Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Endoscopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed2000

Disinfection of gastrointestinal endoscopes and accessories.

A worldwide concern has emerged with regard to endoscope disinfection and many gastrointestinal endoscopy associations have developed guidelines for proper disinfection of endoscopes and endoscopic accessories. A working party was convened to formulate guidelines for the Asia-Pacific region, pertaining to any setting in which gastrointestinal endoscopy is performed. Endoscope reprocessing that meets the established standard of practice helps to ensure a microbial-free endoscope for all patients, reduces the risk of disease transmission and helps to prolong the life of the endoscope. The recommendations included mechanical cleaning as the first and most important step followed by immersion in 2% glutaraldehyde for a minimum period of 10 min. Automated disinfectors have been recommended for busy endoscopy centres to ensure better compliance. Reuse of endoscopic accessories meant for 'single use' remains a controversial issue. Strict quality assurance programmes are a must to preclude lack of compliance with these guidelines.

Disinfection↗
PubMed2002

Evaluation of endoscopic hemostasis in upper gastrointestinal bleeding related to Mallory-Weiss syndrome.

BACKGROUND AND STUDY AIMS: The endoscopic hemostatic method has been introduced as a safe and effective mechanical approach to hemostasis for upper gastrointestinal bleeding related to Mallory-Weiss syndrome (MWS). However, the indications for when to use endoscopic treatment are debatable because many patients need only medical observation. The study was designed to evaluate the necessity and efficacy of endoscopic hemostasis in upper gastrointestinal bleeding related to MWS. PATIENTS AND METHODS: From July 1994 to May 2000, we conducted a clinical trial in 76 patients who were found by endoscopy to have active bleeding (I, spurting; II, oozing), protruding visible vessels (III), and/or adherent clots (IV). Two study periods can be differentiated: in the first 3 years endoscopic treatment (n = 30) was prospectively analyzed and in the final 3 years medical treatment (n = 46) was analyzed in both cases to compare the outcome in MWS bleeding II-IV. In the first study period, in addition, endoscopic treatment was randomised to an injection method, using a mixture of hypertonic saline and epinephrine (HSE) (n = 14) and a hemoclipping or band ligation method (n = 16). RESULTS: Rebleeding was observed in four of 14 patients who had received endoscopic hemostasis with HSE injection and one of 46 patients who had been managed with medical treatment. No rebleeding was found following hemoclipping or band ligation. While all rebleeding was in bleeding stigmata of the I (1) and II (4) grades, there was no rebleeding in protruding visible vessels (III) or in adherent clots (IV), regardless of treatment methods. CONCLUSIONS: Our results suggested that endoscopic hemostasis is not necessary in patients without active bleeding stigmata, and the mechanical hemostatic method is more effective than HSE injection in patients with active bleeding stigmata.

Adult↗
PubMed2003

Do conventional cleaning and disinfection techniques avoid the risk of endoscopic Helicobacter pylori transmission?

BACKGROUND AND STUDY AIMS: The aim of the present study was to determine whether endoscopes serve as a reservoir for Helicobacter pylori and whether the disinfection technique currently recommended for manual cleaning and disinfection of the instruments completely removes the risk of H. pylori transmission. PATIENTS AND METHODS: A prospective study was carried out in 400 patients who were undergoing upper gastrointestinal endoscopy for routine clinical indications. The patients' H. pylori status of the patients was identified using a urea detection system (HUT) and culture. H. pylori contamination was assayed by culturing rinsing samples from the endoscopes before and after manual cleaning and disinfection. Gastric biopsies were assayed using rapid urease testing (Helicobacter urease test, HUT) of two antral and gastric body biopsies and cultures. RESULTS: A total of 128 of the 400 patients examined were found to be H. pylori-positive using HUT testing. Endoscopes were contaminated in 54 of the 128 rinsing samples from endoscopes used in H. pylori-positive patients (42 %) before cleaning and disinfection. One of the 128 rinsing samples (0.8 %) was found to be contaminated with H. pylori even after routine manual cleaning and disinfection - indicating that these cleaning and disinfection procedures may be insufficient to eradicate H. pylori from endoscopes completely. No seroconversion was observed during serological follow-up in the patient who had previously been examined with an endoscope contaminated with H. pylori. The patient was still found to be seronegative 5 months after inoculation. CONCLUSIONS: Endoscopes are frequently contaminated with H. pylori immediately after gastroduodenal endoscopy in H. pylori-infected patients. Iatrogenic transmission is possible, as H. pylori can survive manual cleaning and disinfection with 2 % glutaraldehyde, particularly when there is ineffective cleaning before disinfection.

Aged↗
PubMed2003

The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions.

BACKGROUND AND STUDY AIMS: Dieulafoy lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly from the proximal stomach. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. However, the effectiveness of various endoscopic modalities in treating bleeding Dieulafoy lesion has been little studied. This study was therefore done to compare the hemostatic efficacy of endoscopic hemoclipping and epinephrine injection therapy. PATIENTS AND METHODS: Between January 1998 and December 2001, a consecutive series of 32 patients with bleeding Dieulafoy lesion underwent endoscopic treatment. They were randomly treated either by endoscopic epinephrine injection therapy (n = 16) or by hemoclipping (n = 16). We compared mortality rate, primary hemostasis rate, and rebleeding rate between two groups. RESULTS: There was no bleeding-related death in either group. There was no significant difference in primary hemostasis rates between the hemoclipping group (93.8 %) and epinephrine injection group (87.5 %, P = 1.00). There was a trend toward a lower rate of need for multiple endoscopic sessions to achieve permanent hemostasis in the hemoclipping group compared with the epinephrine injection group (6.3 % vs. 31.3 %, P = 0.086). Hemoclipping was significantly more effective in preventing recurrent bleeding than epinephrine injection therapy (0 % vs. 35.7 %, P < 0.05). With regard to lesion site, hemoclipping was significantly more effective in preventing recurrent bleeding of gastric body Dieulafoy lesion than epinephrine injection therapy (0 % vs. 50 %, P < 0.05). CONCLUSIONS: Bleeding from Dieulafoy lesion was well controlled by therapeutic endoscopic procedures. Hemoclipping was more effective for Dieulafoy lesion than epinephrine injection therapy, with less need for subsequent endoscopy.

Adult↗
PubMed2005

Endoscopic management and follow up of Dieulafoy lesion in the upper gastrointestinal tract.

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is an important cause of upper gastrointestinal bleeding, and the safety and efficacy of endoscopic treatment have been widely accepted. The aim of this study was to evaluate the effectiveness of endoscopic management, including hemoclipping and injection methods, for bleeding Dieulafoy lesions in the upper gastrointestinal tract. PATIENTS AND METHODS: Between 1995 and 2003, 61 patients with bleeding Dieulafoy lesions underwent endoscopic treatment. The available hemostatic methods were hemoclipping, hypertonic saline-epinephrine injection, and pure ethanol injection. Clinical data, endoscopic features, and treatment outcome were analyzed retrospectively. RESULTS: Comorbid conditions were present in 39 patients (64 %). Active bleeding was noted in 20 patients (33 %). Hemoclipping was a selected treatment in 48 patients (79 %). Initial hemostasis was achieved in 61 patients (100 %). One patient had rebleeding 6 days after the initial procedure but was successfully treated endoscopically. The 30-day mortality was 0 %. During follow-up, for a mean of 47 months, 15 patients (25 %) died of causes unrelated to the Dieulafoy lesion. Two patients had recurrent bleeding due to non-Dieulafoy gastric ulcer, and responded to endoscopic therapy. We encountered no patients who required surgery. CONCLUSIONS: Dieulafoy lesion can be successfully managed by endoscopic treatment. The long-term outcome is acceptable.

Adolescent↗
PubMed1994

Patient and staff exposure to glutaraldehyde from KeyMed Auto-Disinfector endoscope washing machine.

Activated glutaraldehyde (2%) is the recommended agent for disinfection of endoscopic equipment. Exposure to the disinfectant is associated with side-effects and guidelines have been set to avoid these complications. Endoscope washing machines are used to provide automated high level disinfection of endoscopes as well as reduce exposure to the irritant aldehyde. We report a design fault in an endoscope washing machine which results in patients and staff being exposed to activated glutaraldehyde. The Auto-Disinfector (KeyMed) comprises a washing chamber supplied by three separate reservoirs (detergent, disinfectant, and rinse water) via a common channel. After the first cycle endoscopes are processed using previously used detergent and rinse water. Rinse water glutaraldehyde concentrations were measured in four machines during routine endoscopy lists on at least two occasions and showed a progressive rise in glutaraldehyde concentration up to 0.1% after two to six cycles. This results in staff being exposed to glutaraldehyde present on the processed instrument and the disinfectant being pumped from the internal channels of the endoscope into direct contact with the gastrointestinal mucosa during endoscopy at concentrations of 200-1000 ppm. The present atmospheric limit for glutaraldehyde is 0.2 ppm. Skin and mucosal irritation occur at concentrations of 0.3 ppm and severe synovitis in experimental animals at 100 pm. Tongue swelling and bloody diarrhoea with characteristic mucosal histological changes have been reported in patients exposed to activated glutaraldehyde on inadequately rinsed equipment. To reduce this problem the rinse water should be changed after every cycle and the endoscope should be dried thoroughly before use.

Disinfection↗
PubMed2000

Role of Doppler US in acute peptic ulcer hemorrhage: can it predict failure of endoscopic therapy?

BACKGROUND: Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem. This study evaluates endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleeding in patients presenting with acute peptic ulcer hemorrhage. METHODS: In this prospective, double-blind, nonrandomized trial, patients were enrolled from a single academic institution. Only patients with endoscopically confirmed gastric, duodenal, pyloric, or anastomotic ulcers were enrolled. The therapeutic endoscopist was blinded to the Doppler US signal from the ulcer and based treatment decisions on standard guidelines. A 16 MHz pulsed-wave, linear scanning, US probe was used through the accessory channel of an endoscope to assess for the presence of a Doppler signal. RESULTS: Fifty-two of 139 screened patients entered the trial (55 Doppler sessions). Endoscopic therapy was performed in 42% (30-day recurrent bleeding rate of 17%). Ulcers that remained persistently Doppler positive immediately after endoscopic therapy had a significantly higher rate of recurrent bleeding than ulcers where the Doppler signal was abolished: 100% versus 11% (p = 0.003). There were no bleeding-related deaths. CONCLUSIONS: A persistently positive Doppler US signal appears to be a marker of inadequate endoscopic therapy in patients with acutely bleeding peptic ulcers.

Acute Disease↗
PubMed2001

Pitfalls in endoscope reprocessing: brushing of air and water channels is mandatory for high-level disinfection.

BACKGROUND: Endoscopic transmission of pathogens has been reported. Guidelines have been formulated concerning the risk of infection via contaminated suction and accessory channels. Contamination of the other 2 channels for air and water has not been demonstrated. These channels were examined to clarify whether they require cleaning. METHODS: Endoscopes used for examinations were divided into 2 groups. Group A endoscopes (n = 20) were brushed along the air and water channels. Group B endoscopes (n = 22) were not. After machine reprocessing, specimens were obtained for bacterial culture. The residual protein was measured in the 2 channels by using amido black 10B dye, and results were compared between the 2 groups. RESULTS: With regard to the air channel, there were no contaminated endoscopes detected in either group. For the water channel, 1 endoscope in group B was positive whereas there were none positive in group A. With regard to quantification of residual protein, brushing diminished the level in both the air and the water channels. CONCLUSION: The air and water channels can become contaminated. Brushing every channel is mandatory for high-level disinfection. A redesign of the fundamental structure of endoscopes is proposed.

Air↗
PubMed2001

Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications.

BACKGROUND: Adenomas of the major duodenal papilla have malignant potential and are traditionally treated by pancreaticoduodenectomy. This is a report of our experience with endoscopic management and a description of techniques for decreasing complications and enhancing efficacy. METHODS: Forty-one patients were referred for endoscopic management of papillary tumors. If there was no duct invasion and the appearance suggested a benign lesion, biductal sphincterotomy with pancreatic duct stent placement was performed. If the lesion could be elevated by injection of an epinephrine solution, piecemeal resection was performed. The base of the lesion was thermally ablated as needed. Resection/ablation together with stent removal was performed 1 month later. RESULTS: Nine patients (22%) had lesions other than papillary adenoma or cancer. Malignant appearance, ductal stricturing, or extension into the ducts was found in 16 of 41 patients (39%) in whom biopsy specimens alone were obtained. Three patients with adenomas (7%) did not undergo endoscopic resection (because of extremely large lesions and/or comorbid illnesses). Thirteen patients with adenomas (32%) had endoscopic resection; 12 (92%) were lesion-free after 32 ERCPs (mean 2.7). Endoscopic management was unsuccessful in 1 patient (8%). Pancreatitis developed in 1 patient. CONCLUSIONS: Endoscopically treatable papillary neoplasms can be identified on the basis of endoscopic, radiographic, and biopsy features. Preresection sphincterotomy, stent placement, elevation by epinephrine injection, and piecemeal resection may reduce complications and permit more aggressive treatment.

Adenoma↗
PubMed2006

Experimental evaluation of an automated endoscope reprocessor with in situ generation of peracetic acid for disinfection of semicritical devices.

OBJECTIVE: To evaluate the effectiveness of a high-level disinfection solution generated inside an endoscope processing system for decontaminating external and internal surfaces of experimentally contaminated heat-sensitive medical devices. METHODS: The American Society for Testing and Materials Simulated-Use Test protocol (E1837-02), which incorporates a soil load in each inoculum, was used to evaluate the efficacy of the system when processing 4 common types of endoscopes contaminated separately with 5 types of nosocomial pathogens: Pseudomonas aeruginosa (ATCC 15442), spores of Clostridium difficile (ATCC 9689), a glutaraldehyde-resistant strain of Mycobacterium chelonae, a vancomycin-resistant strain of Enterococcus faecalis, and a methicillin-resistant strain of Staphylococcus aureus. Rinse solution samples from channels and from surfaces of the processed endoscopes were tested for any microbicidal residues. RESULTS: For all organisms tested, the baseline level of contamination of the endoscopes ranged from 5 log(10) to greater than 7 log(10) at each external surface site and internal channel. All tests showed reductions in viability of the test organisms to undetectable levels. All rinse solution samples from external and internal sites of the endoscopes proved to be free of any residual microbicidal activity. CONCLUSIONS: The endoscope reprocessor, with its processor-generated high-level disinfection solution, successfully reduced the numbers of selected, clinically relevant pathogens to undetectable levels both in the channels and on the outside surfaces of the 4 representative endoscopes tested in this study.

Cross Infection↗
PubMed1991

Disinfection practices for endoscopes and other semicritical items.

OBJECTIVE: To determine the disinfection practices employed by North Carolina hospitals for endoscopes and other semicritical patient care items and to discuss minimally acceptable disinfection procedures for these items. DESIGN: A survey questionnaire was mailed to all North Carolina hospitals to identify their disinfection practices, and a literature review was conducted to ascertain studies that evaluated disinfection techniques for certain semicritical items. PARTICIPANTS: Questionnaires were returned by 107 of 167 (64%) North Carolina acute-care hospitals. RESULTS: Most hospitals (91%) used a glutaraldehyde-based disinfectant (59%, 2% glutaraldehyde; 29%, 0.13% glutaraldehyde-0.44% phenol-0.08% phenate; 3%, either); half (51%) of the hospitals immersed the endoscope into disinfectant for greater than or equal to 20 minutes, but 44% immersed for less than or equal to 10 minutes; nearly all hospitals (97%) disinfected endoscopes at room temperature. Hospitals rinsed the endoscope with sterile water (16%), tap water (54%), tap water followed by alcohol rinse (27%), or other (2%); 58% of the hospitals treated endoscopes from patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or Mycobacterium tuberculosis differently (81%, ethylene oxide [ETO] sterilization; 10%, increased exposure time; 10%, other). Twenty percent of the hospitals used an automated washer for processing endoscopic instruments. Rigid endoscopes (e.g., arthroscopes, laparoscopes) were primarily high-level disinfected (57%), ETO sterilized (17%), or either (13%). The disinfection strategies for other semi-critical items (e.g., applanation tonometers, cryosurgical instruments, and diaphragm fitting rings) were highly variable for the responding hospitals. CONCLUSIONS: This survey indicated the presence of a wide variety of practices for handling semicritical patient care items, many of which are inconsistent with current recommendations. To help establish minimally acceptable disinfection procedures for some patient care instruments (e.g., arthroscopes, laparoscopes, tonometers), the scientific literature was reviewed and recommendations were made.

Disinfection↗
PubMed2005

Combining the CO2 laser and the endoscope to remove soft tissue masses from the forehead area.

OBJECTIVE: The aim of this study was to provide a retrospective analysis of treatment that combines the laser and the endoscope. BACKGROUND DATA: Previously, surgeons faced many complications arising from endoscope-assisted surgery in the region of the forehead. In order to reduce the incidence of complications, such as swelling and hematoma, the CO2 laser is added to endoscope-assisted surgery. METHODS: Between January 1996 and January 2003, 42 patients were treated for the removal of a benign tumor. The group was comprised of 18 males and 24 females, and their ages ranged from 5 to 64 years. The SurgiLase 150XJ CO2 laser system, used in conjunction with the flexible FIBERLASE (Sharplan, NJ), was used in all cases. The endoscope was 4 mm in diameter, with an angle of 30 degrees (Snoden Pancer, USA). The dissection was performed by relaying images from the endoscope to a monitor. The basic instrumentation consists of elevators, a nerve hook, retractors, and endoscopic scissors. Suction of the smoke generated by laser evaporization was also necessary. RESULTS: Of the 42 cases treated, 30 patients displayed lipomas, 10 patients displayed inclusion cysts, and two patients displayed dermoid cysts. After surgery, the follow-up period ranged from 6 months, to 2 years and 6 months, with an average of 1 year and 7 months. In this retrospective review, the incidences of early complications of these 42 patients included one case of scalp alopecia, three of scar alopecia, one of numbness, and three of ecchymosis. No hematoma cases were recorded. Evaluation after 6 months revealed the later complication of one scar alopecia. CONCLUSIONS: SurgiLase CO2 laser, used in conjunction with endoscopic surgery, enables plastic surgeons to work at a distance through small incisions without causing bleeding. Visible scars are reduced and recovery time is diminished.

Adolescent↗
PubMed1995

Endoscopic-assisted recontouring of the facial skeleton: the forehead.

Endoscopic techniques have revolutionized current surgical techniques and have now been introduced to plastic surgery. Advantages of endoscopic assistance include direct visualization, hidden scars, and decreased morbidity. We sought to implement endoscopic techniques to recontour the facial skeleton and avoid the disadvantages of open procedures. A standard video system and endoscopic instrumentation including a 4-mm 30-degree endoscope and a power bur were used. Cadaveric dissections were performed before clinical use. Using endoscopic assistance, the frontal bone of a 42-year-old Korean woman with bony deformities was visualized and sculpted using a power bur. An uneventful postoperative course ensued. This case illustrates the feasibility of using endoscopic techniques in forehead recontouring and sets the stage for further work in malar and mandible recontouring.

Adult↗
PubMed1998

Endoscopic harvest of the gracilis muscle flap.

Endoscopic technique is becoming increasing prevalent in plastic surgery and is being explored for use in tissue harvest for microneurovascular transplantation. To advance the art truly, endoscopic technique must provide similar success and complication rates, operative time, and ease of performance as the traditional "open" surgical harvest. We report the successful microvascular transplantation in 6 patients of gracilis muscles harvested with endoscopic guidance. Dissection of the primary pedicle was done through a small proximal incision, and subsequent dissection was accomplished with an endoscope through the primary incision and a small distal incision. This method provides excellent success of transfer and decreased morbidity compared with the open technique. Specifically, the resulting scar from the endoscopic technique is considerably smaller, with just a 5-cm proximal and a 1.5-cm distal scar. The technique is accomplished with standard endoscopic equipment and is learned rapidly. We believe the improved aesthetic outcome makes endoscopic gracilis harvest a preferred technique.

Adult↗
PubMed1999

Evaluation of endoscope sheaths as viral barriers.

OBJECTIVES: Evaluate ENT endoscope sheaths as barriers to virus passage. STUDY DESIGN: "Defective" sheaths covering an endoscope were challenged with virus to determine how many virus particles could be recovered from the endoscope. METHODS: Sheaths with small laser-drilled holes (2 to 30 microm) were challenged with high-titer virus suspensions (10(8) viruses/mL). The inside of the sheath and the endoscope were separately rinsed to recover any virus that penetrated through the hole in the sheath. In an attempt to assess the possible importance of holes in the sheaths, a sequential test was conducted with an initial virus challenge outside a defective sheath (30-micron hole in the sheath), after which the possibly contaminated endoscope was removed and inserted into a second defective sheath (with a 20-micron hole at the same location) to determine whether the contaminating virus would pass outward through the second sheath. RESULTS: Small volumes of virus-containing fluid penetrated through the hole, e.g., 500 virus particles passed through one of three 30-microm holes. A significant fraction of those virus particles was occasionally found on the endoscope after removal from the sheath. Similar results were obtained with sheaths that had small tears (34-84 microm in length, from punctures with fine wires). Although some virus penetration could occur during the initial challenge contaminating the endoscope, no virus was detected passing outward through the second sheath. CONCLUSIONS: Use of a sheath combined with intermediate level disinfection should provide a safe instrument for ENT endoscopy.

Disinfection↗
PubMedDate not supplied

Endoscopic retrograde cholangio-pancreatography in dogs with chronic gastrointestinal problems.

Endoscopic retrograde cholangio-pancreatography is a combination of endoscopy and fluoroscopy used for radiographic imaging of the biliary and pancreatic ducts. In order to assess its feasibility and to describe abnormal findings in dogs, this technique was performed in 30 dogs with nonspecific chronic gastrointestinal disturbances. Using an 11-mm side-view endoscope, retrograde cholangiography was successful in 20/30 dogs (67%) and pancreatography in 21/30 (70%). Success was affected by intraduodenal food, mucus or blood, problems in papillary cannulation, stomach overdistention, body size, and changes in duodenal mucosa. It was impossible to perform the procedure in dogs weighing < 10 kg with the available material. Endoscopic retrograde cholangiography revealed findings that differed from previous reports in healthy beagles in 5/20 dogs. Findings included enlarged common bile duct (n = 2), intraductal filling defects (n = 2), and deviated course of common bile duct (n = 1), and major papilla stenosis (n = 1). In the dog with major papilla stenosis and intraductal filling defects, endoscopic guided sphincterotomy was performed. Endoscopic retrograde pancreatography revealed an abnormal course of the accessory pancreatic duct in 2/21 dogs. In both dogs with proven end-stage pancreatic acinar atrophy, the left duct branch did not run distal the stomach to the left but went parallel to the right duct branch and the duodenum. Repeated clinical and laboratory examinations revealed no signs of complications after endoscopic retrograde cholangio-pancreatography. It was concluded that this imaging technique is promising for the diagnosis of biliary and pancreatic diseases in dogs. It also offers the chance for new treatment options such as endoscopic guided sphincterotomy in dogs.

Animals↗
PubMed2003

Endoscopic retrograde cholangiopancreatography for surgeons.

Endoscopic retrograde cholangiopancreatography remains an important tool for the management of biliary and pancreatic disease. Endoscopic removal of common bile duct stones is the procedure of choice for retained stones and is a common option preoperatively with the gallbladder in place. Cholangitis is best treated by endoscopic sphincterotomy and stenting along with intravenous antibiotics initially with the possibility of definitive treatment with endoscopic stone removal and/or dilatation and stenting for strictures. Endoscopic sphincterotomy is also recommended in severe or rapidly worsening gallstone pancreatitis or in those with combined pancreatitis and rising bilirubin or cholangitis. Palliation with internal stents for malignant strictures has been possible with good outcome and very little difference in efficacy, complications, mortality, and long-term survival compared to surgical treatment. Biliary fistulae are easily treated by endoscopic stenting, particularly when the source is the cystic or an accessory duct. Benign biliary strictures can be dilated and stented for prolonged periods with good long-term success in selected cases. Pancreatic stenting is useful to treat pancreatic duct strictures and duct hypertension with considerable improvement of pain. Endoscopic drainage of pancreatic pseudocyst appears to be a safe, effective, and definitive treatment for patients in whom anatomic considerations allow its use. In summary, therapeutic uses of ERCP are of broad interest to the general surgeon and should be understood and utilized appropriately by the surgical community.

Bile Duct Diseases↗
PubMed2004

Endoscope-assisted microsurgery for microvascular compression syndromes.

OBJECTIVE: To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS: Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS: The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.

Arterioles↗