Subject(s)
Humans , Male , Female , Patient Care/methods , Patient Care/trends , Patient Education as Topic/methods , Patient Education as Topic/standards , Choledocholithiasis/epidemiology , Patient Care Management/trends , Choledocholithiasis/diagnosis , Choledocholithiasis/therapy , CholedocholithiasisSubject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Hepatic Artery/injuries , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Aged, 80 and over , Catheterization , Hemostasis/physiology , Humans , Male , Medical Errors , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Aged, 80 and over , Hemorrhage/complications , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/surgery , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/methods , Risk Factors , Hemostasis, Surgical/methods , Hemostasis, Surgical/trends , Hemostasis, Endoscopic/methods , Abdomen/pathology , AbdomenSubject(s)
Humans , Female , Middle Aged , Lipoma/complications , Lipoma/diagnosis , Colonic Neoplasms/diagnosis , Colonic Neoplasms/surgery , Intussusception/complications , Intussusception/diagnosis , Intussusception/surgery , Colectomy/methods , Colonoscopy/methods , Lipoma/physiopathology , Lipoma/surgery , Abdominal Pain/etiology , Polyps/surgery , Colonic Polyps/diagnosis , Colonic Polyps/surgery , Endoscopy/methods , Diarrhea/complications , Diarrhea/diagnosis , Biomarkers/analysisABSTRACT
AIM: Due to surgery s high mortality and morbidity, local therapeutic techniques are required for Barrett s high-grade dysplasia (BHGD) and early gastric cancer (EGC). Various techniques are available for endoscopic mucosal resection (EMR) in the GI tract. The " suck and cut technique, which uses a transparent cap or modified multiband variceal ligator, is usually the most practiced method. A multiband ligator (ML) allows sequential resection without the need for submucosal injection and endoscope withdrawal. The objective of this study was to evaluate the efficacy and safety of EMR with a ML device in the treatment of Barrett s high-grade dysplasia and early gastric cancer. PATIENTS AND METHODS: Prospective study. Eight consecutive patients (4 men; median age, 62 years; range 38-89 years) with BHGD (4) or EGC (4) were treated. EMR was performed with a multiband ligator in order to create a pseudopolyp and then permit snare polypectomy of flat mucosal lesions. The pseudopolyp was resected by using pure coagulating current. No submucosal saline injection was administered before resection. RESULTS: A total of 8 consecutive patients were treated with the multiband ligator (ML) technique. Barrett s esophagus (BE): one patient with long BE received 3 EMR sessions. Three patients presented with short BE and received 1 EMR session each. The histology of the EMR specimens confirmed a moderately differentiated adenocarcinoma with submucosal infiltration (1 patient) and BHGD (3 patients). Early gastric cancer (EGC): 3 patients had EGC (type IIa) and 1 patient had high-grade dysplasia. EMR was accomplished in 1 session for each patient. The histology of EMR specimens confirmed a mucinous adenocarcinoma with submucosal infiltration (1 patient), EGC (2 patients), and HGD (1 patient). Complications (mild esophageal stenosis, minor bleeding) occurred in 2 patients. CONCLUSIONS: EMR has diagnostic and therapeutic implications, and represents a superior diagnostic modality as compared to traditional biopsy. By means of EMR the resected mucosa is pathologically examined, and the lesion may be appropriately treated. EMR-ML is a safe and effective technique for the treatment of superficial lesions of the digestive tract, and is accepted as an alternative to surgical therapy for non-invasive lesions. Long-term follow-up is needed to determine the clinical impact of this method.
Subject(s)
Barrett Esophagus/surgery , Gastric Mucosa/surgery , Gastroscopy , Stomach Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Barrett Esophagus/pathology , Female , Humans , Ligation/instrumentation , Male , Middle Aged , Prospective StudiesABSTRACT
Aim: due to surgery´s high mortality and morbidity, local therapeutictechniques are required for Barretts high-grade dysplasia(BHGD) and early gastric cancer (EGC). Various techniques areavailable for endoscopic mucosal resection (EMR) in the GI tract.The suck and cut technique, which uses a transparent cap ormodified multiband variceal ligator, is usually the most practicedmethod. A multiband ligator (ML) allows sequential resection withoutthe need for submucosal injection and endoscope withdrawal.The objective of this study was to evaluate the efficacy and safetyof EMR with a ML device in the treatment of Barretts high-gradedysplasia and early gastric cancer.Patients and methods: prospective study. Eight consecutivepatients (4 men; median age, 62 years; range 38-89 years) withBHGD (4) or EGC (4) were treated. EMR was performed with amultiband ligator in order to create a pseudopolyp and then permitsnare polypectomy of flat mucosal lesions. The pseudopolypwas resected by using pure coagulating current. No submucosalsaline injection was administered before resection.Results: a total of 8 consecutive patients were treated withthe multiband ligator (ML) technique. Barretts esophagus (BE):one patient with long BE received 3 EMR sessions. Three patientspresented with short BE and received 1 EMR session each. Thehistology of the EMR specimens confirmed a moderately differentiatedadenocarcinoma with submucosal infiltration (1 patient) andBHGD (3 patients). Early gastric cancer (EGC): 3 patients hadEGC (type IIa) and 1 patient had high-grade dysplasia. EMR wasaccomplished in 1 session for each patient. The histology of EMRspecimens confirmed a mucinous adenocarcinoma with submucosalinfiltration (1 patient), EGC (2 patients), and HGD (1 patient).Complications (mild esophageal stenosis, minor bleeding)occurred in 2 patients...(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Barrett Esophagus/pathology , Barrett Esophagus/surgery , Gastric Mucosa/surgery , Gastroscopy/methods , Stomach Neoplasms/surgery , Prospective Studies , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Minimally Invasive Surgical Procedures/methodsABSTRACT
Objetivo: valorar la eficacia y seguridad de la dilatación de lapapila de Vater con balones de gran diámetro (BGD) para la extracciónde coledocolitiasis en pacientes con factores que dificultano hacen peligrosa la extracción, por las características de loscálculos o de la anatomía peripapilar.Diseño: prospectivo.Pacientes: estudio que incluye 93 pacientes a los que se realizódilatación hidrostática de la papila con balones de gran diámetroentre junio de 2005 y enero de 2008 por presentar cálculosde gran tamaño, múltiples, colédoco distal afilado, papila peri/intradiverticular,esfinterotomía previa o Billroth-II. Se emplearondilatadores CRE de diámetros entre 12 y 20 mm.Resultados: se consiguió la extracción de los cálculos en unasesión en todos los pacientes (100%). La mayor parte de las exploraciones(86%) no requirieron tiempos prolongados para la extracción.Se precisó litotricia en el 3,2%. Hubo dos complicacionesleves (2,1%). Se detectó hiperamilasemia en el 16% de lospacientes.Conclusiones: la dilatación de la papila de Vater con balónde gran diámetro es una técnica eficaz y segura en la extracciónde cálculos difíciles de la vía biliar, sin incrementar el tiempo de laexploración, ni las complicaciones, evitando la necesidad de litotriciaen la mayoría de los pacientes
Aim: to assess the efficacy and safety of dilatation of the papillaof Vater with large balloons for the treatment of choledocolithiasisin patients with difficult or risky extraction due to stone characteristicsor peripapillary anatomy.Design: prospective.Patients: this study includes 93 patients in whom large-balloondilation was performed between June 2005 and January2008. Patients had multiple large stones, tapered distal CBD(common bile duct), peri-/intra-diverticular papilla, and previoussphincterotomy or Billroth-II surgery. A controlled radial expansion(CRE) balloon with a diameter range of 12-20 mm was used.Results: stone removal was achieved in a single session in allpatients (100 %). Most procedures (86%) did not require an extendedexploration time. Mechanical lithotripsy was needed in 3.2% of cases. There were two mild complications (2.1%). Hyperamilasemiawas detected in 16% of patients.Conclusions: papillary dilation with a large balloon is an effective,safe, and easy technique for the retrieval of difficult commonbile-duct stones. The procedure neither adds time to the exploration,nor increases complications, and obviates the need formechanical lithotripsy in a majority of patients
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Catheterization , Choledocholithiasis/therapy , Ampulla of Vater , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Hyperamylasemia/diagnosis , Pancreatitis/diagnosis , Prospective Studies , Time Factors , Treatment OutcomeABSTRACT
AIM: To assess the efficacy and safety of dilatation of the papilla of Vater with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy. DESIGN: Prospective. PATIENTS: This study includes 93 patients in whom large-balloon dilation was performed between June 2005 and January 2008. Patients had multiple large stones, tapered distal CBD (common bile duct), peri-/intra-diverticular papilla, and previous sphincterotomy or Billroth-II surgery. A controlled radial expansion (CRE) balloon with a diameter range of 12-20 mm was used. RESULTS: Stone removal was achieved in a single session in all patients (100 %). Most procedures (86%) did not require an extended exploration time. Mechanical lithotripsy was needed in 3.2 % of cases. There were two mild complications (2.1%). Hyperamilasemia was detected in 16% of patients. CONCLUSIONS: Papillary dilation with a large balloon is an effective, safe, and easy technique for the retrieval of difficult common bile-duct stones. The procedure neither adds time to the exploration, nor increases complications, and obviates the need for mechanical lithotripsy in a majority of patients.
Subject(s)
Catheterization , Choledocholithiasis/therapy , Adult , Aged , Aged, 80 and over , Ampulla of Vater , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/diagnostic imaging , Female , Humans , Hyperamylasemia/diagnosis , Male , Middle Aged , Pancreatitis/diagnosis , Prospective Studies , Time Factors , Treatment OutcomeABSTRACT
AIM: To assess the efficacy and safety of hydrostatic dilatation with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy. DESIGN: Prospective. PATIENTS: This study included 22 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2005 and April 2006. Patients had multiple large stones, tapered distal common bile duct, peri-/intradiverticular papilla, previous sphincterotomy, or Billroth-II surgery. Esophageal, pyloric and colonic CRE dilatation balloons with diameters ranging from 12 to 20 mm (Boston Scientific Corporation) were used. RESULTS: Stone removal was achieved in a single session in all patients (100%). Most procedures (73%) did not require an extended exploration time. There were no complications. Hyperamilasemia was detected in 18% of patients. CONCLUSIONS: Hydrostatic papillary dilatation with large balloons is a simple, effective, and safe technique for the removal of difficult stones located in the distal common bile duct. It does not add to exploration time, nor increases complications, and reduces the need for lithotripsy. Further studies are needed to define the usefulness of this technique.
Subject(s)
Catheterization , Choledocholithiasis/therapy , Aged , Aged, 80 and over , Catheterization/instrumentation , Equipment Design , Female , Humans , Hydrostatic Pressure , Male , Middle Aged , Prospective StudiesABSTRACT
Objetivo: valorar la eficacia y seguridad de la dilatación hidrostática con balones de gran diámetro en el tratamiento de la coledocolitiasis en pacientes con factores que dificultan o hacen peligrosa la extracción, por las características de los cálculos o de la anatomía peripapilar. Diseño: prospectivo. Pacientes: estudio que incluye 22 pacientes a los que se realizó dilatación hidrostática de la papila con balones de gran diámetro entre junio de 2005 y abril de 2006 por presentar cálculos de gran tamaño, múltiples, colédoco distal afilado, papila peri-/intradiverticular, esfinterotomía previa o Billroth-II. Se emplearon dilatadores CRE de esófago, píloro y colon (Boston Scientific Corporation) de diámetros entre 12 y 20 mm. Resultados: se consiguió la extracción de los cálculos en una sesión en todos los pacientes (100%). La mayor parte de las exploraciones (73%) no requirieron tiempos prolongados para la extracción. No hubo complicaciones. Se detectó hiperamilasemia en el 18% de los pacientes. Conclusiones: la dilatación hidrostática de la papila con balones de gran diámetro es una técnica sencilla, eficaz y segura en la extracción de cálculos difíciles de la vía biliar, sin incrementar el tiempo de la exploración, ni las complicaciones, reduciendo la necesidad de litotricia. Son necesarios estudios adicionales para definir la utilidad de esta técnica
Aim: to assess the efficacy and safety of hydrostatic dilatation with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy. Design: prospective. Patients: this study included 22 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2005 and April 2006. Patients had multiple large stones, tapered distal common bile duct, peri-/intradiverticular papilla, previous sphincterotomy, or Billroth-II surgery. Esophageal, pyloric and colonic CRE dilatation balloons with diameters ranging from 12 to 20 mm (Boston Scientific Corporation) were used. Results: stone removal was achieved in a single session in all patients (100%). Most procedures (73%) did not require an extended exploration time. There were no complications. Hyperamilasemia was detected in 18% of patients. Conclusions: hydrostatic papillary dilatation with large balloons is a simple, effective, and safe technique for the removal of difficult stones located in the distal common bile duct. It does not add to exploration time, nor increases complications, and reduces the need for lithotripsy. Further studies are needed to define the usefulness of this technique
Subject(s)
Male , Female , Middle Aged , Aged , Humans , Choledocholithiasis/therapy , Catheterization/methods , Hydrostatic Pressure , Prospective Studies , Hyperamylasemia/epidemiologyABSTRACT
BACKGROUND: Malignant gastrointestinal obstruction is a secondary complication of cancers in an advanced state. Treatment has consisted of gastrojejunostomy. However, the endoscopic placement of metallic stents has provided positive results. This study aimed to compare the efficiency of both therapeutic options. METHODS: A total of 41 patients with gastrointestinal obstruction caused by inoperable neoplasm were treated endoscopically with enteral stent (24 patients) or gastrojejunostomy (17 patients). RESULTS: In the endoscopic group (EG) 24 patients (100%) achieved efficient gastric emptying, as compared with 82.3% in the surgical group (SG). The difference was not significant. The average time for initiating oral food tolerance was 2.4 days for the EG and 5 days for the SG (p < 0.001). The average inpatient time was 7.1 days for the EG and 11.5 days for the SG (p < 0.001). Mortality at 30 days was lower in the EG (16.6%) than in the SG (29.4%) (p < 0.05). The survival time was 20 weeks for the EG and 21.6 weeks for the SG. The difference was not significant. The rate of complications was 4% in the (EG) and 17.6% in the (SG), with the difference was not significant. CONCLUSION: Endoscopic treatment of malignant gastrointestinal obstruction provides an adequate palliation of the symptoms. It is less invasive, avoids the morbidity associated with open gastrojejunostomy, and achieves a faster start to oral food and a shorter hospital stay, leading to a higher quality of life.
Subject(s)
Gastric Outlet Obstruction/surgery , Gastroscopy , Palliative Care , Stents , Aged , Female , Gastric Outlet Obstruction/etiology , Gastrointestinal Neoplasms/complications , Humans , Male , Prospective StudiesSubject(s)
Colitis/chemically induced , Colonoscopy/adverse effects , Disinfectants/adverse effects , Glutaral/adverse effects , Acute Disease , Adult , Aged , Colonoscopes , Female , Humans , Male , Middle AgedABSTRACT
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