ABSTRACT
The paper reports the authors' experience regarding the use of expandable metal prostheses designed for vascular stenoses but adapted for unoperable esophago-gastric stenoses. Their first impressions are very positive so much so that they affirm that these prostheses are close to being ideal since they are flexible and have an insertion diameter of 3 mm which does not therefore require dilatation. As a result: 1) they involve limited trauma to the patient; 2) reduce the risk of perforation to virtually zero. Moreover: 3) they can be inserted in twisted and angled stenoses and in esophaguses with difficult access due to axial deviations and restriction of the upper cervical aperture; 4) they function well even in notoriously "difficult" sections such as the cardia and esophago-jejunal anastomoses; 5) the unfastening system is easy and rapid. On the strength of these characteristics the authors suggest that these prostheses should be used in an outpatient setting, as occurred in the case of the last of the 10 patients treated, and even at a preoperative stage in preparation for resective surgery so as to preserve normal oral feeding. The structure of these prostheses renders them contraindicated for use in stenoses associated with fistulas in air paths and requires an evaluation of long-term results to verify the incidence with which the following occur: 1) tumoral growth between the mesh; 2) food obstruction; 3) hemorrhage due to compressive necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Esophageal Stenosis/surgery , Palliative Care , Prostheses and Implants , Esophageal Neoplasms/complications , Esophageal Stenosis/etiology , Humans , Surgical Procedures, Operative/methodsABSTRACT
The authors report their views on the treatment of unoperable neoplastic esophago-gastric stenoses with Nitinol prostheses. Despite a number of advantages (reduced trauma, greater tolerability) in relation to plastic prostheses, the paper highlights some problems (difficulty of unfastening, incomplete opening) which may be eliminated by improved materials.
Subject(s)
Alloys , Esophageal Stenosis/surgery , Prostheses and Implants , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedABSTRACT
The authors examined a series of 231 patients suffering from unoperable neoplastic dysphagia of the esophagus and treated using prevalently palliative endoscopic methods (photocoagulation and/or intubation) during the period 1980-1991. They draw the following conclusions: a) endoscopic methods are better than surgical techniques; b) there are a greater number of indications for endoscopic intubation than for photocoagulation (approximately 2 to 1); c) some situation which are indicated for photocoagulation are not contraindicated for intubation; d) the sole contraindication for intubation is stenosis in which the proximal limit is less than 2 cm from the upper esophageal sphincter; e) contraindications for photocoagulation are long stenoses and/or those of the infiltrating type, and/or involving the upper third of the esophagus; f) sometimes the two methods may be complementary in the sense that intubation may be preceded by a few photocoagulation sessions in order to necrotize the vegetating portion of an infiltrating tumour; g) it is best to choose intubation wherever possible since this technique is less expensive and the quality of remaining life better, even if the percentage of severe and generally fatal complications (perforation) is still too high; h) the possible introduction of expandable metal prostheses might increase indications for intubation and reduce the number of severe complication.
Subject(s)
Esophageal Neoplasms/complications , Esophageal Stenosis/therapy , Esophagoscopy , Esophageal Stenosis/etiology , Esophageal Stenosis/mortality , Esophagoscopy/adverse effects , Esophagus , Humans , Intubation , Light Coagulation , Middle Aged , Palliative Care , Prostheses and ImplantsABSTRACT
The paper examines a series of 172 patients undergoing endoscopic intubation with plastic stent due to unoperable esophago-gastric tumoral stenoses during the period 1980-1991. An analysis of the data enabled the following conclusions to be drawn: (1) The majority of perforations occur during the treatment of distal stenoses (15%), anastomotic stenosis (20%) and extrinsic compression stenoses (23% vs 7% in the case of stenosing primary esophageal neoplasia). (2) Severe respiratory problems may occur during treatment of cervical stenoses. (3) Malfunctioning of prostheses is more frequent in the treatment of cardias stenosis (10%). Having a few technical comments on the subject of passing the guide thread through the most twisting and narrow stenoses, the authors express the wish that expandable metal prostheses will be more widely used in order to render the method less traumatic, increase the percentage of success (extending the indications regarding the site and type of stenosis) and reduce severe complications.
Subject(s)
Esophageal Neoplasms/complications , Esophageal Stenosis/therapy , Esophagoscopy , Gastroscopy , Intubation/methods , Stomach Diseases/therapy , Stomach Neoplasms/complications , Adult , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Esophageal Stenosis/etiology , Esophagoscopy/adverse effects , Gastroscopy/adverse effects , Humans , Intubation/adverse effects , Prostheses and Implants/adverse effects , Risk Factors , Stomach Diseases/etiologyABSTRACT
Personal experience in the non-surgical treatment of postoperative biliary fistulas observed between July 1987 and October 1990 is reported. Leakage were treated with an endoscopic technique (papillosphincterotomy+nasobiliary drain) in 11 of 12 patients in an average time of 2 weeks. The 12 patient, who presented a lesion of an intrahepatic duct, needed 2 months to heal following combined endoscopic-percutaneous manoeuvres. On the basis, then, of the good results obtained, it is recommended that in these cases, non-surgical treatment should be carried out on principle, choosing endoscopy as the initial access route.
Subject(s)
Biliary Fistula/therapy , Drainage , Endoscopy , Sphincter of Oddi/surgery , Biliary Fistula/etiology , Biliary Fistula/surgery , Cholangiopancreatography, Endoscopic Retrograde , Humans , Postoperative ComplicationsABSTRACT
The role of operative endoscopy as opposed to surgery in the treatment of obstructive jaundice is in continuous positive evolution due to the rapid technical progress made in the use of this method. Of a total of 93 patients treated over the course of 3 years, some received surgical treatment alone, others endoscopic treatment alone, and a third group received endoscopic therapy followed by surgery. Various parameters were taken into consideration for the three groups studied: the pathological cause of jaundice, age, sex, success of the method used, early and late complications, hospital deaths. Results were then compared.
Subject(s)
Cholestasis/surgery , Endoscopy , Age Factors , Aged , Drainage , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Sex FactorsSubject(s)
Bile Duct Neoplasms/surgery , Cholestasis, Intrahepatic/surgery , Drainage/instrumentation , Endoscopy , Palliative Care , Prostheses and Implants , Aged , Bile Duct Neoplasms/complications , Cholangitis/etiology , Cholangitis/mortality , Cholestasis, Intrahepatic/etiology , Evaluation Studies as Topic , Female , Humans , Intraoperative Care , Italy/epidemiology , MaleSubject(s)
Esophageal Neoplasms/complications , Esophageal Stenosis/therapy , Esophagus , Intubation/methods , Aged , Esophagoscopy , Female , Humans , Male , Middle AgedSubject(s)
Cholestasis/therapy , Drainage/methods , Neoplasms/complications , Adult , Aged , Aged, 80 and over , Cholestasis/etiology , Endoscopy , Female , Humans , Male , Middle AgedSubject(s)
Ampulla of Vater/drug effects , Butylscopolammonium Bromide/pharmacology , Cholangiopancreatography, Endoscopic Retrograde , Duodenum/drug effects , Hymecromone/pharmacology , Scopolamine Derivatives/pharmacology , Sphincter of Oddi/drug effects , Umbelliferones/pharmacology , Female , Humans , MaleABSTRACT
Somatostatin was compared with intensive antacid and thrombin in a randomised controlled study on 15 patients with severe haemorrhages of the upper digestive tract deriving from peptic ulcers and identified endoscopically in order to assess the efficacy of the two drugs. The results in both groups were similar but somatostatin appeared more effective than antacids and thrombin in terms of blood transfusions required and the average time it took to stop the bleeding. The insignificance of these results is in contrast with the data from similar studies using other drugs (anti-H2) and reported by others. This shows the need for controlled polycentric studies conducted on large groups of homogeneous patients.
Subject(s)
Peptic Ulcer Hemorrhage/drug therapy , Somatostatin/therapeutic use , Adult , Aged , Antacids/therapeutic use , Blood Transfusion , Female , Humans , Male , Middle Aged , Thrombin/therapeutic useSubject(s)
Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Liver Cirrhosis/classification , Parenteral Nutrition , Adult , Aged , Blood Transfusion , Embolization, Therapeutic , Female , Humans , Liver Cirrhosis/drug therapy , Liver Cirrhosis/therapy , Liver Cirrhosis, Alcoholic/therapy , Male , Middle AgedSubject(s)
Cholelithiasis/surgery , Aged , Cholangiography , Cholecystectomy , Cholelithiasis/diagnosis , Endoscopy , Female , Humans , Male , Middle AgedSubject(s)
Peptic Ulcer/etiology , Stress, Physiological/complications , Adolescent , Adult , Aged , Cimetidine/therapeutic use , Critical Care , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Peptic Ulcer/complications , Peptic Ulcer/drug therapy , Peptic Ulcer/mortality , RiskABSTRACT
Multivaried and trend analyses were applied to a set of 27 periodic haematochemical checks on 37 patients given surgery for biliopancreatic pathology. Preoperative and postoperative data were separately analysed. The software employed was specially designed for the purpose. The discriminating function was used in the preoperative period to establish the best moment for diagnosis, which turns out to be 5 days after admission to hospital. Variance and regression analyses were used for short term prognosis by calculating survival chances. In one case the prognosis turned out to be distinctly inaccurate.