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At least 1,153 records · Page 64Linked to original sources
PubMed2005

Technology insight: ablative techniques for Barrett's esophagus--current and emerging trends.

New mucosal ablative techniques that can be used in the esophagus have emerged over the past two decades. These techniques have been developed primarily to treat the precursors of esophageal adenocarcinoma: dysplasia in Barrett's esophagus and early esophageal cancer. Although high-grade dysplasia and early stage cancer can be treated with esophagectomy, the inherent morbidity and mortality of esophageal adenocarcinoma and the morbidities, difficulties, costs and limitations of the current technology mean that there has been a significant increase in interest and research regarding alternative treatments such as ablative techniques. At this stage it is not clear which of the numerous endoscopic ablative techniques available-photodynamic therapy, laser therapy, multipolar electrocoagulation, argon plasma coagulation, endoscopic mucosal resection, radiofrequency ablation or cryotherapy-will emerge as superior. In addition, it has yet to be determined whether the risks associated with ablation therapy are less than the risk of Barrett's esophagus progressing to cancer. Whether ablation therapy eliminates or significantly reduces the risk of cancer, eliminates the need for surveillance endoscopy, or is cost-effective, also remains to be seen. Comparative trials that are now underway should help to answer these questions.

Adenocarcinoma↗
PubMed2002

Mucosal ablation in Barrett's esophagus.

Barrett's esophagus is a prevalent, premalignant condition affecting the gastroesophageal junction and distal esophagus. Ablation plus antireflux therapy has recently been advocated to prevent the development of adenocarcinoma or to treat those unfit or unwilling to undergo esophagectomy. The present article, based on a search of Medline/ISI databases and cross-referencing of relevant articles, reviews the literature on this subject. A number of techniques have been used to remove the affected mucosa, including laser, electrocoagulation, argon plasma coagulation and photodynamic therapy but, as yet, none has been shown to be superior. Depending on the method used, ablation results in complete removal of Barrett's esophagus in approximately one third of patients and a partial response in nearly two-thirds. The resultant squamous mucosa is apparently 'normal' but may regress. To promote and maintain regeneration, antireflux therapy must be sufficient to reduce repetitive injury to the esophageal mucosa. Whether ablation reduces the cancer risk or delays its occurrence is unknown, though recent data suggests benefit. Complications are infrequent and usually mild. Regular follow-up endoscopy and deep biopsies continue to be necessary. Careful data from much larger populations with long-term follow-up is required before ablation reaches the stage of broad clinical application.

Animals↗
PubMed1998

A new operative method to treat high teat stenoses in dairy cows.

OBJECTIVE: To evaluate in a pilot study an alternative technique using theloscopic surgery in the management of proximal teat stenoses of dairy cows. MATERIALS AND METHODS: The study included three lactating dairy cows (mean age 3.5 years) with a stenotic fibrous lesion in the proximal region of a teat. The lesions were suspected to be of traumatic origin and the diagnoses were confirmed by ultrasonography. For surgery, the cows were sedated and the base of the teat anaesthetized. The resectoscope was introduced through an incision in the teat cistern. The surgical area was continuously irrigated with saline solution and the stenotic lesions electroresected. Haemorrhage was controlled whenever possible by electrocoagulation. RESULTS: In two cows, the procedure was successful and resulted in normal milk flow. One of the two cows was slaughtered soon after the operation for reasons unrelated to udder health. The other cow could be milked normally at a follow-up examination 4 months later and on ultrasonography, there was no recurrence of the stenotic lesions. In both cows, there was no evidence of concurrent intramammary infection. In the third cow, the procedure had to be discontinued because of severe intraoperative haemorrhage. CONCLUSIONS: Video-assisted theloscopic electroresection of fibrotic teats is a promising, novel and minimally invasive technique for the surgical correction of the glandular part of the cistern. It should be considered as an alternative to conventional surgical methods in valuable dairy cows.

Animals↗
PubMed2006

Gastric antral vascular ectasia (watermelon stomach) in patients with ESRD.

In 1989, Navab et al suggested that watermelon stomach often is observed in patients with chronic renal insufficiency. On the basis of this and some later reports, an etiopathogenetic association between the 2 disorders was postulated. However, the number of relevant publications is still very limited. We describe 2 patients with end-stage renal disease (ESRD; 1 patient, hemodialysis therapy; 1 patient, peritoneal dialysis therapy) and watermelon stomach who presented with upper gastrointestinal bleeding and severe transfusion-dependent iron-deficiency anemia. In 1 patient, apart from the characteristic endoscopic findings of watermelon stomach affecting the antrum, there were vascular ectatic lesions in the proximal stomach. Both patients were treated successfully by using endoscopic bipolar electrocoagulation (Gold probe [GP]; Microvasive Boston Scientific, Natick, MA), which led to significant endoscopic and hematologic improvement. However, upper-gastrointestinal bleeding recurred in the second patient (peritoneal dialysis) because she did not consent to undergo endoscopic treatment on a regular basis. Watermelon stomach in patients with ESRD is a serious condition that can cause either acute or chronic upper-gastrointestinal bleeding. It should be considered in patients with upper-gastrointestinal bleeding and those with iron-deficiency anemia, which frequently presents as recombinant human erythropoietin resistance in patients with ESRD. Diagnosis is based on the distinctive endoscopic appearance of the antrum, but the proximal stomach also may be involved. Application of GP ablation seems to be a safe and effective treatment for watermelon stomach.

Aged↗
PubMed2001

A modified electroshave technique for the treatment of rhinophyma.

Rhinophyma is commonly treated by shaving the involved florid tissue with a scalpel. A technique using a modified electrocoagulation handset, which was used on 11 patients, is described. This technique allows the operator to sculpt the shape of the nose in a relatively bloodless field. The results in 10 of the 11 patients were good to excellent and the rate of complications was both small and avoidable.

Adult↗
PubMed1979

Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry.

In April, 1978, we carried out a survey covering 27 hospitals, in which colonoscopy is performed on a routine basis. With respect to the size of the hospital, the equipment available and the level of training of the examiner, this selection may be regarded as representative. A total of 35,892 colonoscopies, 7,365 polypectomies, 58 electrocoagulations and 14 rugectomies were analysed with respect to the nature, localization and treatment of any complications that arose. The rate of complications seen in diagnostic colonoscopy was 0.008% for bleeding and 0.14% for perforation, the mortality rate being 0.02%. As expected, the complication rate for colonoscopic polypectomy was higher. Bleedings were reported in 2.24%, perforations in 0.34% and deaths in 0.1% of the examinations. Of particular importance would seem to be the possibilities of preventing complications. It was shown on the basis of the survey that a good, standardized training of the endoscopist, the strict observance of the contraindications, the non-use of analgesics and general anaesthesia, fluoroscopic control of "difficult" colons and the use of the best instruments and aids presently available, reduce the complication rate to a minimum.

Colon↗
PubMed2004

Endoscopic suprapapillary blunt dissection of the distal common bile duct in cases of difficult cannulation: a pilot series.

BACKGROUND AND STUDY AIMS: There is no consensus about the optimal alternative procedure in cases of failed cannulation of the common bile duct (CBD). The alternatives are usually considered to be high-risk procedures. This study describes endoscopic dissection of the distal biliary tract (EDBT) as a new technique in cases of difficult cannulation of the CBD. PATIENTS AND METHODS: Out of a total of 1057 patients in whom cannulation was attempted, deep cannulation failed in 49 patients, and 48 of those underwent EDBT. The procedure consists of cutting the mucosa, and the partial isolation of the distal part of the biliary tract using catheters, a needle-knife papillotome, and thin forceps. Access to the biliary tract was achieved with an endoscopic needle or forceps with or without electrocoagulation. RESULTS: EDBT was successful in all cases. In 46 patients EDBT was followed by standard sphincterotomy. Four patients developed clinical pancreatitis and hyperamylasemia occurred in 11 cases. Perforation, uncontrolled bleeding, and other complications did not occur in this series. CONCLUSIONS: EDBT is feasible, safe and constitutes a potential alternative for cannulation of the CBD. The endoscopic visualization of the wall structure and duodenal layers during the maneuvers at the papilla probably accounts for the absence of major complications.

Adult↗
PubMed2005

Endoscopic argon plasma trimming of biliary and gastrointestinal metallic stents.

BACKGROUND AND STUDY AIMS: The aim of this study was to assess the feasibility and efficiency of plasma argon trimming of gastrointestinal and biliary metallic stents. PATIENTS AND METHODS: A total of 31 patients underwent plasma argon trimming of their metallic stents (14 women, 17 men; mean +/- SD age 73 +/- 12.2 years, range 46 - 96 years). Of these 31 patients, 24 had had covered or noncovered Unistep Wallstents placed in the biliary tract (13 patients with pancreatic neoplasms, five patients with Vater ampulloma, five patients with biliary tract carcinoma and one patient with chronic calcifiying pancreatitis); three patients had noncovered Enteral Unistep Wallstents (pyloroduodenal); two patients with obstructive colorectal carcinoma had a noncovered Bard Memotherm stent inserted; and two patients had noncovered Ultraflex stents placed for esophageal carcinoma. Endoscopic trimming of the stents was performed under propofol-induced general anesthesia, with the power set at 70 - 80 watts and an argon flow of 0.8 liters/minute. RESULTS: Complete and satisfactory trimming of the stents was possible, without complications (mean follow-up 15.8 months), in all patients except one, a patient with a covered biliary Wallstent. In 13 patients with biliary or Enteral Wallstents the trimming procedure was preventive. In eight patients with ulceration and/or hemorrhage (duodenal or rectal), healing was achieved after stent trimming and epinephrine (adrenaline) injection followed by electrocoagulation. Stent trimming restored patency of the duodenal lumen in six patients and of the esophageal lumen in two patients, and was done to allow insertion of a biliary stent in one patient whose duodenal stent was covering the papilla. In one patient with rectal tenesmus, stent shortening resulted in complete resolution of symptoms. CONCLUSIONS: Endsocopic plasma argon trimming of metallic stents is an efficient procedure which allows easy, reproducible and well-tolerated correction of complications that arise due to these prostheses.

Aged↗
PubMed1996

An endoscopic follow-up study of the development of diffuse antral vascular ectasia.

No endoscopic follow-up studies are available on the development of diffuse antral vascular ectasia (DAVE). We present here a ten-year follow-up study from discrete initial lesions to the full picture of DAVE. In a 72-year-old female patient with liver cirrhosis, the earliest findings of DAVE were several red spots, with or without a white halo, in the distal antrum. During follow-up, the spots increased in number, coalesced, and extended to the proximal antrum. Three years after the initial findings, latent hemorrhage occurred at a time when confluent lesions were formed. One year later, diffuse distribution of the antral lesions was observed, which led to the diagnosis of DAVE and developed to the full picture within three more years. Two years later, the patient presented with hematemesis, which confirmed the diagnosis of DAVE clinically. Treatment consisted of monopolar electrocoagulation, leading to a stable hemoglobin value for one year. This case study provides some substantial clues to the early detection and treatment of DAVE.

Aged↗
PubMed1989

Endostomy: a new approach to small-bowel endoscopy.

A percutaneous access to the gastrointestinal hollow organs created by new endostomy tubes permits diagnostic and therapeutic endoscopy in particular of the small intestine. A case of a patient with chronic gastrointestinal bleeding of hitherto unknown origin, in whom enteroscopy and electrocoagulation of an angioma in the lower jejunum was performed, is presented.

Chronic Disease↗
PubMed1986

German pelviscopic statistics for the years 1978-1982.

The second set of statistics on pelviscopy in Germany included information on 269,603 pelviscopies done in 322 general hospitals, and 22,859 pelviscopies done in private clinics between 1978 and 1982. In general hospitals the rate of serious complications was 1.9% and in private clinics 2.0%. Injuries to large blood vessels headed the list of complications. The main technique for tubal sterilization was the bipolar high-frequency current method with 75% in general hospitals and 73.1% in private clinics, followed by the endocoagulation technique according to Semm (36.8%). Sterilization failures were reported in 2.6%. Most failures were reported after sterilization with the bipolar electrocoagulation technique, followed by the clip technique. The rate of post-sterilization ectopic pregnancies was 1.06%. The highest rate of ectopic pregnancies was reported after using the bipolar tubal sterilization method (1.4%).

Blood Vessels↗
PubMed1986

Hemostasis--therapeutic alternatives to the laser.

In clinical practice, there are a number of other endoscopic procedures for attaining hemostasis available as alternatives to laser hemostasis. Of these the following may be emphasized: Modified electrocoagulation procedures such as EHT coagulation, bipolar or multipolar coagulation, and sclerotherapy. The efficacy of these "laser-alternative" methods of hemostasis has already been demonstrated in clinical studies, and is unquestioned. Large comparative investigations that would provide definitive information on the relative effectiveness of the various techniques, have yet to be carried out. If, however, we consider such aspects as practicability and economy, the laser would appear to be a "dinosaur" among the endoscopic procedures presently available for hemostasis. The oldest recognized fiber-endoscopic instrument for hemostasis, it is anything but highly mobile, and is bound to a fixed location. In addition, it is as expensive as a museum exhibit. If the only indication for its use were hemostasis, it would probably have vanished from the scene.

Electrocoagulation↗
PubMed1992

[Spontaneous conception after laparoscopic coagulation of the ovarian surfaces in a patient with primary normogonadotropic hyperandrogenemic amenorrhea].

A patient with primary amenorrhoea was kept under hormonal replacement therapy and oral contraceptives since the age of sixteen. At the age of 30 she first consulted the endocrinologist because of infertility after one year of "post-pill-amenorrhoea". This first hormone check detected a severe hypertestosteronaemia (1.3 ng/ml). During four stimulation cycles using gonadotropins she showed a polyfollicular reaction and finally developed a hyperstimulation WHO II. During the following cycle she underwent hystero- and laparoscopy; laparoscopic electrocoagulation of the ovarian surface (LEOS) was carried out during this treatment. She subsequently conceived spontaneously twice.

Adult↗
PubMed1986

[Unusual skin burn during cesarean section].

The author reports on an unusual case of a skin burn at the inside of the thigh caused by contact between the electrocoagulating device and amnion. The technicalities involved are presented and the possibilities of preventing such accidents are discussed.

Burns↗
PubMed2001

Preferential repair by squamous epithelium of thermal induced injury to the proximal stomach in patients undergoing ablation of Barrett's esophagus.

BACKGROUND: The presence of extensions of squamous epithelium into the proximal stomach in patients undergoing routine upper endoscopy has recently been described. The factors that may favor development of squamous epithelium within the proximal stomach remain unknown. METHODS: Patients with Barrett's esophagus who agreed to undergo ablation of Barrett's epithelium by using multipolar electrocoagulation were included. Patients were treated with a high dose of a proton pump inhibitor. The columnar-appearing mucosa was systematically treated. Occasionally, thermal injury was inadvertently induced in the proximal stomach. On endoscopy performed 4 to 6 weeks after treatment, the presence of squamous epithelium extending into the proximal stomach was documented. The use of Lugol's stain assisted in confirming the squamous nature of the abnormal tissue, which was confirmed histologically by cytokeratin immunohistochemistry. RESULTS: The 12 patients included in the study had a mean length of Barrett's epithelium of 3.8 +/- 0.7 cm. Patients were treated with omeprazole, mean dose 66 +/- 6.0 mg, and had a mean percent total time that the pH was less than 4 of 1.9 +/- 0.8. The mean length and width of gastric squamous extensions were 1.7 +/- 0.2 cm and 0.8 +/- 0.1 cm, respectively. None of the squamous extensions into the stomach were documented before mucosal ablation. The extensions stained positively for cytokeratin 13 and negatively for cytokeratin 8, thereby confirming their squamous nature. CONCLUSIONS: Thermal injury to the proximal stomach in patients undergoing ablation of Barrett's epithelium and profound acid suppression results in repair by squamous epithelium. Recognition of this lesion is essential because it may lead to confusion as to the location of the esophagogastric junction in subsequent endoscopic evaluations.

Adult↗
PubMed2002

Argon beam coagulation for post-tonsillectomy hemostasis.

OBJECTIVE: The study goal was to evaluate the effectiveness of argon beam coagulation (ABC) in the prevention of post-tonsillectomy hemorrhage. ABC provides monopolar coagulation by arcing ionized argon gas to the target tissue; it is not a laser. METHODS: Two consecutive studies were performed as follows. In the first, a retrospective analysis of post-tonsillectomy bleeding in 344 patients was conducted. Final tonsil fossa hemostasis was achieved with ABC (257 patients) or with electrocoagulation (EC) (87 patients). In the second, a prospective, randomized, patient-blind study of post-tonsillectomy bleeding was conducted in 88 patients. Final hemostasis was achieved using ABC in one fossa and EC in the other fossa, with the sides chosen at random. RESULTS: Post-tonsillectomy hemorrhage was defined as the expectoration of fresh blood, as opposed to blood-streaked saliva. The rates of bleeding for the 2 studies were as follows. In study 1 for EC, 20% for adults, 6.5% for children, and 10.3% for total; for ABC, 4.7% for adults, 0.6% for children, and 1.9% for total. In study 2 for EC, 19.2% for adults, 1.6% for children, and 6.8% for total; for ABC, 7.7% for adults, 0.0% for children, and 1.1% for total. The rates of hospital admission for observation or reoperation to treat the bleeding in study 1 for EC were 8% for adults, 6.5% for children, and 6.9% for total; for ABC, 1.2% for adults, 0.6% for children, and 0.7% for total. Corresponding rates for study 2 for EC were 15.4% for adults, 1.6% for children, and 5.7% for total; for ABC, 3.8% for adults, 0.0% for children, and 1.1% for total. CONCLUSION: ABC is more effective than EC for hemostasis after tonsillectomy. The costs of ABC use vs the savings achieved from reduced bleeding are discussed.

Adolescent↗
PubMed2001

Comparison of monopolar and bipolar electrosurgical modes for restorative dentistry: a review of the literature.

This review of the literature was undertaken as part of a wider investigation of effective hemostasis in vital pulp therapy. Two general types of electrosurgical units are available: monopolar and bipolar. This review compares the features of both systems. An important hazard referred to as channeling, funneling, or current crowding is described and associated with pulp therapy injury for the first time. Important safety features of bipolar electrocoagulation are identified and applied to dental procedures. Articles were selected by means of a search of MEDLINE, the U.S. National Library of Medicine's bibliographic database, for literature published between 1966 and 2001 on the topics of electrosurgery, electrocautery, electrolysis, and lasers. A search also was completed from a pulp therapy perspective to determine the use of electrosurgery on the pulp. Numerous articles and texts published between 1900 and 1965 had been reviewed previously; their bibliographies were explored and cross-referenced for pertinent reports. Laparoscopic applications of electrosurgery were reviewed for general background information and for clarification of safety and hazard issues; no exclusionary criteria or date limitations were imposed. Beyond the literature review, numerous authors and developers in the field of electrosurgery were contacted for clarification of concepts and controversies. More than 120 articles and texts related to electrosurgery were reviewed, and another 100+ articles were reviewed in the area of pulp therapy.

Dental Pulp↗
PubMed2005

Preoperative luteinizing hormone levels predict the ovulatory response to laparoscopic ovarian drilling in patients with clomiphene citrate-resistant polycystic ovary syndrome.

OBJECTIVE: Laparoscopic ovarian drilling (LOD) is a treatment option for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS), but appropriate indications for this procedure are lacking. The aim of this study was to analyze preoperative factors affecting the efficacy of LOD in producing ovulation in CC-resistant PCOS patients. DESIGN: Retrospective cohort study. PATIENTS AND METHODS: We studied 40 infertile Japanese women with CC-resistant PCOS who received LOD using argon-beam electrocoagulation. These patients satisfied the diagnostic criteria of the revised European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine PCOS consensus. RESULTS: After LOD, ovulation occurred in 33 (83%) patients; pregnancy occurred in 22 patients (55%). Preoperative serum luteinizing hormone (LH) levels were significantly higher in women who ovulated after LOD than in those who did not ovulate. The area under the receiver operator characteristic curve for ovulation using preoperative LH levels was 0.81 (95% confidence interval: 0.67-0.96). After LOD, follicle-stimulating hormone levels increased significantly in the non-ovulating group but were unchanged in the ovulating group. CONCLUSIONS: Preoperative serum LH levels may be a good predictor of LOD efficacy in patients with PCOS. Therefore, eligibility criteria for LOD should be strictly applied, since LOD for patients with inadequate LH levels is not only ineffective, but also may impair ovarian reserve.

Adult↗