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PubMed2001

[Acute cholangitis caused by choledocholithiasis: traditional surgery or endoscopic biliary drainage].

BACKGROUND: Endoscopic drainage of the biliary tree for acute cholangitis is a therapeutic modality with a lower mortality and complication rates. AIM: To compare endoscopic drainage with surgical treatment in the emergency management of acute cholangitis. PATIENTS AND METHODS: Between 1995 and 1998, sixty five patients with acute cholangitis were subjected to an endoscopic drainage of the biliary tree. In the same period, 40 patients were treated with traditional surgical procedures. The evolution of both groups of patients were compared. RESULTS: Sixty two patients (95.4%) subjected to endoscopic treatment had a satisfactory evolution, compared with 23 (58%) of those operated (p < 0.001). Five operated patients and no individual subjected to endoscopic drainage died (p < 0.01). Mean postoperative hospital stay of operated patients was 15.5 +/- 19.6 days compared to 5.8 +/- 4.2 days in those subjected to endoscopic drainage (p < 0.001). Definitive resolution of biliary obstruction was achieved in 83% of patients subjected to endoscopic drainage or traditional surgery. CONCLUSIONS: Endoscopic drainage has a lower rate of complications and mortality than traditional surgery, in the treatment of acute cholangitis.

Acute Disease↗

PubMedDate not supplied

[Large villous adenoma of the colon in carcinomatous transformation: colonic resection after endoscopic excision].

Large colonic villous adenomas are benign neoplasms capable of malignant transformation with a higher frequency than other adenomas. Such transformation often requires surgical therapy after endoscopic resection. The aim of the present study was to establish the indications for surgery in a series of 13 cases of large colonic villous adenomas initially submitted to endoscopic resection. The patients (8 males and 5 females; mean age; 62 years) were observed over the period 1993-2000. All endoscopic resections were performed using the piecemeal technique. In 7 cases there were 2 endoscopic sessions and in one case 3; a single case of post-endoscopic bleeding was treated conservatively. In 5 cases, endoscopic resection was deemed not to be radical and these patients were submitted to surgical resection. Histology on the surgical specimens revealed 2 cases of carcinoma (T1 and T2, respectively), confirmation of colonic villous adenoma in 2 cases and the presence of inflammatory tissue in 1 case. Among the patients treated with endoscopic resection alone one death occurred at two years due to lung and systemic metastases probably due to the malignant adenoma. After a review of the literature and on the basis of their own experience, the authors stress the importance of a combined pathological and endoscopic approach to establish when surgery is required.

Adenoma, Villous↗

PubMed2001

[Sinus-nasal polyposis: one-year outcome after endoscopic sinus surgery followed by topical corticosteroid therapy in 72 patients].

Nasal polyposis (NP) is considered as an inflammatory disease for which first line therapy is topical and/or oral corticosteroid. In this paper we attempted to determine the efficacy of endoscopic endonasal surgery followed by topical corticoid in 72 adults suffering from bilateral NP refractory to corticosteroid therapy and to delineate the clinical characteristics of this cohort of patients. NP was confirmed endoscopically and with computed tomography. Visual analog scale for the subjective evaluation and endoscopic examination of the paranasal cavities for the objective evaluation were obtained 3 and 12 months postoperatively. Endoscopic endonasal surgery was based on a radical removal of the NP with wide opening of all the sinuses in the vast majority of the cases. Topical corticoid therapy was started 2 months after surgery. Clinical characteristics of the 72 patients revealed: 29.2% of coexisting allergy; 34.7% of coexisting asthma; 19.4% with food and/or aspirin intolerance. Anterior and posterior ethmoid sinus and maxillary sinus were the most affected sinuses. 53.5% of our patients presented a stage II. One year after surgery we observed that 59.1% of our patients revealed a marked decrease of their symptoms with no polyp on nasal endoscopic evaluation, that 28.8% revealed a marked decrease of their symptoms with recurrence of the NP on nasal endoscopic evaluation and that 12.1% presented moderate to severe symptoms with recurrence of NP on nasal endoscopic evaluation. Based on this experience, we think that endoscopic endonasal surgery will continue to play an important role in the management of NP when the patient becomes refractory to corticoid.

Administration, Topical↗

PubMed2002

Detection and treatment of an asymptomatic case of early esophageal cancer using chromoendoscopy and endoscopic mucosal resection.

Recent trends in the management of superficial esophageal cancer consist of improved detection and curative endoscopic therapy. However, successful endoscopic therapy has not been reported in Taiwanese patients with this disease. We describe the case of a male, 38-year-old habitual drinker admitted for a general health check-up, whose endoscopic examination revealed a slightly depressed discolored lesion in the middle esophagus. Chromoendoscopy with 3% Lugol's iodine solution showed a mesh-like unstained pattern occupying approximately two-thirds of the circumferential esophageal mucosa. Spraying with 2% toluidine blue solution stained a 3 x 6 cm suspect area pale blue. Endoscopic biopsy confirmed squamous cell carcinoma. Histopathologic examination revealed the lesion was a type IIc superficial esophageal cancer. Endoscopic ultrasonography showed the lesion was limited to the epithelial layer with no evidence of lymph node involvement. The lesion was removed en bloc using endoscopic mucosectomy. Microscopic examination of the resected specimen demonstrated that the depth of invasion was confined to the epithelial layer except for some areas with small nests of tumor cells within the lamina propria. Balloon dilatation to prevent post mucosectomy stricture was performed and the patient recovered uneventfully. At 1 year of follow-up, the patient was alive without any endoscopic signs of local recurrence. This case suggests that chromoendoscopy in combination with endoscopic resection is likely to benefit patients with early-stage esophageal cancer.

Adult↗

PubMed2003

[Quality of hygiene in endoscope reprocessing--the fundamentals of indicator-assisted quality management in gastroenterology].

High level disinfection and infection control in reprocessing gastrointestinal endoscopes is a critical security factor for patients in gastrointestinal health care. National and international guidelines for an adequate high quality disinfection of gastrointestinal endoscopes have been developed aiming to obtain infection control. The German Medical Association has recently published recommendations on quality assurance in gastrointestinal endoscopy including standardised procedures for disinfection and infection control. A prospective study was carried out in a large urban area in both private practices and hospitals to identify and characterise flaws and limitations in disinfection of gastrointestinal endoscopes by measuring a set of indicators of the quality of structures, processes and outcomes. Moreover, the influence of information and continuous medical education on the quality of disinfection and infection control were to be evaluated. The bacterial contamination of endoscopes after reprocessing was measured as a relevant outcome quality indicator. The results revealed substantial flaws in cleaning and disinfection procedures in gastrointestinal endoscopy under routine clinical conditions. Overall, 49 and 39 percent of all (pre- and post-interventionally, resp.) checked endoscopes were contaminated by one or more bacteria. More often failures were discovered in the optic rinse system than in the cleaning/disinfection and the final rinse and drying process. A substantial failure rate was detected in gastrointestinal endoscope reprocessing under routine conditions according to the reprocessing procedure. Compared to manual and semi-automatic cleaning and disinfection, the full automatic cleaning and disinfection machines (RDG-E) showed the best results. Though their cleaning process remains improveable, it seems advisable to prefer RDG-E-machines for disinfection and infection control in gastrointestinal endoscopy. Continuous quality control of disinfection should be obtained by introducing regular microbiological examinations of the reprocessed endoscopes. Negative microbiological controls of the contamination of endoscopes are suitable quality indicators of a quality management system aiming to improve the quality of structures, processes and outcomes in gastroenterological health care.

Disinfection↗

PubMed2003

Failure of endoscopic therapy in upper gastrointestinal hemorrhage due to duodenal ulcers.

OBJECTIVES: to evaluate the efficacy of endoscopic treatment in patients with upper gastrointestinal (UGIH) due to duodenal ulcer with high risk of persistent or recurrent bleeding and to determine the associated failure factors of this procedure. PATIENTS AND METHOD: three hundred and thirty-six patients with UGIH due to duodenal ulcer requiring endoscopic treatment were analyzed between January 1992 and December 2001. The patients were classified according to the endoscopic findings: a) patients with limited bleeding; and b) patients with persistent and/or recurrent bleeding due to therapeutic failure. The clinical guidelines followed in patients with endoscopic treatment failure were previously established in the internal protocol. The variables that obtained statistical significance in the univariate analysis were included in the logistic regression model to identify those with an independent predictive value for failure of the endoscopic treatment. RESULTS: mean age of the patients was 60 +/- 17 years, 271 (81%) were male. Bleeding with severe hemodynamic affectation was detected in 82 patients (24%). The most common location of the duodenal ulcer was on the anterosuperior part of the duodenal bulb (227 patients, 68%). In 43 patients (13%) the ulcer was larger than 2 cm. The bleeding stigmata were classified as: Forrest I in 125 (38%) and Forrest II in 211 (62%). It was initially reached in 297 patients (88%). Twenty-two patients required emergency surgery (6,5%) and the global mortality rate was 3%. Severe hemodynamic affectation at admission (OR 11.8, p>0.001), ulcers exceeding 2 cm (OR 6.95, p = 0.019) and the presence of active bleeding during endoscopy (Forrest I) (OR 3.55, p = 0.08) were the variables included in the multivariate analysis independently associated to endoscopic therapy failure. CONCLUSION: endoscopic therapy is an efficient treatment of upper gastrointestinal bleeding due to duodenal ulcer. By means of a clinical variable, the hemodynamic status and two endoscopies, bleeding stigmata and the size of the ulcer, a group of patients with high risk of endoscopic treatment failure can be selected.

Duodenal Ulcer↗

PubMed2004

Endoscopic aesthetic facial surgery: technique and results.

The endoscopic approach to forehead and midface lifting has become popular method of face rejuvenation with minimal incisions. We have performed 67 endoscopic facelift procedures in the last four years. Forehead lifting technique included five small scalp incisions, wide subperiosteal elevation, endoscopic myotomy and forehead tissue fixation with srews, superficial temporal fascia (STF) suture to deep temporal fascia (DTF). Midface lifting technique included temporal 2.5 cm and 1.5 cm vertical intraoral incision, midface subperiosteal undermining and midface elevation with cable sutures Bichat's fat to DTF. Age mediana of patients who underwent endoscopic front lift was 46, patients who had endoscopic front lift and midface lift procedure age mediana was 40. Postoperative complication rate was 7.5% and included frontal branch weakness (n=2), hematoma (n=1), infraorbital nerve paresthesia (n=1) and asymmetrical smile (n=1). The main question is the quality of the results. We have reviewed 49 patients who were followed 6 months or more. Preoperative and postoperative life-size photographs were analyzed. The mean elevation mediana at medial canthus was 2.2 mm, at medial limbus 2.3 mm, at lateral limbus 2.5 mm, at lateral canthus 2.9 mm. Midface - lift effect resulted cheek elevation from 1.07 till 4.71 mm lip corner elevation 1.03 mm to 3.27 mm. We observed cheek elevation, improving nasolabial line, increasing volume of malar region, elevating lip angles in patients after endoscopic midface lift. We have found that important advantage of subperiosteal midface lift, when performed in conjunction with endoscopic brow lift, is its ability to move the cosmetic eye unit, proportionally, leading to a harmonious facial appearance. Endoscopic facelift is effective procedure for face rejuvenation especially for eyebrows and cheek elevation.

Adult↗

PubMed2004

[Application of metal hemoclip for endoscopic polypectomy in children with thick-pedunculated intestinal polyps].

OBJECTIVE: With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety. METHODS: Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed. RESULTS: Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared. CONCLUSION: Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.

Child↗

PubMed2004

[Endoscopic surgery in neoplasms of the upper digestive tract].

INTRODUCTION: Endoscopic surgery has been performed since 1987 when in France the first laparoscopic cholecystectomy was done. Since then it has evolved and found a place in surgical practice. In the field of surgical oncology it has allowed the diagnosis, staging, resection and palliation of a great variety of neoplasms. OBJECTIVE: evaluate usefulness and recent advances of endoscopic surgery in neoplasms of the upper digestive tract, applied specifically to the esophagus and stomach. METHODS: We did a review of the medical literature using Medline data base (Pubmed). All series of cases, cohort and controlled studies published between January 1995 and April 2003 were included. RESULTS: For esophageal carcinoma as well as for gastric carcinoma, endoscopic surgery is used as a complement for computed tomography and endoscopic ultrasound to define clinical stage, increasing sensibility to detect metastatic disease. Techniques of endoscopic or video assisted esophageal transhiatal and thoracoscopic resection have been described, as well as Japanese studies including radical gastric resections in early gastric cancer with multiple advantages. There are also several developing possibilities of palliative endoscopic or video assisted treatment which are discussed in this article. CONCLUSIONS: Usefulness of endoscopic surgery in staging gastric and esophageal carcinoma is proven. Nevertheless oncologic endoscopic resections are still experimental and the advantages between these and open surgery are still to be shown with prospective randomized trials.

Clinical Trials as Topic↗

PubMedDate not supplied

Endoscopic piecemeal mucosal resection of large colorectal tumors.

BACKGROUND/AIMS: Since endoscopic en bloc resection of large and sessile tumors is technically difficult, endoscopic en bloc piecemeal mucosal resection (EPMR) is usually chosen for resection of such tumors. Tumors resected by EPMR are, however, difficult to evaluate histologically. The aim of this study was to evaluate the safety and effectiveness of EPMR. METHODOLOGY: We removed 30 large colorectal tumors in 30 patients by EPMR between 1992-2000. Endoscopic examination was repeated at 3, 6 and 12 months and later on after initial endoscopic resection. Patients in whom no residual tumor was found by both endoscopic and histologic examination were considered to be "cured". RESULTS: Histological examination of the resected tumor tissues revealed malignancy in 43.3% (13/30). Three patients had invasive malignant tumors and underwent surgery. Following complete endoscopic resection, recurrences were observed in 2 patients with benign tumors, which were resected by additional endoscopic resection. All patients including the two with non-invasive malignant tumors remain free from recurrence during a mean follow-up period of 45.2 months (range, 3-104 months). Bleeding was the only complication and was seen in one patient (3.3%; 1/30), which was treated by endoscopic clipping. CONCLUSIONS: EPMR of benign or non-invasive large malignant tumors is a safe and effective procedure. Complete excision of large, sessile and non-invasive tumors is possible, although complete removal by EPMR cannot be verified histologically.

Adenoma↗

PubMed2005

Curative endoscopic ultrasound-assisted submucosal resection of a gastric stromal tumor.

Endoscopic submucosal resection has been proposed as a feasible alternative for the diagnosis and treatment of small submucosal tumors (< 3 cm), as compared to classic interventions (surgical intervention or frequent follow-up). Therapeutic options should be established after precise endoscopic ultrasound assessment of the tumor characteristics. We present the case of a 60 year-old patient, admitted to the Emergency Department for upper gastrointestinal (GI) bleeding. Upper GI endoscopy showed a submucosal tumor on the posterior gastric wall, with hyperemic covering mucosa, without central ulceration. Endoscopic ultrasound identified a 10-mm well-delimited hypoechoic lesion, with the origin in the third hyperechoic layer (submucosa). After injection of 1:10000 epinephrine in the submucosa, with subsequent elevation of the protrusive formation, we performed an endoscopic submucosal resection without any complications. Pathology exam showed a gastric stromal tumor with low mitotic activity, the endoscopic resection being considered curative. The absence of independent risk factors determined by ultrasound endoscopy (size > 3 cm, irregular margins, hyperechoic foci > 3 mm, cystic spaces > 4 mm, presence of intratumoral Doppler signal), as well as the low mitotic activity, permitted the subsequent follow-up of the patient. A control endoscopic examination performed after 4 weeks showed the healing of the post-resection ulceration. In conclusion, ultrasound endoscopy allowed the establishment of a correct presumptive diagnosis and the subsequent assistance of endoscopic submucosal resection, used for pathological confirmation and for curative endoscopic treatment.

Biopsy↗

PubMedDate not supplied

Staged endoscopic and combined open/endoscopic approach in the management of inverted papilloma of the frontal sinus.

BACKGROUND: The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined. METHODS: We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004. RESULTS: A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. CONCLUSION: The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.

Endoscopy↗

PubMed2002

Endoscopic surveillance in Barrett's esophagus.

Barrett's esophagus (BE), a complication of chronic gastroesophageal reflux disease (GORD), is a condition that is premalignant for adenocarcinoma of the esophagus and esophagogastric junction. Esophageal adenocarcinoma, once an uncommon entity, has been growing rapidly in incidence over the last two decades in several parts of the world. Barrett's esophagus is a change in the esophageal epithelium of any length that can be recognized at endoscopy and is confirmed to have intestinal metaplasia by biopsy (American College of Gastroenterology guidelines). Because of its premalignant nature, it is recommended that patients with BE undergo regular endoscopic surveillance. The recommendation for endoscopic surveillance is based on unproved and controversial assumptions including: 1) the assumption that Barrett's esophagus adversely influences survival; 2) the assumption that endoscopic surveillance can reliably detect early, curable neoplasia in the columnar lined esophagus. Moreover, the low incidence of adenocarcinoma (reported cancer incidence rates in prospective studies on BE range between 0.5% and 1.9%) is used to support an approach of not surveying patients with Barrett's esophagus. Despite these not convincing data, endoscopic surveillance is considered ''reasonable'' and ''desirable'' by the gastroenterological associations and consensus meetings. Endoscopic surveillance for cancer in Barrett's esophagus (BE) is performed primarily to seek dysplasia, to prevent the progression to invasive malignancy; however, one of the limitations of using dysplasia is a lack of understanding of its natural history. The efficacy of endoscopic surveillance for Barrett's esophagus is likely to remain unclear for a long time. The American College of Gastroenterology has recommended the following practice guidelines: a) for patients with no dysplasia, surveillance endoscopy is recommended at an interval of every 2 to 3 years; b) for patients with low grade dysplasia, surveillance endoscopy every 6 months for the first year is recommended, followed by yearly endoscopy if the dysplasia has not progressed in severity; c) for patients with high grade dysplasia, two alternatives are proposed after the diagnosis has been confirmed by an expert gastrointestinal pathologist. One alternative is intensive endoscopic surveillance until intramucosal cancer is detected at an interval of every 3-6 months. The other alternative is esophageal resection. In the situation of indeterminate dysplasia, whereas the pathologist can not come to definite diagnosis, control biopsies are proposed after 2 months of adequate acid suppression by means of proton pump inhibition. In all cases, the technique of random, four quadrant biopsies taken every 2 cm in the columnar-lined esophagus for standard histologic evaluation is recommended. Any grossly abnormal areas may be biopsied too. One can expect however that during the next future these protocol will change considering new data on dysplasia detection (biochemical markers, flow cytometry), new techniques to identify dysplasia (chromoendoscopy, endosonography, coherence optical tomography, fluorescence techniques) and development of better ablative techniques. At present a marker other than dysplasia identifying a high risk group for cancer on which to focus endoscopic surveillance has not yet been established.

Journal Article↗

PubMed2006

[Current topics of endoscopic surgery for thyroid cancer].

Endoscopic surgery has been introduced in the field of thyroid disease. Endoscopic thyroid surgery is divided into complete endoscopic surgery using CO2 gas, which is approached from the axilla, mammary areola, and anterior chest; and video-assisted thyroid surgery without CO2 gas, approached from the neck or anterior chest under the clavicula through a small incision. Many thyroid tumors are benign, and cases of thyroid cancer are few. Only 7.9% of patients who underwent endoscopic thyroid surgery in the English and Japanese literature had papillary thyroid cancer. Most of these underwent video-assisted thyroidectomy without gas. The indications for endoscopic surgery in papillary thyroid cancer is microcancer or small tumor without lympnode metastasis before surgery. In follicular thyroid cancer, minimally invasive thyroid cancer of less than 5cm is recommended for endoscopic thyroid surgery. Furthermore, in medullary carcinoma with multiple endocrine neoplasia, prophylactic thyroidectomy can be performed using these endoscopic techniques. At present, it is still controversial whether endoscopic surgery should be performed to treat thyroid cancer.

Carbon Dioxide↗

PubMed2006

[Endoscopic off-pump coronary artery bypass].

Since 1999, we have performed total endoscopic off-pump coronary artery bypass (OPCAB). Innovation of endoscopic optic techniques and development of endoscopic forceps were necessary to perform this procedure. The operative methods of the endoscopic OPCAB; a 12 mm port for 3-D endoscope is firstly inserted through the 5th intercostal space (ICS) in the mid axillary line, and then the left internal thoracic artery (LITA) is taken down in semi-skeletonized fashion using other 2 instrumental 5 mm ports (the 3rd, 6th anterior axillary ICS). To anastomose LITA to the left anterior descending artery (LAD), other 2 10 mm and 12 mm ports are inserted through the 4th ICS in parallel. A conventional end-to-side anastomosis is manually performed with 8-0 prolene. The average LITA harvesting time and anastomotic time have been shortened significantly thanks to the endoscopic innovation. However, there are some limits to manual manipulations in the endoscopic OPCAB. Robotic surgery might have more advantages to the flexibility of forceps tips. The introduction of robotic surgery system is indispensable to safe and certain endoscopic OPCAB.

Coronary Artery Bypass, Off-Pump↗

PubMed1991

The role of endoscopic papillotomy in ascending cholangitis.

The role of endoscopic papillotomy in calculous cholangitis is unclear. A retrospective review of 41 patients admitted to hospital with calculous cholangitis was carried out. There were 30 women and 11 men and their ages ranged between 49 and 98 years (mean age 77). All patients presented with abdominal pain, tenderness, chills, and fever. Clinical jaundice was present in 95 per cent of the patients. Initial endoscopic papillotomy was successful in 17 of the 41 patients. In 24 patients cholangitis persisted or recurred and further therapy was carried out. Surgery was successful in controlling sepsis in ten of the 24 patients. Repeat endoscopic papillotomy was successful in four of 13 patients. Surgery was successful in one of nine patients who had failed repeat endoscopic papillotomy. Nasobiliary drainage and percutaneous transhepatic drainage of the common bile duct after failed repeat endoscopic papillotomy was successful in only two of nine patients. Six patients died after failed repeat endoscopic papillotomy. We conclude that initial endoscopic papillotomy should be attempted in patients with calculous cholangitis. Surgical exploration of the common bile duct should then be carried out if initial endoscopic papillotomy fails to control cholangitis.

Aged↗

PubMedDate not supplied

[Endoscopic excision of malignant colorectal polyps. Study of a series of 82 cases].

The management of malignant colonic polyps removed by endoscopic polypectomy is a controversial subject. We reported a series of 81 patients with 82 malignant polyps removed by endoscopic polypectomy between 1977 and 1984. 15 polyps contained carcinoma in situ and were treated by endoscopic polypectomy alone. 36 polyps contained superficial cancer; 35 were treated by EP alone; 1 was treated by endoscopic polypectomy and colectomy. 26 polyps contained invasive carcinoma and 2 were classified as polypoid adenocarcinomas. 19 had clear resection margins at polypectomy and seven had involved resection margins: 17 were treated by endoscopic polypectomy alone, 9 were treated by endoscopic polypectomy and colectomy. The patients were followed with colonoscopy. Follow-up has been 6 to 74 months (mean 32 months). The patients whose polyps were treated by endoscopic polypectomy alone, had had no evidence of recurrent tumor at the polypectomy site. Of the 12 patients undergoing colectomy, 4 had residual tumor at the polypectomy site. No patients had involved lymph nodes. There was no evidence of recurrence in any of these cases. Polyps containing contained carcinoma in situ and superficial cancer, polyps containing invasive carcinoma and clear resection margins can be treated with endoscopic polypectomy alone. Polyps with invasive carcinoma and involved resection margins should undergo segmental colonic resection. This approach must be weighed against the age of the patient, the medical status and the morbidity and mortality of the surgical procedure.

Adult↗

PubMed1995

Remaining small bowel endoscopic lesions at surgery have no influence on early anastomotic recurrences in Crohn's disease.

OBJECTIVES: We recently demonstrated that 65% of patients operated on for Crohn's disease (CD) had lesions of the small bowel at perioperative endoscopy (POE). These lesions were unrecognized before surgery in more than half of the patients. The aim of this study was to assess the prognostic value of endoscopic small bowel lesions let in place at time of surgery on further anastomotic endoscopic relapse. METHODS: Twenty one patients (10 women, 11 men, mean age 34 yr) had an enteroscopy from the terminal ileum to the ligament of Treitz during an ileocolectomy performed for CD. All patients were subsequently enrolled in a placebo-controlled trial of mesalazine for the prevention of early endoscopic relapse; 10 patients received placebo, and 11 received mesalazine (1.5 g/day) for 12 wk after surgery. At the end of this trial, they all had a colonoscopy with inspection of the anastomosis and the neoterminal ileum. RESULTS: POE was completed up to the angle of Treitz in all 21 patients. In 10/21 cases (47%), mild lesions were found distributed at random along the small intestine 30 cm beyond the resection margin. At colonoscopy performed 12 wk later, lesions were found in 11/21 cases (52%) between section margin and were estimated to be 25 cm over the anastomosis. Endoscopic recurrence occurred in 5/10 patients who received placebo and 6/11 patients who received mesalazine. Endoscopic recurrence occurred in 5/10 patients having lesions at POE and in 6/11 patients who had no lesions. There was no relationship between endoscopic recurrence at 12 wk and presence of lesions at initial POE, whatever the postoperative treatment. CONCLUSION: Endoscopic lesions let in place after "curative" surgery have no influence on early endoscopic anastomotic recurrences in CD.

Adult↗