeding were managed endoscopically. No complications occurred in endoscopically treated patients, whereas there were complications in 8 of 17 operated patients. Operated patients needed significantly more intensive care unit observation time and had longer hospital stay than patients treated endoscopically. CONCLUSIONS: Endoscopic treatment is a safe procedure with a low mortality, and, if successful, the need for emergency surgery is substantially reduced. In the relatively few patients requiring surgery after unsuccessful endoscopy, the mortality remains high.

Acute Disease↗
PubMed2006

Endoscopic resection of solid intraventricular brain tumors.

OBJECT: Endoscopic removal of intraventricular brain tumors is well established for cystic tumors such as colloid cysts. Aspiration followed by removal or ablation of the membranous wall is possible given the constituent features of these tumors. It is generally expected that endoscopic removal of solid brain tumors from the intraventricular compartment would impose additional technical demands. In this paper, the feasibility and safety of endoscopic removal of solid intraventricular brain tumors is evaluated. METHODS: Eighty-one patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, seven underwent attempted endoscopic surgical removal of a solid primary brain tumor. Patient selection, surgical technique, procedure-related morbidity, and extent of removal were reviewed. Five patients underwent complete resection of a solid intraventricular brain tumor, a treatment option that was based on intraoperative assessment and confirmed by postoperative imaging. No patient experienced any procedure-related morbidity. Of the individuals in whom a total endoscopic resection was successful, there has been no symptomatic or radiological evidence of recurrence (mean follow up 20 months). Maximum tumor diameter ranged from 0.5 to 1.8 cm for patients who underwent complete resection, whereas maximum tumor diameter measured 2.4 and 2.5 cm in the two patients in whom a subtotal excision was performed. CONCLUSIONS: In select patients, complete endoscopic removal of solid intraventricular brain tumors is possible and safe. Factors that influence the ability of a surgeon to perform a complete endoscopic resection include tumor size, composition, and vascularity. The procedure requires careful patient selection, the use of refined endoscopic instrumentation, and a disciplined surgical technique.

Adult↗