Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

Topical pharyngeal anesthesia without intravenous sedation during upper gastrointestinal endoscopy.

BACKGROUND: There have been conflicting reports about the usefulness of topical pharyngeal anesthesia as a pre-endoscopic medication. AIMS: To assess the effect of topical pharyngeal anesthesia without intravenous sedatives on easing upper gastrointestinal endoscopy. METHODS: 153 consecutive consenting patients were randomized to receive either placebo (normal saline) spray (78 patients) or 80 mg of 4% lidocaine spray (75 patients). Difficulty of intubation was judged both by the patient and the physician on a linear analogue scale. RESULTS: There was no significant difference in the scores in the two groups (p > 0.05). The patient and physician assessments correlated well. CONCLUSIONS: Topical lignocaine spray does not facilitate upper gastrointestinal endoscopy in the absence of intravenous sedation.

Synchronous adenocarcinoma and lymphoma of the colon.

Synchronous lymphoma and adenocarcinoma of the colon are extremely rare. A 32-year-old woman was referred to us for colon cancer. Investigations revealed two primary tumors, one in the cecum and the other in the sigmoid colon. Subtotal colectomy with ileorectal anastomosis was performed. Histology revealed the cecal tumor to be non-Hodgkin's lymphoma, diffuse small cell type with plasmacytoid features. The sigmoid colon tumor was moderately differentiated adenocarcinoma. The patient received 6 cycles of chemotherapy postoperatively for lymphoma but died of recurrent disease after 17 months.

Dilatation of radiation-induced esophageal strictures under sublingual buprenorphine analgesia: a pilot study.

BACKGROUND: Pain during dilatation of radiation strictures is a troublesome complaint. There is little information on sedation and analgesia during this procedure. We performed a pilot study to compare the analgesic efficacy of sublingual buprenorphine and intravenous pentazocine during dilatation of radiation-induced esophageal strictures. METHODS: Thirty-one patients with esophageal cancer who had radiation-induced strictures were randomized to receive either buprenorphine 0.2 mg sublingually two hours before dilatation (n = 17) or pentazocine 30 mg intravenously five minutes before dilatation (n = 14). Dilatation was considered successful if it could be performed to 12 mm diameter or more. Pain experienced during dilatation was graded as mild, moderate or severe. RESULTS: Sixteen patients in the buprenorphine group and 12 in the pentazocine group were dilated to > 12 mm size (p = ns). Twelve and nine patients respectively in the two groups experienced mild or no pain; ten and six patients had minor side-effects (p = ns). CONCLUSION: Buprenorphine is useful for sedoanalgesia during dilatation of radiation-induced strictures of the esophagus.

Multiple mucosal bridges of esophagus: an unusual cause of dysphagia.

We describe the clinical, radiographic and endoscopic features of a young man presenting with dysphagia who was detected to have multiple esophageal mucosal bridges. This patients had no predisposing condition responsible for the bridge formation.

Removal of impacted basket during endoscopic papillotomy: a novel method using precut papillotome.

Basket impaction is a rare problem during endoscopic papillotomy and stone extraction for the bile duct. Mechanical lithotriptor is usually employed to break the stone, but a few patients may require surgery. We describe a patient in whom a precut papillotome was used to break the stone and remove the impacted basket.

Massive lower gastrointestinal bleeding from cecal lymphoid polyp in renal transplant recipient.

A 25-year-old renal transplant recipient receiving anticoagulant therapy for renal vein thrombosis, presented with massive lower gastrointestinal bleeding. Superior mesenteric angiogram revealed active bleeding in the cecum. Colonoscopy revealed a sessile ulcerated polyp in the cecum with satellite polyps. The polyps were fulgurated with Nd:YAG laser. Colonoscopy later revealed a remnant of the polyp, which was excised. The histopathology revealed a lymphoid polyp.