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At least 1,225 records · Page 68Linked to original sources
PubMed1997

Are complications of endoscopic sphincterotomy age related?

BACKGROUND: Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endoscopic sphincterotomy in this age group, relative to that in older patients, is unknown. AIM: To determine whether the development of short term complications following endoscopic sphincterotomy is age related. PATIENTS AND METHODS: A prospective multicentre audit of 958 patients (mean age 73, range 14-97, years) undergoing a total of 1000 endoscopic sphincterotomies. RESULTS: Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41-1.67, p = 0.74). CONCLUSION: Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct.

Adolescent↗
PubMed2001

Papillary stenosis in King Chulalongkorn Memorial Hospital: endoscopic findings, treatments and result.

Papillary stenosis usually presents with biliary type abdominal pain, significantly elevated liver enzymes, and cholangiogram revealing dilated common bile duct without stone. In the Western world, endoscopic biliary sphincterotomy is accepted as a standard treatment for papillary stenosis. In Asia, there are only a few reports regarding papillary stenosis. This is a report of our experience on endoscopic biliary sphincterotomy for papillary stenosis in Thai patients. From our ERCP database, twenty-five patients presented with biliary type abdominal pain, elevated liver enzymes and dilated common bile duct by ultrasonography. All of them underwent ERCP for a diagnosis of possible biliary obstruction. Of these 25 cases, seven patients with papillary stenosis were identified. All underwent endoscopic biliary sphincterotomy with or without biliary dilation and stent placement. These patients were followed for clinical improvement and normalization of liver enzymes. Endoscopic biliary sphincterotomy was successful in all patients. One patient required additional biliary dilation and stent placement. All seven patients reported significant improvement of biliary type abdominal pain. Liver enzymes also normalized 3 months after endoscopic treatment. There were no severe complications except one patient who developed post ERCP pancreatitis while another developed minimal bleeding at the sphincterotomy site. Endoscopic biliary sphincterotomy is effective and safe in patients with papillary stenosis. Results of our series are comparable to previous reports from Western countries.

Adult↗
PubMedDate not supplied

Endoscopic sphincterotomy in 100 patients scheduled for laparoscopic cholecystectomy: ultrasound evaluation.

BACKGROUND/AIMS: The aim of the study was to determine to what extent ultrasonography may monitor the process of sphincterotomy and its effectiveness. The study also aimed at determining the sensitivity and specificity of ultrasonography in detecting choledocholithiasis, in comparison with the results of endoscopic retrograde cholangiopancreatography. METHODOLOGY: Between January 1995 and June 2001, endoscopic sphincterotomy was performed on 100 patients with suspected synchronous choledocholithiasis in preparation for laparoscopic cholecystectomy. The main parameters evaluated in the ultrasonography image included the breadth of the common bile duct and absence or presence of concrements in bile ducts before and after sphincterotomy. RESULTS: Applied before the endoscopic operation, ultrasonography revealed choledocholithiasis in 58 patients and dilatation of the common bile duct in 95 patients. Endoscopic retrograde cholangiopancreatography confirmed choledocholithiasis in 74 patients, after sphincterotomy concrements were removed in 63 persons. In 26 patients sphincterotomy was performed for stenosis of Vater's papilla. Patients with the breadth of the duct > 10 mm, were referred to a check-up examination. CONCLUSIONS: Compared with endoscopic retrograde cholangiopancreatography, ultrasonography correctly specifies the breadth of the bile duct and properly monitors the process of endoscopic sphincterotomy, but is less accurate in determining the occurrence of choledocholithiasis, and sensitivity in the test amounted to 73%, and specificity of the examination--84.5%.

Adolescent↗
PubMed2003

Endoscopic diagnosis and treatment of post-cholecystectomy syndrome.

OBJECTIVE: To assess the value of endoscopy in the etiological diagnosis and treatment of post- cholecystectomy syndrome (PCS). METHODS: 386 patients with PCS were given endoscopic retrograde cholangiopancreatography (ERCP). Having been made the etiology clear, patients with choledocholithiasis were subjected to endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation (EPBD) to extract stones, those with papillary inflammatory stricture to EST or EPBD, those with papillary diverticulum and sphincter of Oddi dysfunction (SOD) to EPBD, those with papillary tumor and hepatobiliary tumor to endoscopic metal biliary endoprosthese (EMBE), and those with biliary stricture in the mid bile duct, purulent cholangitis, choledocholithiasis (stones not extracted one time) and bile leakage to endoscopic nose-biliary drainage (ENBD). RESULTS: ERCP was performed successfully in 371 patients (96.1%). No abnormalities were found endoscopically in 30 patients. In 243 patients with choledocholithiasis, 235 had stones removed after one to three times. Thirty-nine patients with papillary inflammatory stricture were successfully treated with EST or EPBD. Nine patients with papillary diverticulum which oppressed the papillary opening and 7 patients with SOD were also successfully treated with EPBD. In 16 patients with stricture in the mid bile duct, 11 showed improvement after ENBD. Six patients with papillary tumor and 5 patients with hepatobiliary stricture after EMBE showed significant alleviation of jaundice. Six patients with bile leakage caused by cholecystectomy received ENBD successfully, avoiding re-operation. Six patients developed gastroduodenal ulcer and 4 residual stones in the cholecystic duct. Complications occurred in 21 patients (5.7%). CONCLUSIONS: ERCP may detect the etiology of post-cholecystectomy syndrome at early stage, and therapeutic measures can be taken accordingly in clinical practice.

Adult↗
PubMedDate not supplied

[External biliary fistulas selectively managed by endoscopic retrograde cholangiography with sphincterotomy and/or stent placement].

External bile duct fistulas are inherent postoperative complications that usually appear after biliary tract surgery, traumatic bile duct injuries and liver surgery for hepatic hydatid disease or liver transplant. The management is highly individualized, while the success and long-term results of endoscopic and surgical techniques are conflicting. The study included 32 cases with external bile duct fistulas managed by endoscopic retrograde cholangiography (ERC) with sphincterotomy and/or stent placement, including "rendez-vous" procedures in 2 cases. The causes of the external fistula were represented by cholecystectomy with/without retained common bile duct stones or strictures (22 cases), cholecystectomy and drainage of a subphrenic abscess caused by severe acute pancreatitis (1 case) and surgical interventions for hepatic hydatid disease (9 cases). Due to the prospective protocol of the study we were able to apply an individualized endoscopic treatment: sphincterotomy with proper relief of the bile duct obstruction (stone extraction) or sphincterotomy with large-size (10 Fr) stent placement for large-sized bile duct defects. The results consisted in closure of the fistula in 3.5 +/- 1.7 days for the subgroup of patients with sphincterotomy alone. Among the patients with stent insertion, fistulas healed slower in 14 +/- 3.5 days. There were no complications after endoscopic treatment; however the stent could not be passed in one patient that required subsequent surgery. In conclusion, endoscopic intervention is the treatment of choice for small external biliary fistulas complicating biliary tract surgery or liver surgery for hepatic hydatid disease. When the fistula is large, the placement of a 10 Fr endoprosthesis becomes necessary, while failure of endoscopic treatment leads to surgery with hepatico-jejunal anastomosis.

Biliary Fistula↗
PubMed1991

[Surgical complications following endoscopic diagnostic and therapeutic manipulations of the papilla Vateri].

The indications for retrograde cholangiopancreatography and for endoscopic papillotomy from the surgeon's view point are discussed. Endoscopic papillotomy is an operation of insufficient volume in chronic pancreatitis with obstacles along the Wirsungian's duct and in bile duct calculosis in younger age. These cases require surgical intervention or its association with endoscopic manipulations. Summarized data are reported on the risk after diagnostic or therapeutic procedures: complications may develop in 1 to 3.6 per cent after retrograde cholangiopancreatography and in 4 to 10 per cent after endoscopic papillotomy. Mortality rates are accordingly 0-0.015 per cent after the diagnostic and 0-5.8 per cent after the therapeutic procedure. Eight personal observations are described, 5 of them after endoscopic papillotomy. Six operated patients died. It is emphasized that, regardless of the existing risk, endoscopic manipulations should be performed with strict observance of the indications.

Adult↗
PubMedDate not supplied

Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is the standard treatment for symptomatic cholecystolithiasis; however, there is debate on the management of patients with concomitant common bile duct stones. Several options have been suggested; endoscopic sphincterotomy and laparoscopic common bile duct exploration seemed to be the preferred methods at this moment. MATERIALS AND METHODS: We performed endoscopic sphincterotomy prior to laparoscopic cholecystectomy in 51 cases of acute symptomatic cholelithiasis. RESULTS: Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy procedure-related complication rate was 5.4%, including 1 pancreatitis, 1 cholangitis, and 2 major bleeds. After follow up period of 15-42 months, recurrent stones were found in 2 patients. CONCLUSION: Endoscopic sphincterotomy combined with laparoscopic cholecystectomy is a safe and effective therapy for symptomatic cholecystolithiasis with concomitant choledocholithiasis. Recurrent stones did occur, but further studies are needed to compare the incidence of recurrent stones after endoscopic sphincterotomy and after laparoscopic common bile duct exploration.

Acute Disease↗
PubMed1998

[Endoscopic interventions of the biliary tract in postoperative complications after cholecystectomy for preventing relaparotomy].

The postoperative complication rate of laparoscopic cholecystectomy (LC) is about 5-6%. The most frequent complications are residual gallstones in the common bile duct, biliary leckage, biliary fistula and duct stenosis. In the period between 01.11.94 and 01.04.96 we performed 1620 endoscopic retrograde cholangio pancreatographies including 410 papillotomies at the second Department of Medicine in the Clinic of Suhl. Thereby in 2.1% (34 cases) of patients a complication after laparosopic cholecystectomy was seen and endoscopically controlled. Residual bile duct stones were removed without any problems by papillotomy and stone extraction. Biliary leckage were brigded by stent implantation. In case of aberrant cystic duct it was also possible to implant a stent depending on anatomical situation. All patients were followed up over a period of 6 to 8 month after endoscopic procedure. All except two patients showed an occlusion of biliary leckage and the bile duct stent could be revved. In one case, a younger patient, with a failed endoscopic occlusion of biliary fistula had to undergo a further operation because of residual gallbladder tissue. In the other case, a 84-years old patient, we use a new method, developed at our department, for selective embolization of the cystic duct to prevent a relaparotomy. The leckage was sufficiently closed. Endoscopic intervention is indicated in case of postoperative complication after LC and successful in the majority of cases. This should primarily discussed between surgeon and physician. Only secondarily a relaparotomy should be performed, if endoscopic procedures have failed.

Adult↗
PubMed1996

Long-term results of endoscopic stenting and surgical drainage for biliary stricture due to chronic pancreatitis.

A retrospective evaluation was made of the long-term results of endoscopic stenting in 58 patients with benign biliary stricture due to chronic pancreatitis. Immediate relief of jaundice and cholestasis was achieved in all patients after endoscopic stent insertion. Median follow-up was 49 months. Five (9 per cent) of the 58 patients had complications following therapeutic endoscopic retrograde cholangiopancreatography. Late stent-related complications occurred in 37 (64 per cent) of 58 patients. There were no deaths. Sixteen (28 per cent) of the 58 patients had regression of the biliary stricture and permanent removal of the stent. Forty-two patients had persistent biliary stricture: 26 had continued stenting and 16 underwent surgical procedures. Early morbidity after surgery was found in six of 16 patients, with no deaths. Postoperative relief of jaundice was achieved in 15 of the 16 patients. In conclusion, endoscopic stenting and surgery are both effective treatments for biliary stricture in patients with chronic pancreatitis. Endoscopic stenting is associated with fewer early complications. However, late stent-related complications remain a major limitation. Endoscopic stenting offers definitive treatment in more than one-quarter of patients (28 per cent).

Adult↗
PubMed2003

An inductively-coupled, detachable receiver coil system for use with magnetic resonance compatible endoscopes.

PURPOSE: To construct an inductively-coupled receiver coil system for use with a magnetic resonance (MR) compatible endoscope, and to evaluate its use in a pilot group of patients with esophageal cancer. MATERIALS AND METHODS: An inductively-coupled coil system, comprising a saddle geometry cylindrical receiver coil fitted as a sleeve around the endoscope tip and a pick-up coil housed within a channel of an MR-compatible endoscope, was designed and developed for use at 0.5 T. Twenty-three patients with esophageal cancer were recruited for MR endoscopy. In 17 cases, the endoscopic coil system was used in conjunction with an external surface coil in order to obtain information from the surrounding mediastinum. The examination took 40-50 minutes. RESULTS: MR imaging using the inductively-coupled endoscopic coil was successful in 21 cases (one failed intubation and one artifact from unrelated external source). Image artifact was largely due to respiration and global patient motion in sedated individuals undergoing endoscopy. CONCLUSION: Inductively-coupled coil systems may be used with endoscopes to allow improved safety through increased patient-system isolation and detachability of coils and electronics for repair or replacement with coils tuned for different frequencies.

Adult↗
PubMed1992

Fenestration of intraventricular cysts using a flexible, steerable endoscope.

Multiloculated hydrocephalus with multiple intraventricular septae due to meningitis associated with ventriculitis and other CSF containing intraventricular cysts can be treated by endoscopic fenestration. Seven patients with various CSF containing intraventricular cysts were treated using a flexible steerable endoscope and the argon laser. The experience using several currently available steerable endoscopes for treatment of this neurosurgical problem is reviewed. Emphasis is placed on the use of the laser for cyst fenestration. Successful decompression of the ventricular cyst(s) was accomplished in five cases with the endoscope alone. Craniotomy was required in two patients in order to complete cyst fenestration. It is the author's impression that laser assisted ventriculoscopy with steerable flexible endoscopes is an alternative and oftentimes superior method of treating CSF containing cysts within the lateral ventricles of hydrocephalic patients. Steerable flexible endoscopes designed specifically for neurosurgical use are needed.

Adolescent↗
PubMed1996

Endoscopic surgery of the rhinobasis with a computer-assisted localizer.

The endoscope is useful for the diagnosis and surgical therapy of diseases of the nose, the paranasal sinuses and its neighboring regions, and allows for microinvasive, functional approaches. The reduced invasiveness of therapeutic procedures is sometimes accompanied by insufficient clearness of the surgical field, however. This significant problem is solved by the computer-assisted-surgery (CAS) system, an intraoperative localizer. It allows continuous orientation based on three-dimensional reconstructed preoperative CT scans with superimposed positioning of the endoscope. We have now adapted CAS for endoscopic sinus surgery, which meant that a variety of visualization methods were tested. A conventional straightforward endoscope was used in combination with, or as, the localizing probe. A dual-display technique was adjusted to video-endoscopic procedures: the information of the localizer is displayed on one monitor while the video-endoscopic picture is viewed on a second screen. In addition, a single-display technique with both images on one monitor was developed. It proved to be the most promising way of combining endoscopy and intraoperative CT-image-guided localization.

Endoscopes↗
PubMed1996

Endoscopic diagnosis and management of biliary complications following orthotopic liver transplantation.

Nonoperative management of biliary complications (BC) with endoscopic retrograde cholangiopancreatography (ERCP) is a natural sequel to the emergence of choledochocholedochostomy as the preferred biliary reconstruction for orthotopic liver transplantation (OLT). Overall, therapeutic ERCP's efficacy for posttransplant BC is difficult to assess because most published data are retrospective, anecdotal, or in abstract form, and there are no prospective, randomized studies. Thus, endoscopic management of posttransplant BC must be individualized. While T-tube-related late bile leaks and ductal calculi are amenable to endoscopic therapy, its efficacy for strictures is more difficult to define. Refined surgical technique has prevented many unifocal anastomotic lesions, while multifocal strictures (for which endoscopic therapeutic experience is minimal) are increasingly prevalent. Whether endoscopic sphincterotomy is appropriate for posttransplant sphincter of Oddi dysfunction is controversial, because the disorder may be transient and the risk significant. Multicenter, prospective studies are needed to determine more accurately the optimal role of endoscopic therapy after OLT.

Biliary Tract Diseases↗
PubMed2004

The universal serial bus endoscope: design and initial clinical experience.

Endoscopic forehead lift is a well-established procedure in aesthetic plastic surgery. Many agree that currently available video-endoscopic equipment is bulky, multipieced and sometimes cumbersome in the operating theater. A novel system, the Universal Serial Bus Endoscope (USBE) was designed to simplify and reduce the number of necessary equipment pieces in the endoscopic setup. The USBE is attached by a single cable to a Universal Serial Bus (USB) port of a laptop computer. A built-in miniaturized cold light source provides illumination. A built-in digital camera chip enables procedure recording. The real-time images and movies obtained with USBE are displayed on the computer's screen and recorded on the laptop's hard disk drive. In this study, 25 patients underwent endoscopic browlift using the USBE system to test its clinical usefulness, all with good results and without complications or need for revision. The USBE was found to be reliable and easier to use than current video-endoscope equipment. The operative time needed to complete the procedure by the authors was reduced approximately 50%. The design and main technical characteristics of the USBE are presented.

Adult↗
PubMed2004

Endoscopic management of early postoperative biliary ascariasis in patients with biliary tract surgery.

Bile leak and residual stones are well known complications of biliary tract surgery. In endemic areas of ascariasis, invasion of the biliary tract by roundworms during the early postoperative period is an infrequent but serious complication. The present study describes the endoscopic management of postoperative biliary ascariasis in 19 consecutive patients. There were 5 men and 14 women with a mean age of 33.3 +/- 6.3 years. All patients had undergone cholecystectomy, with choledocholithotomy and placement of a T-tube in 13 (68.4%) patients. Eight (42.1%) patients including two with T-tubes were acutely sick at referral. Altogether, 16 (84.2%) patients had widened papillae due to previous endoscopic sphincterotomy (3 patients) or recent dilatation of the sphincter of Oddi by Bake's dilators (13 patients). All patients with a T-tube in situ had undergone unsuccessful attempts to remove the worms by flushing saline through the T-tube. Endoscopic retrograde cholangiopancreatography was performed 4 to 16 days after biliary tract surgery and revealed roundworms in the common bile duct in 10 patients, in the hepatic ducts in 2, or in both ducts in 7. Three patients had coexisting biliary leakage: from the cystic duct stump in two and from a T-tube track in one. Endoscopic treatment consisted of extracting the worms from the biliary tree and placing stents in those with coexisting leakage. Endoscopic success was defined as complete worm extraction and resolution of biliary leakage and was achieved in all patients. Complications occurred in one (5.3%) patient. We concluded that endoscopic management is an effective, safe approach for extracting ascarids from the biliary tree during the early postoperative period. It reduces the hospital stay, avoids T-tube-related complications, and permits a postoperative complication to be treated using a nonsurgical method.

Adult↗
PubMed2002

Endoscopic versus operative treatment in high-risk ulcer bleeding patients - results of a randomised study.

BACKGROUND AND AIMS: The treatment of peptic ulcer bleeding is still a matter of controversy in high-risk patients with arterial bleeding or a visible vessel. Patients with recurrent bleeding during hospital stay carry an increased risk of death. Therapeutic concepts using early elective operation compete with solitary endoscopic treatment. Numerous prospective studies have contrasted comparable improvements for the different therapeutic regimens but there is still a lack of a randomised comparison. PATIENTS AND METHODS: We initiated a multicentre randomised clinical trial comparing endoscopic fibrin glue injection with early elective operation in peptic ulcer patients with arterial bleeding or a visible vessel > or =2 mm. After initial endoscopic control of bleeding, patients were randomised to repeated fibrin glue injection or early elective operation. Outcome criteria were recurrent bleeding and death. The study was terminated after a planned interim analysis. RESULTS: Due to strict inclusion and exclusion criteria 61 patients were randomised and 55 patients could be included in the per-protocol analysis, 23 in the early elective operation group and 32 in the patient group with endoscopic therapy. The type of surgery in the early elective operation group was usually gastric resection (79%). Recurrent bleeding occurred in 50% of the endoscopically treated patient group, and in the operative group in one patient (relative risk: 11.5; 95% CI: 1.6 to 80.7). There were no statistically significant differences between the two treatment groups with respect to mortality (relative risk: 0.7, 95% CI: 0.1 to 4.8). CONCLUSION: Early elective surgery is an effective procedure in bleeding peptic ulcer patients at high risk for re-bleeding. Fibrin glue injection carries a risk for re-bleeding, however, the majority of these re-bleeding episodes can be controlled by re-endoscopic treatment, but a subgroup will need an emergency operation with a fatal outcome in individual patients.

Adult↗
PubMed2002

Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty.

BACKGROUND: Peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty (TEP) results in pneumoperitoneum and loss of extraperitoneal space. To avoid bowel adhesions, internal herniation, and mesh migration, closure of the peritoneal opening is preferred. The present study was conducted to evaluate the efficacy of various operative techniques for the closure of peritoneal laceration. METHODS: Between April 2000 and May 2001, 100 consecutive patients undergoing 123 TEPs were recruited for the present study. The incidence of peritoneal tear and techniques for the closure of peritoneal opening were documented. Operative time and postoperative morbidity were compared among groups for which different closure methods of peritoneal laceration were used. RESULTS: The incidence of peritoneal tear was 47%. The mean operative times of unilateral TEPs with and without peritoneal laceration were 66 min and 53 min, respectively (p<0.05). Techniques for the closure of the peritoneal opening included endoscopic stapling (n = 12), endoscopic suturing (n = 14), and pretied suture loop ligation (n = 21). The mean operative times for unilateral TEPs with endoscopic stapling, pretied suture loop ligation, and endoscopic suturing of peritoneal tear were 53, 64, and 82 min, respectively (p<0.05). Comparison of postoperative morbidity showed no significant differences among the three groups. CONCLUSION: Peritoneal tear is a frequent and challenging intraoperative event during TEP. Its occurrence significantly prolongs the length of operation. Endoscopic stapling and pretied suture loop ligation are safe and quick techniques for the closure of peritoneal tear during TEP.

Adult↗
PubMed2006

Milestones in endoscope design for minimally invasive urologic surgery: the sentinel role of a pioneer.

Endoscopically based techniques have revolutionized the entire field of surgical specialties over the past 50 years. Currently, minimal access surgery is commonplace for considerable segments of surgical procedures across specialty lines. Central to this revolution, and arguably foremost in its impact on the development of minimally invasive endoscopic surgery, was the development of the rod-lens optical system by Professor Harold H. Hopkins and the almost simultaneous development of the fiberoptic cold-light light source by Karl Storz. It was George Berci who acted as the catalyst in bringing these two men together in the early 1960s, and from that meeting ensued one of the most successful cooperations in the design of endoscopic equipment. Innovative surgeons quickly recognized the enormous potential of these inventions, and in this context, George Berci's work and vision provided the hallmark events leading to the clinical applications from which surgeons and their patients so greatly benefit currently. In urology, Berci's early work has been recognized as a sentinel event bringing endoscopic endoluminal surgery from the lower urinary tract (urethra, bladder, prostate) to the upper urinary tract (ureter, kidney), and eventually to extraluminal laparoendoscopic surgery. This work has been recognized by the Journal of Urology as a "milestone in urology" leading to the clinical application in the field of endoscopic surgery currently referred to as endourology. In this article, the current state-of-the-art urologic surgery for the management of stone disease, urologic tumors, and anatomic abnormalities is presented, which to a great extent has its roots in George Berci's contributions to the field of innovative endoscope design.

Adrenal Gland Neoplasms↗