Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement.

BACKGROUND AND STUDY AIMS: In difficult cases of selective bile duct cannulation, several expanded techniques are available which have only been partially evaluated in randomized studies. This study describes a prospective, randomized trial investigating a further technique for obtaining selective biliary access--pancreatic duct wire placement. PATIENTS AND METHODS: During a six-month study period, 107 consecutive patients required deep selective biliary cannulation. Accessing the bile duct using a catheter failed within 10 min in 53 of the patients, who were randomly assigned to either pre-insertion of a guide wire into the pancreatic duct or persistence with a conventional catheter. The success rate and complication rate were compared between these two groups. RESULTS: In the pancreatic duct-guide wire group (n=27), the success rate was significantly greater than in the conventional group (93% vs 58%). No pancreatitis complications occurred within either group. CONCLUSIONS: Inserting a guide wire into the pancreatic duct to facilitate deep selective bile duct cannulation is better than persisting with a conventional catheter. Further studies will be needed to confirm these results and to compare this method with other sophisticated techniques for obtaining selective access to the bile duct.

Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: The degree of accuracy of gastroscopy for the detection of gastric cancer is poorly understood. The aim of this retrospective study was to determine the accuracy of gastroscopy by using cancer registry records. PATIENTS AND METHODS: Gastroscopic examinations (n = 37094) conducted between 1984 and 1989 were studied by linking them with hospital-based and population-based (Fukui Prefecture, Japan) cancer registry records between 1984 and 1992. False-negative gastroscopies that had been carried out within the three years preceding the diagnosis of gastric cancer were identified. RESULTS: The numbers of true-positive, false-positive, and false-negative examinations carried out were 659, six and 155, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 81.0%, 100.0%, 99.1%, and 99.6%, respectively. The overall diagnostic accuracy of gastroscopy was 99.6%. There was little difference in sensitivity results between the patient groups with regard to reason for referral, type of endoscope used, experience of endoscopist, or location of gastric cancer. The percentage of tumours representing early gastric cancer, identified after false-negative gastroscopy, was lower for those situated in the cardia or gastric body than for those in the angular notch or the antrum. CONCLUSIONS: The accuracy of gastroscopy in the detection of gastric cancer is satisfactory, but false-negative results are sometimes obtained. We emphasize the importance of repeated endoscopic examination for the detection of gastric cancer.

[Efficiency of segmental SMANCS/Lip-TAE for hepatocellular carcinoma--comparative studies in the efficacy of segmental SMANCS/Lip-TAI].

We compared the segmental SMANCS/Lip-TAI and the segmental SMANCS/Lip-TAE and studied the effectiveness of both treatments and the influence and/or the side effects on liver function. In resected cases, we studied histopathologic examination. The response rate of the group treated by TAI was 28.6%, and that of the group treated by TAE was 76.5%. In the group treated by TAE, the therapeutic effects were good in nodular type HCC, using small doses of SMANCS. In both groups, the incidence and degree of side effects showed no significant difference. Hepatic insufficiency occurred in a few cases of the group treated by TAI. In resected cases, viable areas remained below the tumor capsule. In conclusion, segmental SMANCS/Lip-TAE seemed to be an effective treatment without any serious complications.

Morphological study of cholesterol hepatolithiasis. Report of three cases.

Three cases of pure cholesterol intrahepatic stones are compared morphologically to those of calcium bilirubinate stones. Cholesterol stones were found in the intrahepatic bile duct of the left lateral lobe in two cases and in both the left lateral and the right posterior lobe in one. Although the chronic inflammatory reaction and fibrous thickening of bile duct wall were similar in both types of hepatolithiasis, the proliferation of intrahepatic periductal glands and the production of mucin were rather mild, compared to that is the liner containing calcium bilirubinate stones. Multiple intramural cholesterol calculi and cholesterin granulomas (cholesterin crystals surrounded by foreign-body giant cells) were found within the cystically dilated small bile duct branches and/or conduits of periductal glands. The calculi and granulomas were characteristic for cholesterol hepatolithiasis. These findings suggest that the formation of the cholesterol stones differs from that of calcium bilirubinate stones; the perturbation of factors influencing cholesterol nucleation in the hepatic bile may be related to the changed microenvironment of the intrahepatic bile ducts, which is followed by the formation of cholesterol stones.