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1.
Gastroenterol Clin Biol ; 24(8-9): 714-8, 2000.
Article in French | MEDLINE | ID: mdl-11011246

ABSTRACT

PURPOSE: To evaluate the efficacy of through-the-scope metal stents for palliation of malignant duodenal stenosis. MATERIAL AND METHODS: Fourty two patients with malignant primary or secondary duodenal stenoses who were treated with a through-the-scope metal stent were analysed. When obstructive jaundice occurred either before, during, or after the initial episode of gastrointestinal luminal obstruction, a biliary stent was inserted. RESULTS: Duodenal metal stents were deployed in 40 patients. Endoprosthesis insertion led to restoration of oral intake in 39 patients. The procedure was not associated with morbidity or mortality. During a mean follow-up of 9.7 weeks, adequate oral intake was maintained in 38/39 cases. Tumour in-growth led to stent occlusion in 4 cases and re-cannulation was obtained by placement of another stent within the original stent. Obstructive jaundice occurred during the course of the illness in 32 patients and was successfully treated with a biliary metal stent in all cases. CONCLUSIONS: Endoscopically placed metal stents offer an effective, well-tolerated alternative to surgical palliation in case of incurable malignant obstruction to gastric outflow.


Subject(s)
Digestive System Neoplasms/complications , Duodenal Diseases/surgery , Duodenoscopy , Palliative Care , Stents , Adult , Aged , Aged, 80 and over , Duodenal Diseases/etiology , Female , Humans , Male , Metals , Middle Aged
2.
Eur J Gastroenterol Hepatol ; 11(8): 891-6, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10514123

ABSTRACT

BACKGROUND: Epidemiological data on acute pancreatitis are poorly defined. AIMS: To prospectively evaluate the aetiology of acute pancreatitis and to assess the benefits of intensive investigations. METHODS: In a prospective, 1-year study all cases of acute pancreatitis in the Nice catchment area were enrolled. Subjects underwent routine (serum calcium, phosphate and triglycerides; abdominal ultrasonography and CT scan) and additional, delayed intensive investigations (ERCP with bile sampling and/or endoscopy ultrasonography). RESULTS: One hundred and twenty-one cases were included. After routine investigations, a biliary, alcoholic, miscellaneous or unknown origin was diagnosed in 43%, 31.4%, 9.9% and 15.7%, respectively. In subjects with biliary pancreatitis, 43% had no previous history of biliary disease. In the alcohol-related subgroup, pancreatitis recurred in 18.5% during 114.5 days mean follow-up. In subjects with a first episode of alcoholic pancreatitis, delayed supplemental investigations revealed underlying chronic pancreatitis in 92.8%. After routine investigations, a diagnosis of pancreatitis of unknown origin was made in 15.7% (n = 19) of subjects. Additional investigations revealed an underlying cause in 57.8% of these patients (n = 11), including malignancy (n = 3) and biliary disease (n = 4), reducing the overall rate of pancreatitis with no apparent cause to 6.6%. CONCLUSIONS: Investigative techniques, particularly ERCP, will reveal the underlying aetiology of pancreatitis in the majority of patients presenting with 'idiopathic' pancreatitis and should be considered when routine tests are negative.


Subject(s)
Pancreatitis, Alcoholic/epidemiology , Pancreatitis/epidemiology , Pancreatitis/etiology , Acute Disease , Adult , Aged , Aged, 80 and over , Alcohol Drinking/adverse effects , Biliary Tract Diseases/complications , Biliary Tract Diseases/diagnosis , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , Incidence , Male , Middle Aged , Pancreatitis/diagnosis , Pancreatitis/mortality , Pancreatitis, Alcoholic/diagnosis , Pancreatitis, Alcoholic/mortality , Prospective Studies , Sex Factors
4.
Pancreas ; 17(3): 266-71, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9788540

ABSTRACT

The aim of this study was to document the natural history of chronic hereditary pancreatitis and to compare its evolution to that of chronic alcoholic pancreatitis. Twelve subjects with chronic hereditary pancreatitis were followed up for a mean duration of 15.8 years (range, 1-23) and compared to subjects with chronic alcoholic pancreatitis who were followed up from 1972 to 1980. The subjects with chronic hereditary pancreatitis, when compared to those with chronic alcoholic pancreatitis, were found to have an earlier onset of symptoms (10.5 vs. 46.0 years, p < 0.05); a significant delay in diagnosis (14.3 vs. 3 years); a similar prevalence of pancreatic calcification (58 vs. 57%); a similar amount of pancreatic insufficiency; both endocrine (50 vs. 70%) and exocrine 42 vs. 38%); and a higher prevalence of pseudocysts (33 vs. 10%, p < 0.05). Only one pancreatic adenocarcinoma was diagnosed in a patient with chronic alcoholic pancreatitis. Apart from the earlier onset and the delay in diagnosis, chronic hereditary pancreatitis has a natural history similar to that of chronic alcoholic pancreatitis. The disease is progressive with a high incidence of complications, but all subjects were alive after follow-up.


Subject(s)
Pancreatitis, Alcoholic/diagnosis , Pancreatitis/diagnosis , Pancreatitis/genetics , Adolescent , Adult , Age of Onset , Child , Chronic Disease , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pancreatitis/complications , Pancreatitis/surgery , Pancreatitis, Alcoholic/complications , Pancreatitis, Alcoholic/surgery , Pedigree , Prognosis
5.
Endoscopy ; 30(6): 559-63, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9746166

ABSTRACT

BACKGROUND AND STUDY AIMS: Caroli's disease causes relapsing episodes of cholangitis due to the presence of intrahepatic lithiasis. Strategies for cholangitis prevention are still widely debated. Ursodeoxycholic acid, hepaticojejunostomy, partial hepatectomy, or transplantation, have all been proposed as therapeutic options. The aim of this study was to evaluate the role of therapeutic endoscopy, and especially endoscopic sphincterotomy (ES), in the management of Caroli's disease. PATIENTS AND METHODS: Between 1983 and 1995, six patients with Caroli's disease (mean age 52, range 17-75) underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis. Sphincterotomy was performed if common bile duct stones were present. Extracorporeal shock-wave lithotripsy, (ESWL) or intraductal electrohydraulic lithotripsy (IEL) were performed if necessary. RESULTS: The mean number of endoscopic sessions per patient was four (range three to seven). Sphincterotomy was performed in five patients and cholangioscopy in three. ESWL was performed twice in each of four patients. A Strecker expandable metal stent was placed in one patient to maintain sphincterotomy patency. In one patient, two sessions of IEL and pulsed laser were carried out. Complete clearance of intrahepatic stones was achieved in four of the six subjects (66.6%) and partial clearance in two patients. No morbidity or mortality was observed. During the follow-up (mean 6.2 years; range: 2.1-16.3), only two patients had acute cholangitis at nine months and three years, respectively, after the endoscopic treatment. Both had residual intrahepatic stones left after the initial endoscopic attempt at clearance. CONCLUSION: ERCP is a necessary diagnostic procedure which should always be carried out in patients with Caroli's disease. Our experience shows that ES does not result in an increased incidence of cholangitis and that therapeutic endoscopy allows complete clearance of intrahepatic stones in the majority of patients with unresectable symptomatic Caroli's disease. Nevertheless, the oncological risk in these patients remains unchanged, and they still have an increased risk of cholangiocarcinoma.


Subject(s)
Caroli Disease/therapy , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis/therapy , Gastrointestinal Agents/therapeutic use , Lithotripsy , Sphincterotomy, Endoscopic , Ursodeoxycholic Acid/therapeutic use , Caroli Disease/complications , Cholangitis/etiology , Cholangitis/prevention & control , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Time Factors
7.
Gastroenterol Clin Biol ; 20(1): 106-8, 1996 Feb.
Article in French | MEDLINE | ID: mdl-8734316

ABSTRACT

Treatment of chronic hepatic encephalopathy is difficult. Oral flumazenil has been proposed for long-term treatment but is not presently available on the market. We report the successful treatment of one case of chronic hepatic encephalopathy in cirrhosis without precipitating factors by low dose intravenous injections of flumazenil (Anexate, 1 mg/4 hours). Flumazenil is expensive and not always effective. We suggest reserving this treatment to highly selected patients (without precipitating factor, or after failure of first choice treatment).


Subject(s)
Esophageal and Gastric Varices/complications , Flumazenil/therapeutic use , GABA Modulators/therapeutic use , Hepatic Encephalopathy/drug therapy , Hepatitis C/complications , Liver Cirrhosis/complications , Ambulatory Care , Chronic Disease , Esophageal and Gastric Varices/surgery , Flumazenil/administration & dosage , GABA Modulators/administration & dosage , Hepatic Encephalopathy/etiology , Humans , Injections, Intravenous , Long-Term Care , Male , Middle Aged , Rupture, Spontaneous , Time Factors
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