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At least 721 records · Page 40Linked to original sources
PubMed2000

Clinical utility of endoscopic ultrasound and endscopic ultrasound-guided fine needle aspiration in retroperitoneal neoplasms.

OBJECTIVE: Nonpancreatic, retroperitoneal tumors are a relatively uncommon clinical problem. With the advent of endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration, gastroenterologists may be called upon to assist in the diagnosis and management of these lesions. This paper reviews the spectrum of upper retroperitoneal lesions encountered at a single institution using endoscopic ultrasound. METHODS: We reviewed all cases of nonpancreaticobiliary or nonadrenal retroperitoneal lesions prospectively gathered from our endoscopic ultrasound database from April 1995 to September 1999. RESULTS: Of 1120 upper endoscopic ultrasound examinations, 18 (1.6%) involved a retroperitoneal lesion; 16/18 lesions were neoplasms, nine were primary retroperitoneal tumors (four lymphomas, two leiomyosarcomas, two extraadrenal paraganglionomas, one leiomyoma), and seven were metastatic cancers. There was one fibrous mass and one mass-like abscess. Endoscopic ultrasound-guided fine needle aspiration was used in 15/18 cases. The management of 16 patients was significantly affected by the results of endoscopic ultrasound and biopsy. CONCLUSIONS: Although it is not a frequent indication, assessing upper retroperitoneal tumors with endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration can significantly affect the subsequent management of patients with these lesions.

Adult↗
PubMedDate not supplied

Endoscopic ultrasonography for the diagnosis of intrathoracic lesions in two dogs.

Endoscopic ultrasound was developed initially in humans to overcome limitations of conventional ultrasound in examining certain internal organs due to intervening bone or air-filled structures. Endoscopic ultrasound has been used most widely in investigation of the gastrointestinal tract in humans, but many intrathoracic applications as well as endoscopic ultrasound-guided techniques have recently been described. Mediastinal and pulmonary structures can be examined with endoscopic ultrasound since a high frequency ultrasound probe can be brought into close contact with the areas of interest via a transesophageal approach. The purpose of this report is to describe the application of endoscopic ultrasound as an aid in the diagnosis of intrathoracic disease in the dog. Two dogs, one with a history of prior esophageal foreign body extraction, the other with apathy, weakness and dyspnea were referred for further investigation. Both dogs had caudal intrathoracic soft tissue opacities diagnosed radiographically, but their origin and nature were difficult to determine. Conventional ultrasound was limiting in both dogs due to their location and superimposition of gas-filled structures. With endosonography lesions were characterized more completely. We have found endoscopic ultrasound to be an elegant diagnostic tool for the investigation of radiographically detected intrathoracic lesions in the dog whose origins are difficult to determine or do not lend themselves to investigation by conventional ultrasound. Endoscopic ultrasound provides valuable diagnostic information complementary to that provided radiographically which aids in therapeutic planning. Endoscopic ultrasound was also more sensitive for detecting mediastinal lymphadenomegaly than radiography in one of the dogs. An additional advantage of endoscopic ultrasound is the fact that US-guided tissue sampling can be performed during the examination.

Animals↗
PubMed2005

Esophageal cancer: CT, endoscopic US, and FDG PET for assessment of response to neoadjuvant therapy--systematic review.

PURPOSE: To compare diagnostic accuracy of computed tomography (CT), endoscopic ultrasonography (US), and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for assessment of response to neoadjuvant therapy in patients with esophageal cancer by using a systematic review of the literature. MATERIALS AND METHODS: MEDLINE and EMBASE databases and Cochrane Database of Systematic Reviews were searched for relevant studies. Two reviewers independently assessed the methodological quality of each study. Summary receiver operating characteristic (ROC) analysis was used to summarize and compare the diagnostic accuracy of the three modalities. RESULTS: Four studies with CT, 13 with endoscopic US, and seven with FDG PET met inclusion criteria. Percentages of the maximum score in regard to methodological quality ranged from 15% to 100%. Summary ROC analysis could be performed for three studies with CT, four with endoscopic US, and four with FDG PET. The maximum joint values for sensitivity and specificity were 54% for CT, 86% for endoscopic US, and 85% for FDG PET. Accuracy of CT was significantly lower than that of FDG PET (P < .006) and of endoscopic US (P < .003). Accuracy of FDG PET and that of endoscopic US were similar (P = .839). In all patients, CT was always feasible, whereas endoscopic US was not feasible in 6% of the patients, and FDG PET was not feasible in less than 1%. CONCLUSION: CT has poor accuracy for assessment of response to neoadjuvant therapy in patients with esophageal cancer. Endoscopic US and FDG PET have equivalent good accuracy, but endoscopic US is not always feasible after chemotherapy and radiation therapy. FDG PET seems to be a promising noninvasive tool for assessment of neoadjuvant therapy in patients with esophageal cancer.

Endosonography↗
PubMedDate not supplied

Endoscopic trans-septal frontal sinusotomy: the rationale and results of an alternative technique.

Endoscopic transseptal frontal sinusotomy (TSFS) represents an alternate approach to surgical treatment of chronic frontal sinus disease that is refractory to traditional modes of medical and surgical therapy. We retrospectively reviewed our experience with endoscopic TSFS from 1995-1997. Twenty-one procedures were performed through a transseptal approach. One patient was excluded for failure to follow-up, for a total of 20 procedures. Patients were followed with serial endoscopic examinations and a telephone questionnaire with a mean follow-up of 12 months (Range 1-24 months) and 16 months (range 5-31), respectively. The primary indication for surgery was frontal recess stenosis after previous endoscopic frontal sinusotomy in 17/20 (85%). Three patients were considered poor candidates for a primary endoscopic frontal sinusotomy. Patency was maintained in all patients during the follow-up period. A diameter of greater than 3 mm was confirmed by passage of a curved suction in 19/20 (95%). Of the 19 patients that were evaluated via a telephone questionnaire, 17 patients (89.5%) reported some degree of improvement in their nasal/sinus symptoms, and 12/18 patients (67%) felt the frequency of medication requirements was less than that before undergoing endoscopic TSFS. We conclude that endoscopic TSFS represents an alternate approach to the frontal sinus that may be used by the experienced endoscopist, to augment treatment of refractory frontal sinus disease. This procedure seems especially suited for revision surgery in those patients with acquired frontal sinus stenosis. In revision operations with distorted anatomical landmarks, localization of the frontal sinus may be improved with the aid of 3-dimensional computer assisted localization systems. Unlike traditional frontal sinus obliteration, endoscopic TSFS does not preclude radiographic assessment postoperatively, and allows for endoscopic evaluation of the frontal sinus in the office setting.

Adult↗
PubMed1999

Endoscopic surgery for obstructive hydrocephalus.

Endoscopic surgery is popular in the neurosurgical field. The purpose of this study was to determine the role of endoscopy in obstructive hydrocephalus. From 1989 to 1999, we performed 81 endoscopic third ventriculostomies and 10 septostomies. Seventy-one of 81 operations were performed with endoscopic third ventriculostomy alone and 10 patients had endoscopic third ventriculostomy and ventriculoperitoneal shunt simultaneously. Age distribution varied from 2 months to 62 years of age. Our selection criteria included aqueductal stenosis (39 patients) and obstructive hydrocephalus due to tumor or cyst (42 patients). The most common candidate for endoscopic septostomy was atresia of the foramen of Monro (4 patients). Endoscopic septostomy was also performed to simplify shunting in patient; with multiseptated ventricle due to shunt infection, germinoma, thalamic tumor, craniopharyngioma, cyst and brain abscess. Sixty-five of 71 patients who were treated with endoscopic third ventriculostomy alone showed successful results (91.5%). However, 6 patients had unsatisfactory results and they needed a ventriculoperitoneal shunt. With no mortality, transient surgical complications were observed in 7 patients: 2 transient diabetes insipidus from electrical injury to the pituitary stalk, 1 epidural hematoma from sudden drainage of CSF, 1 delayed intraventricular hemorrhage. 2 obstruction of fenestration site and 1 transient memory disturbance from injury to the fornix. Endoscopic septostomy was useful in simplifying shunting in all cases with complicated hydrocephalus. Endoscopic surgery is straightforward and effective in appropriately selected cases with obstructive by drocephalus.

Adolescent↗
PubMed1999

Relation between endoscopic ultrasound evaluation and survival of patients with inoperable thoracic squamous cell carcinoma of the oesophagus treated by combined radio- and chemotherapy.

AIM: Purpose of this study was to assess prognostic value of endoscopic ultrasound in patients with inoperable squamous cell carcinoma of oesophagus treated by radio-chemotherapy. PATIENTS AND METHODS: Between January 1993 and March 1996, 89 patients (77 males and 12 females, mean age 60.3 years) with squamous cell carcinoma of the oesophagus were treated exclusively by radio-chemotherapy consisting of 3 courses of chemotherapy using 5FU-Cis-platyl and 3 courses of radiation therapy (3 x 15 Gy). Endoscopy and endoscopic ultrasound (Pentax FG 32 UA) were performed before beginning treatment and two weeks after last cycle of radio-chemotherapy. Classical criteria for endoscopic ultrasound lymph node metastases were used after irradiation; response was considered as complete only if endoscopic ultrasound indicated that integrity of oesophageal wall was fully restored. RESULTS: Complete endoscopic ultrasound assessment was achieved in 73 cases (84.9%). Tumours were classified as T1N1 in 1 case, T2N1 in 7, T3N0 in 4, T3N1 in 24, T4N0 in 1 and T4N1 in 49. For patients with a non-invasive tumour (usT1 or T2), malignancy of lymph nodes was proved by endoscopic ultrasound guided biopsy. Eighty-two patients presented one or more suspicious lymph nodes. Metastatic lymph nodes were located in posterior mediastinum in 43 cases, at distant sites in 27 (laterotracheal in 16 and coeliac in 11) and in 16 lymph nodes were located simultaneously in mediastinum and at distant sites. Median overall survival in these 89 patients was 16 months. There was no significant difference in median survival between patients in stage T3 and T4. Conversely, there was a significant difference between patients with more or less than 4 metastatic lymph nodes (9 vs 36 months, respectively, p = 0.005). Site of lymph node metastasis was also a prognostic factor with better survival in patients presenting mediastinal nodes than those presenting coeliac nodes (30 vs 9 months, respectively, p < 0.0001). Median survival was also significantly better in patients considered as having achieved a complete response by both gastroduodenal fibrescopy and endoscopic ultrasound than in those considered to have a complete response by gastroduodenal fibrescopy but not by endoscopic ultrasound (49 vs 10 months). Conversely, there was no difference in survival in function of treatment response assessment by thoracic chemotherapy-scan. CONCLUSION: Endoscopic ultrasound findings regarding number and site of suspicious lymph nodes and degree of treatment response are significant prognostic factors in patients with squamous cell carcinoma of oesophagus treated exclusively by radio-chemotherapy.

Adult↗
PubMed2000

[Efficacy of endoscopic transethmoidal.transsphenoidal surgery for pituitary tumors].

Endoscopic transethmoidal.transsphenoidal surgery was performed on 30 patients with pituitary tumors, and the usefulness of this procedure was evaluated. As with conventional endoscopic intranasal surgery, the ethmoidal sinuses were opened and a broad window was created in the ethmoidal sinus from the directions of the middle meatus and the olfactory cleft. Then an endoscopic washing device was attached to a 0 degree or 30 degrees rigid endoscope and it was immobilized in the left nasal cavity with an endoscope immobilization apparatus. Removal of the tumor was then started from the right side by a bimanual technique. Based on the results, this surgical procedure was judged to be useful for the following reasons (1) it makes it easy to carry out the operative manipulations even in a narrowed nasal cavity, thereby reducing the overall time required for surgery, and (2) it is possible to prevent postoperative deformities of the nasal cavity morphology caused by pressure on its lateral wall. In additional, (3) the surgical wound can be observed, and CSF leakage can be repaired immediately after completion of the operation. Corrective surgery can be performed on an outpatient basis early after the initial operation to correct postoperative deformities of the nasal paranasal cavities, which might later cause nasal obstruction or an olfactory disturbance. Finally, (4) employing the route of endoscopic transethmoidal.transsphenoidal surgery facilitates the performance of a second operation soon, or even several months, after the first operation. A second operation may be necessary in the event of recurrence of the pituitary tumor or complication by chronic sinusitis. On the basis of our experience in the this study, we conclude that our method of endoscopic transethmoidal.transsphenoidal surgery will be useful for reducing invasiveness in the nasal cavities and achieving maximum prevention of postoperative complications. In order to fulfill its potential, neurosurgeons will need to master forceps techniques in the visual field provided by the endoscope and to cooperate with otorhinologists who are skilled in endoscopic techniques.

Adult↗
PubMed2002

Robotically-assisted coronary artery surgery with and without cardiopulmonary bypass - from first clinical use to endoscopic operation.

BACKGROUND: Recently, the ZEUS(tm) Robotic Surgical System has been introduced to increase the precision of endoscopic cardiac surgery. This study investigated its clinical use for endoscopic coronary artery bypass grafting. MATERIAL/METHODS: Between 1998 and 2001, 41 patients with single and multivessel disease were operated on using the ZEUS(tm) system. The robotic system was introduced step by step into clinical practice. Initially, the system was used only for endoscopic internal mammary artery (IMA) harvest (n=12), later for coronary anastomoses on the arrested (n=13) or beating heart after median sternotomy (n=6), and finally for endoscopic coronary bypass grafting on either the arrested (n=2) or beating heart (n=8). RESULTS: Endoscopic IMA harvest ranged from 48 to 110 min and was completed in all cases. In the sternotomy group, the robotic anastomosis time averaged 21 min on the arrested and 25 min on the beating heart, respectively (n.s.). In the endoscopic cases, the average time for endoscopic anastomosis was 41 min on the arrested and 36.5 min on the beating heart (n.s.), with an overall duration of surgery between 4.0 and 8.0 hours. One endoscopic case was intraoperatively converted to a MIDCAB procedure with manual anastomosis. The total patency rate of all graft anastomoses, confirmed by early postoperative angiographic control, was 97%. One patient underwent reoperation with an uneventful postoperative course. CONCLUSIONS: The present study demonstrates the feasibility of endoscopic coronary revascularization using a computer-assisted surgical robotic system on the arrested and beating heart in selected patients.

Adult↗
PubMed2005

Secondary endoscopic forehead lift in patients with previous coronal brow lifts.

INTRODUCTION: The development of endoscopic surgical techniques has allowed an evolution from the standard coronal forehead lift to a minimally invasive one. Endoscopy avoids many of the undesirable results of the coronal approach while it remains very efficacious. The purpose of this study is to evaluate the effectiveness and safety of endoscopic forehead lift in patients who have previously undergone coronal brow lift. MATERIALS AND METHODS: A retrospective review was performed on the medical records of 726 consecutive patients who had undergone endoscopic forehead lift between 1994 and 2004. Sixty-three patients were identified who had undergone prior coronal incision brow lift and then required subsequent elevation of the forehead using endoscopy. Those who had persistent low eyebrows and forehead wrinkles underwent the standard minimal incision endoscopic approach. Patients with severe brow ptosis and excessive height of the forehead underwent a biplanar endoscopic forehead lift. RESULTS: Of the 63 endoscopic forehead lifts performed, 49 used the minimal access technique, while 14 employed the biplanar approach. The subject population consisted of 58 female and 5 male patients whose average age was 57 years (range of 42 to 80 years). Eighty-seven percent of these brow lifts also had concomitant rhytidectomy, and 4% had blepharoplasty. Average follow-up was 21 months (range 1 to 7 years). Following the endoscopic procedure, none of the patients had frontal nerve injury, alopecia, or persistent glabellar wrinkle lines. Complications included 1 forehead dysesthesia, 1 forehead irregularity, 1 eyebrow malposition, 1 persistent horizontal forehead wrinkling, and 2 hematomas. Operative management was not required for any of these complications. CONCLUSION: The secondary endoscopic forehead lift is effective in rejuvenating the upper face in the patient who has had a previous coronal forehead lift. It elevates the eyebrows and reduces both transverse and vertical wrinkles while avoiding further displacement of the hairline. The low rate of complications is comparable to that of primary endoscopic forehead lifts. Finally, serial follow-up indicates that the results are effective at correcting brow ptosis and are long lasting.

Adult↗
PubMed2005

[Endoscopic stapled esophago-diverticulostomy as a new alternative to open surgery in the treatment of Zenker's diverticulum: which operation?].

AIMS: The authors analyse the indications, contraindications, early and late results of two types of operations (resection of the diverticulum with crycopharyngeal myotomy and endoscopic stapled esophago-diverticulostomy) for the treatment of Zenker's diverticulum. PATIENTS AND METHODS: In a five year period 10 patients (5 male, 5 female, mean age 56.9 years) were operated for Zenker's diverticulum. Six open and 4 endoscopic operations were planned, although in one case the placement of the endoscope was unsuccessful. Open surgery was planned if the diverticulum was in lateral position, if it was too small or large and if endoscopic surgery was technically impossible. RESULTS: The operative time was shorter in the endoscopic group (32.3 vs. 80.7 minutes). In the open surgery group (7 patients) one saliva fistula developed caused by suture leak. The length of hospital stay was 8.1 days in the resection group and 4.7 in the endoscopic group. No recurrence developed. CONCLUSIONS: The advantages of the endoscopic oesophago-diverticulostomy are: shorter operating time and hospital stay, less complication rate and it is minimally invasive. The authors suggest endoscopic oesophago-diverticulostomy as the choice of operation in case of Zenker's diverticulum. Open surgery is indicated only if the diverticulum is in lateral position or if it is bigger than 8 cms. The technical contraindications for endoscopic surgery are: short, rigid neck and limited mouth opening.

Adult↗
PubMed2005

[Endoscopic mucosal resection in the treatment of early cancer of the gastrointestinal tract].

Endoscopic mucosal resection is a minimally invasive technique of resection of large pieces of the superficial layers (the mucosa and partially the submucosa) of the gut wall. In the present study we are presenting currently established indications, recent advances in the technique, early and long-term results of the treatment of esophageal, gastric and colorectal early cancer by endoscopic mucosal resection based on the review of the literature, educational materials and personal experience from the training of the first author (KZ) at the National Cancer Center in Tokyo, Japan. Endoscopic mucosal resection should be indicated for every superficial neoplastic lesion of the gut wall that can be safely removed in its entirety by experienced endoscopic team, and subsequently processed and evaluated properly by cooperating histopathologist specializing in gastrointestinal pathology. Eventually a detailed analysis of a resected specimen enables the precise assessment of curability of the procedure and establishment of the rational management of a patient. Curative endoscopic resection allows for regarding this procedure as sufficient and includes a patient into a follow-up program. Potentially curative endoscopic resection requires to consider the risk of lymph node involvement and discuss with a patient potential benefits and risk associated with surgical treatment or its withholding in reference to patients' age and health condition. Non-curative endoscopic resection requires to recommend an additional local (endoscopic resection, endoscopic ablation, brachytherapy) or surgical treatment after a detailed analysis with a patient a potential benefit and risk associated with each option. Despite enormous advance in medical knowledge the outcome of the gastrointestinal cancer treatment is still far unsatisfactory. Early diagnosis and treatment of less advanced cancer remains the most promising method of improvement of the outcome. We hope that popularization of the knowledge regarding early gastrointestinal cancer may improve their early detection rate and thereby the outcome of the treatment.

Colonic Neoplasms↗
PubMed2005

Our experience in endoscopic treatment of vesico-ureteral reflux in children.

AIM OF THE STUDY: To define the guidelines of endoscopic treatment of vesico-ureteral reflux (VUR) in children in relation to grade of VUR, of the location of the ureteral orifice, of the stage of reflux nephropathy and of the association with other urinary tract malformations. MATERIALS AND METHODS: 498 children with vesico-ureteral reflux (VUR) were observed in 702 ureters. All the patients were submitted to a complete urological evaluation and to endoscopic treatment (ET) of the VUR with the implant of a stable polyacrylamid gel (DAM+). RESULTS: The reflux was degree I in 53 ureters, II in 174, III in 301, IV in 165 and V in 9 ureters. VUR was primary in 149 children, secondary to a neurogenic dysfunction of the bladder in 271 patients, complex in the remaining cases. An overall 90.5% success rate of endoscopic treatment with "DAM+" implantation was observed. Success of VUR endoscopic treatment was obtained in 80% of cases with- orifice lateralisation, in 60% of cases with high and low intravesical orifice ectopy, and in 10% of cases with extravesical orifice. In 151 ureters (21.5%) endoscopical treatment of VUR had to be repeated, while a third procedure was necessary in 42 ureters (5.9% of cases). In total 895 endoscopic procedures were performed. Open surgical ureteral reimplantation was performed in the cases with persisting VUR after the third attempt of endoscopic procedure. CONCLUSION: These results of the endoscopic treatment of VUR in children confirm the high efficacy and safety of this method. In any case, before choosing the method of VUR correction, it is necessary to inform the parents of the child about the potential rate of success of the endoscopic treatment in function of the peculiarity of the individual patient.

Child↗
PubMed1989

Endoscopic sclerotherapy: a risk factor for splanchnic venous thrombosis.

Endoscopic sclerotherapy has been widely advocated as primary therapy for patients surviving hemorrhage from esophageal varices. The potential for endoscopic sclerotherapy to limit subsequent surgical options remains unclear. The following study was undertaken to assess the endoscopic sclerotherapy-related incidence of splanchnic venous thrombosis in patients undergoing surgery for variceal bleeding. We retrospectively identified 27 patients who underwent portosystemic shunting after an episode of variceal hemorrhage documented by endoscopic examination. Eleven patients underwent endoscopic sclerotherapy before portosystemic surgery for shunting. Among the patients undergoing prior endoscopic sclerotherapy, 6/11 had partial splanchnic venous thrombosis at surgery compared with 2/16 in the non-endoscopic sclerotherapy group. This difference was statistically significant. Only one of the eight patients with splenic or portal vein thrombosis detected at surgery showed signs of the condition when an angiograph was performed. Endoscopic sclerotherapy appears to impose a significant risk for splanchnic venous thrombosis. This complication, not reliably detected by angiographic means, may limit the operative options and long-term outcomes of patients in whom endoscopic sclerotherapy fails.

Endoscopy↗
PubMed1979

Endoscopic, histological and ultrastructural correlations in chronic gastritis.

Thirty-three patients presenting with dyspepsia were examined with the Olympus Fiber-gastroscope. An endoscopic diagnosis was made in each case and multiple gastric biopsies were obtained for histological and ultrastructural assessment. The endoscopic, histological and ultrastructural findings were compared with each other. Of 33 patients endoscoped, 29 were found to have endoscopic evidence of various types of gastritis and all of these latter had histological evidence of some form of gastritis. Histological confirmation of specific types of endoscopically diagnosed gastritis, however, was only found in 3/9 cases of chronic atrophic gastritis (CAG), 10/14 cases of chronic (superficial) gastritis (CG) and in none of six cases of acute gastritis (AG), indicating that endoscopic diagnosis of specific types of gastritis is relatively inaccurate. Endoscopic diagnosis should thus be restricted to presence or absence of gastritis, leaving the specific typing to histological assessment of the gastric biopsies. Multiple gastric biopsies should be obtained even though the gastric mucosa appears normal endoscopically, since histological evidence of gastritis was found in three out of four cases with endoscopically normal gastric mucosa. Comparison of histological diagnosis with electron microscopy showed that generally there is good correlation between the severity of the histological changes and the ultrastructural grade of damage as defined in this study. It would appear that E.M. examination of the gastric biopsies will not significantly increase the diagnostic accuracy of light microscopy, although it has elucidated the various cellular changes which characterize chronic gastritis. The rough surface contours, the large gastric pit and the increasing number of surface microvilli, seen by scanning E.M., aid the grading of the disease process. Some of these changes are reflected in observations made by transmission E.M. where in addition the basal intercellular edema of the mucosal layer and the appearance of electron-dense mucosal lining cells are observed. The latter, which are the counterpart of "intestinal metaplasia", possess mucus granules which resemble those of gastric mucosal lining cells or intestinal goblet cells, or both.

Adult↗
PubMed1982

Comparison of endoscopic electrocoagulation and laser photocoagulation of bleeding canine gastric ulcers.

The most promising endoscopic hemostatic techniques all depend upon heat to coagulate. Four thermally active techniques under similar controlled conditions in this endoscopic study were compared. The study was undertaken to compare the efficacy and histologic damage of monopolar electrocoagulation (MPEC), bipolar electrocoagulation (BPEC), argon laser photocoagulation (ALP) and neodymium-yytrium-aluminum-garnet (YAG) laser photocoagulation applied endoscopically to control bleeding from standard canine gastric ulcers. An open-closed model utilizing a nontraumatic intestinal clamp in heparinized adult mongrel dogs was used. Bleeding ulcers were randomly assigned to an endoscopic treatment modality or control. The endoscopic techniques and parameters of treatment for this study were established from a previous experience with each modality and from endoscopic treatment in pilot studies. Quantitative efficacy and subjective ease of endoscopic treatment were evaluated acutely; gross and histologic injury were determined after 7 days. Our conclusions were that more energy or greater power was required with each method to treat bleeding standard ulcers efficiently through the endoscope than at laparotomy. It was also concluded that each method was 93% or more effective in halting bleeding in this canine ulcer model but there were differences in ease of endoscopic use. Both lasers were much easier to apply than electrocoagulation. The order of decreasing ease of application was YAG, ALP, MPEC, BPEC. Argon laser and BPEC caused significantly less tissue injury than either MPEC or YAG. The order of increasing injury or decreasing margin of safety was ALP, BPEC, YAG and MPEC. In contrast to electrocoagulation, especially monopolar, laser related tissue injury was generally predictable and correlated with total treatment energy, animal weight or gastric overdistension, or both. The limitations, advantages, and disadvantages of each hemostatic technique are discussed and compared.

Animals↗
PubMed1995

Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon.

OBJECTIVES: Our goal was to assess the incidence of the endoscopically-identified small intestinal and colonic Dieulafoy-like lesions in our GI bleeding population and to characterize the clinical and endoscopic features and response to endoscopic therapy. METHODS: Patients with GI bleeding from Dieulafoy lesions were identified from our Bleeding Team and GI laser data bases from August 1984 to September 1993. Clinical and endoscopic information contained within the data bases and from each patient's medical record were retrospectively reviewed. Diagnostic criteria that had been used to endoscopically diagnose a Dieulafoy lesion were arterial bleeding or nonbleeding visible vessel stigmata, all without ulceration or erosion. RESULTS: Nine patients (three male; six female; median age, 70 yr; range, 16-94) were identified from a population of 3059 patients. Symptoms included: melena (2); hematochezia (7); and unstable hemodynamics (3). The mean hemoglobin was 8.4 +/- 2.2 g/dl. There was no significant nonsteroidal antiinflammatory drug or alcohol use. Four patients had small bowel and five patients had colonic Dieulafoy's lesions. Specific sites were: distal duodenum (3); jejunum (1); cecum (1); hepatic flexure (3); and transverse colon (1). The diagnosis was made at initial endoscopy in seven patients, after two endoscopies in one patient, and after four in another patient. Active bleeding was encountered in seven patients (three small bowel; four colon). Endoscopic therapy was successful. Two patients rebled, one from the same site (small bowel) 1 yr later. Both were successfully retreated. There were no complications or deaths. CONCLUSIONS: The endoscopic Dieulafoy lesion of the small bowel and colon is infrequently encountered. The diagnosis is most often made during active bleeding. The endoscopic diagnosis requires an aggressive approach, including repeated endoscopy. Endoscopic therapy of proximal small intestinal and colonic Dieulafoy lesions is safe, effective, and should be performed.

Adolescent↗
PubMed1994

Gastric carcinoma, an endoscopically curable disease.

Following refinement of endoscopic diagnosis of gastric cancer, the concept of 'early gastric carcinoma' and its endoscopic features have become established. After the wide acceptance of the techniques of endoscopic mucosal resection (EMR), laser therapy and accurate endoscopic-endosonographic assessment of the depth of invasion, curative endoscopic treatment of intramucosal gastric carcinoma has become established. On the basis of the analysis of lymphatic metastasis, the indications for endoscopic treatment of gastric carcinoma have been defined as (1) well-differentiated, intramucosal adenocarcinoma of a superficial elevated lesion (diameter < 2 cm), and (2) well-differentiated, intramucosal adenocarcinoma of a superficial depressed lesion (diameter < 1 cm) having no ulcer or scar inside. The preferred procedure of endoscopic treatment is EMR with careful histological examination of the resected specimen. It is supplemented by repeat EMR, laser therapy, or surgical gastrectomy in case of incomplete resection. For detection of residual cancer and recurrence, periodic endoscopic follow-up is necessary. Early gastric carcinoma is endoscopically curable.

Adenocarcinoma↗
PubMedDate not supplied

Differences between colorectal adenomas removed endoscopically and surgically.

BACKGROUND/AIMS: To date, risk factors for severe dysplasia in colorectal adenomas have been studied mainly in endoscopically removed material. The aim of this study was to determine whether there are any differences between adenomas removed endoscopically and surgically in terms of patient and polyp characteristics. METHODOLOGY: Between 1978 and 1993, 5092 consecutive patients with 9874 colorectal adenomas attending the Medical and Surgical Departments of the University of Erlangen were prospectively documented in the Erlangen Registry of Colorectal Polyps, and statistically examined using regression analysis. RESULTS: 5995 adenomas were removed endoscopically from 3343 patients. 3879 adenomas were surgically resected in 1749 patients. 313 (9.4%) of the former, and 218 (12.5%) of the latter, patients harboured adenomas with severe dysplasia. The size of the adenoma and the tubulovillous or villous structure were the leading risk factors, both in endoscopically and surgically removed adenomas. Adenomas located in the right colon were at a lower risk in both endoscopic and surgical specimens. The risk factors in endoscopically removed adenomas can be described by a model of independent variables. However, the risk of severe dysplasia in surgically resected adenomas needs to be described in an interactive model. Villous structure act as a confounder which modifies the risk profile by increasing the risk associated with multiplicity and right-sided location. CONCLUSIONS: The risk of severe dysplasia in colorectal adenomas needs to be described in different models, depending on the method of adenoma removal-either endoscopic or surgical. A global model describing the colorectal dysplasia-carcinoma sequence will depend on the composition of the endoscopically or surgically removed adenomas and will be a more complex model than the clear and simple description applicable to purely endoscopic studies.

Adenoma↗