ABSTRACT
BACKGROUND: Current management of malignant obstruction of the upper digestive tract includes surgical gastrointestinal bypass or endoscopic insertion of self-expandable metal stents. The safety, efficacy, and long-term patency rates of anastomoses created using the novel technique of endoscopic gastroenteric anastomosis using magnets (EGAM) are evaluated in this study. PATIENTS AND METHODS: 15 patients (13 men, 2 women; mean age 64.5 years) with malignant obstruction, who underwent EGAM and had monthly follow-up between December 2001 and May 2003, were included in this study. RESULTS: The procedure was successful in 13 patients (88.66 %). The mean survival was 5.23 months. There were four minor complications (30.76 %) during the follow-up period. CONCLUSION: Our results demonstrate the feasibility, safety. and efficacy of this technique for creating a gastroenteric anastomosis. The success rate was 86.6 %, there were no immediate complications, and there was no mortality related to the procedure.
Subject(s)
Anastomosis, Surgical/methods , Duodenum/surgery , Endoscopy, Gastrointestinal , Gastric Outlet Obstruction/surgery , Magnetics , Stomach/surgery , Aged , Aged, 80 and over , Digestive System Neoplasms/complications , Female , Follow-Up Studies , Gastric Outlet Obstruction/etiology , Humans , Male , Middle Aged , Pilot Projects , Stents , Treatment OutcomeABSTRACT
INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). 2. PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. 3. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) Follow-up: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). 4. CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.
Subject(s)
Middle Aged , Humans , Male , Female , Infant , Child, Preschool , Child , Adult , Adolescent , Cholangiopancreatography, Endoscopic Retrograde , Aged, 80 and over , Follow-Up Studies , Prospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). 2. PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. 3. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) Follow-up: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). 4. CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated. (AU)
Subject(s)
Middle Aged , Humans , Male , Female , Infant , Child, Preschool , Child , Adult , Aged , Adolescent , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Follow-Up Studies , Aged, 80 and over , Prospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) FOLLOW-UP: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
1. INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). 2. PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. 3. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) Follow-up: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8
), strictures (18
), pancreatic cancer (4.3
), ampullary cancer (2.3
) and normal ERCP (24.4
). 4. CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53
) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.
ABSTRACT
The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients.
Subject(s)
Humans , Male , Female , Middle Aged , Biliary Tract Neoplasms/therapy , Biocompatible Materials , Cholestasis/therapy , Polyurethanes , Stents , Aged, 80 and over , Follow-Up Studies , Pancreatic Neoplasms/complications , Prospective StudiesABSTRACT
The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients. (Au)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Comparative Study , Stents , Cholestasis/therapy , Bile Duct Neoplasms/therapy , Biocompatible Materials , Polyurethanes , Prospective Studies , Aged, 80 and over , Pancreatic Neoplasms/complications , Follow-Up StudiesABSTRACT
UNLABELLED: The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients.
Subject(s)
Biliary Tract Neoplasms/complications , Biocompatible Materials , Cholestasis/therapy , Polyurethanes , Stents , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pancreatic Neoplasms/complications , Prospective StudiesABSTRACT
The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients.
ABSTRACT
BACKGROUND: Cancer of the esophagus and gastric cardia cause progressive dysphagia. Half of patients are not amenable to surgical resection; of those who are, about 20% will suffer either from local recurrence or anastomotic strictures. Self-expandable metallic stents of diverse characteristics have been used in these clinical conditions. However, expandable metallic stents have several drawbacks: low radial force, migration, epithelial trauma, and tumor ingrowth. We herein report our long-term experience with EsophaCoil, a self-expandable esophageal metallic coil, in 81 patients. METHODS: From January 1993 to July 1996, 84 stents were placed in 81 consecutive patients (53 men and 28 women, mean age 69.8 years (range 40 to 90 years). 41 patients had esophageal squamous cell carcinoma, 32 adenocarcinoma of the esophagus and cardia, 5 mediastinal metastasis, 1 sarcoma, and 2 had benign esophageal strictures. Five patients had bronchoesophageal fistulas. Mean dysphagia score before treatment was 3.5, mean stricture length 6 cm. Most patients were hospitalized for at least 24 hours after stent implantation. Patients were followed and early and late complications were recorded. RESULTS: Stents were successfully placed in all patients. Dysphagia improved in 96% of patients (score dropped from 3.5 to 1.2). Mean patient survival after stent insertion was 4 months (range 0.5 to 20 months). Bronchoesophageal fistulas were closed in all 5 cases. Early complications occurred in 11 patients. These were severe in 3 (esophageal perforation) and mild in 8 patients (precordial pain lasting 24 to 48 hours). Late complications occurred in 18 patients and included migration to the stomach (5 patients), stent breakage (5 among the first 20 cases), food impaction (5), tumor overgrowth (2), and bleeding (1). CONCLUSIONS: In a long-term follow-up, EsophaCoil was effective in the palliative treatment of dysphagia caused by malignant esophageal strictures, including cases of fistulas, having low malfunction and migration rates. No tumor ingrowth was seen.
Subject(s)
Deglutition Disorders/therapy , Esophageal Neoplasms/complications , Esophageal Stenosis/therapy , Palliative Care/methods , Stents , Adenocarcinoma/complications , Adenocarcinoma/therapy , Aged , Bronchial Fistula/etiology , Bronchial Fistula/therapy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/therapy , Deglutition Disorders/etiology , Equipment Design , Esophageal Fistula/etiology , Esophageal Fistula/therapy , Esophageal Neoplasms/therapy , Esophageal Stenosis/etiology , Female , Follow-Up Studies , Humans , Male , Stents/adverse effects , Time FactorsABSTRACT
The pancreas divisum is the most frequent congenital anomaly of the pancreas. It is caused by the absence of fusion in the dorsal and ventral pancreatic buds, so that most of the gland drains through the Santorini duct in the minor papilla. It has been suggested that the relative obstruction of the pancreatic pain and pancreatitis in these patients. According to this the treatment consists in facilitating the minor papilla drainage via surgery or endoscopy. Two endoscopic treatment cases are presented. In both pancreatic duct stent and further sphinterotomy were performed. This treatment and their follow-up are evaluated, coming to the conclusion that this method should be taken into account in the future, due to its viability and low morbimortality.
Subject(s)
Pancreas/abnormalities , Pancreas/surgery , Pancreatitis/etiology , Sphincterotomy, Endoscopic/methods , Stents , Adult , Cholangiopancreatography, Endoscopic Retrograde , Chronic Disease , Female , Follow-Up Studies , Humans , Middle Aged , Pancreas/diagnostic imaging , Pancreatitis/surgeryABSTRACT
The pancreas divisum is the most frequent congenital anomaly of the pancreas. It is caused by the abscence of fusion in the dorsal and ventral pancreatic buds, so that most of the gland drains through the Santorini duct in the minor papilla. It has been suggested that the relative obstruction of the pancreatic pain and pancreatitis in these patients. According to this the treatment consists in facilitating the minor papilla drainage via surgery or endoscopy. Two endoscopic treatment cases are presented. In both pancreatic duct stent and further sphinterotomy were performed. This treatment and their follow-up are evaluated, coming to the conclusion that this method should be taken into account in the future, due to its viability and low morbimortality.
Subject(s)
Adult , Middle Aged , Female , Humans , Pancreas/abnormalities , Pancreatitis/etiology , Sphincterotomy, Endoscopic/methods , Stents , Cholangiopancreatography, Endoscopic Retrograde , Chronic Disease , Follow-Up Studies , Pancreas , Pancreas/surgery , Pancreatitis/surgeryABSTRACT
The pancreas divisum is the most frequent congenital anomaly of the pancreas. It is caused by the abscence of fusion in the dorsal and ventral pancreatic buds, so that most of the gland drains through the Santorini duct in the minor papilla. It has been suggested that the relative obstruction of the pancreatic pain and pancreatitis in these patients. According to this the treatment consists in facilitating the minor papilla drainage via surgery or endoscopy. Two endoscopic treatment cases are presented. In both pancreatic duct stent and further sphinterotomy were performed. This treatment and their follow-up are evaluated, coming to the conclusion that this method should be taken into account in the future, due to its viability and low morbimortality. (AU)
Subject(s)
Adult , Middle Aged , Female , Humans , Pancreas/abnormalities , Pancreatitis/etiology , Sphincterotomy, Endoscopic/methods , Stents , Pancreas/diagnostic imaging , Pancreas/surgery , Pancreatitis/surgery , Follow-Up Studies , Cholangiopancreatography, Endoscopic Retrograde , Chronic DiseaseABSTRACT
The endoscopic or percutaneous placement of a stent in the palliative treatment of the malignant obstructions of the biliary tract is a very well established and accepted method in our country. In the last few years the placement of metallic stents has been preconized because they offer advantage over the standard ones. The first three cases where this type of material was used by our team are presented. Effectivity and facility of the method is demonstrated and no early complications were related to it. We make a critical analysis of the presentation world it be advisable to write about this analysis?
Subject(s)
Cholestasis/therapy , Stents , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis/diagnosis , Fatal Outcome , Female , Humans , Male , Middle Aged , Neoplasms/complicationsABSTRACT
El implante endoscópico o percutáneo de prótesis en el tratamiento paliativo de las estrecheces de la vía biliar es un método bien establecido y aceptado en nuestro medio. En los últimos años se ha preconizado la colocación de prótesis metálicas expansibles, las que ofrecen ventajas con respecto a las standard. Se presentan los tres primeros casos en los cuales se ha utilizado este tipo de material en nuestro grupo de trabajo. Se demuesta efectividad y facilidad en el método, sin complicaciones inmediatas ligadas al mismo. Se realiza un análisis crítico del mismo
Subject(s)
Humans , Male , Female , Middle Aged , Cholestasis/therapy , Prostheses and Implants , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis/diagnosis , Fatal Outcome , Metals , StentsABSTRACT
The endoscopic or percutaneous placement of a stent in the palliative treatment of the malignant obstructions of the biliary tract is a very well established and accepted method in our country. In the last few years the placement of metallic stents has been preconized because they offer advantage over the standard ones. The first three cases where this type of material was used by our team are presented. Effectivity and facility of the method is demonstrated and no early complications were related to it. We make a critical analysis of the presentation world it be advisable to write about this analysis?
ABSTRACT
El implante endoscópico o percutáneo de prótesis en el tratamiento paliativo de las estrecheces de la vía biliar es un método bien establecido y aceptado en nuestro medio. En los últimos años se ha preconizado la colocación de prótesis metálicas expansibles, las que ofrecen ventajas con respecto a las standard. Se presentan los tres primeros casos en los cuales se ha utilizado este tipo de material en nuestro grupo de trabajo. Se demuesta efectividad y facilidad en el método, sin complicaciones inmediatas ligadas al mismo. Se realiza un análisis crítico del mismo (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cholestasis/therapy , Prostheses and Implants , Cholestasis/diagnosis , Metals , Stents , Cholangiopancreatography, Endoscopic Retrograde , Aged, 80 and over , Fatal OutcomeABSTRACT
En los 10 años comprendidos entre Abril de 1981 y el mismo mes de 1991, se realizaron 547 EPT, 74 con vesícula in situ, en 2 grupos semejantes desde el punto de vista técnico-anatómico, así como en cuanto a las indicaciones para la práctica, pero disímiles en sus características socio culturales. La morbilidad precoz indicó 31 complicaciones (5,6%), siendo la más frecuente la perforación en 8 casos y la hemorragia en 9. Se utilizó tratamiento médico, que incluye el endoscópico en 20 (3,7%) y quirúrgico en 11 (2,0%). La mortalidad fue de 1.8% (10 casos), debida principalmente a perforación (4) y colecistitits (3). En 3 (0,5%) oportunidades se produjeron óbitos no inherentes al método. Las maniobras agregadas no implicaron un aumento significativo de la morbimortalidad. Analizando las complicaciones en relación con la causa de realización de la EPT, se observa que las mismas se produjeron más frecuentemente en las litiasis coledocianas: 20(3,6%), seguidas por la litiasis coledociana y vesicular: 7(1,2%) pero con una mortalidad respectiva de 0.7% y 0.5%. Se compara críticamente la morbimortalidad de los dos últimos años con la de los precedentes. El seguimiento se realizó en 114 (20,8%) de los casos con una clara disparidad entre el grupo de más alto índice socio cultural (76 casos) y el de bajo (38 casos). Se hallaron 18 patológicos (3,3%), analizándose el tratamiento de cada una de estas complicaciones a largo plazo
Subject(s)
Humans , Sphincterotomy, Endoscopic/adverse effects , Follow-Up Studies , Retrospective Studies , Sphincterotomy, Endoscopic/mortality , Time FactorsABSTRACT
En los 10 años comprendidos entre Abril de 1981 y el mismo mes de 1991, se realizaron 547 EPT, 74 con vesícula in situ, en 2 grupos semejantes desde el punto de vista técnico-anatómico, así como en cuanto a las indicaciones para la práctica, pero disímiles en sus características socio culturales. La morbilidad precoz indicó 31 complicaciones (5,6%), siendo la más frecuente la perforación en 8 casos y la hemorragia en 9. Se utilizó tratamiento médico, que incluye el endoscópico en 20 (3,7%) y quirúrgico en 11 (2,0%). La mortalidad fue de 1.8% (10 casos), debida principalmente a perforación (4) y colecistitits (3). En 3 (0,5%) oportunidades se produjeron óbitos no inherentes al método. Las maniobras agregadas no implicaron un aumento significativo de la morbimortalidad. Analizando las complicaciones en relación con la causa de realización de la EPT, se observa que las mismas se produjeron más frecuentemente en las litiasis coledocianas: 20(3,6%), seguidas por la litiasis coledociana y vesicular: 7(1,2%) pero con una mortalidad respectiva de 0.7% y 0.5%. Se compara críticamente la morbimortalidad de los dos últimos años con la de los precedentes. El seguimiento se realizó en 114 (20,8%) de los casos con una clara disparidad entre el grupo de más alto índice socio cultural (76 casos) y el de bajo (38 casos). Se hallaron 18 patológicos (3,3%), analizándose el tratamiento de cada una de estas complicaciones a largo plazo (AU)
Subject(s)
Humans , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/mortality , Follow-Up Studies , Retrospective Studies , Time FactorsABSTRACT
Between April 1981 and April 1991, there were 547 EPT performed, seventy-five of which had in situ gall bladder. They were performed in two groups, who were similar from the technical-anatomical point of view, and sociocultural background. The early morbidity showed 31 complications (5.6%). The most frequent ones were: perforation in 8 cases and haemorrhage in 5. Medical treatment, which included the endoscopic technique in 20 cases (3.7%) and surgical procedures in 11 cases (2.0%) was used. The mortality rate was 1.8% (10 cases), perforation (4) and cholecystitis (3) being the main causes. There were three deaths (0.5%) not related to the method. The morbi-mortality was not significantly increased by the complementary methods. After analysing the complications related to the cause of EPT performance, it was observed that they were more frequently produced in choledochal stones: 20 (3.6%), followed by choledochal and gall bladder stones: 7 (1.3%). However the mortality was 0.7% in the former and 0.5% in the latter. The morbi-mortality of the last two years is compared to that of the preceding ones. The follow-up was done in 114 (20.8%) of the cases with a marked difference between the high sociocultural group (76 cases) and the low one (36). Eighteen pathological cases were found (3.3%). The treatment of each complication in long term is shown.