ABSTRACT
In the case of Roux-en-Y gastric bypass with a long afferent limb, the need to carry out an ERCP still represents a technical challenge. In this article we describe the case of a 50-year-old male admitted to the ER for abdominal pain in the right upper quadrant, in the context of prior Roux-en-Y gastric bypass (4 years ago), with uncomplicated gallbladder stones discovered 3 months ago. The patient presented recurrent abdominal pain for 3 months but in the last few days the pain became continuous. The blood test revealed elevation of hepatic enzymes and bilirubin levels. The US findings were uncomplicated gallbladder lithiasis with no signs of lithiasic migration in the common bile duct, despite strong clinical suspicion and positive MRI 3 weeks before. We decided therefore to perform a laparoscopic cholecystectomy with perioperative cholangiography and a laparoscopy-assisted transjejunal ERCP through a jejunostomy 80 cm distal to the ligament of Treitz, allowed us to successfully carry out sphincterotomy and extraction of a 10mm lithiasis from the common bile duct.
ABSTRACT
Thirty-two patients with esophageal involvement by lung cancer were managed by endoscopic intubation. In 22 patients with extrinsic esophageal strictures, the success rate of intubation was 91%, and 82% were discharged with their dysphagia relieved and esophageal patency restored. The mean survival rate was 4.4 months. In 10 patients with esophago-bronchial fistulas, 3 had the fistulous tract obliterated and lived a mean of 5 months. This low success rate of closing fistulas is due to failure to seal off the space between the stent and the fistula because of absence of tumor-associated stenosis. The overall morbidity rate was 28.1% (18.8% perforation, 6.3% hemorrhage, and 3.1% tracheal obstruction). The overall mortality rate was 18.8%. Although complications were more frequent than in primary esophageal tumors, endoscopic intubation was the only way to palliate this desperate condition and provided 66.6% of patients with relief of symptoms, nutritional improvement, and a mean survival time of 4.5 months.
Subject(s)
Bronchial Fistula/therapy , Carcinoma, Non-Small-Cell Lung/complications , Esophageal Fistula/therapy , Esophageal Stenosis/therapy , Intubation/methods , Lung Neoplasms/complications , Palliative Care/methods , Bronchial Fistula/etiology , Esophageal Fistula/etiology , Esophageal Stenosis/etiology , Esophagoscopy , Female , Humans , Male , Middle AgedABSTRACT
One hundred forty-four patients with unresectable malignant strictures of the upper digestive tract were managed by palliative endoscopic methods: 116 by intubation and 28 by YAG laser phototherapy. The success rate was 95% for intubation and 100% for laser. The morbidity rate was 13.8% for intubation (perforation 7.8%, bleeding 3.4%, and aspiration pneumonia 2.2%) and 3.6% (one perforation) for laser. The mortality rate was 4.3% for intubation and 0% for laser. Specific indications for intubation were esobronchial fistulas, extensive strictures, and very long stenotic lesions. Very high cervical strictures and nonocclusive asymmetrical tumors were better treated with laser. In select cases, combined therapy can be useful. We conclude that both methods are highly efficient in restoring patency and relieving dysphagia. Further large scale randomized trials are necessary to compare functional results and survival rate.
Subject(s)
Esophageal Neoplasms/therapy , Laser Therapy , Palliative Care , Prostheses and Implants , Stomach Neoplasms/therapy , Aged , Aged, 80 and over , Esophagoscopy , Female , Gastroscopy , Humans , Intubation/adverse effects , Lasers/adverse effects , Male , Middle Aged , Retrospective StudiesSubject(s)
Adenocarcinoma/surgery , Laser Therapy , Rectal Neoplasms/surgery , Adenocarcinoma/complications , Aged , Aged, 80 and over , Female , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Male , Middle Aged , Palliative Care , Proctoscopy , Rectal Neoplasms/complicationsABSTRACT
Among 857 patients admitted from October 1977 to December 1984 with acute upper gastrointestinal hemorrhage, 165 (19.5%) had endoscopically proved esophageal or gastric varices. Among this group, varices were considered as the actual bleeding lesion in only 83 (9.7%). Stigmata of variceal bleeding were observed in 76 (92%) including 35 venous spurts, 12 venous oozes, 20 adherent clots, and 14 "platelet aggregates." In only seven cases, variceal rupture could only be presumed, because no other lesion was present. In the other 82 patients, a lesion other than varices was the bleeding source, mostly peptic ulcers (32 = 38%) and erosive gastritis (30 = 36%). One-third of the patients with bleeding varices required more than one endoscopy to provide evidence of variceal bleeding. The most frequent bleeding point was the cardia and a good correlation between variceal size and bleeding was observed. There was no relationship with evidence of gastroesophageal reflux.
