ABSTRACT
PURPOSE: To describe our initial experiences with the standardized introducer technique for percutaneous endoscopic gastrostomy and to compare clinical outcomes and complications with the pull technique. METHODS: The introducer technique was used on 91 patients. The clinical outcomes of procedures were retrospectively collected and compared with those of 22 patients who had procedures using the pull technique. RESULTS: Mean operation time was significantly longer in the introducer technique group as compared with the pull technique group. Increased inflammation markers (body temperature, white blood cell count, and C-reactive protein) were observed in the pull technique group as compared with the introducer technique group. Incidences of peristomal infection and pneumonia were lower in the introducer method group than in the pull method group. CONCLUSIONS: The introducer technique is a useful and safe method for percutaneous endoscopic gastrostomy in terms of reduced incidences of peristomal infection, pneumonia, pain, and discomfort.
Subject(s)
Endoscopy, Digestive System/adverse effects , Endoscopy, Digestive System/methods , Enteral Nutrition/instrumentation , Gastrostomy/adverse effects , Gastrostomy/methods , Suture Techniques , Aged , C-Reactive Protein , Equipment Design , Female , Humans , Leukocyte Count , Male , Middle Aged , Operative Time , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: The Pringle maneuver is traditionally used to avoid hemorrhage during hepatectomy for hepatic metastasis. However, metastasis can occur under ischemic conditions due to some unknown mechanism. METHODOLOGY: An orthotopic model of murine colon cancer was established in syngeneic BALB/c mice. Viable CT-26 cells were implanted into the spleen of these mice. The mice underwent a laparotomy 5 days after the implantation and the hepato-duodenal ligament was clamped for 0 or 10 minutes (Pringle maneuver). The mice were sacrificed 7 days after this maneuver and the number of hepatic metastasis were counted. RESULTS: The mice that underwent the maneuver developed a greater number of hepatic metastasis. An immunohistochemical analysis revealed that the expression of microvessel density, VEGF and KDR/Flk-1 were higher in the hepatic metastasis in the mice treated with the maneuver. In addition, the mice which were treated by the maneuver had a higher level VEGF in the serum. CONCLUSION: These data suggest that the Pringle maneuver induces hepatic metastasis by stimulating the overexpression of tumor vasculature.
