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At least 1,027 records · Page 57Linked to original sources
PubMed2005

Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: an animal study.

OBJECTIVE: Current endoscopic mucosal resection techniques are suboptimal for large circumferential mucosal resections intended to treat Barrett mucosa with multicentric foci of high-grade intraepithelial neoplasia or early adenocarcinomas. A rigid modified endoscope was developed for extended endoscopic mucosal resection in the esophagus. This pilot animal study investigated the feasibility of circumferential endoscopic mucosal resections of different lengths in the sheep esophagus. METHODS: Circumferential esophageal endoscopic mucosal resections of 2.2 cm (n = 6), 3.3 cm (n = 6), 4.4 cm (n = 7), and 5.5 cm (n = 5) were performed in 24 sheep. Circumferential resections consisted of two opposite hemicircumferential mucosectomies. Animals were followed up with endoscopic examinations at 1 week and then monthly to 6 months, or until complete re-epithelialization without stenosis eventually ensued. Strictures were treated with a single or repeated dilatations with Savary bougies. RESULTS: Circumferential resections 2.2 to 5.5 cm in length were successfully performed in 23 of 24 of the animals. One perforation occurred directly after mucosectomy. Accurate depth of resection through the submucosa was obtained in 85% of the specimens. Cicatricial stenosis was controlled in 95% by bougienage. CONCLUSION: Endoscopic mucosal resection performed with the rigid esophagoscope allowed extensive circumferential resections in a single session. There is thus potential to eradicate complete Barrett esophagus with high-grade intraepithelial neoplasia or early adenocarcinomas.

Animals↗
PubMed2004

Chronic panrhinosinusitis without nasal polyps: long-term outcome after functional endoscopic sinus surgery.

OBJECTIVE: The goal of this study was to evaluate the long-term outcome after functional endoscopic sinus surgery (FESS) for chronic panrhinosinusitis without nasal polyps by using symptom scoring and an endoscopic outcome evaluation. STUDY DESIGN: Seventy-seven patients with chronic panrhinosinusitis without nasal polyps (Kennedy computed tomography [CT] scan stages I to III) were followed up for at least 3 years after FESS. Preoperative evaluation included a CT scan and an immunoallergologic evaluation. Three years after FESS, all patients were interviewed and scored endoscopically. RESULTS: Ninety-two percent of the patients showed a marked global improvement after FESS. The endoscopic control showed normal findings in 54% of all ethmoidal cavities. The postoperative endoscopic score correlated significantly with the subjective satisfaction ratings (P < 0.001). The preoperative CT staging proposed by Kennedy was predictive for necessity of revision surgery in 15% of the patients. CONCLUSIONS: Our data suggest that FESS for chronic panrhinosinusitis without nasal polyps has a good long-term outcome on subjective symptoms and endoscopic findings. SIGNIFICANCE: According to this study, subjective improvement correlates significantly with the postoperative endoscopic findings in the ethmoidal cavities of patients with chronic panrhinosinusitis without polyps at a long-term follow-up.

Adolescent↗
PubMed2007

Endoscopic versus external repair of orbital blowout fractures.

OBJECTIVES: This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit. STUDY DESIGN AND SETTING: This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications. RESULTS: Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma. CONCLUSIONS: Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.

Adult↗
PubMed2004

Colorectal carcinoma in endoscopic biopsies; additional histologic criteria for the diagnosis.

In endoscopic biopsies, desmoplastic stroma and/or tumor invasion of the submucosa are generally regarded as histologic features that allow for the diagnosis of colorectal carcinoma (CRC). They are not present in all endoscopic biopsies of CRC. We investigated tumor necrosis and invasion of adjacent normal mucosa for their usefulness as possible additional histologic criteria for CRC, and evaluated quantitatively the diagnostic reliability of each of the four aforementioned histologic features in routine biopsy practice. We analyzed 440 endoscopic biopsies of lesions endoscopically suspicious of CRC and compared them with 26 colorectal adenomas with malignant change and 344 colorectal adenomas. The slides were stained by H&E and the Kreyberg-Jareg trichrome method. The endoscopic histologic diagnoses were verified by histologic examination of surgically resected specimens. In endoscopic biopsies of CRC, desmoplastic stroma was found in 83.6% of the cases, tumor necrosis in 75.7%, submucosal invasion in 27.0%, and invasion of normal mucosa in 22.7%. When only one of the diagnostic features was present, there was a false positivity of 2.5-13.3%; however, the latter has fallen to 0.8% when two features were present, but disappeared when there were three or four histologic features. Adenomas with malignant change showed necrosis in 69.2% and invasion of adjacent mucosa in 15.3%. In adenomas, necrosis was present in 0.6% of the cases, desmoplastic stroma in 3.2%, and shallow erosions in 27.3%. The presence of tumor necrosis and invasion of normal mucosa were characteristic histologic features of CRC; therefore, they represent useful additional histologic criteria for the diagnosis of CRC in endoscopic biopsies. The reliability of the histologic diagnosis of CRC correlated with the number of the four aforementioned histologic features.

Adenoma↗
PubMedDate not supplied

Open versus endoscopic lumbar pedicle screw fixation and posterolateral fusion in a sheep model: a feasibility study.

BACKGROUND CONTEXT: Conventional open procedures for lumbar pedicle screw instrumentation are often associated with significant morbidity resulting in longer postoperative recovery and hence have led to the advent of less invasive techniques of spinal instrumentation and fusion. PURPOSE: This study compares lumbar pedicle screw fixation and posterolateral fusion using endoscopic and open techniques in a sheep model. STUDY DESIGN: Endoscopic and open techniques of lumbar pedicle screw instrumentation and posterolateral fusion are compared in a sheep model (12 sheep in each group). The safety and fusion outcome are assessed by postoperative computed tomography (CT) scans performed at 6 months. METHODS: Twelve sheep underwent bilateral L4-L5 pedicle screw fixation and posterolateral fusion by means of endoscopic instrumentation and another 12 sheep by means of conventional open technique. For posterolateral fusions, an autologous iliac crest bone or bone graft substitute (Healos/MP52; Orquest, Mountain View, CA) was used on either the animal's left or right side. The animals were euthanized 6 months after surgery and the lumbar spines were harvested. Pedicle dimensions and screw insertion angles were measured and the two techniques were compared using CT and image analysis software. Pedicle screw misplacement was detected by means of direct inspection and CT scan, and fusions were evaluated by CT scans. RESULTS: The endoscopic group's screw insertion angle was more convergent, corresponded more closely to the human pedicle angle and was less variable than in the open technique. Three of the endoscopic group's 48 screws were misplaced medially, whereas in the open technique, 5 screws were misplaced laterally. Posterolateral bone fusion masses were palpable 6 months after surgery for both the autologous bone grafts and graft substitutes. There were no complications. The ratio of screw to pedicle diameter was approximately 0.6, greater than in human studies. CONCLUSIONS: Despite differences between pedicle dimensions and screw angles, most screws could be inserted into the sheep pedicle using endoscopic or open techniques. Bone fusion was successful in both groups. Thus, minimally invasive, endoscopic transpedicular screw-plate fixation and posterolateral fusion is feasible, and as effective as the conventional open technique.

Animals↗
PubMed2006

Retrograde endoscopic management of ureteral stones more than 2 cm in size.

OBJECTIVES: To verify the safety and efficacy of retrograde endoscopic lithotripsy as the treatment modality for large ureteral stones. METHODS: From July 1996 to May 2005, we performed retrograde endoscopic treatment in 54 patients with large ureteral stones more than 2 cm in size, using a small-caliber ureteroscope and a holmium:yttrium-aluminum-garnet laser lithotriptor. Although the mean maximal stone diameter was 2.4 cm, 6 patients had stones measuring larger than 3 cm. Of the 54 patients, 11 had stones that could not be effectively fragmented by shock wave lithotripsy previously. RESULTS: Of the 54 patients, 48 were treated solely using retrograde ureteroscopy. In 47 patients (87%), the stones were fragmented completely by a single endoscopic procedure. Additional shock wave lithotripsy was performed after endoscopic debulking in 2 patients, and any stones remaining in the ureter were easily treated by shock wave lithotripsy. Pyelonephritis resulting from obstruction caused by ureteral stones was observed in 4 patients, 3 of whom required percutaneous nephrostomy and 1 of whom required stent insertion before the endoscopic procedure. These patients then underwent retrograde endoscopic lithotripsy, which completely cleared the calculi in one session. No intraoperative complications occurred. The only postoperative complication was found in 1 patient presenting with a ureteral stricture. One month after the final treatment, no patients had evidence of residual stones. CONCLUSIONS: With use of a small-caliber ureteroscope and a holmium:yttrium-aluminum-garnet laser lithotriptor, retrograde endoscopic lithotripsy seems to be an effective first-line therapy for large ureteral stones measuring more than 2 cm in size.

Adult↗
PubMed1988

Operative versus endoscopic gastrostomy. Preliminary results of a prospective randomized trial.

Percutaneous endoscopic gastrostomy in 23 patients was compared with operative gastrostomy in 25 patients in a prospective randomized fashion. Procedure-related morbidity occurred in five patients in each group. Tube feeding was initiated within 48 hours in 96 percent of the percutaneous endoscopic gastrostomy group and in 82 percent of the operative gastrostomy group (p less than 0.1). There were no deaths in the percutaneous endoscopic gastrostomy group, but two patients in the operative gastrostomy group died within 30 days of operation (p less than 0.1). Neither death appeared directly attributable to gastrostomy placement. The cost for a percutaneous endoscopic gastrostomy was less than that of an operative gastrostomy ($757 versus $1,446); however, if endoscopically placed tubes required replacement, as was seen in six patients, total percutaneous endoscopic gastrostomy cost increased to $1,198. Definitive conclusions regarding the superiority of one technique over the other cannot be drawn from this data. Trends favoring the use of percutaneous endoscopic gastrostomy merit continued study.

Adult↗
PubMed2005

Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus.

BACKGROUND: The aim of this study was to prospectively evaluate endoscopic resection (ER) combined with photodynamic therapy (PDT) for the treatment of selected patients with early neoplasia in Barrett's esophagus. METHODS: Patients with Barrett's esophagus and neoplastic lesions <2 cm in diameter and no sign of submucosal infiltration, positive lymph nodes, or distant metastasis underwent diagnostic ER (cap technique). Patients with a T1sm tumor in the resection specimen were referred for surgery; those with a T1m or a less invasive tumor underwent additional endoscopic therapy (ER, PDT, and/or argon plasma coagulation [APC]), or they were followed. PDT was performed with 5-aminolevulinic acid and a light dose of 100 J/cm 2 at lambda = 632 nm. RESULTS: Thirty-three patients underwent diagnostic ER. Endoscopic treatment was not performed in 5 patients, who underwent surgery (4 T1sm; 1, patient preference). Five patients were immediately entered into a follow-up protocol, and 23 received additional endoscopic treatment (13 additional ER, 19 PDT, 3 APC). Endoscopic treatment was successful in 26/28 patients; no severe complication was observed. During follow-up (median 19 months, range 13-24 months), 5/26 patients had a recurrence of high-grade dysplasia: all were successfully re-treated with ER. At the end of follow-up, 26/33 originally enrolled patients (79%) and 26/28 endoscopically treated patients (93%) were in local remission. CONCLUSIONS: Endoscopic therapy is safe and effective for selected patients with early stage neoplasia in Barrett's esophagus.

Aged↗
PubMed1987

Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy.

Endoscopic sphincterotomy is an accepted treatment for retained common bile duct stones, but there is little specific information available regarding its application in acute suppurative obstructive cholangitis with sepsis due to choledocholithiasis. Thirteen patients with this condition were referred to the authors for consideration of urgent endoscopic common bile duct decompression. All had been judged to be poor surgical candidates. Pus was released from the common bile duct by sphincterotomy within 24 hours of admission in all 13. Stones were removed endoscopically in 10 patients (77%) without complications. After endoscopic stone removal, symptoms, signs, and abnormal laboratory values returned to normal rapidly; follow-up endoscopic retrograde cholangiography did not show retained stones. Three patients whose large stones precluded endoscopic removal underwent operative choledocholithotomy. Urgent endoscopic sphincterotomy offers an important alternative in the treatment of acute suppurative obstructive cholangitis secondary to choledocholithiasis.

Aged↗
PubMedDate not supplied

Clinical features and endoscopic management of Dieulafoy's disease.

The experience of a specialized management team using urgent endoscopy in the management of acute gastrointestinal bleeding from Dieulafoy's disease is presented. Dieulafoy's disease was found in 19 of 1124 consecutive patients with upper gastrointestinal bleeding. Most patients with Dieulafoy's disease were elderly men with severe acute upper gastrointestinal hemorrhage. Endoscopic diagnosis was possible in all patients, but required multiple endoscopies in 37%. The lesions were in the proximal stomach (79%) and duodenal bulb (21%). Endoscopic therapy included epinephrine injection, then heater probe coagulation in 17 patients, bipolar electrocoagulation in 1, and Nd:YAG laser photocoagulation in 1. Endoscopic therapy was successful in 18 patients (95%); one patient had successful surgery after endoscopic therapy failed. There were no deaths due to bleeding and no endoscopic complications. Dieulafoy's disease is an unusual cause of acute gastrointestinal bleeding. Endoscopic diagnosis is sometimes difficult, but primary endoscopic therapy is safe, successful, and should be attempted.

Aged↗
PubMedDate not supplied

Carcinoid tumors of the gastrointestinal tract: evaluation with endoscopic ultrasonography.

To evaluate the usefulness of endoscopic ultrasonography for carcinoid tumors, we examined 29 patients with gastrointestinal carcinoid tumors (5 gastric, 7 duodenal, and 17 rectal). The smallest size detectable by endoscopic ultrasonography was 2 mm in diameter histologically. The cross-sectional image of the tumors was primarily oval to round. The internal echo was generally hypoechoic and homogeneous. The margins were clearly visualized, and the contour was somewhat smooth. The tumors were mainly located in the third layer. The second layer covered the tumor with the third layer at its base, and it abutted the tumor and became indistinct near its upper interface. These findings were especially recognized in lesions with submucosal invasion and were similar at all sites. The overall accuracy of determining the depth of invasion using endoscopic ultrasonography was 75% (27 of 36 lesions). Limited to the lesions detectable by endoscopic ultrasonography, the accuracy was 90%. Endoscopic ultrasonography was useful in determining the presence of local metastases. Moreover, endoscopic ultrasonography allowed direct detection of perigastrointestinal lymph node metastases (75%, three of four patients). In conclusion, endoscopic ultrasonography was found to be useful for the staging of gastrointestinal carcinoid tumors by determining depth of involvement and presence of perigastrointestinal lymph node metastases.

Carcinoid Tumor↗
PubMed1997

A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion.

BACKGROUND: The purpose of this study was to re-evaluate echo features of lymph nodes during endoscopic ultrasound and assess the utility of these echo features and endoscopic ultrasound-guided fine-needle aspiration in predicting malignant lymph node invasion. METHODS: Thirty-five lymph nodes in 25 patients with lung, esophageal, and pancreatic cancer were evaluated by endoscopic ultrasound. Endoscopic ultrasound examinations were performed with a radial scanning echoendoscope. Confirmation of benign lymph nodes was obtained by surgical resection while malignant lymph nodes were confirmed by real-time endoscopic ultrasound-guided fine-needle aspiration with a linear array echoendoscope. RESULTS: Nineteen benign lymph nodes and 16 malignant lymph nodes in the mediastinum, celiac axis, and the peripancreatic area were included in the study. The following echo features were compared between benign and malignant lymph nodes: size greater than 1 cm, hypoechoic, distinct margins, and round shape. No single feature independently predicted malignant invasion. When all four of the above features were present in the same lymph node, the accuracy for predicting malignant invasion was 80%. However, all four features of malignant involvement were present in only 25% (4 of 16) of malignant lymph nodes. Our study also suggests that the above echo features may be a less reliable predictor of malignant invasion in pulmonary malignancies when compared to gastrointestinal cancers. Endoscopic ultrasound-guided fine-needle aspiration of lymph nodes in 22 patients revealed malignant lymph node invasion in 16 and benign cells in 6 patients. CONCLUSION: Endoscopic ultrasound-guided fine-needle aspiration is an important adjunct for accurate lymph node assessment for malignancy.

Biopsy, Needle↗
PubMed1997

Gastric inflammatory fibroid polyps: endoscopic ultrasonographic analysis in comparison with the histology.

BACKGROUND: Histologic diagnosis of inflammatory fibroid polyp is usually difficult on routine endoscopic examinations. The aim of this study was to describe endoscopic ultrasonographic features of gastric inflammatory fibroid polyps. METHODS: Endoscopic ultrasonography was performed in 10 patients with gastric inflammatory fibroid polyps before resection. All lesions were resected by either endoscopic removal or gastrectomy and then confirmed histologically as inflammatory fibroid polyps. To evaluate the diagnostic value of endosonography, endoscopic ultrasonographic images of the lesions were analyzed and compared with resected specimens retrospectively. RESULTS: All lesions were located in the second and/or third sonographic layer of the gastric wall without involvement of the fourth layer. The most frequent endoscopic ultrasonographic features were an indistinct margin (90%), and a hypoechoic (80%), homogeneous (90%) echo pattern. Histologically, inflammatory fibroid polyps developed in the deep mucosa and/or submucosa by proliferation of fibrous tissue, but did not have a capsule. CONCLUSIONS: The characteristic endoscopic ultrasonographic attributes of gastric inflammatory fibroid polyps are indistinct margin, hypoechogenicity, homogeneous appearance, and location within the second and/or third layer. These findings correlate very closely to the histologic findings.

Adult↗
PubMed1998

Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe.

BACKGROUND: The usefulness of and problems associated with an ultrasound catheter probe in the pretreatment staging of endoscopically early gastric cancer remain unexplored. METHODS: Endoscopic ultrasonography using a 15 MHz catheter probe of 2.6 mm diameter was performed in a prospective study to determine the pretherapy staging of endoscopically early gastric cancer in 78 patients. The results of the ultrasound images were compared with the histologic findings of the specimens obtained by endoscopic mucosal resection or surgical resection. RESULTS: The accuracy of the catheter probe for depth of invasion of endoscopically early gastric cancers was 67% (52 of 78 patients). The accuracy in determining depth of invasion in relation to endoscopic type was significantly higher for the elevated type (91%) than for the depressed type of early cancer (56%) (p < 0.01). The staging accuracy classified by histologic type was significantly higher for differentiated (86%) than for undifferentiated (18%) cancer (p < 0.01). Staging accuracy decreased as tumor size increased. The accuracy, sensitivity, and specificity for nodal staging were 80%, 17%, and 90%, respectively. CONCLUSIONS: A 15 MHz ultrasound catheter probe is most useful for determining depth of invasion when the tumor is histologically differentiated and endoscopically of the small elevated type early gastric cancer, but it is unreliable in the diagnosis of metastatic lymph nodes.

Adenocarcinoma↗
PubMed2006

Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection.

PURPOSE: Current American Urological Association treatment guidelines for vesicoureteral reflux do not include any recommendations pertaining to endoscopic therapy (subureteral injection of bulking agent). We performed a meta-analysis of the existing literature pertaining to endoscopic treatment to allow comparison with reports of open surgical correction. MATERIALS AND METHODS: We searched all peer reviewed articles published through 2003 pertaining to endoscopic treatment of vesicoureteral reflux. A total of 63 articles were double reviewed by 9 pediatric urologists, and the data were tabulated on data retrieval sheets. A mixed effects logistic regression model was used to obtain overall estimates of event probabilities (eg reflux resolution, ureteral obstruction) together with their 95% confidence intervals. Individual study estimates were obtained with overall estimate and observation characteristics using empirical Bayes calculations. Differences between or among specific groups were assessed using the F-test. RESULTS: The database included 5,527 patients and 8,101 renal units. Following 1 treatment the reflux resolution rate (by ureter) for grades I and II reflux was 78.5%, grade III 72%, grade IV 63% and grade V 51%. If the first injection was unsuccessful, the second treatment had a success rate of 68%, and the third treatment 34%. The aggregate success rate with 1 or more injections was 85%. The success rate was significantly lower for duplicated (50%) vs single systems (73%), and neuropathic (62%) vs normal bladders (74%). The success rate was similar among children and adults. Following a previous failed open reimplantation endoscopic treatment was successful in 65% of patients. After endoscopic treatment with variable followup pyelonephritis developed in 0.75% of patients and cystitis in 6%. There were few reports of renal scarring following treatment. CONCLUSIONS: Endoscopic treatment provides a high rate of success in children with reflux that decreases with increasing grade, although multiple treatments may be necessary. Future reports of endoscopic therapy should include rates of urinary tract infection and renal scarring.

Child↗
PubMed2000

Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma.

PURPOSE: To describe rectal mucosal damage in an endoscopic study after conformal radiotherapy of prostate cancer and to correlate this with clinical outcome. MATERIALS AND METHODS: Flexible rectosigmoidoscopy was performed on 44 patients who voluntarily accepted the examination. The median follow-up was 29 months (20-41 months) after 3-D-planned conformal radiotherapy of prostate cancer (66 Gy at the ICRU Reference point, 2 Gy per fraction). To enable a systematic topographic description of endoscopic findings the rectum was divided into four sections. Additionally we differentiated between anterior, posterior, right and left lateral rectal wall. Due to the lack of an existing valid graduation system for radiation induced proctitis, we introduced a six-scaled rectoscopy score for describing and reporting endoscopic findings based on the standardization of the endoscopic terminology published by the ESGE (European Society for Gastrointestinal Endoscopy). Endoscopic findings were compared to the EORTC/RTOG morbidity score. In addition, since 3-D dose distribution of organs at risks was available, a correlation could be made between the location of the rectal lesions and the absorbed dose at that level. RESULTS: In general, endoscopic findings increased from the proximal rectum to the anorectal transition, as well as from the posterior to the anterior rectum wall. Telangiectasia grade 1 and 2 were observed at the whole circumference, only telangiectasia grade 3 were limited to the high dose region at the anterior rectum wall. Similar results were found for congested mucosa (reddening and edematous mucosa). Correlation with symptoms, 7/9 patients who suffered from intermittent rectal bleeding (EORTC/RTOG grade 2) had multiple telangiectasia grade 2-3 and/or congested mucosa grade 3 and microulcerations. However, the same extent of mucosal damage (rectoscopy score 2-3) was found in seven out of 35 patients who have never developed a period of macroscopic rectal bleeding. CONCLUSION: Rectoscopy offers the possibility of detecting signs of tissue dysfunction below the level of subjective symptoms. Systematic analytic examinations such as rectoscopy, in addition to clinical examinations, as already foreseen in the LENT-SOMA-score, will be necessary due to the fact that even telangiectatic lesions have been observed for asymptomatic patients. For the opportunity of sharing and comparing data collected from endoscopy after radiotherapy a graduation system as proposed based on a standardisation of the endoscopic terminology will be necessary.

Aged↗
PubMed2000

Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: comparison of sclerotherapy and ligation.

BACKGROUND/AIMS: Endoscopic variceal ligation is superior to sclerotherapy because of its lower rebleeding and complication rates. However, ligation is not without drawbacks due to a higher tendency to variceal recurrence. We conducted a randomized cohort study to delineate the long-term history of variceal recurrence following ligation and sclerotherapy, and to clarify the impact of recurrence on rebleeding and on the consumption of endoscopic treatment resources. METHODS: Two hundred cirrhotic patients with esophageal variceal bleeding were randomized to undergo maintenance endoscopic variceal sclerotherapy or ligation. RESULTS: One hundred and forty-one patients achieved variceal eradication and were regularly followed up for 2.2 to 6.7 (mean: 5.1 +/- 1.2) years. The demographic data, hepatic reserve, bleeding severity, and endoscopic features of both sclerotherapy (n=70) and ligation (n=71) showed no difference. Forty (57.1%) patients who underwent sclerotherapy experienced 58 recurrences of esophageal varices, in contrast to the 46 (64.8%) patients who underwent ligation and experienced 81 episodes of recurrence. Kaplan-Meier analysis showed that within 2 years variceal recurrence was more frequent for ligation than sclerotherapy, and the difference decreased thereafter. Multiple recurrence appeared more common with ligation (1/2/3/4/5 episodes of recurrence: 46/23/8/3/1 vs. 40/14/3/1/0, p=0.08). On multifactorial analysis, the endoscopic treatment method and red wale markings were the two factors determining variceal recurrence. Rebleeding from recurrent esophageal varices was unusual and showed no difference between the two groups (7/58 vs. 6/81, p>0.05). Rebleeding from gastric varices was more common after eradication by sclerotherapy (7/19 vs. 1/16, p=0.085) than by ligation. The number of sessions required for eradication of recurrent varices was no different between the two groups. CONCLUSIONS: Early recurrence and multiple recurrence of esophageal varices are more likely in patients undergoing endoscopic ligation, compared to sclerotherapy; however, the recurrence did not lead to a higher risk of rebleeding or require more endoscopic treatment.

Aged↗
PubMed2002

Endoscopic examination of the cerebellar pontine angle.

This anatomic study describes how to optimize the use of the endoscope in the cerebellar pontine angle (CPA) through a retrosigmoid approach. Unlike the microscope, that only permits visualization of structures directly ahead, the endoscope can see 'around the corner', also showing the structures down narrow. Nevertheless, to use the endoscope it is necessary to insert it into the CPA that is full of neurovascular structures which limit its movements. Thus, to avoid damages it is important to inspect this region accurately, by means of preferential trajectories to insert the endoscope. A retrosigmoid approach was performed in cadaver heads, and the CPA region was inspected employing 0 degrees, 45 degrees rigid endoscopes (4 mm in diameter). The neurovascular structures of the CPA have been visualized using three trajectories. The limits of view offered by each trajectory as well as the neurovascular structures together with the obstacles encountered on each route have been described. The systematic adoption of three different endoscope trajectories at the CPA level permits to view from different angulation the same structure as well as its relationships with the surrounding nerves and vessels. Considerable experience on cadavers should have already been obtained with the endoscope prior to any application in the operating room.

Anthropometry↗