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Sample records for cholangiopancreatography endoscopic retrograde

  1. Unusual duodenal perforation following endoscopic retrograde cholangiopancreatography

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    Martin Kobborg

    2011-02-01

    Full Text Available Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP with endoscopic sphincterotomy (ES. Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP and Computerized Tomography (CT verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation.

  2. A phantom gallbladder on endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Various complications have been related to laparoscopic cholecystectomy but most occur shortly after the procedure. In this report, we present a case with very late complications in which an abscess developed within the gallbladder fossa 6 years after laparoscopic cholecystectomy. The abscess resolved after treatment with CT-guided extrahepatic aspiration. However, 4 years later, an endoscopic retrograde cholangiopancreatography (ERCP) performed for choledocholithiasis demonstrated a "gallbladder" which communicated with the common bile duct via a patent cystic duct. This unique case indicates that a cystic duct stump may communicate with the gallbladder fossa many years following cholecystectomy.

  3. Vagal withdrawal during endoscopic retrograde cholangiopancreatography

    DEFF Research Database (Denmark)

    Christensen, M; Rasmussen, Verner; Schulze, S;

    2000-01-01

    BACKGROUND: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are at risk of developing cardiorespiratory complications, but the mechanism is still unknown. Treatment with metoprolol 2 h before the endoscopy has been shown to decrease the incidence of myocardial ischaemia...... during ERCP. The present study evaluated whether the endoscopic stress would decrease vagal tone and whether metoprolol given before the procedure could prevent this defence-like reaction. METHODS: Thirty-eight patients were randomized to receive either placebo or 100 mg metoprolol 2 h before ERCP....... During ERCP the patients were monitored with a Holter tape recorder. Holter tapes from 31 patients (16 receiving metoprolol) were available to analyse the ratio of the standard deviations of the RR intervals (SDRR) to the mean RR intervals (measure of vagal tone) during ERCP. RESULTS: A decreased vagal...

  4. Biliary Access During Endoscopic Retrograde Cholangiopancreatography

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    David L Carr-Locke

    2004-01-01

    Full Text Available Several techniques have been developed to facilitate cannulation of the papilla during endoscopic retrograde cholangiopancreatography (ERCP. The position of the endoscope should generally provide a 'straight' route to the papilla, and the efforts should be directed at shortening the intraduodenal portion of the bile duct. If a guidewire is used, one should be chosen that possesses suitable tip and shaft characteristics, including flexibility, strength, low friction and trackability, but no one device is likely to be suitable for all purposes. The development of guidewires composed of nitinol has revolutionized endoscopic practice. Access papillotomy ('pre-cut' can be employed as an alternative to (or in addition to insertion of a guidewire when cannulation of the major papilla has been unsuccessful. The same techniques may be used to allow deep cannulation of the bile or pancreatic duct after ductography, when fluoroscopy can also be used. The 'needle-knife', which must be used carefully because it cuts with even slight tissue contact, is moved in the expected direction of the intramural bile (or pancreatic duct to gain direct access into the duct. Access papillotomy is a valuable procedure in difficult cases, but is associated with greater risks than standard ERCP techniques (except perhaps for a reduced likelihood of pancreatitis, and is best employed by personnel who have extensive experience with therapeutic endoscopy. Technical details for a variety of clinical situations are described. Success requires application of 'the four Ps': position, practice, patience and perseverance.

  5. Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

    Institute of Scientific and Technical Information of China (English)

    Adem Akcakaya; Orhan Veli Ozkan; Ismail Okan; Orhan Kocaman; Mustafa Sahin

    2009-01-01

    AIM: To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS: Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCl and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS: The mean age of the patients was 28 years (range, 21-33 years). The mean gestational age for the fetus was 23 wk (range, 14-34 wk). Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION: Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree.

  6. Pancreatits after endoscopic retrograde cholangio-pancreatography

    Institute of Scientific and Technical Information of China (English)

    Ayman M Abdel Aziz; Glen A Lehman

    2007-01-01

    Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.

  7. Electrocardiographic Changes in Elderly Patients During Endoscopic Retrograde Cholangiopancreatography

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    NG Kounis

    2003-01-01

    Full Text Available BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP via Holter monitoring in elderly patients older than 70 years of age.

  8. Endoscopic retrograde cholangiopancreatography-related adverse events: general overview.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) represents a monumental advance in the management of patients with pancreaticobiliary diseases, but is a complex and technically demanding procedure with the highest inherent risk of adverse events of all routine endoscopic procedures. Overall adverse event rates for ERCP are typically reported as 5-10%. The most commonly reported adverse events include post-ERCP pancreatitis, bleeding, perforation, infection (cholangitis), and cardiopulomary or "sedation related" events. This article evaluates patient-related and procedure-related risk factors for ERCP-related adverse events, and discusses strategies for the prevention, diagnosis and management of these events.

  9. Conscious Sedation for Endoscopic Retrograde Cholangiopancreatography: Dexmedetomidine Versus Midazolam

    Science.gov (United States)

    Kilic, Neslihan; Sahin, Sukran; Aksu, Hale; Yavascaoglu, Belgin; Gurbet, Alp; Turker, Gurkan; Kadioglu, Asli Guler

    2011-01-01

    Objective: Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects. Materials and Methods: Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3–4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2–0.7 mcg/kg/hr, titrated to achieve an RSS of 3–4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9–10. Patient heart rates, arterial pressure and pain were evaluated. Results: Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). Conclusion: The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam. PMID:25610153

  10. Cost-effectiveness of endoscopic ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in patients suspected of pancreaticobiliary disease

    DEFF Research Database (Denmark)

    Ainsworth, A P; Rafaelsen, S R; Wamberg, P A;

    2004-01-01

    BACKGROUND: It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163.......93 and 0.92, respectively. Eighty-four (52%) patients needed endoscopic therapy in combination with ERCP, giving an effectiveness of MRCP, EUS, and ERCP of 0.44, 0.45 and 0.92, respectively. The cost-effectiveness of MRCP, EUS, and ERCP was 6622, 7353 and 4246 Danish Kroner (DKK) per fully investigated...

  11. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation

    Institute of Scientific and Technical Information of China (English)

    Ahmed Youssef Altonbary; Monir Hussein Bahgat

    2016-01-01

    Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography(ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD,suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation.

  12. Feasibility of endoscopic retrograde cholangiopancreatography in healthy cats.

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    Spillmann, Thomas; Willard, Michael D; Ruhnke, Isabelle; Suchodolski, Jan S; Steiner, Jörg M

    2014-01-01

    Cats are predisposed to diseases of the biliary tract and the exocrine pancreas and these can be challenging to diagnose. In humans and dogs > 10 kg, endoscopic retrograde cholangiopancreatography (ERCP) has been successfully used to diagnose some of these disorders. The purpose of our study was to determine whether ERCP would also be feasible in cats using a pediatric duodenoscope. Four purpose-bred, clinically healthy, castrated domestic shorthair cats participated in two studies. Study 1 compared standard white light endoscopy with chromoendoscopy for localizing the major duodenal papilla. In Study 2 ERCP was performed. Repeated clinical examinations and measurements of serum feline pancreatic lipase immunoreactivity (fPLI) were performed before and up to 18 hours after interventions on all cats. Chromoendoscopy was subjectively judged to be superior for localizing the major papilla. Insertion of the ERCP catheter was best accomplished when cats were in dorsal recumbency. Complete ERCP was successful in two cats. In the other cats, either retrograde cholangiography or pancreatography was possible. Serum fPLI concentrations increased temporarily in two cats during Study 2 when measured immediately, 2, 4, and 18 h after ERCP. Peak fPLI concentrations were detected either immediately after ERCP or 2 h later. No clinical signs of complications were observed within 18 h after the procedures. Findings indicated that ERCP is technically demanding but feasible in healthy cats. Future studies need to determine whether the temporary increases in serum fPLI concentrations are clinically important and to investigate the utility of ERCP in feline patients.

  13. The clinical and radiological observation of endoscopic retrograde cholangiopancreatography

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    Park, Choong Shik; Park, Byoung Lan; Chun, Hyun Woo; Kim, Byung Geun; Park, Hong Bae [Kwangju Christian Hospital, Kwangju (Korea, Republic of)

    1981-12-15

    Endoscopic retrograde cholangiopancreatography (ERCP) is a new diagnostic method for pancreatic and biliary disease which has been made possible by the development of fiberoptic duodenoscopy. It has been thought that ERCP will serve an important role in the early detection of pancreatic cancer, but in order to detect minor lesions of the pancreas and improve the diagnostic accuracy of resectable pancreatic cancer, Endoscopic Retrograde Parenchymography of the pancreas (ERPP) was developed recently. The authors analyzed 117 cases of ERCP performed at the Kwangju Christian Hospital between January and December 1980, and compared them with the final diagnosis. The results were as follows: 1. One of 117 cases, successful visualization of the duct of concern was achieved in 105 cases. Of these, 25 cases were ERPP. 2. The ratio of males to females was 1.44 : 1. Most patients were in the 4th to 6th decade. 3. The commonest clinical manifestations were upper abdominal pain (77 cases), jaundice (23 cases), indigestion, vomiting and abdominal mass, in order of frequency. 4. Out of 46 cases of suspected pancreatic diseases, the pancreatic duct was visualized in 36 cases, and 24 cases revealed pathognomonic findings. These were diagnosed as 16 cases of pancreatic cancer, 4 cases of chronic pancreatitis, 2 cases of pancreatic pseudocyst and 2 cases of periampullary cancer with pancreas invasion. In pancreatic cancer findings were; encasement, local dilatation, delayed excretion, poor filling, obstruction of pancreatic duct, accompanying C.B.D. obstruction or stenosis and so called double duct sign. The chronic pancreatitis findings included; ductal dilatation (with or without) obstruction, tortuosity with dilated saccular lateral branching, stone formation and the parenchymal filling defect. 5. Out of 71 cases of suspected biliary tract disease, the biliary tract was visualized in 57 cases, and in 31 cases abnormalities were suggested; such as 20 cases of biliary stone, 1 case

  14. Continued evidence for safety of endoscopic retrograde cholangiopancreatography during pregnancy

    Institute of Scientific and Technical Information of China (English)

    Sean; Fine; Joshua; Beirne; Silvia; Delgi-Esposti; Fadlallah; Habr

    2014-01-01

    AIM: To report the safety of continued use of endoscopic retrograde cholangiopancreatography(ERCP) during pregnancy at various maternal ages.METHODS: A retrospective chart review of pregnant patients who underwent ERCP at a tertiary academic center was undertaken between 2002 and 2012. Pertinent past medical history and initial presenting laboratory data were collected. Review of the procedure note for each ERCP performed provided documentation of lead shielding, type of sedation, fluoroscopy time, and post-procedure complications. Patients’ clinical courses were reviewed until the time of delivery and pregnancy complications with fetal outcomes were examined. Data was stratified based upon the mother’s age at the time of ERCP: 18-21, 22-29, and ≥ 30 years of age.RESULTS: Twenty pregnant patients who underwent ERCP between 2002 and 2012 were identified. The mean age at the time of ERCP was 26.4 years(18-38 years) and the average trimester was the second. The indications for ERCP were choledocholithiasis in 17 patients, gallstone pancreatitis in 2 patients, and cholangitis in 1 patient. The mean fluoroscopy time of ERCP was 3.8 min(0.3-23.6 min). Sphincterotomy was performed in 18 patients with therapeutic intent and not as a prophylactic measure to prevent recurrences. Clinical documentation of use of protective shielding was found in only 8 notes(40%). Post procedure complications were limited to two cases of post-ERCP pancreatitis(10%). Elective cholecystectomy was performed shortly after ERCP in 11 of the pregnant patients. Birth records were available for 16 patients, of which 15 had fullterm pregnancies. Cesarean sections were performed in 5(31%) patients. Term birth weight was greater than 2500 g in all cases except one in which the mother had a known hypercoagulable state. CONCLUSION: ERCP during pregnancy is both safe and efficacious regardless of maternal age or trimester.

  15. Pharmacological prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.

    Science.gov (United States)

    Pande, Hemant; Thuluvath, Paul

    2003-01-01

    The incidence of clinically significant pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) ranges from 1-13.5%. It is more common after therapeutic procedures such as sphincterotomy or balloon dilatation of the sphincter, and diagnostic procedures such as biliary or pancreatic manometry. The severity of post-ERCP pancreatitis may vary from very mild to extremely severe disease with multiple organ failure and fatal outcome. Several factors including papillary oedema, injection of hyperosmolar contrast-material, introduction of previously activated enzymes during repeated cannulation, bacterial contamination and thermal injury from endoscopic sphincterotomy have been implicated as triggering factors that initiate the sequential cascade of pancreatic autodigestion and release of proinflammatory cytokines leading to acute pancreatitis. Recovery from post-ERCP pancreatitis is usually rapid when the injury is confined to the pancreas. However, systemic production of inflammatory mediators may lead to the development of more serious manifestations including multiorgan failure.A wide range of pharmacological agents has been tested in experimental and clinical trials, but the results have been largely disappointing. Several drugs are discussed in this review, but only somatostatin and gabexate (gabexate mesilate) have consistently shown a moderate beneficial effect. In clinical trials, both gabexate and somatostatin appear equally effective in reducing the incidence of pancreatitis by two-thirds compared with controls. However, both drugs need to be given by continuous infusion for about 12 hours and this makes them less cost-effective than conventional treatment. One potential strategy is to reserve these drugs for high-risk patients undergoing ERCP. Preliminary studies have shown encouraging results with nitroglycerin, antibacterials and heparin. However, these observations need to be corroborated in a rigorous fashion in large, randomised, double

  16. Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events: post-ERCP pancreatitis.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), and not uncommonly is the reason behind ERCP-related lawsuits. Patients at high risk for PEP include young women with abdominal pain, normal liver tests, and unremarkable imaging. Procedure-related factors include traumatic and persistent cannulation attempts, multiple injections of the pancreatic duct, pancreatic sphincterotomy, and, possibly, use of precut sphincterotomy. Aggressive hydration, use of rectal indomethacin, and prophylactic pancreatic stenting can diminish the risk (and likely severity) of PEP. Though hugely beneficial, these measures do not supersede careful patient selection and technique.

  17. Is the 'Trondsen Discriminant Function' useful in patients referred for endoscopic retrograde cholangiopancreatography?

    DEFF Research Database (Denmark)

    Ainsworth, A P; Pless, T; Mortensen, M B;

    2003-01-01

    BACKGROUND: Ideally, patients should only be referred to endoscopic retrograde cholangiopancreatography (ERCP) if therapy is indicated. The aim of this study was to evaluate whether or not the 'Trondsen Discriminant Function' (DF) could be used for selecting patients directly for ERCP. METHODS: T...

  18. The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation

    NARCIS (Netherlands)

    Jeurnink, S. M.; Steyerberg, E. W.; Kuipers, E. J.; Siersema, P. D.

    2012-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that proves burdensome to patients. Nevertheless, very little data are available on patient tolerance of this procedure that may improve practice guidelines and could aid in decreasing the burden of ERCP. This study there

  19. Air Embolism after Endoscopic Retrograde Cholangiopancreatography in a Patient with Budd Chiari Syndrome

    Science.gov (United States)

    Wills-Sanin, Beatriz; Cárdenas, Yenny R.; Polanco, Lucas; Rivero, Oscar; Suarez, Sebastian; Buitrago, Andrés F.

    2014-01-01

    Endoscopic retrograde cholangiopancreatography is a procedure commonly used for the diagnosis and treatment of various pancreatic and biliary diseases. Air embolism is a rare complication, which may be associated with this procedure. This condition can be manifested as cardiopulmonary instability and/or neurological symptoms. Known risk factors include: sphincterotomy; application of air with high intramural pressure; anatomic abnormalities; and chronic hepatobiliary inflammation. It is important for the health-care staff, including anesthesiologists, interventional gastroenterologists, and critical care specialists, amongst others, to promptly recognize air embolism and to initiate therapy in a timely fashion, thus preventing potentially fatal outcomes. We submit a brief review of the literature and a case report of air embolism which occurred in the immediate postoperative stage of an endoscopic retrograde cholangiopancreatography, performed in a woman with a history of liver transplantation due to Budd Chiari syndrome and biliary stricture. PMID:25478242

  20. Canadian Association of Gastroenterology Practice Guideline for Clinical Competence in Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography

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    Alan Cockeram

    1997-01-01

    Full Text Available This Practice Guideline is intended to assist individuals, training programs and credentialling bodies in understanding the training for and application of endoscopic retrograde cholangiopancreatography (ERCP, as well as in designating credentialling and maintenance of competence. The Canadian Association of Gastroenterology (CAG Practice Guideline on training and credentialling provides the necessary background (1. Many of the principles outlined have been previously accepted by CAG (2.

  1. Diaanostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma

    Institute of Scientific and Technical Information of China (English)

    Ryan W Himes; Isaac Raijman; Hilton J Finegold; Heidi V Russell; Douglas S Fishman

    2008-01-01

    Biliary rhabdomyosarcoma (BRHS) is an uncommon childhood malignancy which has been managed surgically.We present a case of a 3-year-old boy with BRHS,in whom endoscopic retrograde cholangiopancreatography (ERCP) was successfully used both diagnostically and therapeutically,thus obviating the need for surgery and its attendant risks of morbidity and mortality.We conclude that ERCP is an effective alternative to surgery for BRHS in some patients.

  2. Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Takao Itoi; Fumihide Itokawa; Atsushi Sofuni; Toshio Kurihara; Takayoshi Tsuchiya; Kentaro Ishii; Shujiro Tsuji; Nobuhito Ikeuchi; Fuminori Moriyasu

    2008-01-01

    Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.

  3. Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease

    Institute of Scientific and Technical Information of China (English)

    Ersan (O)zaslan

    2006-01-01

    The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.

  4. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children

    Institute of Scientific and Technical Information of China (English)

    Joo; Young; Jang; Chong; Hyun; Yoon; Kyung; Mo; Kim

    2010-01-01

    AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were investigated.RESULTS:The mean age of the 122 patients was 8.0 ± 4.2 years.Indications were biliary pathology in 78...

  5. Gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy: a case report

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    Goyal Amit

    2008-11-01

    Full Text Available Abstract Introduction Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Although the disorder is a rare cause of small bowel obstruction (1% to 2%, it has been reported to cause up to 25% of cases of non-strangulated small bowel obstruction in patients over 65 years of age. Case presentation We report a case of a 67-year-old woman who presented with gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy for choledocholithiasis. She had a history of terminal ileum resection with ileocolic anastomosis for Crohn's disease. A 3 cm gallstone was found to be impacted just proximal to the previous ileocolic anastomosis. A second gallstone was found on digital examination of the proximal small bowel. Conclusion A gallstone may enter the gastrointestinal tract following endoscopic retrograde cholangiopancreatography and sphincterotomy and impact proximal to an anastomotic stricture as demonstrated here. The radiographic image of small bowel obstruction plus air in the biliary tree is a classic diagnostic finding. After stone extraction, the entire small bowel and colon should be digitally examined for further stones.

  6. Diclofenac Is Associated With a Reduced Incidence of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

    DEFF Research Database (Denmark)

    Leerhøy, Bonna; Nordholm-Carstensen, Andreas; Novovic, Srdan

    2014-01-01

    OBJECTIVE: The aim of this study was to assess the clinical effect of diclofenac administered as a single dose for the prevention of postprocedure pancreatitis in a consecutive series of patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients with a nat......OBJECTIVE: The aim of this study was to assess the clinical effect of diclofenac administered as a single dose for the prevention of postprocedure pancreatitis in a consecutive series of patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients...... with a native papilla Vateri subjected to ERCP during 2010 (control group, n = 218) and 2012 (diclofenac group, n = 182) were included. Patients with a history of chronic pancreatitis or recent acute pancreatitis were excluded. From January 2012, a rectal suppository containing 100 mg of diclofenac...... patients in the diclofenac group (P = 0.002). Moderate to severe pancreatitis occurred in 22 (10.1%) of the 218 patients in the control group versus 8 (4.4%) of the 182 patients in the diclofenac group (P = 0.036). CONCLUSIONS: This controlled cohort study suggests that the implementation of a single dose...

  7. Endoscopic retrograde cholangiopancreatography forsuspected choledocholithiasis: From guidelines to clinicalpractice

    Institute of Scientific and Technical Information of China (English)

    Joana Magalh?es; Bruno Rosa; José Cotter

    2015-01-01

    AIM: To study the practical applicability of the AmericanSociety for Gastrointestinal Endoscopy guidelinesin suspected cases of choledocholithiasis.METHODS: This was a retrospective single centerstudy, covering a 4-year period, from January 2010to December 2013. All patients who underwentendoscopic retrograde cholangiopancreatography(ERCP) for suspected choledocholithiasis were included.Based on the presence or absence of predictors ofcholedocholithiasis (clinical ascending cholangitis,common bile duct (CBD) stones on ultrasonography(US), total bilirubin 〉 4 mg/dL, dilated CBD on US,total bilirubin 1.8-4 mg/dL, abnormal liver functiontest, age 〉 55 years and gallstone pancreatitis),patients were stratified in low, intermediate or highrisk for choledocholithiasis. For each predictor andrisk group we used the χ 2 to evaluate the statisticalassociations with the presence of choledocolithiasisat ERCP. Statistical analysis was performed usingSPSS version 21.0. A P value of less than 0.05 wasconsidered statistically significant.RESULTS: A total of 268 ERCPs were performed forsuspected choledocholithiasis. Except for gallstonepancreatitis (P = 0.063), all other predictors of cho-ledocholitiasis (clinical ascending cholangitis, P = 0.001;CBD stones on US, P ≤ 0.001; total bilirubin 〉 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001;dilated CBD on US, P ≤ 0.001; abnormal liver functiontest, P = 0.012; age 〉 55 years, P = 0.002) showed astatistically significant association with the presence ofcholedocholithiasis at ERCP. Approximately four fifthsof patients in the high risk group (79.8%, 154/193patients) had confirmed choledocholithiasis on ERCP,vs 34.2% (25/73 patients) and 0 (0/2 patients) in theintermediate and low risk groups, respectively. Thedefinition of "high risk group" had a sensitivity of 86%,positive predictive value 79.8% and specificity 56.2%for the presence of choledocholithiasis at ERCP

  8. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia

    Institute of Scientific and Technical Information of China (English)

    Fatih; Sumer; Cuneyt; Kayaalp; Mehmet; Ali; Yagci; Emrah; Otan; Huseyin; Kocaaslan

    2014-01-01

    This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.

  9. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia.

    Science.gov (United States)

    Sumer, Fatih; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Otan, Emrah; Kocaaslan, Huseyin

    2014-11-16

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period.

  10. Predictors of Successful Clinical and Laboratory Outcomes in Patients with Primary Sclerosing Cholangitis Undergoing Endoscopic Retrograde Cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    R Enns

    2003-01-01

    Full Text Available Endoscopic retrograde cholangiopancreatography (ERCP in patients with primary sclerosing cholangitis (PSC can be a challenging and sometimes gratifying opportunity for therapeutic intervention. Although there often appears to be initial radiological improvement after ERCP, the benefit as measured by serial estimations of subsequent liver enzymes is questionable. The fluctuating course of the inflammatory process makes the interpretation of serology even more difficult.

  11. Tension pneumothorax complicating endoscopic retrograde cholangiopancreatography: case report and systematic literature review.

    Science.gov (United States)

    Al-Ashaal, Yousef I; Hefny, Ashraf F; Safi, Farouk; Abu-Zidan, Fikri M

    2011-01-01

    Perforation of the duodenum, which is usually retroperitoneal, is a known complication of endoscopic retrograde cholangiopancreatography (ERCP). Association of the duodenal perforation with pneumothorax is rare and the development of tension pneumothorax is even rarer. We report a case of tension pneumothorax following an ERCP, which we successfully treated with chest tube insertion and laparotomy, and systematically review the other 10 cases reported in the literature. Four of these 10 cases had tension pneumothorax. All were to the right side of the chest. Patients were mainly female (7/10). The median (range) age was 70.5 (55-89) years. Four patients required surgery (40%) and one patient, who was not operated on, died (10%). Clinicians should be aware of this serious complication. Unexplained chest pain, dyspnoea, and oxygen desaturation with abdominal distension during ERCP must raise this possibility. Early clinical recognition and prompt management is essential to improve the outcome.

  12. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist.

    Science.gov (United States)

    Marchesi, Matteo; Battistini, Alessio; Pellegrinelli, Moira; Gentile, Guendalina; Zoja, Riccardo

    2016-01-01

    Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis.

  13. Ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the morphologic diagnosis of pancreatic disease

    Energy Technology Data Exchange (ETDEWEB)

    Swobodnik, W.; Meyer, W.; Brecht-Kraus, D.; Wechsler, J.G.; Geiger, S.; Malfertheiner, P.; Junge, U.; Ditschuneit, H.

    1983-03-15

    From February to November 1981 the diagnostic relevance of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) was compared prospectively in 75 patients with suspected pancreatic disease. Final diagnosis was confirmed by autopsy, surgery, clinical course, and further laboratory data. Thus it was possible to exclude pancreatic disorders in 32 patients. By ERCP we diagnosed all tumors; sensitivity was 100%. Sensitivity of US and CT were 63% each. In five cases US made the false positive diagnosis' pancreatic malignant tumor' (specifity 93%), CT and ERCP in two cases (specifity 97% each). In chronic pancreatitis specifity of US and ERCP were 100% and specifity of CT was 98%. Sensitivity of ERCP amounted to 93%, CT and US revealed 74% and 52%, respectively. We conclude that ERCP is the best morphologic diagnostic tool in differentiating chronic pancreatitis from pancreatic carcinoma. US is a good screening method and CT reveals good diagnostic results in acute pancreatitis.

  14. NSAIDs for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: Ready for prime time?

    Institute of Scientific and Technical Information of China (English)

    Mansour A Parsi

    2012-01-01

    Acute pancreatitis is the most common and the most fearful complication of endoscopic retrograde cholangiopancreatography (ERCP).Prevention of post-ERCP pancreatitis has therefore been of great interest to endoscopists performing ERCP procedures.So far,only pancreatic duct stenting during ERCP and rectal administration of a non-steroidal anti-inflammatory drug (NSAID) prior to or immediately after ERCP have been consistently shown to be effective for prevention of post-ERCP pancreatitis.This commentary focuses on a short discussion about the rates,mechanisms,and risk factors for post-ERCP pancreatitis,and effective means for its prevention with emphasis on the use of NSAIDs including a recent clinical trial published in The New England Journal of Medicine by Elmunzer et al[11].

  15. Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    John G Lieb II; Peter V Draganov

    2007-01-01

    Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP).The only way to prevent this complication is to avoid an ERCP all together. Because of the risks involved, a careful consideration should be given to the indication for ERCP and the potential risk/benefit ratio of the test. Once a decision to perform an ERCP is made, the procedure should be carried out with meticulous care by an experienced endoscopist, and with a minimum of pancreatic duct opacification. Several pharmacologic agents have been tested, but to date the most important method of reducing post ERCP pancreatitis is the placement of pancreatic stent. Pancreatic stents should be placed in all patients at high risk of this complication such as those undergoing pancreatic sphincterotomy,pancreatic duct manipulation and intervention, and patients with suspected sphincter of Oddi dysfunction.Pancreatic stents should be also considered in patients requiring precut sphincterotomy to gain biliary access.

  16. Oral allopurinol to prevent hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Hector Martinez-Torres; Xochilt Rodriguez-Lomeli; Carlos Davalos-Cobian; Jesus Garcia-Correa; Juan Manuel Maldonado-Martinez; Fabiola Medrano-Mu(n)oz; Clotilde Fuentes-Orozco; Alejandro Gonzalez-Ojeda

    2009-01-01

    AIM: To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). METHODS: One hundred and seventy patients were enrolled and randomized to two groups: a study group ( n = 85) who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography (ERCP) and a control group ( n = 85) receiving an oral placebo at the same times. Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis. Serum amylase levels were classified as normal (<150 IU/L) or hyperamylasemia (>151 IU/L). Episodes of PEP were classified following Ranson's criteria and CT severity index. RESULTS: Gender distribution was similar between groups. Mean age was 53.5 ± 18.9 years for study group and 52.8 ± 19.8 years for controls. Also, the distribution of benign pathology was similar between groups. Hyperamylasemia was more common in the control group ( P = 0.003). Mild PEP developed in two patients from the study group (2.3%) and eight (9.4%) from control group ( P = 0.04), seven episodes were observed in high-risk patients of the control group (25%) and one in the allopurinol group (3.3%, P = 0.02). Risk factors for PEP were precut sphincterotomy ( P = 0.02),pancreatic duct manipulation ( P = 0.002) and multiple procedures ( P = 0.000). There were no deaths or side effects.CONCLUSION: Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.

  17. Deep sedation for endoscopic retrograde cholangiopancreatography: a comparison between clinical assessment and NarcotrendTM monitoring

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2011-03-01

    Full Text Available Somchai Amornyotin, Wiyada Chalayonnawin, Siriporn KongphlayDepartment of Anesthesiology and Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandIntroduction: Moderate to deep sedation is generally used for endoscopic retrograde cholangiopancreatography (ERCP. The depth of sedation is usually judged by clinical assessment and electroencephalography-guided monitoring. The aim of this study was to compare the clinical efficacy of clinical assessment and NarcotrendTM monitoring during deep-sedated ERCP.Methods: One hundred patients who underwent ERCP in a single year were randomly assigned to either group C or group N. Patients in group C (52 were sedated using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S scale. Patients in group N (48 were sedated using the NarcotrendTM system. The MOAA/S scale 1 or 2 and the NarcotrendTM index 47–56 to 57–64 were maintained during the procedure. The primary outcome variable of the study was the successful completion of the endoscopic procedure. The secondary outcome variables were the total dose of propofol used during the procedure, complications during and immediately after procedure, and recovery time.Results: All endoscopies were completed successfully. The mean total dose of propofol in group C was significantly lower than that in group N. However, the mean dose of propofol, expressed as dose/kg or dose/kg/h in both groups, was not significantly different (P = 0.497, 0.136. Recovery time, patient tolerance and satisfaction, and endoscopist satisfaction were comparable between the two groups. All sedation-related adverse events during and immediately after the procedure, such as hypotension, hypertension, tachycardia, bradycardia, transient hypoxia, and upper airway obstruction, in group C (62.2% were significantly higher than in group N (37.5% (P = 0.028.Conclusion: Clinical assessment and NarcotrendTM-guided sedation using

  18. Effect of body weight on fixed dose of diclofenac for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

    DEFF Research Database (Denmark)

    Leerhøy, Bonna; Nordholm-Carstensen, Andreas; Novovic, Srdan

    2016-01-01

    OBJECTIVE: The aim of this study was to assess the influence of patient body weight on the clinical effect of 100 mg diclofenac administered as a single dose for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). MATERIALS AND METHODS: All patients subjected...... to endoscopic retrograde cholangiopancreatography (ERCP) from 2009 to 2014 were evaluated for inclusion. In total, 772 patients were included of whom 378 (49%) received diclofenac prophylaxis. RESULTS: In the diclofenac prophylaxis group, body weight was higher in patients with PEP (mean ± SD: 82 ± 18 kg) than...... of 100 mg diclofenac for the prophylaxis of PEP. CONCLUSIONS: High patient body weight was associated with a reduced effect of 100 mg diclofenac for prophylaxis of PEP....

  19. A randomized controlled trial of preprocedure administration of parecoxib for therapeutic endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Amornyotin S

    2012-08-01

    Full Text Available Somchai Amornyotin, Wiyada Chalayonnawin, Siriporn KongphlayDepartment of Anesthesiology and Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandIntroduction: Parecoxib is occasionally used for analgesia in postprocedural patients. The clinical efficacy of parecoxib used for endoscopic retrograde cholangiopancreatography (ERCP is controversial. The aim of the study was to determine the clinical efficacy of preprocedure administration of parecoxib for therapeutic ERCP patients.Methods: Eighty-five patients who underwent therapeutic ERCP in a single year were randomly assigned to normal saline group (C, n = 43 and parecoxib group (P, n = 42. Patients in group C received normal saline and those in group P received 40 mg of parecoxib intravenously in equivalent volume. Patients in both groups received the saline or parecoxib 60 seconds before administration of the sedative agents. All patients were monitored for the depth of sedation by using the NarcotrendTM monitor, maintaining stage D0–E0 during ERCP. All patients were oxygenated with 100% O2 via nasal cannula and sedated with 0.03 mg/kg of intravenous midazolam and 1 µg/kg of intravenous fentanyl as well as the titration of intravenous propofol. After the ERCP procedure, pethidine in an intramuscular dose of 0.5–1.0 mg/kg was used as rescue medication. The pain scores (visual analog scale [VAS], 0–10 at 2, 12, and 24 hours post-ERCP, the total number of doses of pethidine used, the dose volume of pethidine used, patient satisfaction, endoscopist satisfaction, and complications were recorded.Results: There were no significant differences in sedative and analgesic agents used during the procedure, pain at 24 hours post-ERCP, endoscopist satisfaction, and complications in both groups. The total number of doses of pethidine used post-ERCP in group C was significantly higher than in group P. Additionally, the mean pain score at 2 and 12 hours

  20. Post-endoscopic retrograde cholangio-pancreatography pancreatitis: Is time for a new preventive approach?

    Institute of Scientific and Technical Information of China (English)

    Stella Tammaro; Roberta Caruso; Francesco Pallone; Giovanni Monteleone

    2012-01-01

    Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangio-pancreatography (ERCP) and its incidence may exceed 25% in some high-risk patient subsets.In some patients,pancreatitis may follow a severe course with pancreatic necrosis,multiorgan failure,permanent disability and even death.Hence,approaches which minimize both the incidence and severity of post-ERCP pancreatitis are worth pursuing.Pancreatic stents have been used with some success in the prevention of post-ERCP,while so far pharmacological trials have yielded disappointing results.A recent multicenter,randomized,placebocontrolled,double-blind trial has shown that rectally administered indomethacin is effective in reducing the incidence of post-ERCP pancreatitis,the occurrence of episodes of moderate-to-severe pancreatitis and the length of hospital stay in high-risk patients.These results together with the demonstration that rectal administration of indomethacin is not associated with enhanced risk of bleeding strongly support the use of this drug in the prophylaxis of post-ERCP pancreatitis.

  1. Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Thawee Ratanachu-ek; Pitchaya Prajanphanit; Kawin Leelawat; Suchart Chantawibul; Sukij Panpimanmas; Somboon Subwongcharoen; Jerasak Wannaprasert

    2007-01-01

    AIM: To determine the role of ciprofloxacin in reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP).METHODS: A randomized, controlled trial was performed in 48 cholestatic patients at Rajavithi Hospital (Tertiary Referral Center for ERCP: 600 cases per year). All the 48 patients received 200 mg ciprofloxacin intravenous injection for 30 min before starting any procedures, and then were randomly divided in two groups. Twenty-two patients in study group continually received ciprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and blood (in cholangitis) and clinical cholangitis were recorded.RESULTS: Forty-eight patients were enrolled and divided into continuous ciprofloxacin treatment group (n = 22) and discontinuous ciprofloxacin treatment group (n = 26). During ERCP, stones were found in 22 patients,malignant diseases in 24 patients and other pathologic lesions in 5 patients. One (4.5%) of the 22 patients who received ciprofloxacin and 2 (6.3%) of the 26 patients who discontinued ciprofloxacin after ERCP developed cholangitis (relative risk = 0.71; 95% CI = 0.14-3.65;P = 0.88). Bacterobilia was found in 27 (56.3%) out of 48 patients. E. coli and Streptococcus viridans were the most common organisms.CONCLUSION: Continual use of ciprofloxacin in patients with cholestasis after adequate biliary drainage procedures plays no role in reducing cholangitis.

  2. Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Lu-Long Bo; Yu Bai; Jin-Jun Bian; Ping-Shan Wen; Jin-Bao Li; Xiao-Ming Deng

    2011-01-01

    AIM: To investigate the efficacy and safety of propofol sedation for endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials updated as of October 2010 were searched. Main outcome measures were ERCP procedure duration, recovery time, incidence of hypotension and hypoxia. RESULTS: Six trials with a total of 663 patients were included. The pooled mean difference in ERCP procedure duration between the propofol and traditional sedative agents was -8.05 (95% CI: -16.74 to 0.63), with no significant difference between the groups. The pooled mean difference in the recovery time was -18.69 (95% CI: -25.44 to -11.93), which showed a significant reduction with use of propofol sedation. Compared with traditional sedative agents, the pooled OR with propofol sedation for ERCP causing hypotension or hypoxia was 1.69 (95% CI: 0.82-3.50) and 0.90 (95% CI: 0.55-1.49), respectively, which indicated no significant difference between the groups. CONCLUSION: Propofol sedation during ERCP leads to shorter recovery time without an increase of cardiopulmonary side effects. Propofol sedation can provide adequate sedation during ERCP.

  3. Assessment of patient dose and radiogenic risks during endoscopic retrograde cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Sulieman, A.; Elzaki, M. [Sudan University of Science and Technology, College of Medical Radiologic Science, P. O. Box 1908, Khartoum 11111 (Sudan); Alkhorayef, M.; Babikir, E. [King Saud University, College of Applied Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433 (Saudi Arabia); Abuzaid, M. [University of Sharjah, College of Health Sciences, Medical Diagnostic Imaging Department, Sharjah (United Arab Emirates); Dalton, A.; Bradley, D., E-mail: Abdelmoneim_a@yahoo.com [University of Surrey, Centre for Nuclear and Radiation Physics, Department of Physics, GU2-7XH, Guildford, Surrey (United Kingdom)

    2015-10-15

    Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive technique that has been used for over 30 years in the diagnosis and management of pancreaticobiliary disorders. The objectives of this study were to evaluate the patient entrance surface air kerma doses (ESAK) and estimate the organ and effective doses during ERCP in three hospitals in Khartoum. A total of 55 patients were examined in three hospitals in Khartoum state, Sudan. Calibrated thermoluminescence dosimeters (TLD)-Gr-200-A)) were used to measure patients ESAK. The overall mean of ESAK for all ERCP procedures was 42.4 mGy. The mean patient ESAK in Fedail, Soba and Ibn sena centers were 26.7 mGy, 26.0 mGy, 72.4 mGy, respectively. The effective doses in three centers were 1.6, 1.56 and 2.67 mSv in that order and the overall mean effective dose was 2.01 mSv. Patient radiation doses vary widely among the different hospitals. Patient ESAK is low compared to previous studies in the light of the current practice. Patient dose was decreased significantly in the last two decades. (Author)

  4. An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice

    Institute of Scientific and Technical Information of China (English)

    Georgios Tziatzios; Paraskevas Gkolfakis; Ioannis S Papanikolaou; George Dimitriadis; Konstantinos Triantafyllou

    2016-01-01

    ABSTRACT:Despite the effectiveness of endoscopic retro-grade cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the ifrst case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and nor-malization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, exclud-ing possible remaining choledocholithiasis. Nevertheless, se-rum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient’s liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

  5. Dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    SomchaiAmornyotin; WichitSrikureja; WiyadaChalayonnavin; SiripornKongphlay

    2011-01-01

    BACKGROUND: In general, the dose requirement and complications of propofol are lower when used in the diluted form than in the undiluted form. The aim of this study was to determine the dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography. METHODS: Eighty-six patients were randomly assigned to either group D (diluted propofol) or U (undiluted propofol). All patients were sedated with 0.02-0.03 mg/kg midazolam (total dose ≤2 mg for age RESULTS:  All endoscopies were completed successfully. Mean propofol doses per body weight and per body weight per hour in groups D and U were 3.0 mg/kg, 6.2 mg/kg per hour and 4.7 mg/kg, 8.0 mg/kg per hour, respectively. The mean dose of propofol, expressed as total dose, dose/kg or dose/kg per hour and the recovery time were not significantly different between the two groups. Sedation-related adverse events during and immediately after the procedure were higher in group U (42.9%) than in group D (18.2%) (P=0.013). CONCLUSIONS: Propofol requirement and recovery time in the diluted and undiluted propofol groups were comparable. However, the sedation-related hypotension was significantly lower in the diluted group than the undiluted group.

  6. Significance of C-reactive Protein in the Endoscopic Retrograd Cholangiopancreatography Related Pancreatitis

    Directory of Open Access Journals (Sweden)

    Mete Akin

    2016-01-01

    Full Text Available Aim: Endoscopic retrograde cholangiopancreatography (ERCP may be related with complications such as pancreatitis. C-reactive protein (CRP can be provides reliable informations about post-ERCP complications and their severity. In our study, the role of CRP levels in the follow-up post-ERCP pancreatitis was investigated. Material and Method: 476 patients, whom performed ERCP for different indications, were retrospectively evaluated. 136 patients with measurement of serum amylase, lipase and CRP levels before and 12-24 hours after the procedure were included the study. Alterations of these parameters in complicated and uncomplicated patiens were investigated. The role of CRP in the follow-up and prediction of severity of pancreatitis was investigated in 22 complicated patients with measurement of serum amylase, lypase and CRP levels 36-48 hours after the procedure. Pancreatitis were classified as mild, moderate, or severe. Results: Post-ERCP pancreatitis occured in 23 (17% patients (9 mild and 14 moderate pancreatitis. The mean CRP levels (mg/l at 12 to 24 hours were 23,5 ± 24,18 in uncomplicated patients, and 59,2 ± 44,87 in patiens with pancreatitis (p

  7. Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Michael P Swan; Michael J Bourke; Stephen J Williams; Sina Alexander; Alan Moss; Rick Hope; David Ruppin

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center.METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP.RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 na?ve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017).CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

  8. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly

    Science.gov (United States)

    Tohda, Gen; Ohtani, Masahiro; Dochin, Masaki

    2016-01-01

    AIM To investigate the efficacy and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with acute cholangitis. METHODS From June 2008 to May 2016, emergency ERCPs were performed in 207 cases of acute cholangitis at our institution. Patients were classified as elderly if they were aged 80 years and older (n = 102); controls were under the age of 80 years (n = 105). The patients’ medical records were retrospectively reviewed for comorbidities, laboratory data, etiology of cholangitis (presence of biliary stones, biliary stricture and malignancy), details of the ERCP (therapeutic approaches, technical success rates, procedure duration), ERCP-related complications and mortality. RESULTS The frequency of comorbidities was higher in the elderly group than the control group (91.2% vs 67.6%). Periampullary diverticulum was observed in the elderly group at a higher frequency than the control group (24.5% vs 13.3%). Between the groups, there was no significant difference in the technical success rates (95.1% vs 95.2%) or endoscopic procedure durations. With regard to the frequency of ERCP-related complications, there was no significant difference between the two groups (6.9% vs 6.7%), except for a lower rate of post-ERCP pancreatitis in the elderly group than in the control group (1.0% vs 3.8%). Neither angiographic nor surgical intervention was required in any of the cases with ERCP-related complications. There was no mortality during the observational periods. CONCLUSION Emergency ERCP for acute cholangitis can be performed safely even in elderly patients aged 80 years and older. PMID:27729744

  9. Wire-guided cannulation versus contrast-guided cannulation in pediatric endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Maher Al Hatlani

    2015-01-01

    Full Text Available Background/Aim: Wire-guided cannulation (WGC of the common bile duct may be associated with fewer complications and higher success rate compared with contrast-guided cannulation (CGC in adults. Data in children are lacking. The aim of this study was to compare the successful cannulation and complication rate of WGC and CGC in pediatric endoscopic retrograde cholangiopancreatography (ERCP. Patients and Methods: We report a retrospective cohort study comparing WGC to CGC in a pediatric cohort. We reviewed the medical records of 167 children who underwent ERCP over a 10-year time period (CGC, 1999-2003, WGC, 2003-2009. Indications, findings, and success were analyzed. Results: A total of 93 patients (56% underwent WGC and 74 (44% CGC. Children in the WGC group were younger (9.5 ± 4.7 vs. 11.5 ± 4.6 years in CGC; P = 0.006 and underwent more therapeutic ERCP interventions (70% vs. 40% in CGC, whereas diagnostic ERCP was more common in the CGC group (60%; P < 0.005. The overall success (96% and complication rate (8% were identical in both groups but a trend toward a reduction in the complication rate over time was noted in the WGC group. Post-ERCP pancreatitis (PEP was documented in one patient in the WGC group (1.1% and three patients (4.2% in the CGC group (P-NS. Conclusion: The success and complication rate in both CGC and WGC are comparable in children but considering the patient and procedure complexity and the trend toward lower PEP in the WGC group, WGC may be the preferable cannulation technique for ERCP in children.

  10. Application of needle-knife in dififcult biliary cannulation for endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Ping-Hong Zhou; Li-Qing Yao; Mei-Dong Xu; Yun-Shi Zhong; Wei-Dong Gao; Guo-Jie He; Yi-Qun Zhang; Wei-Feng Chen; Xin-Yu Qin

    2006-01-01

    BACKGROUND:Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10%of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or ifstulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in dififcult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups. RESULTS:A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with dififcult biliary cannulation, 43 patients underwent needle-knife cut:the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques:the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Signiifcant differences were observed in cannulation success rate and cannulation time but in complication rate between the two groups. CONCLUSION: The early application of the needle-knife in dififcult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.

  11. Comparison of Clinical Effects of Dexketoprofen and Paracetamol Used for Analgesia in Endoscopic Retrograde Cholangiopancreatography

    Science.gov (United States)

    Akıncı, Nuran; Bakan, Nurten; Karaören, Gülşah; Tomruk, Senay Göksu; Sökmen, Hacı Mehmet; Yanlı, Yonca; Akçay, Mehmet Erdem

    2016-01-01

    Objective This study aimed to compare 50 mg dexketoprofen vs. 1 g paracetamol that were parenterally administered before endoscopic retrograde cholangiopancreatography (ERCP) under sedoanalgesia with comparable anaesthesia depth regarding haemodynamic, pain, narcotic analgesic requirement, recovery and post-procedural cognitive functions. Methods Overall, 80 ASA I–III patients aged 18–75 years who were undergoing scheduled ERCP were randomly assigned into three groups. In all patients, the mini-mental test (MMT) was conducted before the procedure. No drug was administered to controls (Group C; n=26); patients were transferred to ERCP unite 30 min after parenteral dexketoprofen (50 mg) in group D (n=27) and paracetamol (1 g) in group P (n=27). The standard monitoring was applied. After intravenously administering loading doses of midazolam (0.02 mgkg) and propofol (1 mg kg−1), propofol infusion was administered at a dose of 2–4 mg kg−1 h−1 to maintain a bispectral index value of 50–70. Fentanyl (0.05 μg kg−1) was intravenously administered when patients experienced pain. Haemodynamic effects, additional analgesic requirement, adverse effects during procedure, time to reach Aldrete score of 9 and satisfaction of an endoscopist and patient were recorded. MMT was repeated 3 h after completing the procedure. Results Fentanyl requirement during the procedure was significantly low in group D (p<0.05). Apnoea during the procedure and nausea after the procedure were least common in group D while significantly lower than group C (p<0.05). There was no significant difference with respect to MMT scores and endoscopist’s satisfaction, while patient satisfaction was greater in group P. Conclusion Parenterally administered dexketoprofen provided better haemodynamic effect and pain control, thereby decreasing incidence of adverse events by reducing the requirement for narcotic analgesics. PMID:27366549

  12. N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Janusz Milewski; Grazyna Rydzewska; Malgorzata Degowska; Maciej Kierzkiewicz; Andrzej Rydzewski

    2006-01-01

    AIM: Acute pancreatitis (AP) is the most common and often severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The early step in the pathogenesis of acute pancreatitis is probably the capil lary endothelial injury mediated by oxygen-derived freeradicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine (ACC) can reduce the severity of disease in experimental model of AP.METHODS: One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine (two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP). The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity.RESULTS: There were no significant differences in the rate of post-ERCP pancreatitis between two groups (10patients overall, 4 in the ACC group and 6 in the control group). There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group.CONCLUSION: N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.

  13. Effects of indomethacin suppositories on serum amylase, inflammatory factors and immune function after endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Xiao-Bin Peng; Xiao-Yun Wang; Gao-Jue Wu; Zhen Hu; Shuang Tang; Lei Gong

    2016-01-01

    Objective:To explore the effects of indomethacin suppositories on serum amylase, inflammatory factors and immune function after endoscopic retrograde cholangiopancreatography (ERCP).Methods:A total of 85 patients with common bile duct stones or obstructive jaundice were divided into the observation group (n=45) and the control group (n=40) according to the different treatment methods, both two groups patients were treated with ERCP, patients in the observation group was given indomethacin suppositories 50 mg preoperative 30 min. Serum amylase, inflammatory factors and T cell subsets were detected preoperative, postoperative 6h and postoperative 24h. Inflammatory factors including interleukin -10 (IL-10), interleukin -6 (IL-6), tumor necrosis factor alpha (TNF-α) and interleukin-4 (IL-4). T cell subsets including CD3+, CD4+, CD8+ and calculated CD4+/CD8+.Results:In both two groups, postoperative 6h, 24h serum amylase were significantly higher than before surgery; in the observation group, the postoperative 6h, 24h serum amylase were significantly lower than in the control group at the same time point and the differences were statistically significant (P<0.05). Both two groups’ postoperative 6h, 24h serum pro-inflammatory factor IL-6 and TNF-α increased first and then decreased, both were significantly higher than before surgery; both two groups’ postoperative 6h, 24h serum anti-inflammatory factor IL-10 and IL-4 gradually increased, both were significantly higher than before surgery, and the differences were statistically significant (P<0.05); In the observation group, anti-inflammatory factor IL-10 and IL-4 significantly increased while pro-inflammatory factor IL-6 and TNF-α significantly decreased compared with the control group at the same time point 6h and 24h after surgery, the difference between the two groups was statistically significant (P<0.05). Both two groups’ postoperative 6h, 24h T cell subsets CD3+, CD4+, CD4+/CD8+first decreased and then

  14. Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography: A meta-analysis and systematic review

    Institute of Scientific and Technical Information of China (English)

    Yao Cheng; Xian-Ze Xiong; Si-Jia Wu; Jiong Lu; Yi-Xin Lin; Nan-Sheng Cheng; Tai-Xiang Wu

    2012-01-01

    AIM:To assess the safety and efficacy of carbon dioxide (CO2) insufflation during endoscopic retrograde cholangiopancreatography (ERCP).METHODS:The Cochrane Library,Medical Literature Analysis and Retrieval System Online,Excerpta Medica Database,Science Citation Index Expanded,Chinese Biomedical Literature Database,and references in relevant publications were searched up to December 2011 to identify randomized controlled trials (RCTs)comparing CO2 insufflation with air insufflation during ERCP.The trials were included in the review irrespective of sample size,publication status,or language.Study selection and data extraction were performed by two independent authors.The meta-analysis was performed using Review Manager 5.1.6.A randomeffects model was used to analyze various outcomes.Sensitivity and subgroup analyses were performed if necessary.RESULTS:Seven double-blind RCTs involving a total of 818 patients were identified that compared CO2insuftlation (n =404) with air insufflation (n =401)during ERCR There were a total of 13 post-randomization dropouts in four RCTs.Six RCTs had a high risk of bias and one had a low risk of bias.None of the RCTs reported any severe gas-related adverse events in either group.A meta-analysis of 5 RCTs (n =459)indicated that patients in the CO2 insufflation group had less post-ERCP abdominal pain and distension for at least 1 h compared with patients in the air insufflation group.There were no significant differences in mild cardiopulmonary complications [risk ratio (RR) =0.43,95% CI:0.07-2.66,P =0.36],cardiopulmonary (e.g.,blood CO2 level) changes [standardized mean difference (SMD) =-0.97,95% CI:-2.58-0.63,P =0.23],cost analysis (mean difference =3.14,95% CI:-14.57-20.85,P =0.73),and total procedure time (SMD=-0.05,95% CI:-0.26-0.17,P =0.67) between the two groups.CONCLUSION:CO2 insufflation during ERCP appears to be safe and reduces post-ERCP abdominal pain and discomfort.

  15. Increased fat in pancreas not associated with risk of pancreatitis post-endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Pokhrel B

    2014-06-01

    Full Text Available Bhupesh Pokhrel,1 Eun Kwang Choi,1 Omer Khalid,2 Kumar Sandrasegaran,3 Evan L Fogel,1 Lee McHenry,1 Stuart Sherman,1 James Watkins,1 Gregory A Cote,1 Henry A Pitt,4 Nicholas J Zyromski,4 Beth Juliar,1 Glen A Lehman11Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 2Department of Gastroenterology, St Louis University School of Medicine, St Louis, MO, 3Department of Radiology, 4Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USABackground: A preliminary study has shown increased pancreatic fat in patients with idiopathic pancreatitis and sphincter of Oddi dysfunction. In this study, we aimed to determine if an increased quantity of pancreatic fat is an independent risk factor for pancreatitis post-endoscopic retrograde cholangiopancreatography (ERCP.Methods: In this case control study, we retrospectively reviewed a local radiological and ERCP database to identify patients who had had abdominal magnetic resonance imaging (MRI followed by ERCP no more than 60 days later between September 2003 and January 2011. Percentage of fat was determined by recording signal intensity in the in-phase (Sin and out-of-phase (Sout T1-weighted gradient sequences, and calculation of the fat fraction as (Sin - Sout/(Sin × 2 by an abdominal radiologist blinded to clinical history. Controls matched for age, gender, and other pancreatobiliary disease were selected from a group with no post-ERCP pancreatitis (before fat content of the pancreas was analyzed.Results: Forty-seven patients were enrolled. Compared with controls, subjects with post-ERCP pancreatitis were similar in terms of age (41.4 years versus 41.1 years, gender (21.2% versus 20.2% males, pancreatobiliary disease characteristics, and most ERCP techniques. Measurements of pancreatic head, body, and tail fat and body mass index were similar in patients and controls.Conclusion: Increased pancreatic fat on MRI criteria is not an independent

  16. Prophylactic effect of glyceryl trinitrate on post-endoscopic retrograde cholangiopancreatography pancreatitis: A randomized placebo-controlled trial

    Institute of Scientific and Technical Information of China (English)

    Jian-Yu Hao; Dong-Fang Wu; Yue-Zeng Wang; Ying-Xin Gao; Hai-Po Lang; Wei-Zhen Zhou

    2009-01-01

    AIM: To examine the prophy lacticef fect of glyceryl trinitrate on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasemia.METHODS: Patients scheduled for ERCP were randomly divided into study group and placebo group. Patients in study group and placebo group were treated with 5 mg glyceryl trinitrate and 100 mg vitamin C, respectively, 5 min before endoscopic maneuvers.RESULTS: A total of 74 patients were enrolled in the final analysis. Post-ERCP pancreatitis occurred in 3 patients (7.9%) of the study group and 9 patients (25%) in the placebo group ( P = 0.012).Hyperamylasemia occurred in 8 patients of the study group (21.1%) and 13 patients (36.1%) of the placebo group ( P = 0.037).CONCLUSION: Glyceryl trinitrate before ERCP can effectively prevent post-ERCP and hyperamylasemia.

  17. Comparison between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP); Comparacion entre calongiografia por resonancia magnetica (CPRM) y colangiografia retrograda endoscopia (CPRE)

    Energy Technology Data Exchange (ETDEWEB)

    Pulpeiro, J. R.; Armesto, V. [Clinica Nosa Senora dos Ollos Grandes. Lugo (Spain); Lopez-Roses, L.; Lancho, A.; Gonzalez, A. [Hospital Xeral. Lugo (Spain)

    2000-07-01

    To assess the correlation between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). The authors carried out a prospective study of 71 patients suspected of having biliary diseases. MRCP was performed, followed by ERCP.MRCP was done with a 1.5-T system using hypergradients, abdominal phase array coil and single-shot fast spin-echo (SSFSE) sequences with maximum signal intensity in T2-weighted images. This sequence only provides images of the fluids, similar to those obtained with ERCP. The results of ERCP were employed as a reference standard. Thirty patients were found to have stenosis (19 malignant and 11 benign). 25 had choledocholithiasis and 16 showed no abnormal findings. The correlation was complete in patients with stenosis. MRCP detected 23 cases of choledocholithiasis (ERCP was normal in the remaining two patients, but calculi were discovered on shpincterotomy). MRCP confirmed the normal condition of the bile duct in 12 of the 16 patients free of biliary disease (2 patients in whom ERCP had been normal had been diagnosed as having bile duct dilatation due to choledocholithiasis 24 hours and 10 days earlier, respectively, and two cases of presented ectasia due to fibrosis of the sphincter of Oddi showed good emptying during ERCP). MRCP using SSFSE is highly correlated with ERCP, which should be reserved for cases in which the diagnosis is in doubt or endoscopic management is necessary. (Author) 25 refs.

  18. Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Yoshiaki Kawaguchi; Masami Ogawa; Fumio Omata; Hiroyuki Ito; Tooru Shimosegawa; Tetsuya Mine

    2012-01-01

    AIM:To determine the effectiveness of pancreatic duct (PD) stent placement for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high risk patients.METHODS:Authors conducted a single-blind,randomized controlled trial to evaluate the effectiveness of a pancreatic spontaneous dislodgement stent against post-ERCP pancreatitis,including rates of spontaneous dislodgement and complications.Authors defined high risk patients as having any of the following:sphincter of Oddi dysfunction,difficult cannulation,prior history of post-ERCP pancreatitis,pre-cut sphincterotomy,pancreatic ductal biopsy,pancreatic sphincterotomy,intraductal ultrasonography,or a procedure time of more than 30 min.Patients were randomized to a stent group (n =60) or to a non-stent group (n =60).An abdominal radiograph was obtained daily to assess spontaneous stent dislodgement.Post-ERCP pancreatitis was diagnosed according to consensus criteria.RESULTS:The mean age (± standard deviation) was 67.4 ± 13.8 years and the male:female ratio was 68:52.In the stent group,the mean age was 66 ± 13years and the male:female ratio was 33:27,and in the non-stent group,the mean age was 68 ± 14 years and the male:female ratio was 35:25.There were no significant differences between groups with respect to age,gender,final diagnosis,or type of endoscopic intervention.The frequency of post-ERCP pancreatitis in PD stent and non-stent groups was 1.7% (1/60) and 13.3% (8/60),respectively.The severity of pancreatitis was mild in all cases.The frequency of post-ERCP pancreatitis in the stent group was significantly lower than in the non-stent group (P =0.032,Fisher's exact test).The rate of hyperamylasemia were 30% (18/60) and 38.3% (23 of 60) in the stent and non-stent groups,respectively (P =0.05,x2 test).The placement of a PD stent was successful in all 60 patients.The rate of spontaneous dislodgement by the third day was 96.7% (58/60),and the median (range) time to

  19. Bispectral index monitoring as an adjunct to nurse-administered combined sedation during endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Se Young Jang; Hyun Gu Park; Min Kyu Jung; Chang Min Cho; Soo Young Park; Seong Woo Jeon; Won Young Tak

    2012-01-01

    AIM:TO determine whether bispectral index (BIS)monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP).METHODS:Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010.This was a randomized cross-over study,in which each patient underwent ERCP twice,once with BIS monitoring and once with control monitoring.Whether BIS monitoring was done during the first or second ERCP procedure was random.Patients were intermittently administered a mixed regimen including midazolam,pethidine,and propofol by trained nurses.The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring.The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups.RESULTS:The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9± 30.8 mg in the control group (P =0.673).The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P =0.103).The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups.The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor.No significant differences in the frequency of < 80% oxygen saturation,hypotension (< 80 mmHg),or bradycardia (< 50 beats/min) were observed between the two study groups.Four cases of poor cooperation occurred,in which the procedure should be stopped to add the propofol dose.After adding the propofol,the procedure could be conducted successfully (one case in the BIS group,three cases in the control group).The endoscopist rated patient sedation as excellent for

  20. Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure

    Directory of Open Access Journals (Sweden)

    Chalkoo Mushtaq

    2009-01-01

    Full Text Available We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

  1. The Diagnostic Value of Endoscopic Balloon Catheter Usage for Detecting Early-Stage Primary Sclerosing Cholangitis in Endoscopic Retrograde Cholangiopancreatography:A Case Report

    Directory of Open Access Journals (Sweden)

    Burhan Ozdil

    2010-02-01

    Full Text Available A 34-year-old woman was admitted to our clinic with abdominal pain, jaundice and pruritus. Endoscopic retrograde cholangiopancreatography was performed for cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP was judged as normal, after a standard ERCP cannula was used for the cholangiogram. However, marked canalicular irregularities were identified in cholangiography when pressurized contrast agent was administrated via balloon catheter. This cholangiographic view was thought to reveal an early-stage alteration of sclerosing cholangitis. Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease characterized by destruction and fibrosis of the bile ducts. The diagnosis of PSC is based on typical cholangiographic findings, supported by nonspecific clinical signs and symptoms, cholestatic liver biochemical tests, and liver biopsy. Cholangiography is considered to be the gold standard for the diagnosis of PSC. The diagnosis is easy when diffuse multifocal biliary strictures, the hallmarks of the disease, resulting in a ‘beaded’ appearance on ERCP is detected. However, it may reveal a normal image in an early stage of the disease when bile duct changings are not prominent. We think that balloon catheter ERCP appears to facilitate the diagnosis of early-stage primary sclerosing cholangitis.

  2. Propofol-based deep sedation for endoscopic retrograde cholangiopancreatography procedure in sick elderly patients in a developing country

    Directory of Open Access Journals (Sweden)

    Amornyotin S

    2011-06-01

    Full Text Available Somchai Amornyotin1,3, Udom Kachintorn2,3, Wiyada Chalayonnawin1,3, Siriporn Kongphlay1,31Department of Anesthesiology, 2Department of Medicine, 3Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandIntroduction: The aim of this study was to evaluate and compare the clinical efficacy of propofol-based deep sedation (PBDS for endoscopic retrograde cholangiopancreatography (ERCP procedure in sick (American Society of Anesthesiologists [ASA] physical status III–IV and nonsick (ASA physical status I–II elderly patients in a teaching hospital in Thailand.Methods: We undertook a retrospective review of the anesthesia or sedation service records of elderly patients who underwent ERCP procedures from October 2007 to September 2008. All patients were classified into two groups according to the ASA physical status. In group A, the patients had ASA physical status I–II, while in group B, the patients had ASA physical status III–IV. The primary outcome variable of the study was the successful completion of the procedure. The secondary outcome variables were sedation-related adverse events during and immediately after the procedure.Results: There were 158 elderly patients who underwent ERCP procedure by using PBDS during the study period. Of these, 109 patients were in group A and 49 patients were in group B. There were no significant differences in age, gender, weight, duration of ERCP, indication of procedure, and the mean dose of fentanyl, propofol, and midazolam between the two groups. All patients in both groups successfully completed the procedure except eight patients in group A and three patients in group B (P = 0.781. Overall, respiratory and cardiovascular adverse events in both groups were not significantly different. All adverse events were easily treated, with no adverse sequelae.Conclusion: In the setting of a developing country, PBDS for ERCP procedure in sick elderly patients by

  3. Diagnosis of mild chronic pancreatitis (Cambridge classification): Comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To investigate the usefulness of secretin injection MRCP for the diagnosis of mild chronic pancreatitis. METHODS: Sixteen patients having mild chronic pancreatitis according to the Cambridge classification and 12 control subjects with no abnormal findings on the pancreatogram were examined for the diagnostic accuracy of secretin injection-MRCP regarding abnormal branch pancreatic ducts associated with mild chronic pancreatitis (Cambridge Classification), using endoscopic retrograde cholangiopancreatography (ERCP) for comparison. RESULTS: The sensitivity and specificity for abnormal branch pancreatic ducts determined by two reviewers were respectively 55%-63% and 75%-83% in the head, 57%-64% and 82%-83% in the body, and 44%-44%and 72%-76% in the tail of the pancreas. The sensitivity and specificity for mild chronic pancreatitis were 56%-63% and 92%-92%, respectively. Interobserver abnormal branch pancreatic duct and of mild chronic pancreatitis was good to excellent. CONCLUSION: Secretin injection-MRCP might be useful for the diagnosis of mild chronic pancreatitis.

  4. Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructivegastrointestinal surgical anatomy

    Institute of Scientific and Technical Information of China (English)

    Majed El Zouhairi; James B Watson; Svetang V Desai; David K Swartz; Alejandra Castillo-Roth; Mahfuzul Haque; Paul S Jowell; Malcolm S Branch; Rebecca A Burbridge

    2015-01-01

    AIM: To evaluate the success rates of performingtherapy utilizing a rotational assisted enteroscopy devicein endoscopic retrograde cholangiopancreatography(ERCP) in surgically altered anatomy patients.METHODS: Between June 1, 2009 and November8, 2012, we performed 42 ERCPs with the use ofrotational enteroscopy for patients with alteredanatomy (39 with gastric bypass Roux-en-Y, 2 withBillroth Ⅱ gastrectomy, and 1 with hepaticojejunostomyassociated with liver transplant). The indications forERCP were: choledocholithiasis: 13 of 42 (30.9%),biliary obstruction suggested on imaging: 20 of 42(47.6%), suspected sphincter of Oddi dysfunction: 4 of42 (9.5%), abnormal liver enzymes: 1 of 42 (2.4%),ascending cholangitis: 2 of 42 (4.8%), and bile leak: 2of 42 (4.8%). All procedures were completed with theOlympus SIF-Q180 enteroscope and the Endo-EaseDiscovery SB overtube produced by Spirus Medical.RESULTS: Successful visualization of the majorampulla was accomplished in 32 of 42 procedures(76.2%). Cannulation of the bile duct was successfulin 26 of 32 procedures reaching the major ampulla(81.3%). Successful therapeutic intervention wascompleted in 24 of 26 procedures in which the bile duct was cannulated (92.3%). The overall intention to treat success rate was 64.3%. In terms of cannulation success, the intention to treat success rate was 61.5%. Ten out of forty two patients (23.8%) required admission to the hospital after procedure for abdominal pain and nausea, and 3 of those 10 patients (7.1%) had a diagnosis of post-ERCP pancreatitis. The average hospital stay was 3 d. CONCLUSION: It is reasonable to consider an attempt at rotational assisted ERCP prior to a surgical intervention to alleviate biliary complications in patients with altered surgical anatomy.

  5. Endoscopic Retrograde Cholangiopancreatography Using a Dual-Lumen Endogastroscope for Patients with Billroth II Gastrectomy

    Directory of Open Access Journals (Sweden)

    Wei Yao

    2013-01-01

    Full Text Available Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy. Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed. Results. The success rate of selective cannulation was 82.6% (38/46. Of the 38 cases with successful selective cannulation, endoscopic sphincterotomy was achieved in 23 cases by placing the needle knife through the 2nd lumen, while endoscopic papillary balloon dilatation was conducted in the other 15 cases. Of the 8 failed cases of selective cannulation, 6 had failed afferent loop intubation, and 3 of these 6 patients had Braun’s anastomosis. The safety and efficacy of catheter-assisted endoscopic sphincterotomy were increased by placing the needle knife through the 2nd lumen without altering the conventional endoscopic sphincterotomy procedure. Conclusions. A dual-lumen forward-viewing endoscope can be safely and effectively used to perform ERCP in patients with a Billroth II gastrectomy, except for patients with additional Braun’s anastomosis.

  6. Detection of K-ras point mutation and telomerase activity during endoscopic retrograde cholangiopancreatography in diagnosis of pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Guo-Xiong Zhou; Jie-Fei Huang; Zhao-Shen Li; Guo-Ming Xu; Feng Liu; Hong Zhang

    2004-01-01

    AIM: To study the value of monitoring K-ras point mutation at codon 12 and telomerase activity in exfoliated cells obtained from pancreatic duct brushings during endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic cancer.METHODS: Exfoliated cells obtained from pancreatic duct brushings during ERCP were examined in 27 patients: 23with pancreatic cancers, 4 with chronic pancreatitis. K-fas point mutation was detected with the polymerase chain reaction and restriction fragment-length polymorphism (PCR-RFLP). Telomerase activity was detected by PCR and telomeric repeat amplification protocol assay (PCR-TRAPELISA).RESULTS: The telomerase activities in 27 patients were measured in 21 exfoliated cell samples obtained from pancreatic duct brushings. D450 value of telomerase activities in pancreatic cancer and chronic pancreatitis were 0.446±0.27and 0.041±0.0111, respectively. Seventy-seven point eight percent (14/18) of patients with pancreatic cancer and none of the patients with chronic pancreatitis showed telomerase activity in cells collected from pancreatic duct brushings when cutoff value of telomerase activity was set at 2.0. The K-ras gene mutation rate (72.2%) in pancreatic cancer was higher than that in chronic pancreatitis (33.3%)(P<0.05). In considering of both telomerase activities and K-ras point mutation, the total positive rate was 83.3%(15/18), and the specificity was 100%.CONCLUSION: Changes of telomerase activities and K-ras point mutation at codon 12 may be an early event of malignant progression in pancreatic cancer. Detection of telomerase activity and K-ras point mutation at codon 12may be complementary to each other, and is useful in diagnosis of pancreatic cancer.

  7. Outpatient endoscopic retrograde cholangiopancreatography: Safety and efficacy of anesthetic management with a natural airway in 653 consecutive procedures

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    Basavana G Goudra

    2013-01-01

    Full Text Available Background: Endoscopic retrograde cholangiopancreatography (ERCP is a unique diagnostic and therapeutic procedure performed in high risk patients in prone/semi-prone position. Propofol based deep sedation has emerged as the method of choice however, the ability to predict possible complications is yet un-explored. Aims: The present study aimed to evaluate known high risk-factors for general anesthesia (American Society of Anesthesiologists (ASA status, body mass index (BMI, and Mallampati class for their ability to affect outcomes in ERCP patients. Study Design: Retrospective data of 653 patients who underwent ERCP during a period of 26 months at university hospital of Pennsylvania was reviewed. Patient-specific and procedure specific data was extracted. Desaturation was defined by fall of pulse oximeter saturation below 95% and its relation to patient specific high risk-factors was analyzed. Results: Only 45 patients had transient de-saturation below 95% without any residual sequlae. No statistically significant relation between desaturation episodes and patients higher ASA status or BMI or modified Mallampati (MMP class was found. Despite 60% patients being ASA III/IV none required emergency intubation or procedural interruption. Optimal oxygenation and airway patency was maintained with high degree of success using simple airway maneuvers or conduit devices (nasal/oral trumpet with oxygen supplementation in all patients. Conclusions: Unlike general anesthesia, pre-operative patient ASA status, higher MMP or increasing BMI does not bear relation with likelihood of patients desaturating during ERCP. In presence of vigilant apnea monitoring and careful dose titration of maintenance anesthetics with airway conduits, general anesthesia, emergency intubations, and procedure interruptions can be avoided.

  8. Factors Affecting the Efficacy of Nonsteroidal Anti-inflammatory Drugs in Preventing Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

    Science.gov (United States)

    Rustagi, Tarun; Njei, Basile

    2016-01-01

    Objectives To identify the factors affecting the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods We systematically searched databases for relevant studies published from inception to November 2013. Results A meta-analysis of 11 randomized trials (n = 2497) revealed a significant reduction in PEP in patients who received NSAIDs compared with that in patients who received placebo (relative risk [RR], 0.59; 95% confidence interval [CI], 0.41–0.85; P = 0.005). In subgroup analysis by treatment type, indomethacin had no significant effect (RR, 0.66; 95% CI, 0.38–1.15; P = 0.14), whereas other NSAIDs showed significant benefit (RR, 0.51; 95% CI, 0.29–0.91; P = 0.02). Only rectal administration significantly reduced the incidence of PEP (RR, 0.43; 95% CI, 0.32–0.58; P < 0.00001). The risk for PEP was the lowest among patients who received NSAIDs before ERCP (RR, 0.48; 95% CI, 0.29–0.78; P = 0.003). NSAIDs did not significantly reduce the risk of PEP in men (RR, 0.61; 95% CI, 0.34–1.09), patients with sphincter of Oddi dysfunction (RR, 0.98; 95% CI, 0.38–2.54), or patients with pancreatic duct injection (RR, 0.64; 95% CI, 0.35–1.18). Conclusions Rectal administration of NSAIDs (especially diclofenac), before ERCP, seemed to be the most effective strategy for preventing PEP. PMID:26168316

  9. High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

    Science.gov (United States)

    Schumann, Roman; Natov, Nikola S; Rocuts-Martinez, Klifford A; Finkelman, Matthew D; Phan, Tom V; Hegde, Sanjay R; Knapp, Robert M

    2016-01-01

    AIM To examine whether high-flow nasal oxygen (HFNO) availability influences the use of general anesthesia (GA) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and associated outcomes. METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras (era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era (era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively. RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P sedation was significantly higher in era 2 compared to era 3 (P sedation (P ≤ 0.007) as was the anesthesia-only time (P ≤ 0.001). CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation. PMID:28058020

  10. Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial

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    Priyanka Sethi

    2014-01-01

    Full Text Available Background: Traditionally, midazolam has been used for providing conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP. Recently, dexmedetomidine has been tried, but very little evidence exists to support its use. Objective: The primary objective was to compare haemodynamic, respiratory and recovery profile of both drugs. Secondary objective was to compare the degree of comfort experienced by patients and the usefulness of the drug to endoscopist. Study Design: Open-label Randomised Controlled Trial. Methods: Subjects between 18 and 60 years of age with American Society of Anaesthesiologist Grade I-II requiring ERCP were enrolled in two groups (30 each. Both groups received fentanyl 1 μg/kg IV at the beginning of ERCP. Group M received IV midazolam (0.04 mg/kg and additional 0.5 mg doses until Ramsay Sedation Scale (RSS score reached 3-4. Group D received dexmedetomidine at loading dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/h infusion until RSS reached 3-4. The vital parameters (heart rate (HR, blood pressure (BP, respiration rate, SpO 2 , time to achieve RSS 3-4 and facial pain score (FPS were compared during and after the procedure. In the recovery room, time to reach modified Aldrete score (MAS 9-10 and patient and surgeon′s satisfaction scores was also recorded and compared. Any complication during or after the procedure were also noted. Results: In Group D, patients had lower HR and FPS at 5, 10 and 15 min following the initiation of sedation (P<0.05. There was no statistically significant difference in BP and respiratory rate. The procedure elicited a gag response in 29 (97% and 7 (23% subjects in Group M and Group D respectively (P<0.05. MAS of 9-10 at 5 min during recovery was achieved in 27 (90% subjects in Group D in contrast to 5 (17% in Group M (P<0.05. Dexmedetomidine showed higher patient and surgeon satisfaction scores (P<0.05. Conclusion: Dexmedetomidine can be a superior alternative to midazolam

  11. Assessment of the effects of ketamine-fentanyl combination versus propofol-remifentanil combination for sedation during endoscopic retrograde cholangiopancreatography

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    Sayed Morteza Heidari

    2014-01-01

    Full Text Available Background: Endoscopic retrograde cholangiopancreatography (ERCP as a diagnostic and treatment procedure is used in most biliary tract and pancreatic. Either sedation or general anesthesia could be considered for this procedure. Combining a sedative with an opioid agent can provide effective moderate sedation. This study compared the impact of ketamine-fentanyl (KF versus propofol-remifentanil (PR on sedation scale in patients undergoing ERCP. Materials and Methods: As a double-blinded randomized clinical trial, 80 patients selected by convenient sampling, allocated randomly into two groups. KF group received ketamine 0.5 mg/kg body weight intravenously over 60 s and then fentanyl 1 mcg/kg body weight intravenously. PR group received propofol l mg/kg body weight intravenously over 60 s and then remifentanil 0.05 mcg/kg body weight/min intravenously. Intravenous (IV infusion of propofol was maintained by 50 mcg/kg body weight/min throughout ERCP. Ramsay Sedation Score, vital signs, oxygen saturation (SpO 2 , recovery score (modified Aldrete score and visual analog scales of pain intensity, and endoscopist′s satisfaction were considered as measured outcomes. All analysis were analyzed by SPSS Statistics version 22 and using t-test, Chi-square and repeated measured ANOVA and Mann-Whitney tests for data analysis. Results: Respiratory rate and SpO 2 level during the time intervals were lower in PR group (P < 0.001. Sedation score at intervals was not significantly different (P = 0.07. The frequency of apnea in PR group was significantly higher than the KF group (P = 0.003. The percentage of need to supplemental oxygen in PR group was 35.1% that was also significantly higher than 8.8% in the KF group (P = 0.008, but the dosage frequency was significantly higher in KF group (P < 0.001. The KF and PR groups average length of stay in the recovery room were 50.71 standard deviation (SD = 9.99 and 42.57 (SD = 11.99 minutes, respectively, indicating a

  12. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography

    Science.gov (United States)

    Khashab, Mouen A.; Van der Merwe, Schalk; Kunda, Rastislav; El Zein, Mohamad H.; Teoh, Anthony Y.; Marson, Fernando P.; Fabbri, Carlo; Tarantino, Ilaria; Varadarajulu, Shyam; Modayil, Rani J.; Stavropoulos, Stavros N.; Peñas, Irene; Ngamruengphong, Saowanee; Kumbhari, Vivek; Romagnuolo, Joseph; Shah, Raj; Kalloo, Anthony N.; Perez-Miranda, Manuel; Artifon, Everson L.

    2016-01-01

    Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon’s severity grading system. Overall survival and duration of stent patency were calculated using Kaplan–Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 – 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 – 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 – 86

  13. Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial

    Science.gov (United States)

    Bahrami Gorji, Fakhroddin; Amri, Parviz; Shokri, Javad; Alereza, Hakimeh; Bijani, Ali

    2016-01-01

    Background Endoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation. Objectives In this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP. Methods In this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded. Results The sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05). Conclusions The results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease. PMID:27853681

  14. Colangiopancreatografia endoscópica retrógrada (CPRE intraoperatória como alternativa no tratamento de coledocolitíase Intraoperative endoscopic retrograde cholangiopancreatography (CPRE as an alternative for choledocholithiasis treatment

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    Eric Ettinger Júnior

    2007-03-01

    Full Text Available RACIONAL: O tratamento da coledocolitíase continua controverso, podendo ser realizado por pancreatocolangiografia retrógrada endoscópica pré-operatória seguida de videolaparocolecistectomia ou por videolaparocolecistectomia com exploração de vias biliares. Há relato na literatura de taxa de insucesso da pancreatocolangiografia retrógrada endoscópica pré-operatória em torno de 6%. OBJETIVO: Apresentar caso de uma paciente que necessitou da realização de CPRE intra-operatória para resolução de coledocolitíase tratada sem êxito por CPRE. RELATO DO CASO: Paciente de 45 anos, admitida na emergência com quadro de dor abdominal em epigástrio e hipocôndrio direito. A ultra-sonografia da admissão evidenciou coledocolitíase, sendo ela encaminhada para pancreatocolangiografia retrógrada endoscópica pré-operatória onde não houve sucesso na cateterização da papila. Foi optado então pela realização de videolaparocolecistectomia com exploração de via biliar por pancreatocolangiografia retrógrada endoscópica pré-operatória intra-operatoria com a cateterização da papila direcionada por fio guia passado pelo ducto cístico. Foi realizada duodenoscopia com captura do fio guia que serviu para a passagem do papilótomo dando seqüência à pancreatocolangiografia retrógrada endoscópica pré-operatória e retirada dos cálculos. A paciente evoluiu satisfatoriamente tendo alta no 2º dia do pós-operatório. CONCLUSÃO: A abordagem da coledocolitíase por pancreatocolangiografia retrógrada endoscópica intra-operatória seguida de videolaparocolecistectomia, mostrou-se segura e eficaz.BACKGROUND:Choledocholithiasis treatment is still a controversial topic, being done either with endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy or by the use of laparoscopic cholecystectomy and exploration of common bile duct. According to literature, there is an unsuccessful rate of 6% when utilizing pre

  15. A colangiopancreatografia retrógrada endoscópica pode ser realizada com segurança em caráter ambulatorial Safety of endoscopic retrograde cholangiopancreatography performed in ambulatory centers

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    Mara Virginia Lellis Marçal

    2005-03-01

    á evolução nos pacientes inicialmente liberados, confirmando a segurança na realização da colangiopancreatografia endoscópica retrógrada em ambulatório.BACKGROUND: Endoscopic retrograde cholangiopancreatography is effective technique to approach various biliary and pancreatic disorders. Safety of endoscopic retrograde cholangiopancreatography on an outpatient basis has been questioned. OBJECTIVES: To evaluate the safety of outpatient endoscopic retrograde cholangiopancreatography and describe procedure complications. PATIENTS/METHOD: We prospectively assessed outpatients endoscopic retrograde cholangiopancreatography during 2001 to 2003 period. Complications were defined according to consensus criteria and all adverse effects related to procedure were included. RESULTS: One hundred and ninety five outpatients endoscopic retrograde cholangiopancreatography were performed, 79 (40.5% diagnostic and 116 (59.5% therapeutic. The study group included 112 women, mean age 51 (± 18.9 years. The most common diagnoses were: biliary calculi (30.2%, benign stenosis, (13.8%, malignant obstruction (10.2% and chronic pancreatitis (10.2%. Success was achieved in 88.6% of diagnostic endoscopic retrograde cholangiopancreatography and 78.5% in therapeutic. Complications necessitating observation developed in 10 (5.1% of 195 endoscopic retrograde cholangiopancreatography, among them, 7 (3.6% were hospitalized, (2 acute pancreatitis, 2 perforations, 1 bleeding, 1 cardio-respiratory e 1 fever. Among 188 patients initially discharged 8 (4.2% needed readmission (1 acute pancreatitis, 1 bleeding, 1 perforation, 3 cholangitis, 2 abdominal pain. Comparing the first group where complications were immediately identified to the second, no significant statistical difference concerning to age, sex, diagnoses and procedure difficulty degree was found. CONCLUSION: Sample size and negative statistical results failed to determinate independent risk factors for outpatients endoscopic retrograde

  16. 儿童胰腺炎ERCP术后并发症研究%Complications of endoscopic retrograde cholangiopancreatography(ERCP) in children with pancreatitis

    Institute of Scientific and Technical Information of China (English)

    施新岗; 李兆申; 许国铭; 邹晓平; 金震东; 孙振兴

    2002-01-01

    目的分析儿童胰腺炎患者经内镜逆行胰胆管造影(endoscopic retrograde cholangiop-ancreatography, ERCP)术后高淀粉酶血症、胰腺炎及出血等并发症的发生率,探讨其安全性.方法回顾分析1997年2月~2002年2月间入住我科确诊为儿童胰腺炎并行ERCP术的27例患者的临床资料,其中急性胰腺炎(acute pancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例;诊断性ERCP 9例,治疗性ERCP18例.结果 27例患者ERCP术后总体并发症发生率为51.85%(14/27),其中,高淀粉酶血症发生率22.22%(6/27),术后4、24 h血清淀粉酶水平分别为(410.75±230.31) U/L、(367.25±233.90) U/L,48~72h后均恢复正常;胰腺炎发生率22.22%(6/27),均为轻型胰腺炎;乳头切开处出血、黑便发生率7.41%(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)+取石术后;诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义.结论儿童胰腺炎患者ERCP术后具有较高的并发症发生率,内镜医师于ERCP术中应高度重视,采取必要的预防措施以减少并发症的发生.

  17. Estudo comparativo entre a colangiopancreatografia por ressonância magnética e a colangiopancreatografia endoscópica no diagnóstico das obstruções biliopancreáticas Comparative study between magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in the diagnosis of the pancreatic and biliary obstruction

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    Julio Cesar PISANI

    2001-09-01

    Full Text Available Racional — A colangiopancreatografia endoscópica e a colangiopancreatografia por ressonância magnética são métodos de diagnóstico das doenças que envolvem o sistema biliopancreático. Objetivo - Comparar a concordância diagnóstica, analisando sensibilidade, especificidade, valores preditivos positivos, negativos e acurácia de ambos. Casuística e Método - Compreendeu 41 pacientes divididos em dois grupos: I — sem obstrução em canais biliares ou pancreáticos e II — com obstrução. O grupo II foi subdividido em A — obstrução por cálculo e B — obstrução por outras causas. Resultados - A concordância entre os dois métodos foi de 67% no grupo I e 82% no grupo II. A sensibilidade da colangiopancreatografia endoscópica foi de 94% e da colangiopancreatografia por ressonância magnética de 89%. A especificidade da colangiopancreatografia endoscópica foi de 100% e da colangiopancreatografia por ressonância magnética de 67%. A colangiopancreatografia por ressonância magnética mostrou valor preditivo positivo de 93%, valor preditivo negativo de 50% e acurácia de 85%. Conclusão - Os dois métodos mostraram a mesma sensibilidade.Background — The endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography were methods used for diagnosis of the diseases in the biliary and pancreatic ducts. Aim - Compare the diagnostic concordance among, analyzing sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Patients/Methods - There were 41 patients in the studied group, divided in two groups: I — without biliary or pancreatic tract obstruction, and II — with obstruction. Group II was further divided in A — obstruction due to lithiasis, and B — due to other causes. Results - Concordance between the two methods was found in 67% in group I and 82% in group II. Sensitivity of endoscopic retrograde cholangiopancreatography was 94% and magnetic resonance

  18. Is prophylactic somatostatin effective to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis or hyperamylasemia? A randomized, placebo-controlled pilot trial

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    WANG Zi-kai; YANG Yun-sheng; CAI Feng-chun; WANG Yong-hua; SHI Xiao-lin; DING Chen; LI Wen

    2013-01-01

    Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography (ERCP)pancreatitis (PEP) and hyperamylasemia remain inconclusive.This study aimed to examine whether high-dose,long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia.Methods This was a randomized,placebo-controlled pilot trial.One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions:pre-ERCP somatostatin (0.5 mg/h for 24 hours,starting 1 hour prior to ERCP; n=36),post-ERCP somatostatin (0.5 mg/h for 24 hours,starting 1 hour after ERCP; n=47),or placebo (saline for 24 hours,starting 1 hour prior to ERCP; n=41).Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6,24,and 48 hours after ERCP.Results The three groups did not differ in age,gender,medical history,or ERCP procedure (catheterization using contrast or guidewire,pancreatic duct visualization,procedure time,or procedure type).The rate of PEP was 13.7% (17/124)in the overall study sample and 16.7% (6/36),10.6% (5/47),and 14.6% (6/41) in the pre-ERCP somatostatin,postERCP somatostatin,and placebo groups,respectively (P=0.715).The rate of post-ERCP hyperamylasemia was 19.4% (7/36),21.3% (10/47),and 46.3% (19/41) in the pre-ERCP somatostatin,post-ERCP somatostatin,and placebo groups,respectively (P=0.011).Conclusions High-dose,long-term continuous infusion (0.5 mg/h for 24 hours) of somatostatin,performed as either a pre-or post-ERCP,can reduce the incidence of hyperamylasemia,but not PEP.

  19. Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones:Results of a retrospective,single center study between 1996-2002

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    Gabor Mester; Gyorgy Reti; Attila Nagy; Peter Laszlo Lakatos

    2004-01-01

    AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 dbefore laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP.RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).

  20. 右美托咪定在经内镜逆行胰胆管造影术的应用进展%Application advancement of dexmedetomidine in endoscopic retrograde cholangiopancreatography

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    郑子豪; 刘喜成; 张中军

    2015-01-01

    经内镜逆行胰胆管造影术(ERCP)是一种微创手术,目前已广泛用于胰胆管疾病的诊断与治疗,但与普通内镜检查相比,治疗性ERCP具有其特殊性。右美托咪定(dexmedetomidine, Dex)是一种新型的、高选择性的α2肾上腺素能受体激动剂,具有镇静、镇痛和抗焦虑等作用,常用于ICU患者的镇静、多种侵入性操作的麻醉以及复合麻醉,近年也常将其用于ERCP的麻醉。%Endoscopic retrograde cholangiopancreatography (ERCP) is a kind of minimally invasive surgical technology and now extensively applied in diagnose and therapy of pancreaticobiliary disease. Compared with the normal endoscopy, ERCP has its unique characteristics. Dexmedetomidine (Dex) is a novel and highly selective α2-adrenoceptor agonist, producing sedation, analgesia and antianxiety function. It’s widely used in sedation of intensive care unit patients, anaesthesia of invasive therapies and general anesthesia.

  1. Analysis of clinical application of endoscopic retrograde cholangiopancreatography for the pancreatic diseases in children%内镜下逆行胰胆管造影术在儿童胰腺疾病中的应用分析

    Institute of Scientific and Technical Information of China (English)

    吕涛; 张筱凤

    2013-01-01

    Objective To study the feasibility and risk of endoscopic retrograde cholangiopancreatography (ERCP) for children in clinic,and to evaluate the effects of ERCP in diagnosis and treatment of the pancreatic diseases in children.Method Totally 98 patients under 14 years of age who underwent ERCP from 1994 to 2011 were enrolled in the study.The data of diagnosis,anesthesia type,treatments,and postoperative complications were collected.Result The 98 patients were 4 to 14 years old,of whom 32 cases suffered from acute pancreatitis (30 cases with biliary disease and 2 with hyperlipidemia) ;42 cases had chronic pancreatitis,of whom 36 had calculus of pancreatic duct,pancreatic pseudocyst was seen in 6 cases.Pancreas divisum was found in 20 cases,choledochopancreatic junction anomaly in 6 cases,and annular pancreas in 1 case.The operations of dissection of pancreatic duct and biliary duct,calculus removal,insertion of endoprosthesis and draining tube in pancreatic duct or biliary duct were performed.No patients died from ERCP complications.In observation of postoperative complications,acute pancreatitis after ERCP occurred in 1 case,with the incidence rate of 1 %,1 ease had bleeding(1%),and 5 cases had hyperamylasemia (5%).All the complications were cured within 1 week.The average hospital stay was 5.51 d.Conclusion ERCP is useful and safe in children under suitable condition of doctors and equipments,and no high rates of complications were observ ed.%目的 探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在儿童胰腺疾病中的应用价值、可行性及风险.方法 1994至2011年在杭州市第一人民医院消化内科住院,行ERCP诊治的14岁以下胰腺疾病患儿84例,其中男32例,女52例,平均年龄(11.03±2.05)岁,共行ERCP98例次.回顾分析本组患儿病因、ERCP麻醉方式、术中操作、疗效及术后并发症情况.结果 98例次接受ERCP检查的患儿中,急性胰腺炎32

  2. Risk factors of post endoscopic retrograde cholangiopancreatography complicated pancreatitis%经内镜逆行胰胆管造影术后并发胰腺炎危险因素分析

    Institute of Scientific and Technical Information of China (English)

    黄继征; 霞明; 龚传明; 程建国; 文峰

    2011-01-01

    Objective To explore the risk factors of post endoscopic retrograde cholangiopancreatography(ERCP) complicated pancreatitis(PEP) and to provide references to its prevention. Methods Totally 1 896 patients who underwent ERCP were divided into PEP group ( n= 285) and non-PEP group ( n= 1 161 ). The risk factors of patients, operation and operator were analyzed. Results In patient factors, female, age( less than 60), pancreatitis history,without choledocholithiasis, suspected Oddi's sphincter dysfunction were the risk factors for PEP ( P < 0.05 ), but bilirubin increase, common bile duct diameter( less than 0.4cm), ampulla diverticulum, complicated diabetes or hypertension were not related with PEP( P > 0.05 ). In operation factors, pancreas imaging, pancreatic duct sphincterotomy, aerocyst dilatation of bililary sphincter muscle were related with PEP( P < 0.05 ), but the remedial or diagnostic ERCP, Oddi's sphincterometry, bile duct sphincterotomy were not related with PEP. For operators, fewer operation cases, prolonged operation time and difficult intubation were related with PEP ( P < 0.05 ), but ERCP operation defeat was not the risk factor for PEP ( P>0.05 ). Conclusion Female, aged under 60, pancreatitis history, suspected Oddi's sphincter dysfunction, poor pancreas imaging and operator's skill as well as difficult intubation were the main risk factors for PEP.%目的 探讨经内镜逆行胰胆管造影术(ERCP)后并发胰腺炎(PEP)的危险因素,为PEP的预防提供参考.方法 回顾性分析1 896例ERCP患者,分为PEP组(n=285)及无PEP组(n=1 161),对比分析两组各相关危险因素,涉及患者因素、操作因素及术者因素.结果 患者因素中女性、年龄(小于60岁)、胰腺炎病史、无胆总管结石、疑有Oddi括约肌功能障碍者易并发PEP(P0.05).操作因素中胰腺显影、胰管括约肌切开术、胆道括约肌气囊扩张术患者在PEP组所占比例明显高于无PEP组(P0.05).结论 年龄小于60

  3. 老年患者治疗性内镜逆行胰胆管造影的临床分析%Clinical analysis of therapeutic endoscopic retrograde cholangiopancreatography in elderly patients

    Institute of Scientific and Technical Information of China (English)

    韩宏锋; 陈虹; 薛伟红

    2012-01-01

    目的 研究治疗性内镜逆行胰胆管造影(ERCP)对老年患者的临床治疗有效性和安全性.方法 回顾性分析2009年4月至2011年12月我科123例行ERCP治疗的老年胆胰疾病患者,观察ERCP治疗成功率及并发症发生情况.结果 123例患者,年龄为75~91岁,胆总管结石91例(74.0%),胆管良性狭窄3例(2.4%),胆管恶性狭窄29例(23.6%),伴有合并症83例(67.5%).ERCP治疗成功119例(96.7%).术后发生并发症9例(7.3%),胰腺炎6例,胆管感染2例,其中急性胰腺炎合并胆管感染1例,十二指肠乳头括约肌切开(EST)后迟发出血1例.除急性重症胰腺炎合并胆管感染1例死亡外,余均经治疗后痊愈出院.结论 老年患者不应该作为治疗性ERCP的禁忌证,即使合并有心肺系统疾病,经过充分的术前准备,采用简洁有效的手术方式,减少操作时间,并没有增加严重并发症的发生.老年患者ERCP的并发症发生率较高可能与恶性肿瘤所占比例高有关,与合并其他系统疾病未必有关联.%Objective To study the clinical efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography( ERCP) for elderly patients. Methods Retrospective analysis was made on 123 elderly patients with bile duct and pancreatic diseases who got treatment with ERCP in the department from April 2009 to December 2011. The success rate and complications were observed and statistically analyzed. Results 123 patients aged 75 to 91 years old were treated with ERCP,including 91 cases(74. 0%) with bile duct stones,3 cases(2. 4%) with bile duct benign stricture and 29 cases(23. 6%) bile duct malignant narrow,83 cases(67. 5%) with complications. 119 cases (96. 7%) were successfully treated with ERCP. Postoperative complications occurred in 9 cases(7. 3% ), pancreatitis 6 cases,bile duct infection 2 cases including acute pancreatitis with bile duct infection in 1 case, late bleeding after duodenal nipple sphincter(EST) cut in 1 case

  4. 生长抑素预防内镜逆行胰胆管造影术后胰腺炎效果的Meta分析%Meta-analysis: somatostatin for prophylaxis against post endoscopic retrograde cholangiopancreatography pancreatitis

    Institute of Scientific and Technical Information of China (English)

    潘树波; 耿小平

    2016-01-01

    Objective To evaluate the efficacy of somatostatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods A standardized comprehensive literature search was performed by Cochrane library,PubMed,OVID,Springer Linker,Science Direct,EBSCO.Randomized controlled studies on the prevention of pancreatitis after ERCP before Octorber 2015were enrolled in the study and were analyzed by 2 independent reviewers.Random-effects model (REM) or fixed-effects model (FEM) was applied to calculate pooled estimates of drug efficacy depending on the outcomes.The bias risk of the included studies was evaluated by Cochrane Handbook 5.1.All data were analyzed by the RevMan 5.3 software.Results Twelve studies,including 3 268 participants,met the inclusion criteria.The results of subgroup analysis showed that high-dose somatostatin infused over 12 h could significantly decrease the incidence of pancreatitis after ERCP(11.3% vs.4.9%,OR =0.34,95%CI:0.20-0.58,P =0.000),however,low-dose or bolus injection proved ineffective in reducing rate of pancreatitis after ERCP (8.5% vs.6.4%,OR =1.37,95% CI:0.89-2.12,P =0.150;4.9% vs.9.3%,OR =0.39,95% CI:0.14-1.04,P =0.060).Results of intention-to-treat analysis showed that high-dose somatostatin infused over 12 h could significantly decrease the incidence of pancreatitis after ERCP (OR =0.45,0.49;95% CI:0.25-0.81,0.27-0.91;P =0.008,0.020).Conclusions High-dose somatostatin could prevent post-ERCP pancreatitis.Low-dose nor bolus injection somatostatin produced no significant effect in reducing pancreatic injury.%目的 系统评价生长抑素预防内镜逆行胰胆管造影(ERCP)术后胰腺炎的效果.方法 以内镜下逆行胰胆管造影术或ERCP、生长抑素、胰腺炎为关键词检索Cochrane library、PubMed、OVID、Springer Linker、Science Direct、EBSCO数据库,并手工检索相关的参考文献,纳入2015年10月之前有关生长抑素预防ERCP术后胰腺炎效果的

  5. The Application of Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients%经内镜逆行胰胆管造影在儿科患者中的应用效果分析

    Institute of Scientific and Technical Information of China (English)

    许威; 夏时海

    2013-01-01

    目的 评价儿科患者行经内镜逆行胰胆管造影(ERCP)的效果.方法 选取2000-2012年行ERCP治疗的患者42例,其中年龄<18岁的儿科患者12例为儿科组,年龄≥18岁的成人患者30例为成人组,均行ERCP治疗.比较两组原发疾病构成和治疗成功率,采用Fisher确切概率法进行统计学分析.结果 儿科组慢性胰腺炎5例(42%)、胆源性急性胰腺炎2例(17%)、胰腺分裂症2例(17%)、胆总管结石2例(17%)、胆总管囊肿1例(8%),成人组分别为2例(7%)、4例(13%)、3例(10%)、20例(67%)、1例(3%),两组原发疾病构成比较,差异有统计学意义(P=0.018).儿科组ERCP治疗一次即成功9例,重复ERCP治疗后成功2例,总治疗成功率为92%(11/12),1例插管未成功继续非手术治疗;成人组ERCP治疗一次即成功23例,重复ERCP治疗后成功4例,总治疗成功率为90%(27/30),3例插管未成功,其中1例继续非手术治疗,2例转外科手术治疗.两组治疗成功率比较,差异无统计学意义(P=1.000).儿科组治疗成功的病例中治疗性ERCP占72.7%(8/11),成人组中治疗性ERCP占81.5%(22/27),两组比较差异无统计学意义(P=0.667).儿科组术后并发胰腺炎3例、行十二指肠乳头切开术(EST)后切口出血1例,并发症发生率为33%;成人组术后并发胰腺炎3例,并发症发生率为10%,两组比较差异无统计学意义(P=0.169).结论 儿科患者行ERCP效果良好,最常见的指证是慢性胰腺炎.%Objective To evaluate the utility of endoseopic retrograde cholangiopancreatography ( ERCP ) in pediatrie patients. Methods A total of 42 patients receiving ERCP from 2000 to 2012 were selected and divided into pediatric group (12 cases under eighteen ) and adult group ( 30 cases ) . The composition of primary diseases and treatment success rate were compared between two groups. Results In pediatric group, there were 5 cases of chronic pancreatitis ( 42% ), 2 cases of acute gallstone pancreatitis(17% ), 2 cases of pancreas

  6. The clinical values of ursodeoxycholic acid in prevention of postoperative complications of endoscopic retrograde cholangiopancreatography%熊去氧胆酸预防ERCP术后并发症的临床价值

    Institute of Scientific and Technical Information of China (English)

    刁同进; 赵晓东

    2014-01-01

    Objective To investigate the clinical therapeutic values of ursodeoxycholic acid(UDCA)in prevention of postoperative complications of endoscopic retrograde cholangiopancreatography(ERCP).Methods The clinical data of 62 cases,which underwent ERCP because of hepatobiliary and pancreatic duodenal diseases in department of hepatobiliary surgery of our hospital from January to September in 2013,was retrospectively analyzed.Among them,there were 45 males (73.3%)and 17 females (26.7%),range from 24 to 65 years,respectively.In this study,62 patients were randomly divided into treatment group (30 cases)and control group (32 cases).There were no significant differences in age,gender, preoperative function and biochemical indexes of liver and kidney between two groups.Treatment group was treated with conventional basic therapy,routine liver protective therapy and ursodeoxycholic acid (UDCA)produced by the German FALK pharmaceutical factory,with a daily dose of 20 mg/kg.The dose was 500mg,administrated 2 times/day by oral,and 28 days was a course of treatment.The control group was given the basic treatment and routine treatment without the use of ursodeoxycholic acid.Clinical symptoms at the 3rd,7th,14th,28th day after ERCP operation were observed,such as infection,anorexia,nausea,diarrhea,skin pruritus and jaundice.Results In this study,of 30 patients in treatment group after ERCP by application of ursodeoxycholic acid capsule,mild discomfort was found in 7 cases,while 3 of those were possible independent from adverse drug reaction,3 cases were unrelated and 1 case was unable to j udge.Without evident drug adverse effects and serious adverse events,ursodeoxycholic acid presented its efficacy and safety.The biochemical indexes of liver function in the treatment group after ERCP were better than those of the control group,there was statistically significant difference (P<0.05 ).The clinical symptoms after ERCP in the treatment group significantly improved compared with those in

  7. Complications of endoscopic retrograde cholangiopancreatography: A study in a small ERCP unit Complicaciones de la colangiopancreatografía retrógrada endoscópica: Estudio en una unidad pequeña de CPRE

    Directory of Open Access Journals (Sweden)

    J García-Cano Lizcano

    2004-03-01

    Full Text Available Backgrounds and aim: endoscopic retrograde cholangiopancreatography (ERCP is an established procedure to drain the biliary and pancreatic ducts. Nevertheless, there are complications which seem to be more common in centers performing less than 200 ERCPs per year. Sometimes, however, due to the distribution of health resources, it is necessary to perform this technique in centers with a smaller number of procedures. We present the experience of ERCP-related complications in a small unit. Material and methods: this is a retrospective study on prospective data recorded during six years (1997-2002. In this period, two endoscopists working together performed 507 ERCPs, which yields an approximately average of 84 procedures per year. Results: in 507 ERCPs performed during this period of time, 55 complications arose (10.85%, and four patients died (0.79% as a consequence of the procedure. There were 28 pancreatitis (5.5%, eight post-sphincterotomy bleeding events (1.6%, seven bilioduodenal perforations (1.4%, eight sepsis episodes of biliary origin (1.6%, and other 4 different complications. There were 418 (82.4% successful ERCPs -either diagnostic or therapeutic-, which gave rise to 46 (11% complications. There were 89 (17.6% failed diagnostic or therapeutic ERCPs, which gave rise to 9 (10.11% complications (p = 0.8 between both groups. Thirty five (7% ERCPs were exclusively diagnostic and caused 6 (17% complications. The 187 procedures performed for coledocho-lithiasis originated 14 (7.4% complications, and represented the group with the lowest morbidity rate (p = 0.04. Conclusions: the complications rate in our center is within the range of reported figures. ERCPs performed for choledoco-lithiasis was associated with the lowest complications rate. The risk-benefit ratio in the anticipated, purely diagnostic ERCP must be carefully weighed due to its morbidity.Antecedentes y objetivo: la colangiopancreatografía retrógrada endoscópica (CPRE es un

  8. Double blind randomised controlled trial of effect of metoprolol on myocardial ischaemia during endoscopic cholangiopancreatography.

    OpenAIRE

    Rosenberg, J.; Overgaard, H.; Andersen, M.; Rasmussen, V; Schulze, S.

    1996-01-01

    OBJECTIVE--To evaluate the effect of metoprolol, a beta adrenergic blocking drug, on the occurrence of myocardial ischaemia during endoscopic cholangiopancreatography. DESIGN--Double blind, randomised, controlled trial. SETTING--University Hospital. SUBJECTS--38 (two groups of 19) patients scheduled for endoscopic cholangiopancreatography. INTERVENTIONS--Metoprolol 100 mg or placebo as premedication two hours before endoscopy. MAIN OUTCOME MEASURES--Heart rate, arterial oxygen saturation by c...

  9. Factores asociados a complicaciones de la colangiopancreatografía retrógrada endoscópica en un hospital de alta complejidad Factors associated to complications of endoscopic retrograde cholangiopancreatography in a third-level hospital

    Directory of Open Access Journals (Sweden)

    Angel Quispe-Mauricio

    2010-06-01

    Full Text Available El tratamiento endoscópico de las enfermedades de la vía biliar es posible gracias a la colangiopancreatografía retrógrada endoscópica (CPRE; no obstante, no está exenta de complicaciones. Objetivos. Describir las características e indicaciones de la CPRE y determinar los factores asociados al desarrollo de complicaciones tras la realización de este procedimiento. Materiales y métodos. Se realizó un estudio observacional retrospectivo en el Departamento de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen en Lima, Perú; desde marzo de 2002 a junio de 2005. Resultados. Se evaluaron 294 informes en 280 pacientes, la mediana de la edad fue 58 y 155 (52,7% fueron mujeres; cinco procedimientos se efectuaron en la Unidad de Cuidados Intensivos (UCI. La indicación más frecuente fue la coledocolitiasis en el 67,3% de los casos, 205 (69,7% procedimientos fueron exitosos complicándose sólo 33 de ellos. Las complicaciones más frecuentes fueron la pancreatitis aguda y la hemorragia, en 16 y 13 pacientes, respectivamente. No se reportó casos de perforación o defunción. La canulación del conducto pancreático más de una vez fue un factor asociado (OR=2,01; IC95%: 1,11 - 5,92; p=0,03. Conclusiones. El 11,2% de los casos se complicaron, siendo la pancreatitis aguda y la hemorragia leve las complicaciones más frecuentes. Sólo la canulación al conducto pancreático en más de una oportunidad es un factor asociado para tener complicaciones.Endoscopic treatment of the bile duct diseases is possible thanks to the ERCP (endoscopic retrograde cholangio pancreatography, nevertheless, it is not free of complications. Objectives. To describe the characteristics and indications of the ERCP and determine the factors associated to the development of complications after performing the procedure. Materials and methods. An observational retrospective study was done in the Gastroenterology Department of the Hospital Guillermo Almenara

  10. Cholangiocarcinoma in Magnetic Resonance Cholangiopancreatography and Fascioliasis in Endoscopic Ultrasonography

    Directory of Open Access Journals (Sweden)

    Amir Houshang Mohammad Alizadeh

    2011-10-01

    Full Text Available Fascioliasis is a worldwide zoonotic infection with Fasciola hepatica and Fasciola gigantica. The zoonoses are particularly endemic in sheep-raising countries and are also endemic in Iran. Typical symptoms that may be associated with fascioliasis can be divided by phases of the disease, including the acute or liver phase, the chronic or biliary phase, and ectopic or pharyngeal fascioliasis. Cholestatic symptoms may be absent, and in some cases diagnosis and treatment may be preceded by a long period of abdominal pain, eosinophilia and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 4 years, with imaging suggesting cholangiocarcinoma. Considering a new concept of endoscopic ultrasonography, at last F. hepatica was extracted with endoscopic retrograde cholangiography.

  11. Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation Fatores preditivos de dessaturação de oxigênio de pacientes submetidos a colangiopancreatografia endoscópica retrógrada sob sedação consciente

    Directory of Open Access Journals (Sweden)

    Suzana Müller

    2004-09-01

    Full Text Available BACKGROUND AND AIMS: Hypoxemia can occur during endoscopic retrograde cholangiopancreatography probably induced by the analgesia and sedation done. Moreover the patient’s prone position difficults the adequate ventilation. The hypoxemia and hypoventilation may not be noticed by nursing staff. A transversal study was used to investigate possible predictive factors of oxygen desaturation in sedated patients with midazolam associated to meperidine undergoing endoscopic retrograde cholangiopancreatography. PATIENTS AND METHODS: A total of 186 patients were monitored with continuous pulse oximetry. Poisson regression was used to measure the independent effect of each factor adjusted for effects of each of the other factors. The variables studied were: age, gender, hematocrit and hemoglobin levels, scopolamine use, diagnostic or therapeutic exam, American Society of Anesthesiologists Scores (ASA, duration time of exam, sedative used midazolam in the average of 0.07 mg/kg and analgesic drug meperidine in the average of 0.7 mg/kg that was titrated according patient’s reaction. RESULTS: No desaturation was found in 113 (60.8% patients, mild desaturation (SpO2 60 years old and ASA score III. The duration of exam was barely significant for desaturation. CONCLUSIONS:The variables of age of 60 years old or more, and ASA III score are identified as increased risk for desaturation for patients who undergo endoscopic retrograde cholangiopancreatography under conscious sedation. Long time of exam suggests the patient oxygen desaturate. Such patients require very close monitoring to desaturation and hypoventilation by the assistants and nursing staff alerting to respiratory depression. The use of pulse oximeter and asking for deep breaths during the exam helps to diminish such risks.RACIONAL: A hipoxemia pode ocorrer durante a colangiopancreatografia endoscópica retrógrada, provavelmente induzida pela analgesia e sedação realizadas, além da posição do

  12. Massive hemobilia due to hepatic arteriobiliary fistula during endoscopic retrograde cholangiopancretography: An extremely rare guidewir-related complication

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Jeong Gu; Seo, Young Woo; Hwang, Jae Cheol; Weon, Young Cheol; Kang, Byeong Seong; Bang, Sung Jo; Bang, Min Seo [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2015-05-15

    Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for diagnosis and treatment of biliary and pancreatic diseases, the risk for procedure-related complications is high. Hemorrhage is one of major complications of ERCP. Most ERCP-associated bleeding is primarily a complication related to sphincterotomy rather than diagnostic ERCP. We are reporting a case of massive hemobilia due to hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP, which was successfully treated with transarterial embolization of the hepatic artery.

  13. Clinical Research of Improving Anxiety of Patients in Endoscopic Retrograde Cholangiopancreatography by Acupoint Massage Therapy%穴位按摩疗法对改善经内镜逆行胰胆管造影治疗患者焦虑的临床研究

    Institute of Scientific and Technical Information of China (English)

    刘淑艳; 齐越; 潘金凤; 夏丽芳; 郑秋

    2012-01-01

    目的:探讨采用穴位按摩疗法对经内镜下逆行胰胆管造影术(ERCP)患者进行术前护理的临床效应.方法:特124例患者随机分为对照组和实验组,各62例.对照组采用传统的术前准备和心理护理方法,实验组在对照组的基础上采用穴位按摩疗法进行行为干预,观察2组患者生理指标的变化情况,并用焦虑自评量表(SAS)对2组患者术前及术后焦虑情况进行评估.结果:实验组患者生理指标、焦虑改善情况明显优于对照组.结论:穴位按摩疗法有助于消除患者的焦虑情绪,简单易行,患者痛苦小,提高患者配合治疗的积极性,促进患者早日康复.%Objective: To explore the use of acupoint massage therapy on endoscopic retrograde cholangiopancreatography (ERCP) in patients with preoperative care and results. Methods: 124 cases were randomly divided into control and experimental groups, 62 cases in each groups.Conlrol group using traditional preoperative preparation and psychological care methods,experimental group-were based on the use of acupoint massage therapy for behavioral intervention. Observe changes of physiological indexes in each group patients, and assess the anxiety of patients before and after operation using self-rating anxiety scale(SAS). Results: The improvement both physiological indexes and anxiety of patients in experimental group much better than the control group. Conclusion; Acupoint massage therapy helps to eliminate the patient's anxiety. The method is simple and little pain,which may improve the treatment of patients with the enthusiasm and promote early recovery of patients.

  14. Hypoxaemia and myocardial ischaemia during and after endoscopic cholangiopancreatography: call for further studies

    DEFF Research Database (Denmark)

    Rosenberg, J; Jørgensen, L N; Rasmussen, Verner;

    1992-01-01

    Sixteen non-selected patients undergoing endoscopic cholangiopancreatography (ERCP) after diazepam premedication were monitored for oxygen saturation (SpO2) with a pulse oximeter and for myocardial ischaemia with a Holter tape recorder from 2 h before ERCP to 6 h after the procedure. One patient...

  15. Endoscopic retrograde cholangiopancreatography causes reduced myocardial blood flow

    DEFF Research Database (Denmark)

    Christensen, M; Hendel, H W; Rasmussen, V;

    2002-01-01

    ). PATIENTS AND METHODS: 11 patients scheduled for ERCP were monitored with a Holter tape recorder and underwent myocardial perfusion scintigraphies, to evaluate myocardial perfusion at rest and during ERCP. RESULTS: Ten patients completed the study. Eight patients had no sign of myocardial ischemia...... with either of the two methods, while two patients developed signs of ischemia during ERCP with both the Holter tape recording and on myocardial scintigraphy (P = 0.02). CONCLUSIONS: Patients undergoing ERCP may develop true myocardial ischemia with reduced myocardial blood flow. Although this is a small...

  16. Clinical observation of therapeutic effects of endoscopic retrograde cholangiopancreatography in elderly patients over 80 years old with biliary-pancreatic diseases%逆行胰胆管造影治疗80岁以上老年人胆胰疾病的临床观察

    Institute of Scientific and Technical Information of China (English)

    王敏; 文卫; 缪林; 蒋国斌; 范志宁; 吴萍

    2009-01-01

    Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients over 80 years old with biliary-pancreatic diseases. Methods One hundred and twenty patients over 80 years old who underwent ERCP between January 2004 and April 2008 were retrospectively analyzed. The clinical efficacy, safety and complication were observed and followed up. Results One hundred and seventeen patients successfully underwent therapeutic ERCP and the success rate was 97.5%. All diseases of the patients included cholangiocarcinoma in 22 cases, duodenal papilla carcinoma in 3 cases, pancreatic carcinoma in 8 cases, acute pancreatitis in 15 cases, chronic pancreatitis in 5 cases, acute suppurative cholangitis in 9 cases and choledocholithiasis in 58 cases. During the procedure of ERCP, 3 cases failed to insert the duodenoscope, 3 cases were found hemobilia and 2 cases were found acute pancreatitis. Conclusions Therapeutic ERCP is effective and safe in elderly patients over 80 years. Age is not the contraindication of therapeutic ERCP.%目的 评价治疗性逆行胰胆管造影术(ERCP)对80岁以上老年患者胆胰疾病的疗效及安全性. 方法 回顾分析我院自2004年1月至2008年4月诊治的80岁以上行ERCP治疗的老年患者120例,同时观察其并发症. 结果 120例患者,造影成功117例(成功率97.5%),其中胆管癌22例,十二指肠乳头癌3例,胰腺癌8例,急性胆源性胰腺炎15例,慢性胰腺炎5例,急性化脓性胆管炎9例,胆总管结石58例.在ERCP过程中因血氧饱和度进行性下降和严重的心律失常而中止治疗2例;插镜失败1例,失败原因系肿瘤侵犯导致十二指肠球降部狭窄,镜身不能通过.胆道出血3例,急性胰腺炎2例. 结论 治疗性ERCP对80岁以上老年人胆胰疾病的诊治创伤小,且有效及安全,高龄并非治疗性ERCP的禁忌证.

  17. 内镜下逆行胰胆管造影技术诊治成人胆道蛔虫病19例的临床分析%Nineteen cases of biliary ascariasis diagnosed and managed by endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    杨卓; 高峰; 赵云峰; 麻树人; 张宁; 宫照杰

    2013-01-01

    Objective To investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of adult biliary ascariasis.Methods Clinical data of 19 cases of adult biliary ascariasis diagnosed and treated with ERCP during Jan 2005 to Dec 2012 were retrospectively analyzed.Results Among the 19 adult patients with biliary ascariasis,11 were male,and the mean age was (62.7± 10.8) years.Eight cases lived in the countryside,7 cases in the integration of urban and rural area,and 4 cases in urban area.All cases had histories of eating raw fruits and vegetables.Living worms were found in 9 cases.Four cases were complicated with common bile duct stones.Petrification of residual dead worms in the common bile duct was found in 10 cases.All ascariasis and residual bodies were removed successfully by ERCP.There were no postoperative complications except for 3 cases of hyperamylasemia.Conclusions Adult biliary ascariasis commonly occurs in the elderly,and is frequently complicated with common bile duct stones.ERCP is efficacious in treating biliary ascariasis.%目的 探讨内镜下逆行胰胆管造影(ERCP)在成人胆道蛔虫病诊断、治疗中的临床应用.方法 回顾性分析沈阳军区总医院内镜科2005年1月至2012年12月收治的19例经ERCP诊断、治疗的成人胆道蛔虫病患者的临床资料.结果 胆道蛔虫病患者共19例.其中男11例,女8例;平均年龄(62.7±10.8)岁.居住于农村8例,城乡结合部7例,城镇4例;全部病例均有生食蔬菜、瓜果习惯.19例患者中发现活体蛔虫9例,同时存在胆总管结石4例.胆总管内已死亡蛔虫残体石化10例,同时存在胆总管较大结石5例.全部患者均经内镜成功取出蛔虫和胆总管结石.术后出现高淀粉酶血症3例,未见其他并发症.结论 成人胆道蛔虫病的发病以中老年为主,易并发胆管结石,ERCP是治疗胆道蛔虫病的有效方法.

  18. Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones.

    Directory of Open Access Journals (Sweden)

    Stephen Morris

    Full Text Available Patients with suspected common bile duct (CBD stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP, an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS or Magnetic Resonance CholangioPancreatography (MRCP first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs per patient from the perspective of the UK National Health Service (NHS over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively, with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively. Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

  19. [Retrospective evaluation of 500 endoscopic cholangiopancreatographies performed at the Instituto Nacional de la Nutrición "Salvador Zubiran"].

    Science.gov (United States)

    Elizondo, J; Gallo, S; Valdovinos, M A; Paez, R

    1989-01-01

    We evaluated 500 endoscopic retrograde cholangiopancreatographies (ERCP) performed on 422 patients during a 5-year period in the Gastrointestinal Endoscopy Department, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F. ERCP combines endoscopic and radiologic techniques in order to obtain high quality opacification of pancreatic and biliary ducts. The rate of success for cannulation was 90%; desired duct opacification was possible in 89%. The most frequent indication for ERCP was to establish the differential diagnosis for jaundice; biliary stones in the common bile duct was the most frequent diagnosis, followed by normal biliary ducts. Pancreatography was normal in 74% of patients. ERCP complications were detected in 5.6%; fever and transient pain was the most common complaint in 1.6%. Mortality attributable to the procedure was 0.8%. From histological corroboration of cases by surgery or postmortem studies, diagnostic sensitivity was 92%, specificity 76%, positive predictive value 96% and a prevalence of 89%. We conclude that ERCP is highly sensitive and specific in diagnosing bilio-pancreatic-duodenal disease. Our results are comparable to other's experiences published throughout the world.

  20. Biliopancreatic ascariasis: endoscopic approach.

    Science.gov (United States)

    Kamiya, Toshiaki; Justiniano, Mario; Durán, Abel; Uechi, Chikara

    2002-01-01

    From June 1985 to June 1999, 120 patients were diagnosed by means of panendoscopy, choledocoscopy, and endoscopic retrograde cholangiopancreatography as having biliary and pancreatic ascariasis. All duodenoscopic procedures were performed under fluoroscopic control. Endoscopic extraction was successful in 99 of 108 (92%) patients, some of whom had had previous endoscopic sphincterotomy. The endoscopic accessories used were a basket catheter, polypectomy snare, and balloon catheter. Because no significant complications were observed after this endoscopic treatment, we recommend endoscopic extractions for biliary ascariasis.

  1. Perioperative management of endoscopic retrograde cholangiopancreatography in the treatment of biliary complications following liver transplantation%内镜下逆行性胰胆管造影术治疗肝移植术后胆道并发症的围手术期管理

    Institute of Scientific and Technical Information of China (English)

    巫织娥; 林颖; 陶金; 梁艳娉; 郑丰平

    2014-01-01

    目的探讨内镜下逆行性胰胆管造影术(ERCP)治疗肝移植术后胆道并发症的围手术期管理。方法本前瞻性研究对象为2008年12月至2012年12月在中山大学附属第三医院消化内镜中心接受ERCP治疗的102例肝移植术后胆道并发症患者。其中男90例,女12例;年龄23~65岁,中位年龄56岁。所有患者均签署知情同意书,符合医学伦理学规定。术前给予患者针对性心理疏导、严格器械消毒、应用术前药物等积极准备,术中医护人员密切配合,术后给予禁食、输液、抗感染、制酸剂、生长抑素等对症处理,妥善固定鼻胆管,密切观察病情,出院后给予健康指导。结果102例患者中成功获得ERCP治疗94例,成功率为92.2%(94/102)。94例患者治愈率77%(72/94),好转率20%(19/94),总有效率97%(91/94)。患者发生术后并发症15例,其中高淀粉酶血症8例、轻型胰腺炎4例、乳头肌切口出血3例,均经保守治疗痊愈。结论术前积极心理疏导、术中医护人员密切配合、术后严密观察并发症情况及出院后健康指导为ERCP治疗肝移植术后胆道并发症成功的重要因素。%Objective To investigate the perioperative management of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of biliary complications following liver transplantation (LT). Methods A total of 102 patients with biliary complications following LT undergoing ERCP in Digestive Endoscopy Center, the Third Afifliated Hospital of Sun Yat-sen University from December 2008 to December 2012 were included in this prospective study. There were 90 males and 12 females with the age ranging from 23 to 65 years old and a median of 56 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Positive preoperative preparations were given to the patients:personalized psychological counseling, strict

  2. Effect and safety of remifentanil combined with dexmedetomidine during anesthesia of painless endoscopic retrograde cholangiopancreatography in elderly patients%瑞芬太尼联合右美托咪定用于老年患者无痛经内镜逆行性胆管造影术的镇痛效果及安全性分析

    Institute of Scientific and Technical Information of China (English)

    顾政; 朱家沂; 成敏

    2015-01-01

    Objective To explore the effect and safety of remifentanil combined with dexmedetomidine during anesthesia of painless endoscopic retrograde cholangiopancreatography (ERCP) in the elderly patients.Methods Totally 65 elderly patients undergoing painless ERCP were randomly divided into remifentanil combined with dexmedetomidine group (32 cases) and diazepam combined with dolantin group (33 cases).The heart rate (HR),mean arterial pressure (MAP),respire rate (RR),pulse oxygen saturation (SPO2) before (T0) and after induction (T1),during endoscopy (T2),10 rain after endoscopy (T3),at withdrawal (T4) and at the end of the operation (T5) were recorded; the observer's assessment of alertness/sedation (OAA/S) scale was assessed at T3 time point scores; the adverse reactions during and after operation were observed; the duration of operation and anesthesia,and the patients' satisfaction rate were recorded.Results Compared with those in group D,the MAP,the HR and the RR in RY group were lower from T1 to Ts [MAP:(96 ± 14) mmHg vs (114 ± 18) mmHg,(97 ± 12) mmHg vs (110±14) mmHg,(92±11) mmHg vs (111 ±15) mmHg,(95±11) mmHg vs (111 ±16) mmHg,(95 ± 10) mmHg vs (107 ± 13) mmHg; HR:(61 ± 11) times/min vs (78 ± 18) times/min,(71 ± 12) times/min vs (92 ± 18) times/min,(67 ±8) times/min vs (85 ±9) times/min,(65 ±7) times/min vs (84 ± 13) times/min,(70 ± 8) times/min vs (80 ± 9) times/min; RR:(12.4 ± 2.2) times/min vs (17.9 ± 3.6) times/min,(13.6 ± 1.8) times/min vs (19.8 ±3.3) times/min,(11.9 ±2.2) times/min vs (19.5 ±3.4) times/min,(14.1 ± 2.0) times/min vs (19.4 ± 2.9) times/min,(14.9 ± 2.4) times/min vs (20.5 ± 3.1) times/min] (P < 0.05) ; the SPO2 showed no significantly differences between the two groups (P > 0.05).The incidences of movement,postoperative nausea and vomiting in RY group were significantly lower than those in D group [0.0% (0/32) vs 12.1% (4/33),0.0% (0/32) vs 12.1% (4/33),P<0.05].The OAA/S score was significantly lower

  3. Transnasal endoscopic retrograde chalangiopancreatography using an ultrathin endoscope:A prospective comparison with a routine oral procedure

    Institute of Scientific and Technical Information of China (English)

    Akihiro Mori; Noritsugu Ohashi; Takako Maruyama; Hideharu Tatebe; Katsuhisa Sakai; Takashi Shibuya; Hiroshi Inoue; Shoudou Takegoshi; Masataka Okuno

    2008-01-01

    AIM:To investigate if transnasal endoscopic retrograde cholangiopancreatography(n-ERCP)using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the largecaliber side-viewing duodenoscope.METHODS:The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups.We compared the requirements of esophagogastroduodenoscopy(EGD)prior to ERCP,rates and times required for successful cannulation into the pancreatobiliary ducts,incidence of post-procedure hyperamylasemia,cardiovascular parameters during the procedure,the dose of a sedative drug,and successful rates of endoscopic naso-biliary drainage (ENBD).RESULTS:Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group.There was no significant difference in the rates or times for cannulation,or incidence of hyperamylasemia between the groups.However,the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy.Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group.ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required.CONCLUSION:n-ERCP is likely a well-tolerable method with less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube.However,a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.

  4. MRCP. Magnetic resonance cholangiopancreatography; MRCP. Magnetresonanzcholangiopankreatografie

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja [Wisconsin-Madison Univ., Madison, WI (United States). Dept. of Radiology; Lauenstein, Thomas [Evangelisches Krankenhaus Duesseldorf (Germany). Radiologie

    2016-06-15

    Magnetic resonance cholangiopancreatography (MRCP) is a special MR technique to display and analyze the biliary tract and pancreatic ducts. MRCP sequences are equivalent to endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic purposes due to technical developments of the classical T2 weighted MRCP sequences and the availability of contrast enhanced T1 weighted sequences. Therefore, MRCP plays a fundamental role in the diagnoses of hepatobliary and pancreatic diseases, which are presented in this review article as are technical details of sequence acquisitions and the underlying anatomy.

  5. Efecto de la administración de indometacina rectal sobre los niveles séricos de amilasa posteriores a colangiopancreatografía retrógrada endoscópica y su impacto en la aparición de episodios de pancreatitis secundaria Effect of the rectal administration of indomethacin on amylase serum levels after endoscopic retrograde cholangiopancreatography, and its impact on the development of secondary pancreatitis episodes

    Directory of Open Access Journals (Sweden)

    A. Montaño Loza

    2007-06-01

    Full Text Available Introducción: hiperamilasemia y pancreatitis aguda representan las complicaciones mayores más frecuentes posteriores a colangiopancreatografía retrógrada endoscópica (CPRE, apareciendo en 1-30% de los casos. Objetivo: determinar la incidencia de hiperamilasemia y pancreatitis posterior a CPRE y evaluar la utilidad de indometacina rectal para la prevención de estos. Material y métodos: ensayo clínico controlado. Durante un periodo de 12 meses se incluyeron 150 pacientes. Estos fueron divididos en grupo de estudio (n = 75, a quienes se administró indometacina rectal 100 mg 2 horas previas al procedimiento, y control (n = 75 que recibió glicerina. Dos horas posteriores a la CPRE se determinó el nivel de amilasa sérica y se clasificaron en: 0 ≤ 150 UI/l, 1 = 151-599 UI/l, 2 ≥ 600 UI/l. Los episodios de pancreatitis clínica se cuantificaron y clasificaron de acuerdo a los criterios de Ranson. Resultados: distribución por género: 100 mujeres y 50 hombres. Edad media: 55,37 ± 18,0 para el grupo de estudio y 51,1 ± 17,0 para el control. El diagnóstico de patología benigna se presentó en 56 (74,7% casos del grupo de estudio y 59 (78,7% del control. Posterior al procedimiento, 13 (17,3% pacientes del grupo experimental y 28 (37,3% del control desarrollaron hiperamilasemia (p 600 UI/l en 3 pacientes del grupo de estudio y 10 del control (p = 0,001. Se detectó pancreatitis leve en 5,3% de los pacientes del grupo de estudio y 16% del control (p Background: hyperamylasemia and acute pancreatitis represent the most frequent major complication after endoscopic retrograde cholangiopancreatography (ERCP, developing in 1-30% of cases. Objective: to determine the incidence of hyperamylasemia and acute pancreatitis after ERCP, and to assess the utility of rectal indomethacin to prevent these events. Material and methods: a randomized clinical trial. During a 12-month period 150 patients were included. They were divided up into a study group

  6. Endoscopic retrograde pancreatography: When should we do it?

    Institute of Scientific and Technical Information of China (English)

    Renáta; Bor; László; Madácsy; Anna; Fábián; Attila; Szepes; Zoltán; Szepes

    2015-01-01

    Endoscopic retrograde pancreatography(ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques(computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis(1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.

  7. Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach.

    LENUS (Irish Health Repository)

    Dunne, Ruth

    2013-12-01

    Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations.

  8. Is There a Difference in Diagnostic Accuracy and Clinical Impact between Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography?

    DEFF Research Database (Denmark)

    Ainsworth, Alan Patrick; Rafaelsen, Søren Rafael; Wamberg, Peter;

    2003-01-01

    BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS...... following EUS compared with 11 patients following MRCP ( P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing...... endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP...

  9. Endoscopic tissue diagnosis of cholangiocarcinoma.

    LENUS (Irish Health Repository)

    Harewood, Gavin C

    2008-09-01

    The extremely poor outcome in patients with cholangiocarcinoma, in large part, reflects the late presentation of these tumors and the challenging nature of establishing a tissue diagnosis. Establishing a diagnosis of cholangiocarcinoma requires obtaining evidence of malignancy from sampling of the epithelium of the biliary tract, which has proven to be challenging. Although endoscopic ultrasound-guided fine needle aspiration performs slightly better than endoscopic retrograde cholangiopancreatography in diagnosing cholangiocarcinoma, both endoscopic approaches demonstrate disappointing performance characteristics.

  10. Endoscopic management of biliary leaks after laparoscopic cholecystectomy.

    Science.gov (United States)

    Rustagi, Tarun; Aslanian, Harry R

    2014-09-01

    Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic cholelithiasis. Although it has distinct advantages over open cholecystectomy, bile leak is more common. Endoscopic retrograde cholangiopancreatography is the diagnostic and therapeutic modality of choice for management of postcholecystectomy bile leaks and has a high success rate with the placement of plastic biliary stents. Repeat endoscopic retrograde cholangiopancreatography with placement of multiple plastic stents, a covered metal stent, or possibly cyanoacrylate therapy may be effective in refractory cases. This review will discuss the indications, efficacy, and complications of endoscopic therapy.

  11. Endoscopic retrograde cholangiography for pediatric choledocholithiasis:Assessing the need for endoscopic intervention

    Institute of Scientific and Technical Information of China (English)

    Douglas S Fishman; Bruno P Chumpitazi; Isaac Raijman; Cynthia Man-Wai Tsai; E O’Brian Smith; Mark V Mazziotti; Mark A Gilger

    2016-01-01

    AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary children’s hospital.We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected choledocholithiasis.Patients were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected CBDS.RESULTS:CBDS were identified in 84% at the time of ERCP.Abdominal ultrasound identified CBDS in 36% of patients.Conjugated bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to 8.8.Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,respectively.CONCLUSION:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.

  12. Retrieval-balloon-assisted enterography in post-pancreaticoduodenectomy endoscopic retrograde cholangiopancreatography post-pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Ming Zhuang; Wen-Jie Zhang; Jun Gu; Ying-Bin Liu; Xue-Feng Wang

    2012-01-01

    This case reports an application of conventional duodenoscope in a post pancreaticoduodenectomy patient with the help of retrieval balloon assisted enterography.The 56-year-old woman had pancreaticoduodenectomy with Child reconstruction 9 mo ago because of pancreatic adenocarcinoma and now there are recurrent enlarged lymph nodes in the anastomotic stoma of hepaticojejunostomy.Considering the patient's late-stage cancer,a plastic stent was then successfully placed there to drainage.The main challenge in this case was the extremely long afferent loop and blind cannulation through the anastomotic stoma of hepaticojejunostomy.Retrieval balloon assisted enterography is very helpful for duodenoscope going through the reconstructed intestinal tract and for the cannulation.After two weeks,the patient remained free of painful symptoms and free of fever.Liver function improved well.Four months after the placement of stent,the patient died of cachexia without jaundice,fever and abdominal pain according to her daughter's statement.

  13. [Massive cerebral air embolism following endoscopic retrograde cholangiopancreatography. A case report and review of the literature].

    Science.gov (United States)

    Fernandez-Fernandez, J; Real-Noval, H; Rodriguez-Rodriguez, E

    2016-12-01

    Introduccion. La embolia aerea cerebral tras procesos endoscopicos es una complicacion infrecuente, pero que puede tener consecuencias catastroficas. Caso clinico. Varon de 85 años, diagnosticado de colangiocarcinoma distal con criterios de irresecabilidad, al cual se coloca una protesis biliar de drenaje. Se realiza una colangiopancreatografia retrograda endoscopica para el cambio de protesis. Tras el procedimiento, el paciente sufre un deterioro de las constantes vitales y del nivel de consciencia, y requiere intubacion orotraqueal. En la tomografia axial computarizada craneal se evidencia una embolia aerea masiva con focos de isquemia hiperaguda en ambos hemisferios. El paciente fallece posteriormente. Conclusiones. El embolismo aereo cerebral tras una colangiopancreatografia retrograda endoscopica es infrecuente, pero potencialmente letal. La manipulacion de la pared biliointestinal en las exploraciones endoscopicas podria originar comunicaciones entre la luz y el sistema venoso. Esto, unido a la alta presion de insuflacion para la realizacion de la prueba, condicionaria el paso de aire al sistema venoso portal y, de ahi, al sistema circulatorio. En el sistema nervioso central, las burbujas de aire provocarian una obstruccion vascular, con la consiguiente isquemia y necrosis del tejido. Es fundamental un diagnostico precoz y una terapia de soporte vital. Su rapido manejo puede contribuir a un mejor pronostico, que en principio es sombrio.

  14. Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

    Science.gov (United States)

    Kochhar, R.; Bhasin, D.; Nagi, B.; Wig, J. D.; Singh, G.; Sriram, P. V. J.; Singh, K.

    1997-01-01

    In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days) following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%), while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%). Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%. Endoscopic nasobiliary drainage using a 7 Fr pig-tail catheter was attempted in 14 patients and could be established in 12 of them. Bile duct leak sealed in all but one of these 12 patients after an interval of 3 days to 40 days (mean ± SEM, 12.2 ± 3.2 days). A single patient with large defect and a proximal bile duct stricture did not respond and required surgery. Common bile duct stones were removed by endoscopic sphincterotomy in 3 out of 4 patients. One patient with large stone required surgical choledocholithotomy. In conclusion, endoscopic retrograde cholangiography was safe and useful in confirming the presence of leak as well as its site, size and associated abnormalities. Endoscopic nasobiliary drainage proved an effective therapy in post-operative biliary leak and could avoid re-exploration in 71.4% patients. PMID:18493440

  15. Endoscope disinfection and its pitfalls - requirement for retrograde surveillance cultures

    NARCIS (Netherlands)

    Buss, A. J.; Been, M. H.; Borgers, R. P.; Stokroos, I.; Melchers, W. J. G.; Peters, F. T. M.; Limburg, A. J.; Degener, J. E.

    2008-01-01

    Background and study aims: Several endoscopy-related outbreaks of infection have been reported in recent years. For early recognition of inadequate disinfection of endoscopes we designed a microbiological surveillance system to evaluate the efficacy of the cleaning and disinfection procedure, and to

  16. Mirizzi Syndrome with Endoscopic Ultrasound Image

    OpenAIRE

    2013-01-01

    We describe a 66-year-old Caucasian man with type 1 Mirizzi syndrome diagnosed on endoscopic ultrasound. He presented with acute onset of jaundice, malaise, dark urine over 3-4 days, and was found to have obstructive jaundice on lab testing. CT scan of the abdomen showed intrahepatic biliary ductal dilation, a 1.5 cm common bile duct (CBD) above the pancreas, and possible stones in the CBD, but no masses. Endoscopic retrograde cholangiopancreatography (ERCP) by a community gastroenterologist ...

  17. Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines: a systematic review

    NARCIS (Netherlands)

    Geenen, E.J.M. van; Santvoort, H.C. van; Besselink, M.G.; Peet, D.L. van der; Erpecum, K.J. van; Fockens, P.; Mulder, C.J.; Bruno, M.J.

    2013-01-01

    OBJECTIVES: Several randomized controlled trials studied the role of endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy (ES) in acute biliary pancreatitis (ABP). No study assessed whether these trials resulted in international consensus in published meta-analyses a

  18. Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

    Directory of Open Access Journals (Sweden)

    M. K. Goenka

    1997-01-01

    Full Text Available In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%, while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%. Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%.

  19. Hepatic microabscess with ascending cholangitis complicated by endoscopic retrograde cholangiopancreatogram (ERCP): A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Auh, Yong Ho; Lee, Moon Gyu [Asan Medical Center, College of Medicine, University of Ulasn, Seoul (Korea, Republic of)

    1994-07-15

    Complicated hepatic microabscess secondary to ascending cholangitis following ERCP (Endoscopic retrograde cholangiopancreatogram) is rare, and needs to be differentiated from other microabscesses, metastasis or Caroli's disease. We experienced a case of hepatic microabscess associated with septic cholangitis following ERCP. Cholangiogram showed multiple sac-like abscess pockets with characteristic biliary communication, and CT scan revealed multiple low attenuated lesions. At the resolving stage of cholangitic microabscess, CT scan showed partial rim enhancement of the abscesses and disproportional dilatation of intrahepatic ducts. The residual parenchymal enhancement surrounding the resolved microabscess pockets and dilatated biliary ducts, however, remained even after clinical recovery.

  20. 3 T MR cholangiopancreatography appearances of biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Z.X., E-mail: hangzhoudzx73@126.co [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China); Yuan, J.H. [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China); Chong, V. [Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore (Singapore); Zhao, D.J. [Department of Hepatobiliary Surgery, Zhejiang Provincial People' s Hospital, Hangzhou (China); Chen, F.H.; Li, Y.M. [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China)

    2011-03-15

    Aim: To evaluate the 3 T MR cholangiopancreatography (MRCP) appearances of biliary ascariasis. Materials and methods: Nine patients with a MRCP diagnosis of biliary ascariasis were reviewed. All patients had endoscopic retrograde cholangiopancreatography (ERCP) or surgical confirmation of the disease. Results: On thin-slab MRCP imaging, Ascaris worms are clearly demarcated within the biliary tree. All the identified worms demonstrated a characteristic three-parallel-lines appearance. The middle high-signal intensity line is sandwiched between two low-signal intensity lines and they are in turn surrounded by high signal bile. On thick-slab MRCP the worms also show the three-line sign but with less clarity. However, thick-slab MRCP has the advantage of providing three-dimensional ERCP-like images of the pancreaticobiliary system. Conclusion: The 'three-line' sign appears to be a characteristic sign of biliary ascariasis on 3 T MRCP.

  1. Endoscopic ultrasound for the diagnosis of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Tyler; Stevens; Mansour; A; Parsi

    2010-01-01

    Endoscopic ultrasound(EUS) has become a well accepted test for the diagnosis of chronic pancreatitis.Advantages include its ability to detect subtle and severe changes of the pancreatic duct and parenchyma,and its relative safety compared with endoscopic retrograde cholangiopancreatography.Limitations include inter-and intraobserver variability,operator dependence,and an incomplete understanding of its true accuracy.The Rosemont classif ication has recently been proposed as a weighted,standardized method th...

  2. Management of urine leak after laparoscopic cyst decortication with retrograde endoscopic fibrin glue application and ureteral stent placement.

    Science.gov (United States)

    Chen, Mang L; Tomaszewski, Jeffrey J; Matoka, Derek J; Ost, Michael C

    2011-01-01

    Urine leakage is an uncommon complication after renal cyst decortication that typically resolves with adequate drainage. With prolonged large volume urine leakage from a perinephric drain, however, consideration for open surgical repair must be taken into account. We present the successful management of persistent urine leakage after laparoscopic cyst decortication with endoscopic retrograde fibrin glue injection and ureteral stent placement.

  3. Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Chi-Liang Cheng; Yung-Kuan Tsou; Cheng-Hui Lin; Jui-Hsiang Tang; Chien-Fu Hung; Kai-Feng Sung; Ching-Song Lee

    2012-01-01

    AIM:To describe characteristics of a poorly expandable (PE) common bile duct (CBD) with stones on endoscopic retrograde cholangiography.METHODS:A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment.Between 2003 and 2006,endoscopic retrograde cholangiography (ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital.Patients with characteristic PE bile duct on ERC were identified from the database.Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS:A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study.The median patient age was 45 years (range,20 to 92 years); 66.7% of the patients were men.The diameters of the widest non-PE CBD segment,the PE segment,and the largest stone were 14.3 ± 4.9 mm,5.8 ± 1.6 mm,and 11.2 ± 4.7 mm,respectively.The length of the PE segment was 39.7±15.4 mm (range,12.3 mm to 70.9 mm).To remove the CBD stone(s) completely,mechanical lithotripsy was required in 25 (83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature.The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy.Post-ERC complications occurred in 4 cases:pancreatitis in 1,cholangitis in 2,and an impacted Dormia basket with cholangitis in 1.Two (6.7%)of the 28 patients developed recurrent CBD stones at follow-up (50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION:Patients with a PE duct frequently require mechanical lithotripsy for stones extraction.To retrieve stones successfully and avoid complications,these patients should be identified during ERC.

  4. High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Hornslet, Pernille; Konge, Lars;

    2016-01-01

    BACKGROUND AND STUDY AIMS: Whereas data on moderate nurse-administered propofol sedation (NAPS) efficacy and safety for standard endoscopy is abundant, few reports on the use of deep sedation by endoscopy nurses during advanced endoscopy, such as Endoscopic Retrograde Cholangiopancreatography (ER...

  5. Review of endoscopic techniques in the diagnosis and management of cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Katherine Nguyen; James T Sing Jr

    2008-01-01

    Cholangiocarcinoma is a rare malignancy of the biliary tract. Key factors in determining therapeutic options include knowledge of tumor extent, anatomy and obtaining tissue diagnosis. Endoscopically, there are three modalities available to make the diagnosis of cholangiocarcinoma. These include endoscopic retrograde cholangiopancreatography, endoscopic ultrasound with fine needle aspiration and cholangioscopy. Management of cholangiocarcinoma endoscopically is typically confined to stent placement for palliative purposes or as a bridge to surgery. In this article, we will review the endoscopic techniques available for the diagnosis and management of cholangiocarcinoma.

  6. Role of endoscopic ultrasound/SpyScope in diagnosis and treatment of choledocholithiasis in pregnancy

    Institute of Scientific and Technical Information of China (English)

    Mohit; Girotra; Niraj; Jani

    2010-01-01

    Cholelithiasis and choledocholithiasis occur frequently in pregnancy and their management can be complicated. Traditional endoscopic retrograde cholangiopancreatography(ERCP)is the first line treatment for choledocholithiasis,but in addition to its baseline risks,fluoroscopy poses an additional radiation risk to the fetus. Endoscopic ultrasound(EUS)is an accurate modality for detecting common bile duct stones,but its role has not been defined in pregnancy.We describe an alternative management strategy to co...

  7. Comparison of brush and basket cytology in differential diagnosis of bile duct stricture at endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Ki Bae Bang; Hong Joo Kim; Jung Ho Park; Dong Il Park; Yong Kyun Cho; Chong Il Sohn; Woo Kyu Jeon; Byung Ik Kim

    2014-01-01

    BACKGROUND: A previous report has identiifed a signiifcantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato­ graphy (ERCP). This study aimed to compare the diagnostic accuracy of Geenen brush and Dormia basket cytology in the differential diagnosis of bile duct stricture.METHOD:  The  current  study  enrolled  one  hundred  and fourteen patients who underwent ERCP with both Geenen brush and Dormia basket cytology for the differential diagnosis of bile duct stricture at our institution between January 2008 and December 2012.RESULTS: We adopted sequential performances of cytologic samplings  by  using  initial  Geenen  brush  and  subsequent Dormia basket cytology in 59 patients and initial Dormia basket and subsequent Geenen brush cytology in 55 patients. Presampling balloon dilatations and biliary stentings for the stricture were performed in 17 (14.9%) and 107 patients (93.9%), respectively. The sensitivity, speciifcity, positive predictive value, negative predictive value, and accuracy of Geenen brush cytology for the diagnosis of malignant bile duct stricture were 75.0%, 100.0%, 100.0%, 66.7% and 83.3%, respectively, and those of Dormia basket cytology were 64.5%, 100.0%, 100.0%, 58.5% and 76.3%, respectively (P=0.347 and 0.827 for sensitivity and accuracy, respectively). The good and excellent cellular yields (≥ grade 2) were obtained by Geenen brush and Dormia basket cytology in 88 (77.2%) and 79 (69.3%) patients, respectively.CONCLUSION: The  sensitivity,  speciifcity  and  accuracy  of biliary sampling with a Dormia basket are comparable to those with conventional Geenen brush cytology in the detection of malignant bile duct stricture.

  8. A new endoscopic therapeutic method for acute obstructive suppurative cholangitis post Roux-en-Y anastomosis: endoscopic retrograde cholangiography through jejunostomy

    Directory of Open Access Journals (Sweden)

    Zhuo YANG

    2012-01-01

    Full Text Available  Objective  To probe the value of endoscopic retrograde cholangiography (ERC through jejunostomy in patients in whom ERC could not be performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract. Methods  In two patients suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma, ERC could not be performed through the mouth due to the presence of a long non-functional jejunal loop. A jejunostomy was first done in the afferent loop of the jejunum, and a gastroscope was then inserted via the jejunostomy and passed retrogradely, to find the stoma of the cholangiointestinal anastomosis. ERC was then successfully performed, and followed by endoscopic retrograde biliary drainage (ERBD. Results  The operation was successful. It was found that cholangio-jejunostomy stoma was narrow, and a large amount of purulent mucus was present in the enlarged intrahepatic duct. ERC was done to enlarge the stoma, and a stent was placed into the main branch of the intrahepatic duct. Two patients achieved surgical success and smooth recovery after the operation. Conclusion  ERC through a jejunostomy in the patients who had Roux-en-Y cholangiojejunostomy following radical resection for cholangiocarcinoma, is a safe and effective surgical procedure.

  9. Magnetic resonance cholangiography compared with endoscopic retrograde cholangiography in the diagnosis of primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Hossein Ahrar

    2014-01-01

    Full Text Available Background: Magnetic resonance cholangiography (MRC has gained popularity for diagnosing primary sclerosing cholangitis (PSC. We determined the accuracy of MRC compared with endoscopic retrograde cholangiography (ERC for diagnosing PSC. Materials and Methods: This retrospective case-control study was conducted on patients referred to an outpatient gastroenterology clinic from 2001 to 2013. Patients with established diagnosis of PSC who had undergone MRC and ERC within a 6-month interval were included. Controls were selected from patients who had undergone imaging for reasons other than PSC evaluation. Disease outcome at the study time and liver biochemistry data at diagnosis and 1-year thereafter were retrieved. Diagnostic accuracy of MRC in comparison with ERC was evaluated. Results: A total of 46 definite PSC patients (age at diagnosis = 36.8 ± 11.6 years, 33 male were found. Diagnostic imaging for PSC was ERC alone in 12, MRC alone in 23, and ERC plus MRC in 11 patients. Controls were 89 patients mostly with bile stones. The sensitivity, specificity, and positive and negative likelihood ratios of MRC was 90.9%, 95.5%, 20.23, and 0.10, respectively. Early PSC was found more frequently by MRC compared with ERC (30.4% vs. 8.3%, P = 0.146. No significant difference was found between imaging modalities with regards to patients′ outcome (P = 0.786 or liver biochemistry at diagnosis or 1-year thereafter (P >0.05. Conclusion: Starting diagnostic imaging for PSC with MRC seems better and may provide diagnosis of PSC at its earlier phase. Further studies with larger sample of patients and longer follow-ups are warranted.

  10. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography.

    Science.gov (United States)

    Vogl, Thomas J; Schwarz, Wolfram O; Heller, Matthias; Herzog, Christopher; Zangos, Stephan; Hintze, Rainer E; Neuhaus, Peter; Hammerstingl, Renate M

    2006-10-01

    The aim of the study was to compare prospectively magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) with endoscopic retrograde cholangiography (ERC) in the diagnosis and staging of Klatskin tumours of the biliary tree (hilar cholangiocarcinomas). Forty-six patients with suspected Klatskin tumours of the biliary tract underwent MRI and heavily T2-weighted, non-breathhold, respiratory-triggered fast spin-echo MRC. Forty-two patients underwent ERC within 24 h; in four patients, ERC was not feasible, and percutaneous trans-hepatic cholangiography (PTC) was carried out instead. Two independent investigators evaluated imaging results for the presence of tumour, bile duct dilatation, and stenosis. Clinical and histopathological correlation revealed Klatskin tumours in 33 patients. MRI revealed a slightly hyperintense signal of infiltrated bile ducts in T2-weighted fast spin-echo sequences. The malignant lesion was regularly visualized as a hypointense area in T1-weighted gradient-echo sequences with substantial contrast enhancement along the involved bile duct walls. MRC revealed the location and extension of the tumour in 31 of 33 cases correctly (sensitivity 94%, specificity 100%, diagnostic accuracy 95%). In 27 of 31 cases, ERC enabled accurate staging and diagnosis of Klatskin tumours with a sensitivity of 87%. ERC and PTC combined yielded a sensitivity of 84% and a specificity of 97%. Tumours were grouped according to the Bismuth classification, with MRC allowing correct identification of type I tumour in seven patients, type II tumour in four patients, type III tumour in 12 patients, and type IV tumour in ten patients. MRC provided superior visualization of completely obstructed peripheral systems. MRC in combination with MRI is a reliable non-invasive diagnostic method for the pre-therapeutic staging of Klatskin tumours.

  11. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J.; Schwarz, Wolfram O.; Heller, Matthias; Herzog, Christopher; Zangos, Stephan; Hammerstingl, Renate M. [Johann Wolfgang Goethe University of Frankfurt am Main, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Hintze, Rainer E. [Humboldt University of Berlin, Department of Gastroenterology, Berlin (Germany); Neuhaus, Peter [Humboldt University of Berlin, Department of Surgery, Berlin (Germany)

    2006-10-15

    The aim of the study was to compare prospectively magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) with endoscopic retrograde cholangiography (ERC) in the diagnosis and staging of Klatskin tumours of the biliary tree (hilar cholangiocarcinomas). Forty-six patients with suspected Klatskin tumours of the biliary tract underwent MRI and heavily T2-weighted, non-breathhold, respiratory-triggered fast spin-echo MRC. Forty-two patients underwent ERC within 24 h; in four patients, ERC was not feasible, and percutaneous trans-hepatic cholangiography (PTC) was carried out instead. Two independent investigators evaluated imaging results for the presence of tumour, bile duct dilatation, and stenosis. Clinical and histopathological correlation revealed Klatskin tumours in 33 patients. MRI revealed a slightly hyperintense signal of infiltrated bile ducts in T2-weighted fast spin-echo sequences. The malignant lesion was regularly visualized as a hypointense area in T1-weighted gradient-echo sequences with substantial contrast enhancement along the involved bile duct walls. MRC revealed the location and extension of the tumour in 31 of 33 cases correctly (sensitivity 94%, specificity 100%, diagnostic accuracy 95%). In 27 of 31 cases, ERC enabled accurate staging and diagnosis of Klatskin tumours with a sensitivity of 87%. ERC and PTC combined yielded a sensitivity of 84% and a specificity of 97%. Tumours were grouped according to the Bismuth classification, with MRC allowing correct identification of type I tumour in seven patients, type II tumour in four patients, type III tumour in 12 patients, and type IV tumour in ten patients. MRC provided superior visualization of completely obstructed peripheral systems. MRC in combination with MRI is a reliable non-invasive diagnostic method for the pre-therapeutic staging of Klatskin tumours. (orig.)

  12. Diagnosis of pancreatic tumors : comparison of MR pancreatography(MRP) and endoscopic retrograde pancreatography(ERP)

    Energy Technology Data Exchange (ETDEWEB)

    Noh, Ki Suh; Seo, Jung Hoon; Kim, Myeong Jin; Chung, Jae Bok; Chung, Jae Joon; Lee, Jong Tae; Yoo, Hyung Sik [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-11-01

    Magnetic resonance pancreatography(MRP) is a non-invasive imaging technique for visualization of the pancreatic duct system, and is similar to those obtained by means of endoscopic retrograde pancreatography(ERP). To determine the role of MRP in the diagnosis of pancreatic tumors, the diagnostic confidence and imaginal difference of MRP and ERP were compared. Twenty patients(13 male and 7 female, mean age 59 years) with pancreatic tumors underwent MRP and ERP. The former involved the use of a single shot fast spin-echo sequence on a 1.5T system. All images were retrospectively reviewed by a radiologist and a gastroenterologist, working together. Both MRP and ERP were compared for separate visualization of the head, body and tail portion of the pancreatic duct, and scored as excellent (4), good (3), fair (2), poor (1), or no visualization (0). In addition, the overall diagnostic confidence of both modalities was graded subjectively from non-diagnoses (0) to definite information (4). The final diagnoses derived from surgical findings (n=9) or imaging findings and clinical follow-up (n=7) were as follows : pancreatic cancer (n=12), mucin-producing pancreatic cancer (n=2), mucinous ductectatic tumor (n=4), serous cystadenoma (n=2). To assess the statistical significance of difference, the paired t-test was used. Mean scores of visualization of the pancreatic duct by MRP and ERP were 2.91 and 3.15 in the pancreatic head (p=NS), 3.11 and 2.18 in the pancreatic body (p=NS), and 3.07 and 1.09 in the pancreatic tail (p<0.01). The mean score of diagnostic confidence was 4.03 for MRP and 2.51 for ERP, a statistically significant difference (p<0.05). In 11 patients with obstruction of the pancreatic duct due to malignant lesions, MRP visualized the duct both proximally and distally to the site of obstruction, while ERP visualized only the distal duct to the site of obstruction. MRP was also better at defining the extent of tumor by visualization of surrounding pancreatic

  13. Primary sclerosing cholangitis in children: utility of magnetic resonance cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Babyn, Paul S.; Manson, David E. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Roberts, Eve [The Hospital for Sick Children, Department of Gastroenterology, Toronto (Canada); Moineddin, Rahim [University of Toronto, Department of Family and Community Medicine, Toronto (Canada)

    2008-08-15

    Even when histologic findings are highly suggestive of primary sclerosing cholangitis (PSC), cholangiographic correlation is required for the diagnosis. The present gold standard, endoscopic retrograde cholangiopancreatography (ERCP), is invasive and associated with complications. To evaluate the usefulness of magnetic resonance cholangiopancreatography (MRCP) in diagnosing PSC in children. MRCP studies were retrospectively reviewed in 20 children with clinical suspicion of PSC and who had undergone liver biopsy. MRCP studies were considered positive or negative for PSC depending on the presence or absence of dilatation, irregularity, multifocal strictures and beading of the bile ducts. Twenty children (14 boys, 6 girls) with an average age of 13 years qualified for the study. Of 19 diagnostic MRCP studies, 16 were called positive and 3 were called negative. An overall diagnosis of PSC-positive was assigned to all 19 patients based on clinical and laboratory findings, biopsy results and cholangiographic data. Based on this overall diagnosis, MRCP was 84% sensitive and accurate to diagnose PSC in children. MRCP can be a valuable tool in diagnosing pediatric PSC that can demonstrate major intra- and extrahepatic ducts in most cases. An unequivocally positive MRCP study should not be followed by ERCP for diagnosing PSC in children. (orig.)

  14. The role of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Yukinao; Nishikawa, Kunihisa; Ohtaki, Tetsuo; Hata, Masanori; Miyaji, Hideki; Hayashi, Shigeyuki [Fukui Red Cross Hospital (Japan)

    2001-07-01

    Recently, magnetic resonance cholangiopancreatography (MRCP) has been widely used in the clinical field as a noninvasive method to visualize the main pancreatic duct and the biliary system. We evaluated the accuracy of MRCP, abdominal CT and abdominal urtrasonography in the diagnosis of choledocholithiasis in comparison with that of endoscopic retrograde cholangiopancreatography (ERCP). Forty patients with choledocholithiasis with some complications, such as icterus, pancreatitis or cholangitis, were examined by MRCP, CT, US and ERCP. We studied the detection rate of the common bile duct stones in MRCP, CT, US separately, and the diagnostic value of each of the other techniques was compared with that of ERCP. The detection rate of common bile duct stones in MRCP, CT and US was 87.5%, 80.5% and 45.0%, respectively. The combined detection rate in MRCP and CT, MRCP and US, CT and US, and MRCP, CT and US was 95.0%, 97.5%, 80.0% and 100%, respectively. MRCP could not efficiently detect common bile duct stones less than 5 mm in size. Moreover, it was impossible to detect impacted stones in the papilla of Vater by MRCP. Currently, it would seem that the combination of MRCP, CT and US has comparable efficacy for the diagnosis of common bile duct stones in patients with the complications to that of ERCP. (author)

  15. Magnetic resonance cholangiopancreatography in primary sclerosing cholangitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Ferrara, Calogero; Valeri, Gianluca; Salvolini, Luca [Department of Radiology, University of Ancona (Italy); Giovagnoni, Andrea [Department of Radiology, University of Modena (Italy)

    2002-06-01

    Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown aetiology. Diagnosis is based on clinical and laboratory data in conjunction with imaging of the biliary tree using endoscopic retrograde cholangiopancreatography (ERCP). Objective: To evaluate the clinical usefulness of MR cholangiopancreatography (MRCP) in the diagnosis of PSC in children. Materials and methods: Twenty-one children with clinical and laboratory suspicion of PSC were enrolled. MRCP was performed using a superconductive system with a phased-array coil. Rapid acquisition with relaxation enhancement (RARE) T2-weighted and half-Fourier single-shot turbo-spin-echo (HASTE) sequences were used. The distribution and extent of biliary tree changes were evaluated and classified according to Majoie's classification. A comparison between MRCP and ERCP was performed blind in all cases to evaluate the usefulness of MRI. Results: In 13 cases (62%), MRCP showed abnormalities of the biliary tree which were considered positive for PSC, while in 8 cases there were no signs of PSC. Both MRCP and ERCP correctly identified changes in 13 cases and excluded abnormalities in 5. MRCP had a sensitivity of 81%, specificity of 100%, negative predictive value of 62%, positive predictive value of 100% and an accuracy of 85%. Conclusions: MRCP can be proposed as the preliminary non-invasive imaging modality for the diagnosis of PSC in children. (orig.)

  16. Recent advances in endoscopic ultrasonography-guided biliary interventions.

    Science.gov (United States)

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-08-28

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.

  17. Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Ulku Saritas; Bunyamin Aydin; Yucel Ustundag

    2007-01-01

    Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure.After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow-up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

  18. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS),or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis,and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures,seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

  19. Endoscopic electrosurgical papillotomy and manometry in biliary tract disease.

    Science.gov (United States)

    Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C

    1977-05-01

    Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.

  20. Endoscope disinfection and its pitfalls--requirement for retrograde surveillance cultures.

    NARCIS (Netherlands)

    Buss, A.J.; Been, M.H.; Borgers, R.P.; Stokroos, I.; Melchers, W.J.G.; Peters, F.T.; Limburg, A.J.; Degener, J.E.

    2008-01-01

    BACKGROUND AND STUDY AIMS: Several endoscopy-related outbreaks of infection have been reported in recent years. For early recognition of inadequate disinfection of endoscopes we designed a microbiological surveillance system to evaluate the efficacy of the cleaning and disinfection procedure, and to

  1. Endoscopic management of biliary fascioliasis: a case report

    Directory of Open Access Journals (Sweden)

    Kasnazani Kalandar A

    2010-03-01

    Full Text Available Abstract Introduction Fasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation. Case presentation A 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. Conclusion Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.

  2. Endoscopic management of benign biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Benign biliary strictures are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic management has evolved over the last 2 decades as the current standard of care. The most common etiologies of strictures encountered are following surgery and those related to chronic pancreatitis. High-quality cross-sectional imaging provides a road map for endoscopic management. Currently, sequential placement of multiple plastic biliary stents represents the preferred approach. There is an increasing role for the treatment of these strictures using covered metal stents, but due to conflicting reports of efficacies as well as cost and complications, this approach should only be entertained following careful consideration. Optimal management of strictures is best achieved using a team approach with the surgeon and interventional radiologist playing an important role.

  3. Sclerosing cholangitis with autoimmune pancreatitis versus primary sclerosing cholangitis: comparison on endoscopic retrograde cholangiography, MR cholangiography, CT, and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim; Jin Hee; Byun, Jae Ho; Kim, So Yeon; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu [Dept. of Radiology and Research Inst. of Radiology, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)], e-mail: jhbyun@amc.seoul.kr; Kim, Myung-Hwan [Dept. of Internal Medicine, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2013-07-15

    Background: It is essential to differentiate sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) from primary sclerosing cholangitis (PSC) as the treatment and prognosis of the two diseases are totally different. Purpose: To compare image findings of SC-AIP and PSC on endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), computed tomography (CT), and magnetic resonance imaging (MRI). Material and Methods: Two radiologists retrospectively reviewed ERC, MRC, CT, and MRI in 28 SC-AIP and 23 PSC patients in consensus. Factors evaluated included the length, location, and multiplicity of bile duct stricture, the presence of characteristic cholangiographic features of PSC on ERC and MRC, and the presence, location, thickness, and pattern of bile duct wall thickening on CT and MRI. Results: On ERC, focal stricture, multifocal and intrahepatic bile duct stricture, and beaded, pruned-tree, and diverticulum-like appearance were more frequent in PSC than in SC-AIP patients (P = 0.006). On MRC, multifocal and intrahepatic bile duct stricture and pruned-tree appearance were more frequent in PSC than in SC-AIP patients (P = 0.044). On CT and MRI, the bile duct wall was thicker (5.1 mm vs. 3.1 mm; P = 0.033 and 4.3 mm vs. 3.0 mm; P = 0.01, respectively) in SC-AIP than in PSC patients. PSC was more frequently associated with intrahepatic bile duct wall thickening on both CT (93% vs. 50%; P = 0.024) and MRI (100% vs. 50%; P = 0.023) than SC-AIP. Conclusion: The combination of ERC or MRC with cross-sectional images, including CT and MRI, may be helpful in differentiating between SC-AIP and PSC.

  4. Mucin gene expression in bile of patients with and without gallstone disease, collected by endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Alexander Vilkin; Alex Geller; Zohar Levi; Yaron Niv

    2009-01-01

    AIM: To investigate the pattern of mucin expression and concentration in bile obtained during endoscopic retrograde cholangiography (ERC) in relation to gallstone disease.METHODS: Bile samples obtained at ERC from 29 consecutive patients, 17 with and 12 without gallstone disease were evaluated for mucin content by gel filtration on a Sepharose CL-4B column. Dot blot analysis for bile mucin apoproteins was performed with antibodies to Mucin 1 (MUC1), MUC2, MUC3, MUC5AC, MUC5B and MUC6. Staining intensity score (0-3) was used as a measure of antigen expression. RESULTS: MUC1, MUC2, MUC3, MUC5AC, MUC5B and MUC6 were demonstrated in 34.4%, 34.4%, 51.7%, 51.7%, 55.1% and 27.5% of bile samples, respectively. The staining intensity scores were 0.62 ± 0.94, 0.58 ± 0.90, 0.79 ± 0.97, 1.06 ± 1.22, 1.20 ± 1.26 and 0.41 ± 0.73, respectively. Mean mucin concentration measured in bile by the Sepharose CL-4B method was 22.8 ± 24.0 mg/mL (range 3.4-89.0 mg/mL). Mean protein concentration was 8.1 ± 4.8 mg/mL (range 1.7-23.2 mg/mL).CONCLUSION: High levels of MUC3, MUC5AC and MUC5B are expressed in bile aspirated during ERC examination. A specific pattern of mucin gene expression or change in mucin concentration was not found in gallstone disease.

  5. Reality named endoscopic ultrasound biliary drainage

    Institute of Scientific and Technical Information of China (English)

    Hugo; Gon?alo; Guedes; Roberto; Iglesias; Lopes; Joel; Fernandez; de; Oliveira; Everson; Luiz; de; Almeida; Artifon

    2015-01-01

    Endoscopic ultrasound(EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangio-graphy, but nowadays it emerges as a powerful thera-peutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage(EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retro-grade cholangiopancreatography(ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage(PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or trans-papillary, which, again, can be antegrade or retrograde [rendezvous(EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.

  6. Endoscopic ultrasonography is a valuable diagnostic tool in patients with incidental findings in the pancreas or bile ducts

    DEFF Research Database (Denmark)

    Al-Najami, Issam; Ainsworth, Alan Patrick

    2015-01-01

    INTRODUCTION: Incidental findings are often seen at computed tomographies (CT). This study describes patients who had an endoscopic ultrasonography (EUS) because of an incidental finding in the pancreas/bile duct. METHODS: Patients referred for EUS between September 2012 and September 2013 because...... evaluation (n = 27), referred for new EUS or other imaging procedures (n = 14) and referred for surgery/endoscopic retrograde cholangiopancreatography (n = 6). In total, 6 patients proved to have neoplastic diseases in the pancreas. None of the patients who were stopped from further evaluation following EUS...

  7. Endoscopic therapy in acute recurrent pancreatitis

    Institute of Scientific and Technical Information of China (English)

    John Baillie

    2008-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic rnodality.Cross-sectional imaging,such as computed tomography (CT) and magnetic resonance imaging (MRI),and less invasive endoscopy,especially endoscopic ultrasound (EUS),have largely taken over from ERCP for diagnosis.However,ERCP remains the"first line" therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis,including bile duct stones(choledocholithiasis),ampullary masses (benign and malignant),congenital variants of biliary and pancreatic anatomy (e.g.pancreas divisum,choledochoceles),sphincter of Oddi dysfunction (SOD),pancreatic stones and strictures,and parasitic disorders involving the biliary tree and/or pancreatic duct(e.g Ascariasis,Clonorchiasis).

  8. Current endoscopic approach to indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

    David W Victor; Stuart Sherman; Tarkan Karakan; Mouen A Khashab

    2012-01-01

    Biliary strictures are considered indeterminate when basic work-up,including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing,are non-diagnostic.Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome.Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery,but also potential timely targeted chemotherapies.A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is,thus,paramount to avoid unnecessary surgery.Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy.Emerging data on other diagnostic modalities,such as ancillary cytology techniques,single operator cholangioscopy,and endoscopic ultrasonography-guided fine needle aspiration,revealed promising results with much improved sensitivity.

  9. Endoscopic management of biliar y disorders during pregnancy

    Institute of Scientific and Technical Information of China (English)

    Vui Heng Chong; Anand Jalihal

    2010-01-01

    BACKGROUND: Biliary interventions during pregnancy are associated with risks to both the pregnancy and developing fetus. In this report we summarize our experience with endoscopic interventions including endoscopic ultrasound (EUS) in the management of biliary disorders during pregnancy. METHODS: Endoscopic retrograde cholangiopancreatographies (ERCPs) performed between May 2003 through January 2010 (n=607) were identiifed from our database, and cases of interventions during pregnancy were reviewed. All procedures were done using conscious sedation and lead shielding. RESULTS: Nine ERCPs (1.5%) were performed in 8 pregnant patients. Their median gestational period was 22 weeks (range, CONCLUSIONS: ERCP is a safe procedure for pregnant women. It can be conducted for biliary stenting and subsequent clearance after deliveries. EUS has a complementary role. Different strategies can be applied according to the conditions or expertise of endoscopists.

  10. Lethal post-endoscopic retrograde cholangiopancreatography pancreatitis following fully covered metal stent placement in distal biliary obstruction due to unresectable cholangiocarcinoma.

    Science.gov (United States)

    Itoi, Takao; Tsuchiya, Takayoshi; Tanaka, Reina; Ikeuchi, Nobuhito; Sofuni, Atsushi

    2013-05-01

    Biliary self-expandable metallic stent (SEMS) is the preferred and first-line therapy for unresectable malignant biliary obstruction. To date, several reports have revealed the relatively high incidence of acute complications such as pancreatitis and cholecystitis due to mechanical stent compression. In the present case, we encountered fatal pancreatitis following fully covered metal stent placement. An 85-year-old man had middle bile duct strictures due to cholangiocarcinoma. A 10-mm diameter fully covered SEMS was placed across the papilla for biliary decompression. Laboratory data and physical evidence the following day revealed acute pancreatitis. Therefore, antibiotics and protein degeneration enzyme inhibitors were given. However, his condition did not improve. Two days after the procedure, we removed the stent and returned him to his original hospital. Serum amylase level decreased below 400 mg/dL 6 h after the procedure. However, the acute pancreatitis worsened. Although we treated the patient in the intensive care unit, he died 32 days after the second admission.

  11. Retrograde gastroesophageal intussusception.

    Science.gov (United States)

    David, S; Barkin, J S

    1992-01-01

    This is an initial report of spontaneous retrograde gastroesophageal intussusception in an adult. The patient is a 72-yr-old women with a history of ovarian cancer and hiatal hernia, who presented with symptoms of upper gastrointestinal obstruction. Retrograde intussusception was diagnosed endoscopically and confirmed radiographically with an upper gastrointestinal series. Heightened awareness of this entity may lead to its more frequent diagnosis.

  12. Magnetic Resonance Cholangiopancreatography in the Diagnosis of Haemobilia

    Directory of Open Access Journals (Sweden)

    Ines Casazza

    2013-01-01

    Full Text Available Haemobilia is a rare cause of unrecognized gastrointestinal bleeding and is hard to diagnose. Through the present case report we aim to corroborate magnetic resonance relevance in the evaluation of biliary system and bile features, investigating on its role in patients with acute biliary diseases. We report a case of a Caucasian 48-year-old man who was admitted due to abdominal pain and fever. After an ultrasonography exam we detected multiple cysts in the hepatic left lobe: imaging features, laboratory findings, and patient past work experience (woodcutter suggested a diagnosis of hepatic Echinococcosis. Once surgery decision was taken, patient underwent an intervention of cystopericystectomy. On the 8th postoperative day, the procedure was complicated by black stool, jaundice, and severe anaemia. Acomputed tomography revealed an inhomogeneous collection with some air bubbles in the area of previous surgical intervention, but it was not able to solve the diagnosis question. At this stage a magnetic resonance study was mandatory. On T2-weighted images we observed an expanse gallbladder with hypointense intraluminal material and a considerable intrahepatic biliary system dilatation due to bloody material. On the basis of these examination results, we supposed haemobilia arising from previous surgical intervention. A therapeutic endoscopic retrograde cholangiopancreatography procedure led to decompression of biliary system through a major papilla sphincterotomy with spillage of bile mixed with blood clots.

  13. Developments in flexible endoscopic surgery: a review

    Directory of Open Access Journals (Sweden)

    Feussner H

    2014-12-01

    Full Text Available Hubertus Feussner,1 Valentin Becker,2 Margit Bauer,1 Michael Kranzfelder,1 Rebekka Schirren,1 Tim Lüth,3 Alexander Meining,2 Dirk Wilhelm1 1Department of Surgery, 22nd Medical Department, 3Institute of Microtechnology and Medical Device Technology, Klinikum rechts der Isar, Technische Universität München, Germany Abstract: Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel – for long a "white spot" for gastrointestinal endoscopy – and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings. Keywords: flexible endoscopic surgery, endoscopic ultrasound, advanced techniques, natural orifice transluminal endoscopic surgery

  14. Endoscopic ultrasound and pancreas divisum

    DEFF Research Database (Denmark)

    Rana, Surinder S; Gonen, Can; Vilmann, Peter

    2012-01-01

    cholangiopancreatography is the gold standard for its diagnosis, but is invasive and associated with significant adverse effects. Endoscopic ultrasound (EUS) allows the detailed evaluation of the pancreaticobiliary ductal system without injecting contrast in these ducts. Moreover, it provides detailed images...

  15. Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Maria Chiara Petrone; Paolo G Arcidiacono; Pier Alberto Testoni

    2008-01-01

    Acute recurrent pancreatitis(ARP)is still a complex diagnostic and therapeutic challenge in clinical practice.In up to 30% of cases of ARP,it is not possible to establish the etiology of the disease.In the other 70%,many factors play an etiological role in ARP:microlithiasis,sphincter of Oddi dysfunction(SOD),pancreas divisum,hereditary pancreatitis,cystic fibrosis,a choledochocele,annular pancreas,an anomalous pancreatobiliary junction,pancreatic tumors or chronic pancreatitis are diagnosed.EUS should be useful in ARP as it is sensitive for diagnosing bile duct stones,gallbladder sludge,pancreatic lesions,ductal abnormalities and chronic pancreatitis.Endoscopic ultrasound (EUS) appears to be diagnostic in the majority of patients with previously unexplained pancreatitis,and offers an alternative to endoscopic retrograde cholangiopancreatography(ERCP)as the initial diagnostic test in patients with ARR

  16. Endoscopic ultrasound guided biliary and pancreatic duct interventions

    Institute of Scientific and Technical Information of China (English)

    David; Prichard; Michael; F; Byrne

    2014-01-01

    When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention.

  17. Significance of cytomorphological and microbiological examination of bile collected by endoscopic cannulation of the papilla of vater

    Directory of Open Access Journals (Sweden)

    Misra Vatsala

    2009-07-01

    Full Text Available Background: Bile analysis yields important information such as "biliary microlithiasis" and biliary tract colonization by microorganisms like Salmonella typhi or paratyphi, Escherichia coli , etc., which may progresses to cholelithiasis and have been found to have a role in the development of gallbladder cancer in India. Aim: To perform microscopic, cytomorphological and microbiological examination of bile collected during endoscopic retrograde cholangiopancreatography in patients with benign and malignant lesions of the gallbladder. Materials and Methods: Bile was collected from 48 patients by a catheter inserted through the cystic duct during endoscopic retrograde cholangiopancreatography. Direct microscopy and grading of crystals was performed. Smears prepared from centrifuged deposits were stained with Giemsa, Papanicolaou stain and Gram′s stain for cytological and microbiological examination. Special staining for Helicobacter pylori was performed using Loeffler′s Methylene blue and Warthin Starry stain. The rest of the sample was used for culture and complete microbiological examination. Results: Thirty-six patients had inflammatory lesions while 12 had malignant lesions. Crystals were observed in 93% of the cases, 13 (28.8% had only cholesterol crystals, three (6.6% had bilirubinate and 29 (64.4% had both cholesterol and bilirubinate crystals. Smears from the centrifuged deposit mainly showed coccoid or cocobacillary bacteria on Gram′s staining (81.3%. Five of 12 (41.6% malignant cases showed epithelial atypia while none of the benign or inflammatory lesions showed such a change in hematoxylin and eosin and Pap-stained smears. Microbiologic analysis showed Staphylococcus aureus (14%, S. saprophyticus (5.5%, Peptococcus (5.5%, Peptostreptococcus (5.5%, Proteus mirabilis (5.5%, E. coli (17%, Enteorbacter cloacae (5.5% and H. pylori (2.8%. Conclusion: Complete microscopic and microbiological examination of bile directly obtained from

  18. Successful Endoscopic Therapy of Traumatic Bile Leaks

    Directory of Open Access Journals (Sweden)

    Matthew P. Spinn

    2013-02-01

    Full Text Available Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP after traumatic bile duct injury secondary to blunt (motor vehicle accident or penetrating (gunshot trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%. The mean duration of follow-up was 85.6 days (range 54-175 days. There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.

  19. MR cholangiopancreatography: technique, potential indications, and diagnostic features of benign, postoperative, and malignant conditions

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D. [Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Grossholz, M. [Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Mentha, G. [Department of Surgery, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Peyer, R. de [Division of Gastroenterology, University Hospital of Geneva, CH-1211 Geneva (Switzerland); Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva (Switzerland)

    1997-08-01

    The objective of this article is to review technical aspects, discuss potential clinical indications for MR cholangiopancreatography (MRCP) and demonstrate the spectrum of diagnostic findings in benign, postoperative, and malignant conditions. We describe our current imaging protocol in comparison with other available techniques. Using a non-breath-hold, heavily T2-weighted fast-spin-echo (FSE) sequence with or without respiratory gating we obtained coronal and axial source images and maximum intensity projections (MIPs) in 102 patients with suspected abnormalities of the biliary or pancreatic ducts. Based on this series we demonstrate the diagnostic appearance of a variety of benign, postoperative, and malignant conditions of the biliary and pancreatic ducts and discuss potential clinical indications for MRCP. The non-breath-hold FSE technique enables a consistent image quality even in patients who cannot cooperate well. Respiratory gating increased the rate of diagnostic examinations from 79 to 95 %. Acquisition of coronal and axial source images enables detection of bile duct stones as small as 2 mm, although calculi that are impacted and not surrounded by hyperintense bile may sometimes be difficult to detect. The MIP reconstructions help to determine the level of obstruction in malignant jaundice, delineate anatomical variants and malformations, and to diagnose inflammatory conditions, e. g., sclerosing cholangitis, the Mirizzi syndrome and inflammatory changes in the main pancreatic duct. The MRCP technique also correctly demonstrates the morphology of bilio-enteric or bilio-biliary anastomoses. Because MRCP provides sufficient diagnostic information in a wide range of benign and malignant biliary and pancreatic disorders, it could obviate diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in many clinical settings. The ERCP technique may be increasingly reserved for patients in whom nonsurgical interventional procedures are anticipated. (orig

  20. Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Byun, Jae Ho; Lee, So Jung; Park, Seong Ho; Kim, Hyoung Jung; Lee, Seung Soo; Lee, Moon-Gyu [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Myung-Hwan [University of Ulsan College of Medicine, Asan Medical Center, Department of Internal Medicine, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Jihun [University of Ulsan College of Medicine, Asan Medical Center, Department of Diagnostic Pathology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of)

    2012-11-15

    To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases. Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared. At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P {<=} 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P {<=} 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC. Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases. (orig.)

  1. Meta-analysis: endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis%荟萃分析:超声内镜和ERCP诊断胆总管结石的比较

    Institute of Scientific and Technical Information of China (English)

    周艳; 陈翔

    2008-01-01

    目的 通过荟萃分析对超声内镜和ERCP对胆总管结石诊断能力进行比较.方法 从Pubmed、Embase、Elsevier Science Direct和中国期刊全文数据库中检索比较超声内镜和ERCP对怀疑有胆总管结石病人诊断能力的前瞻性研究.对各项研究中的敏感性、特异性、准确率的比数比(OR)行荟萃分析,采用固定效应模型或随机效应模型进行数据统计分析.结果 共有5项对照研究入选(n=325).超声内镜的敏感性显著高于ERCP(146/159 vs 134/159,固定效应模型:OR 2.02,95%CI=1.01-4.03,P=0.05).超声内镜和ERCP对检测胆总管结石的特异性相似(161/166 vs 164/166,固定效应模型:OR 0.49,95% CI=0.12-1.99,P>0.05).超声内镜的准确性略高于ERCP,但没有显著性差异(307/325 vs 298/325,固定效应模型:OR 1.53,95% CI=0.83-2.80,P>0.05).ERCP相关的不良反应发生率显著高于超声内镜(P<0.01).结论 由于准确率、安全性高,侵入性相对较小,超声内镜可认为是诊断胆总管结石的理想检查项目并能替代诊断性ERCP.对于这两种方法 的选择,应该取决于病人的一般状况、医疗单位所具备的能力,以及病灶是否可能需要采取进一步的介入治疗.

  2. Finding of biliary fascioliasis by endoscopic ultrasonography in a patient with eosinophilic liver abscess.

    Science.gov (United States)

    Behzad, Catherine; Lahmi, Farhad; Iranshahi, Majid; Mohammad Alizadeh, Amir Houshang

    2014-09-01

    Fascioliasis is an endemic zoonotic disease in Iran. It occurs mainly in sheep-rearing areas of temperate climates, but sporadic cases have been reported from many other parts of the world. The usual definitive host is the sheep. Humans are accidental hosts in the life cycle of Fasciola. Typical symptoms may be associated with fascioliasis, but in some cases diagnosis and treatment may be preceded by a long period of abdominal pain and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 6 months, with imaging suggesting liver abscess and normal biliary ducts. The patient had no eosinophilia with negative stool examinations, so she was initially treated with antibiotics for liver abscess. Her clinical condition as well as follow-up imagings showed appropriate response after antibiotic therapy. Finally, endoscopic ultrasonography revealed Fasciola hepatica, which was then extracted with endoscopic retrograde cholangiopancreatography.

  3. Noninvasive study of anatomic variations of the bile and pancreatic duct using magnetic resonance cholangiopancreatography; Estudio no invasivo de variantes anatomicas de la via biliar y pancreatica mediante colangiopancreatografia por resonancia magnetica (CPRM)

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Campo, R.; Martin, J.; Brullet, E. [SDI-UDIAT Corporacio Sanitaria Parc Tauli. Sabadell (Spain); Espinos, J. [Hospital Mutua de Tarrasa (Spain)

    1999-07-01

    To identify anatomic variations of the bile duct and pancreatic duct and papillary anomalies by means of magnetic resonance cholangiopancreatography (MRCP) and determine their correlation with endoscopic retrograde cholangiopancreatography (ERCP) findings. Eighty-five patients were selected by means of a prospective study comparing MRCP and ERCP. Coronal and axial HASTE images and coronal and oblique coronal RARE images were acquired in all the patients. Four of the studies (6%) were excluded because of poor technical quality. Anatomic variations were observed in 26 cases (30.5%), including trifurcation (n=7; 27%), right hepatic duct draining into left hepatic duct (n=2, 7.7%), right hepatic duct draining into common bile duct (n=4; 15.4%), extrahepatic confluence (n=2; 7.7%), medial cystic duct (n=2; 7.7%), parallel cystic duct (n=3; 11.5%), juxtapapillary duodenal diverticulum (n=3; 11.5%) and pancreas divisum (n=3; 11.5%). A good correlation was observed between the MRCP and ERCP findings. The introduction of MRCP into the noninvasive study of biliary disease may be useful in the detection of anatomic variations relevant to laparoscopic surgery and other endoscopic and interventional techniques. (Author) 11 refs.

  4. Diagnosis of primary sclerosing cholangitis: prospective comparison of MR cholangiography with endoscopic retrograde cholangiography; Diagnostik der primaer sklerosierenden Cholangitis: prospektiver Vergleich von MR-Cholangiographie mit endoskopisch retrograder Cholangiographie

    Energy Technology Data Exchange (ETDEWEB)

    Oberholzer, K.; Mildenberger, P.; Grebe, P.; Bantelmann, M.; Thelen, M. [Mainz Univ. (Germany). Klinik fuer Radiologie; Lohse, A.W. [Mainz Univ. (Germany). Inst. fuer Innere Medizin; Schadeck, T.

    1998-12-01

    Purpose: To assess the accuracy of MR cholangiography (MRC) in the diagnosis of primary sclerosing cholangitis (PSC) in comparison to endoscopic retrograde cholangiography (ERC). Method: 20 patients with PSC were examined by ERC and MRC (1.0 T. HASTE sequence). Visualization and pathologic changes of the extra- and intrahepatic bile ducts were evaluated with both methods. Results: Mural irregularities of the common bile duct were seen with MRC in 6/7 cases, stenoses and dilatation of the common bile duct were detected correctly in all patients. Diffuse, multifocal strictures of the intrahepatic bile duct were the most common intrahepatic findings and correctly diagnosed in all patients. Mural irregularities of the intrahepatic ducts in early stages may be missed by MRC because of the limited spatial resolution. MRC is superior to ERC in visualization of nonopacified intrahepatic ducts. Conclusions: MRC is a reliable, non-invasive method to detect typical diagnostic features of PSC. It should be considered as an adjunct to ERC in patients with suspected PSC for primary diagnosis and as an alternate method for follow-up studies. (orig.) [Deutsch] Ziel: Ueberpruefung der MR-Cholangiographie (MRC) als alternative Methode zur endoskopisch retrograden Cholangiographie (ERC) bei der Diagnostik der primaer sklerosierenden Cholangitis (PSC). Patienten und Methoden: 20 Patienten mit PSC wurden mit der ERC und MRC (1.0 T, HASTE-Sequenz) untersucht. Die Untersuchungen wurden hinsichtlich Darstellbarkeit und pathologischer Veraenderungen des extra- und intrahepatischen Gallengangsystems ausgewertet. Ergebnisse: Wandunregelmaessigkeiten des D. choledochus und hepaticus wurden mit der MRC in 6/7 Faellen richtig beurteilt, Stenosen oder Dilatationen sind bei allen Patienten richtig erkannt worden. Diffuse, multifokale Strikturen und Dilatationen intrahepatischer Gallengaenge konnten mit der MRC ueberlegen praesentiert werden, waehrend mit der ERC aufgrund unzureichender

  5. Endoscopic treatment of biliary complications after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications. METHODS: This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis p erformed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography (ERCP) was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after 1 year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach (PTC) or surgery was adopted. RESULTS: From .lune 2003 to .lune 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of FRCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, 1 patient was re- transplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3 + 13.13 mo and 21.02:1:14.10 raG, respectively. CONCLUSION: Albhough ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whether other endoscopic protocols or new devices, could improve the current results.

  6. Technical difficulties and success of endoscopic retrograde colangiopancreatography in a group of patients Dificultad técnica y éxito de la colecistopancreatografía retrógrada endoscópica en un grupo de pacientes

    Directory of Open Access Journals (Sweden)

    Mabel Vega Galindo

    2011-04-01

    Full Text Available Background: Endoscopic Retrograde Cholangiopancreatography has been effective in the diagnosis and treatment of diseases of the biliopancreatic system. Objective: To determine the grade of technical difficulties and the success of cholangiopancreatography in a group of patients. Methods: prospective, descriptive, observational study that included all the patients who were tested through this procedure from January to December 2009 in the hospital “Dr. Gustavo Aldereguía Lima” from Cienfuegos. Inclusion and exclusion criteria were applied so the sample was composed by 34 patients. In order to define the technical difficulty of this test Madhotra’s difficulty modified test was used. Results: 67,6 % of the patients were males. Age comprised the interval from 31 to 90 years old patients with a mean age of 60.8±16 years. Cholestatic icterus was the predominant medical indication in (55,9 %, followed by choledocholitiasis (26,5 %. Echogram showed normal results in 41,2 % of the patients. The most frequent diagnosis of this test was postcholecystectomy with dilated biliary tract (17,6 % followed by choledocho and cholelithiasis (14,7 % each one. The grade of technical difficulty was 1 in 91,2 %, grade 2 in 8,8 %. A complete technical success was obtained in 55,9 %, partial success was obtained in 32,3 % and the attempt failed in 11,8 % of the patients. Conclusion: the grade of technical difficulty can influence upon the success of Endoscopic Retrograde Cholangiopancreatography. Its usefulness has been demonstrated with a minimum amount of complications for the patient.Fundamento: la colangiopancreatografía retrógrada endoscópica resulta eficaz para el diagnóstico y tratamiento de enfermedades del sistema biliopancreático. Objetivo: determinar el grado de dificultad técnica y el éxito de la colangiopancreatografía en un

  7. Endoscopic ultrasonography is a valuable diagnostic tool in patients with incidental findings in the pancreas or bile ducts

    DEFF Research Database (Denmark)

    Al-Najami, Issam; Ainsworth, Alan Patrick

    2015-01-01

    evaluation (n = 27), referred for new EUS or other imaging procedures (n = 14) and referred for surgery/endoscopic retrograde cholangiopancreatography (n = 6). In total, 6 patients proved to have neoplastic diseases in the pancreas. None of the patients who were stopped from further evaluation following EUS...... later proved to have a malignant disease in the pancreas. CONCLUSION: EUS is a valuable diagnostic tool in patients with incidental findings in the pancreas/bile duct noted at a CT. Many patients can be stopped from further diagnostic work-up after EUS with a minimal risk of overlooking a malignant......INTRODUCTION: Incidental findings are often seen at computed tomographies (CT). This study describes patients who had an endoscopic ultrasonography (EUS) because of an incidental finding in the pancreas/bile duct. METHODS: Patients referred for EUS between September 2012 and September 2013 because...

  8. Endoscopic ultrasound guided interventional procedures

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Endoscopic ultrasound (EUS) has emerged as animportant diagnostic and therapeutic modality in thefield of gastrointestinal endoscopy. EUS provides accessto many organs and lesions which are in proximity tothe gastrointestinal tract and thus giving an opportunityto target them for therapeutic and diagnostic purposes.This modality also provides a real time opportunityto target the required area while avoiding adjacentvascular and other structures. Therapeutic EUS hasfound role in management of pancreatic fluid collections,biliary and pancreatic duct drainage in cases of failedendoscopic retrograde cholangiopancreatography,drainage of gallbladder, celiac plexus neurolysis/blockage,drainage of mediastinal and intra-abdominal abscessesand collections and in targeted cancer chemotherapyand radiotherapy. Infact, therapeutic EUS has emergedas the therapy of choice for management of pancreaticpseudocysts and recent innovations like fully coveredremovable metallic stents have improved resultsin patients with organised necrosis. Similarly, EUSguided drainage of biliary tract and pancreatic ducthelps drainage of these systems in patients with failedcannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUSguided gall bladder drainage is a useful emergentprocedure in patients with acute cholecystitis who arenot fit for surgery. EUS guided celiac plexus neurolysisand blockage is more effective and less morbid vis-à-visthe percutaneous technique. The field of interventionalEUS is rapidly advancing and many more interventionsare being continuously added. This review focuses onthe current status of evidence vis-à-vis the establishedindications of therapeutic EUS.

  9. Genomic Epidemiology of an Endoscope-Associated Outbreak of Klebsiella pneumoniae Carbapenemase (KPC-Producing K. pneumoniae.

    Directory of Open Access Journals (Sweden)

    Jane W Marsh

    Full Text Available Increased incidence of infections due to Klebsiella pneumoniae carbapenemase (KPC-producing Klebsiella pneumoniae (KPC-Kp was noted among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP at a single hospital. An epidemiologic investigation identified KPC-Kp and non-KPC-producing, extended-spectrum β-lactamase (ESBL-producing Kp in cultures from 2 endoscopes. Genotyping was performed on patient and endoscope isolates to characterize the microbial genomics of the outbreak. Genetic similarity of 51 Kp isolates from 37 patients and 3 endoscopes was assessed by pulsed-field gel electrophoresis (PFGE and multi-locus sequence typing (MLST. Five patient and 2 endoscope isolates underwent whole genome sequencing (WGS. Two KPC-encoding plasmids were characterized by single molecule, real-time sequencing. Plasmid diversity was assessed by endonuclease digestion. Genomic and epidemiologic data were used in conjunction to investigate the outbreak source. Two clusters of Kp patient isolates were genetically related to endoscope isolates by PFGE. A subset of patient isolates were collected post-ERCP, suggesting ERCP endoscopes as a possible source. A phylogeny of 7 Kp genomes from patient and endoscope isolates supported ERCP as a potential source of transmission. Differences in gene content defined 5 ST258 subclades and identified 2 of the subclades as outbreak-associated. A novel KPC-encoding plasmid, pKp28 helped define and track one endoscope-associated ST258 subclade. WGS demonstrated high genetic relatedness of patient and ERCP endoscope isolates suggesting ERCP-associated transmission of ST258 KPC-Kp. Gene and plasmid content discriminated the outbreak from endemic ST258 populations and assisted with the molecular epidemiologic investigation of an extended KPC-Kp outbreak.

  10. Genomic Epidemiology of an Endoscope-Associated Outbreak of Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae.

    Science.gov (United States)

    Marsh, Jane W; Krauland, Mary G; Nelson, Jemma S; Schlackman, Jessica L; Brooks, Anthony M; Pasculle, A William; Shutt, Kathleen A; Doi, Yohei; Querry, Ashley M; Muto, Carlene A; Harrison, Lee H

    2015-01-01

    Increased incidence of infections due to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) was noted among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at a single hospital. An epidemiologic investigation identified KPC-Kp and non-KPC-producing, extended-spectrum β-lactamase (ESBL)-producing Kp in cultures from 2 endoscopes. Genotyping was performed on patient and endoscope isolates to characterize the microbial genomics of the outbreak. Genetic similarity of 51 Kp isolates from 37 patients and 3 endoscopes was assessed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Five patient and 2 endoscope isolates underwent whole genome sequencing (WGS). Two KPC-encoding plasmids were characterized by single molecule, real-time sequencing. Plasmid diversity was assessed by endonuclease digestion. Genomic and epidemiologic data were used in conjunction to investigate the outbreak source. Two clusters of Kp patient isolates were genetically related to endoscope isolates by PFGE. A subset of patient isolates were collected post-ERCP, suggesting ERCP endoscopes as a possible source. A phylogeny of 7 Kp genomes from patient and endoscope isolates supported ERCP as a potential source of transmission. Differences in gene content defined 5 ST258 subclades and identified 2 of the subclades as outbreak-associated. A novel KPC-encoding plasmid, pKp28 helped define and track one endoscope-associated ST258 subclade. WGS demonstrated high genetic relatedness of patient and ERCP endoscope isolates suggesting ERCP-associated transmission of ST258 KPC-Kp. Gene and plasmid content discriminated the outbreak from endemic ST258 populations and assisted with the molecular epidemiologic investigation of an extended KPC-Kp outbreak.

  11. Pretreatment with Drotaverine Hydrochloride before endoscopic retrograde cholangiopanc reatogra-phy: a prospective multicenter randomized controlled trial%盐酸屈他维林在ERCP术前应用价值的多中心随机对照试验

    Institute of Scientific and Technical Information of China (English)

    汪鹏; 李兆申; 刘枫; 杨建锋; 方超英; 唐秀芬; 朱春兰; 张啸; 何利平; 任旭

    2009-01-01

    Objective To evaluate the effects of drotaverine hydrochloride versus scopolamine in re-ducing duodenal motility and in facilitating cannulation during endoscopic retrograde cholangiopancreatogra-phy (ERCP). Methods Randomized controlled trial of 650 participants from 4 endoscopic centers assigned to receive scopolamine 20 mg or drotaverine hydrochloride 40 mg intravenously 15 minutes before ERCP. Pa-rameters including duodenal motility grades, success rates of deep cannulation, ERCP-related complications and adverse effects were recorded. Results The data of 638 patients (319 in each group) were valid. There were no significant differences in duodenal motility grades (1.17 ±0. 82 vs. 1.13 ± 0.89, P =0. 705), success rate of deep cannulation (90. 9% vs. 91.8%, P =0. 672) and incidence of ERCP-related complications (11.3% vs. 11.0%, P =0. 900) between 2 groups. However, the incidence of tachycardia (heart rate > 120 bpm) during ERCP was lower in drotaverine group than in scopolamine group (2. 2% vs. 6. 9%, P = 0. 004). There was no significant difference in other adverse effects (nausea, vomiting) between 2 groups. Conclusion Drotaverine hydrochloride may provide a reasonable alternative as antimotility agent before ERCP.%目的 比较ERCP术前应用盐酸屈他维林和东莨菪碱抑制十二指肠蠕动的效果,探讨ERCP术前应用盐酸屈他维林的有效性和安全性.方法 4个消化内镜中心共650例患者纳入研究.按1:1的比例随机分成屈他维林组和东莨菪碱组.ERCP术前15 min分别给予盐酸屈他维林40 mg或东莨菪碱20 mg静推,观察十二指肠收缩评分、插管成功率、不良反应及术后并发症等.结果 638例患者完成试验,屈他维林组和东莨菪碱组各319例,2组平均十二指肠收缩评分[(1.13 ±0.89)分比(1.17 ±0.82)分]、插管成功率[91.8%(293/319)比90.9%(290/319)]、术后并发症发生率[11.0%(35/319)比11.3%(36/319)]等比较差异均无统计学意义(P值分别为0.705、0

  12. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis.

    Science.gov (United States)

    Lee, Linda S; Bellizzi, Andrew M; Banks, Peter A; Sainani, Nisha I; Kadiyala, Vivek; Suleiman, Shadeah; Conwell, Darwin L; Paulo, Joao A

    2012-01-01

    Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN) was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

  13. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis

    Directory of Open Access Journals (Sweden)

    Linda S. Lee

    2012-01-01

    Full Text Available Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P<0.05 was present in higher concentrations in mixed IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

  14. Anesthesia with Flurbiprofen Axetil and Propofol for Endoscopic Retrograde Cholangiopancreatography%ERCP 术中氟比洛芬酯复合异丙酚麻醉的效果

    Institute of Scientific and Technical Information of China (English)

    朱龙泉; 朱云生; 陈世彪; 赵为禄

    2012-01-01

      目的评价内镜下逆行胰导管造影(ERCP)术患者用氟比洛芬酯复合异丙酚麻醉的安全性和有效性.方法60例行ERCP患者,年龄20~70岁,ASAⅠ级或Ⅱ级,按随机数字表法分为氟比洛芬酯复合异丙酚组(F组)和对照组(C组),每组30例.鼻导管给氧情况下,每组以2 mg・kg -1异丙酚诱导,术中以10 mg・kg -1・h-1异丙酚维持麻醉,F组于诱导时缓慢追加氟比洛芬酯50 mg ,记录起效时间、恢复时间、术中体动(程度和次数)、镇痛效果、呼吸抑制评分和HR、MAP、SpO2及术后并发症的发生情况等.结果2组间麻醉起效时间和恢复时间差异无统计学意义(P>0.05),F组术中体动和呼吸抑制评分的例数低于C组(P0.05).结论氟比洛芬酯复合异丙酚麻醉用于ERCP术中麻醉效果较好,但术后嗜睡的发生率较高.

  15. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Juana; Gonzalo-Marin; Juan; Jose; Vila; Manuel; Perez-Miranda

    2014-01-01

    Endoscopic ultrasonography(EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography(CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T stagingwith less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.

  16. Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct Ecoendoscopia versus colangiografia retrógrada endoscópica para o diagnóstico da coledocolitíase: a influência do tamanho do cálculo e do diâmetro da via biliar principal

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Silva Ney

    2005-12-01

    Full Text Available BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7% had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67% for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%. Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a

  17. Current situation of endoscopic biliary cannulation and salvage techniques for difficult cases: Current strategies in Japan.

    Science.gov (United States)

    Yasuda, Ichiro; Isayama, Hiroyuki; Bhatia, Vikram

    2016-04-01

    In the pancreatobiliary session at Endoscopic Forum Japan (EFJ) 2015, current trends of routine biliary cannulation techniques and salvage techniques for difficult biliary cannulation cases were discussed. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. It was concluded that, currently, in Western countries, the wire-guided cannulation (WGC) technique is favored during initial cannulation attempts. However, the conventional technique using an endoscopic retrograde cholangiopancreatography catheter with contrast medium injection is still used as first choice at most Japanese high-volume centers. The WGC technique is used as the second choice at some institutions only. After failed biliary cannulation attempts, the initial salvage option preferred in most centers includes pancreatic guidewire placement, followed by precut techniques as the second salvage choice. Among several precut techniques, the free-hand needle knife sphincterotomy with cutting upwards from the pancreatic duct is most popular. Endoscopic ultrasonography-guided rendezvous technique is also carried out as a final salvage option at select institutions.

  18. Adult-to-adult right lobe living donor liver transplantation: Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy

    Institute of Scientific and Technical Information of China (English)

    Perdita Wietzke-Braun; Felix Braun; Dieter Müller; Thomas Lorf; Burckhardt Ringe; Giuliano Ramadori

    2006-01-01

    AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications,postoperatively.METHODS: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared usingthe Ohkubo classification.RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%)with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation.Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3recipients with biliary leak received a graft with multiple (≥2) bile ducts.CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

  19. Endosonography with linear array instead of endoscopic retrograde cholangiography as the diagnostic tool in patients with moderate suspicion of common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Maciej Kohut; Andrzej Nowak; Ewa Nowakowska-Dutawa; Tomasz Marek; Roman Kaczor

    2003-01-01

    AIM: To evaluate the diagnostic efficiency of endoscopic ultrasound (EUS) as the main imaging modality in patients with moderate suspicion of common bile duct stones (CBDS).METHODS: 55 patients with moderate clinical suspicion of CBDS were prospectively included to the study and evaluated with EUS. This study was done in single blind method in the clinical and biochemical data of patients. EUS was done with echo-endoscope Pentax FG 32-UA (f=5-7,5 MHz) and Hitachi EUB 405 ultrasound machine. Patients diagnosed with CBDS by EUS were excluded from this study and treated with ERC. All the other patients were included to the follow up study obtained by mail every 6 months for clinical evaluation (need of ERC or surgery).RESULTS: CBDS was found in 4 patients by EUS. Diagnosis was confirmed in all cases on ERC. The remaining 51 patients without CBDS on EUS were followed up for 6-26 months (meanly 13 months) There were: 40 women, 42cholecystectomized patients, aged: 55 (mean). Biochemical values (mean values) were as follows: bilirubin: 14,9 μmol.L-1,alkaline phosphatase: 95 IU.L-,1 γ-GTP: 131 IU.L-1, ALT: 50IU.L-1, AST: 49 IU.L-1, Only 1 patient was lost for follow up.In the remaining 50 patients with follow up, there was only 1 (2 %) patient with persistent biliary symptoms in whom CBDS was finally diagnosed by ERC with ES. All other patients remained symptoms free on follow up and did not require ERC or biliary surgery.CONCLUSION: Vast majority of patients with moderate suspicion of CBDS and no stones on EUS with linear array can avoid invasive evaluation of biliary tree with ERC.

  20. Systematic review and meta-analysis on the prophylacticrole of non-steroidal anti-inflammatory drugs to preventpost-endoscopic retrograde cholangiopancreatographypancreatitis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To critically appraise the published randomized,controlled trials on the prophylactic effectiveness ofthe non-steroidal anti-inflammatory drugs (NSAIDs),in reducing the risk of post-endoscopic retrogradecholangiopancreatography (ERCP) pancreatitis.METHODS: A systematic literature search (MEDLINE,Embase and the Cochrane Library, from inception of thedatabases until May 2015) was conducted to identifyrandomized, clinical trials investigating the role ofNSAIDs in reducing the risk of post-ERCP pancreatitis.Random effects model of the meta-analysis was carriedout, and results were presented as odds ratios (OR)with corresponding 95%CI.RESULTS: Thirteen randomized controlled trials on3378 patients were included in the final meta-analysis.There were 1718 patients in the NSAIDs group and 1660patients in non-NSAIDs group undergoing ERCP. Theuse of NSAIDs (through rectal route or intramuscularroute) was associated with the reduced risk of post-ERCPpancreatitis [OR, 0.52 (0.38-0.72), P = 0.0001]. Theuse of pre-procedure NSAIDs was effective in reducingapproximately 48% incidence of post-ERCP pancreatitis,number needed to treat were 16 with absolute riskreduction of 0.05. But the risk of post-ERCP pancreattiswas reduced by 55% if NSAIDs were administered afterprocedure. Similarly, diclofenac was more effective (55%)prophylactic agent compared to indomethacin (41%).CONCLUSION: NSAIDs seem to have clinically provenadvantage of reducing the risk of post-ERCP pancreatitis.

  1. Single shot MR-cholangiopancreatography (MRCP) by a fast acquisition spin echo sequence (FASE). A substitute for ERCP?; Einzelschuss MR-Cholangiopankreatographie (MRCP) mittels einer ``Fast-Acquisition-Spin-Echo``-Sequenz (FASE). Ersatz fuer die ERCP?

    Energy Technology Data Exchange (ETDEWEB)

    Schulte, B.; Beyer, D.; Wedekind, G [Inst. fuer Diagnostische und Interventionelle Radiologie, Krankenhaus Porz am Rhein, Koeln (Germany); Meuser, W. [Medizinische Klinik, Krankenhaus Porz am Rhein, Akademisches Lehrkrankenhaus der Univ. zu Koeln (Germany)

    1998-01-01

    Purpose: 118 patients with suspected obstruction of the biliary tract or pancreatic duct were examined to evaluate the accuracy of MR cholangiopancreatography (MRCP) in comparison with diagnostic findings in endoscopic retrograde cholangiopancreatography (ERCP). Results: In all MRCP examinations images of satisfactory quality were obtained. In cases of obstruction of the biliary or pancreatic duct, locations and lengths of stenoses were correctly demonstrated. Gallstones within the gallbladder or in the extrahepatic bile ducts were also properly visualised in MRCP. Stenoses caused by non-depicted pancreatic carcinoma, gallbladder carcinoma, or segmental pancreatitis were reliably shown. Conclusion: Even if MRCP will not replace ERCP, a number of clinical applications for non-invasive MRCP examination arise: Primary diagnosis in patients with obstructive jaundice, obstruction of the biliary or pancreatic duct, if ERCP is not possible due to anatomic reason and in patients scheduled for laparoscopic cholecystectomy. (orig./AJ) [Deutsch] Ziel: Zur Beurteilung der diagnostischen Wertigkeit der MR-Cholangiopankreatographie in Ergaenzung zur endoskopischen retrograden Cholangiopankreatographie (ERCP) untersuchten wir 118 Patienten unter dem Verdacht auf Obstruktion des Gallenwegsystems bzw. des Pankreasganges. Ergebnisse: Alle MRCP-Untersuchungen ergaben Aufnahmen von diagnostischer Qualitaet. Obstruktionen des Ductus hepaticus, Ductus choledochus sowie des Pankreasganges konnten sowohl in Laenge als auch hinsichtlich der Lokalisation korrekt beschrieben werden. Ebenso liessen sich karzinom- oder entzuendungsbedingte Gangstenosen nachweisen. Gallenblasensteine und Gallenwegkonkremente wurden zuverlaessig dargestellt. Schlussfolgerung: Selbst wenn die MRC letztendlich die ERCP nicht ersetzt, so konkurriert sie in einigen Faellen mit der diagnostischen ERCP. Die ERCP kann somit gezielter aus therapeutischen Gesichtspunkten angewendet werden. (orig./AJ)

  2. Airway Management During Upper GI Endoscopic Procedures: State of the Art Review.

    Science.gov (United States)

    Goudra, Basavana; Singh, Preet Mohinder

    2017-01-01

    With the growing popularity of propofol mediated deep sedation for upper gastrointestinal (GI) endoscopic procedures, challenges are being felt and appreciated. Research suggests that management of the airway is anything but routine in this setting. Although many studies and meta-analyses have demonstrated the safety of propofol sedation administered by registered nurses under the supervision of gastroenterologists (likely related to the lighter degrees of sedation than those provided by anesthesia providers and is under medicolegal controversy in the United States), there is no agreement on the optimum airway management for procedures such as endoscopic retrograde cholangiopancreatography. Failure to rescue an airway at an appropriate time has led to disastrous consequences. Inability to evaluate and appreciate the risk factors for aspiration can ruin the day for both the patient and the health care providers. This review apprises the reader of various aspects of airway management relevant to the practice of sedation during upper GI endoscopy. New devices and modification of existing devices are discussed in detail. Recognizing the fact that appropriate monitoring is important for timely recognition and management of potential airway disasters, these issues are explored thoroughly.

  3. A retrospective analysis of endoscopic treatment outcomes in patients with postoperative bile leakage

    Science.gov (United States)

    Sayar, Suleyman; Olmez, Sehmus; Avcioglu, Ufuk; Tenlik, Ilyas; Saritas, Bunyamin; Ozdil, Kamil; Altiparmak, Emin; Ozaslan, Ersan

    2016-01-01

    OBJECTIVE: Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage. METHODS: Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed. RESULTS: Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases. CONCLUSION: ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula. PMID:28058396

  4. Biliary Drainage Method and Temporal Trends in Patients Admitted with Cholangitis: A National Audit

    Directory of Open Access Journals (Sweden)

    Julia McNabb-Baltar

    2013-01-01

    Full Text Available BACKGROUND: In patients presenting with ascending cholangitis, better outcomes are reported in those undergoing endoscopic retrograde cholangiopancreatography (ERCP compared with surgical drainage.

  5. Musculoskeletal Injuries among ERCP Endoscopists in Canada

    Directory of Open Access Journals (Sweden)

    Sinead O’Sullivan

    2002-01-01

    Full Text Available BACKGROUND: There are few reports in the literature describing musculoskeletal complaints among endoscopists, and none are specific to those who perform endoscopic retrograde cholangiopancreatography (ERCP.

  6. Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater: Three-year follow-up of exocrine pancreatic function and clinical symptoms

    Institute of Scientific and Technical Information of China (English)

    Nils Ewald; Axel Michael Marzeion; Reinhard Georg Bretzel; Hans Ulrich Kloer; Philip Daniel Hardt

    2007-01-01

    AIM: To investigate retrospectively the long-term effect of endoscopic sphincterotomy (ES) including exocrine pancreatic function in patients with stenosis of ampulla of Vater.METHODS: After diagnostic endoscopic retrograde cholangiopancreatography (ERCP) and ES because of stenosis of the ampulla of Vater (SOD Type I), follow-up examinations were performed in 60 patients (mean follow-up time 37.7 mo). Patients were asked about clinical signs and symptoms at present and before intervention using a standard questionnaire. Before and after ES exocrine pancreatic function was assessed by determination of immunoreactive fecal elastase 1. Serum enzymes indicating cholestasis as well as serum lipase and amylase were measured.RESULTS: Eighty percent of patients reported an improvement in their general condition after ES. The fecal elastase 1 concentrations (FEC) in all patients increased significantly after ES. This effect was even more marked in patients with pathologically low concentrations (< 200 ng/g) of fecal elastase prior to ES. The levels of serum lipase and amylase as well as serum alcaline phosphatase (AP) and gamma-glutamyltranspeptidase (GGT) decreased significantly after ES.CONCLUSION: The results of this study demonstrate that patients with stenosis of the ampulla of Vater can be successfully treated with endoscopic sphincterotomy. The positive effect is not only indicated by sustained improvement of clinical symptoms and cholestasis but also by improvement of exocrine pancreatic function.

  7. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

    DEFF Research Database (Denmark)

    Burtea, Daniela Elena; Dimitriu, Anca; Maloş, Anca Elena

    2015-01-01

    Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the pati...

  8. What are the current and potential future roles for endoscopic ultrasound in the treatment of pancreatic cancer?

    Institute of Scientific and Technical Information of China (English)

    Stephen Y Oh; Shayan Irani; Richard A Kozarek

    2016-01-01

    Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound(EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUSguided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.

  9. Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    Tae Hyeon Kim; Seong Hun Kim; Hyo Jeong Oh; Young Woo Sohn; Seung Ok Lee

    2012-01-01

    AIM:To determine the utility of endoscopic ultrasoundguided biliary drainage (EUS-BD) with a fully covered self-expandable metal stent for managing malignant biliary stricture.METHODS:We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography (ERCP) fails.EUS-guided choledochoduodenostomy (EUS-CD) and EUS-guided hepaticogastrostomy (EUS-HG) was performed in 9 patients and 4 patients,respectively.RESULTS:The technical and functional success rate was 92.3% (12/13) and 91.7% (11/12),respectively.Using an intrahepatic approach (EUS-HG,n =4),there was mild peritonitis (n =1) and migration of the metal stent to the stomach (n =1).With an extrahepatic approach (EUS-CD,n =10),there was pneumoperitoneum (n =2),migration (n =2),and mild peritonitis (n =1).All patients were managed conservatively with antibiotics.During follow-up (range,1-12 mo),there was re-intervention (4/13 cases,30.7%) necessitated by stent migration (n =2) and stent occlusion (n =2).CONCLUSION:EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.

  10. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Science.gov (United States)

    Yamasaki, Shuuji

    2016-01-01

    Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

  11. Endoscopic diagnosis and treatment of biliar y leak in patients following liver transplantation:a prospective clinical study

    Institute of Scientific and Technical Information of China (English)

    Jia-Zhi Liao; Qiu Zhao; Hua Qin; Rong-Xiang Li; Wei Hou; Pei-Yuan Li; Nan-Zhi Liu; De-Ming Li

    2007-01-01

    BACKGROUND:Orthotopic liver transplantation has been widely used in patients with end-stage liver disease within the last two decades. However, the prevalence of biliary complications after liver transplantation remains high. The most common short-term biliary complication may be biliary leak. So, we examined 13 patients with biliary leak after liver transplantation, attempting to evaluate the role of endoscopic diagnosis and treatment of biliary leak and the incidence of bile duct stricture after healing of the leak. METHODS: Six cases of T-tube leak and seven cases of anastomosis leak complicating liver transplantation were enrolled in this prospective study. Six patients were treated by endoscopic plastic stent placement, two by nasobiliary catheter drainage, two by papillosphincterotomy, and three by nasobiliary catheter drainage combined with plastic stent placement. Some patients received growth hormone treatment. RESULTS: The bile leak resolution time was 10-35 days in 10 patients with complete documentation. The median time of leak resolution was 15.3 days. Four cases of anastomosis stricture, three cases of common hepatic duct and one case of multiple bile duct stenosis were detected by follow-up nasobiliary catheter cholangiography or endoscopic retrograde cholangiopancreatography. CONCLUSIONS:Endoscopic nasobiliary catheter or plastic stent placement is a safe and effective treatment for bile duct stricture occurring after bile leak resolution in most liver transplantation patients. Nasobiliary catheter combined with plastic stent placement may be the best choice for treating bile leak, because, theoretically, it may prevent the serious condition resulting from accidental nasobiliary catheter dislocation, and it may have prophylactic effects on upcoming bile duct stricture, although this should be further conifrmed.

  12. Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy

    Directory of Open Access Journals (Sweden)

    Hu Tian

    2015-01-01

    Full Text Available Background: Biliary cast syndrome (BCS was a postoperative complication of orthotopic liver transplantation (OLT, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI, and to observe pathological changes and morphology of biliary casts. Methods: Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy. Results: HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P 1 (OR = 1.300; 1.223; and 1.889, respectively. The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024. The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts. Conclusions: HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

  13. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Andreas Weber; Claus van Weyhern; Falko Fend; Jochen Schneider; Bruno Neu; Alexander Meining; Hans Weidenbach; Roland M Schmid; Christian Prinz

    2008-01-01

    AIM:To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.METHODS:Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures.Fifty-eight consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.RESULTS:Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy.The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients).In 20/58 patients (34.5%),diagnosis were obtained by both positive cytology and positive histology,in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).CONCLUSION:Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors.In our eyes,additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

  14. Diagnostic value of magnetic resonance cholangiopancreatography in low choledochal joint and its complications%MRCP对胆囊管低位汇合及其并发症的诊断价值

    Institute of Scientific and Technical Information of China (English)

    赵欣; 谢明; 陈竹卿; 王振山; 张书泽

    2015-01-01

    To investigate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for di-agnosing low choledochal joint and its complications. MRCP results of 29 low choledochal joint patients con-firmed were analyzed retrospectively, and then compared with those by endoscopic retrograde cholaniopancreatography (ERCP). MRCP could display clearly the location of low choledochal joint, and the patients with complications involved 4 ones with cholecystolithiasis, 5 ones with cholangiolithiasis, 15 ones with cholecystolithiasis and cholangiolithi-asis, 3 ones with Mirizz syndrome, 2 ones with pancreatitis, 1 case with carcinoma of head of pancreas after cholecystec-tomy and 1 case of Vater ampullary carcinoma. Interoperative and ERCP findings proved that MRCP could be used for the diagnosis of low choledochal joint and its complications with no missed diagnosis. MRCP can be involved for the diagnosis of low choledochal joint and its complications, and thus can be used for preoperative planning and treat-ment of the complications.%目的:探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)对胆囊管低位汇合及其并发症的诊断价值。方法:回顾性分析29例MRCP检查发现的胆囊管低位汇合病例,与术中或内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)检查结果相对照。结果:MRCP能清晰显示胆囊管汇入位置,并发症包括单纯胆囊结石4例,单纯胆管结石5例,胆囊及胆管均有结石15例,合并Mirizzi综合征3例,合并胰腺炎2例,胆囊切除术后患者合并胰头癌1例,合并乏特氏壶腹癌1例。对照术中或ERCP所见,MRCP术前检查胆囊管低位汇合及其并发症诊断符合率为100%。结论:MRCP可清晰显示胆囊管低位汇合及其并发症,能为术前制订手术方案及并发症处理提供重要信息。

  15. Endoscopic sphincterotomy and risk of cholangiocarcinoma: a population-based cohort study in Finland and Sweden

    Science.gov (United States)

    Strömberg, Cecilia; Böckelman, Camilla; Song, Huan; Ye, Weimin; Pukkala, Eero; Haglund, Caj; Nilsson, Magnus

    2016-01-01

    Background and study aims: Elevated long-term risk of cholangiocarcinoma is reported after endoscopic sphincterotomy (ES), but in a previous study we found a trend towards a decreased risk. The aim of this study was to evaluate the association in a larger cohort with a longer follow-up. Patients and methods: Data concerning all patients having had an inpatient endoscopic retrograde cholangiopancreatography (ERCP) were collected from the hospital discharge registries of Finland and Sweden. Incident cases of malignancy were identified through linkage to the nationwide Cancer Registries. Patients with a diagnosis of malignancy, before or within 2 years of the ERCP, were excluded. The cohorts were followed until a diagnosis of malignancy, death or emigration, or end of follow-up (end of 2010). The relative risk of malignancy was calculated as standardized incidence ratio (SIR) compared with the general population, inherently adjusting for age, gender, and calendar year of follow-up. Results: A total of 69 925 patients undergoing ERCP from 1976 through 2008 were included in the pooled cohort. ES was performed in 40 193 subjects. The risk of malignancy was elevated in the total cohort (SIR = 2.3; 95 % confidence interval [CI] 2.1 – 2.5) irrespective of whether ES was performed or not. The SIRs diminished with duration of follow-up. Conclusions: We found an elevated risk of malignancy both in the bile ducts alone and in the bile ducts, liver or pancreas together, after ERCP. The risk was the same, regardless of whether ES had been performed or not, so ES was unlikely to be the cause, and a common carcinogenic exposure previous to the ERCP procedure, possibly ductal gallstone disease, was more likely.

  16. Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening.Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature.We describe a case of retrograde intussusception,associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.

  17. Endoscopic Intermetatarsal Ligament Decompression.

    Science.gov (United States)

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

  18. Biliary ascariasis on magnetic resonance cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Mohammad A Hashmi

    2009-01-01

    Full Text Available A 17-year-old girl presented with features of biliary obstruction. Magnetic resonance cholangi-pancreatography revealed typical linear signals in common bile duct, which appears like Ascaris lumbricoides. The diagnosis was confirmed by endoscopic removal of the worm.

  19. Endoscopic ultrasound

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007646.htm Endoscopic ultrasound To use the sharing features on this page, please enable JavaScript. Endoscopic ultrasound is a type of imaging test. It is ...

  20. Application of Cook MOB-15 system in guiding wire insertion during endoscopic retrograde cholangiopancreatography%Cook MOB-15三腔气囊导管在内镜逆行胰胆管造影操作中的应用

    Institute of Scientific and Technical Information of China (English)

    施云星; 曾晓虹; 吕礁; 周国中; 刘长云; 薛晶晶

    2008-01-01

    目的:探讨Cook MOB-15三腔气囊导管引导内镜下逆行胰胆管造影(ERCP)操作中导丝插入的价值.方法:回顾性分析2005年1月~2007年12月51例在加用Cook MOB-15三腔气囊导管引导下行ERCP操作患者的临床资料,与2002年1月~2004年12月间40例采用常规ERCP术恶性阻塞性黄疸患者进行对照,并比较两组患者导丝插入成功率.结果:加用Cook MOB-15三腔气囊导管组导丝插入的成功率为90.2%(46/51),明显高于对照组72.5%(29/40),差异具有统计学意义(P<0.05).结论:ERCP操作中采用Cook MOB-15三腔气囊导管可以明显提高导丝插入的成功率.

  1. Efficacy of Different Doses of Diclofenac for Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis%不同剂量双氯芬酸钠预防内镜逆行胰胆管造影术后胰腺炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈泽宇; 曹文瑜; 林晖

    2016-01-01

    Objective To investigate the preventive effect of diclofenac at different doses on post‐ERCP pancreatitis and hyperamylasemia . Methods A total of 244 patients with choledocholithiasis from January 2013 to June 2015 were enrolled to receive ERCP and randomly divided into four groups to receive low dose diclofenac group (50 mg ,n=61) ,moderate dose diclofenac group (100 mg ,n=61) ,high dose diclofenac group (150 mg ,n=61) or no diclofenac ,at half an hour to one hour ,before ERCP . The level of serum amylase before and 3 h or 24 h after ERCP were measured ,Incidence of post‐ERCP pancreatitis and hyperamylasemia were assessed in four groups . Results There were no significant differences among four groups in age ,gender ,surgery method and time of ERCP . The incidences of post‐ERCP pancreatitis were 16 .4% (10/61) ,6 .6% (4/61) and 4 .9% (3/61) ,and 18% (11/61)in diclofenac dose groups and in blank group respectively . The total incidences of post‐ERCP pancreatitis in four groups were significant‐ly different (χ2 =8 .07 , P=0 .045) . There was no significant difference either between low dose group and blank group (χ2 = 0 .058 , P= 0 .810 ) , or between moderate dose group and high dose group (χ2 =0 .152 ,P=0 .697) . There was significant difference between low dose group and high dose group (χ2 =4 .219 ,P=0 .040) . The incidences of hyperamylasemia had no significant difference among four groups (χ2 =2 .83 ,P=0 .419) . There was one case of severe PEP in blank group ,while none in experi‐mental groups . Three moderat PEP was observed in blank group and two in low dose group . The PEP that was observed in moderate and high dose groups were mild . Conclusion The prevention of PEP may not be achieved with diclofenac suppository at 50 mg ,however at 100 mg or 150 mg ,diclofenac supposito‐ry can have preventive effect on post‐ERCP pancreatitis and the effect is similar for the two doses . Therefore ,we recommend that 100 mg diclofenac suppository should be used for preventing PEP .%目的:探讨不同剂量双氯芬酸钠对内镜逆行胰胆管造影术(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的预防效果。方法收集行ERCP取石术的患者244例,随机分为4组,每组61例,其中低剂量组、中剂量组、高剂量组于术前30~60 min分别予双氯芬酸钠栓剂50,100,150 mg塞肛,空白组术前未予处理,观察其术前及术后3,24 h血清淀粉酶水平,评估ERCP术后PEP及高淀粉酶血症发生率及严重程度。结果4组在年龄、性别、ERCP手术方式及操作时间等方面差别均无统计学意义。PEP发生率低剂量组为16.4%(10/61),中剂量组为6.6%(4/61),高剂量组为4.9%(3/61),空白组为18%(11/61),4组术后 PEP总体发病率差别有统计学意义(χ2=8.07,P=0.045),其中,空白组与低剂量组、中剂量组与高剂量组比较差别均无统计学意义(χ2=0.058, P=0.810;χ2=0.152,P=0.697),而低剂量组与高剂量组比较差别有统计学意义(χ2=4.219,P=0.040)。术后高淀粉酶血症总体发病率差别无统计学意义(χ2=2.83,P=0.419)。空白组发生重度PEP 1例,各实验组均未发生;空白组发生中度PEP 3例,低剂量组发生2例;中、高剂量组发生的PEP均为轻度。结论50 mg双氯芬酸钠栓剂未能有效预防PEP的发生,100及150 mg双氯芬酸钠栓剂均能有效降低PEP的发生率,且效果相当,故推荐使用100 mg双氯芬酸钠栓剂预防PEP发生。

  2. Diagnosis and treatment value of endoscopic retrograde cholangiopancreatography for intraductal papillary mucinous neoplasms of biliary and pancreatic ducts%内镜下胰胆管逆行造影术在胆胰管导管内乳头状黏液性瘤中的应用价值

    Institute of Scientific and Technical Information of China (English)

    郑金辉; 何利平; 陈勇; 王丽珍; 高丽影; 张咩仔

    2015-01-01

    目的 探讨内镜下胰胆管逆行造影术(ERCP)对胆胰管导管内乳头状黏液瘤(IPMN)的诊治作用.方法 回顾性分析经ERCP诊治的9例IPMN,分析临床表现、实验室检查、影像学表现等方面特点,经ERCP结合超声内镜作出初步诊断,采用超细内镜进入囊腔活检,以求术后病理确诊,后根据具体病情予相应内镜处理.结果 5例胆管导管内乳头状黏液瘤(IPMNs-B),4例胰管导管内乳头状黏液瘤(IPMNs-P),均无特异性的临床表现和实验室检查;超声、CT、MRI主要表现为胆胰管扩张,仅1例IPMNs-P胰头部见囊实性团块、壁结节及主胰管明显扩张(5.5 cm);ERCP均显示乳头开口扩张,胶冻样黏液流出,胰胆管不同程度扩张.9例行ERCP抽吸黏液后,1例IPMNs-B同时置入胆管及胰管支架,3例IPMNs-P置入胰管支架,1例放置胆道金属支架;术后1例出现轻症胰腺炎(11.1%,1/9),3例出现淀粉酶升高而无症状(33.3%,3/9),无出血或穿孔等并发症发生.结论 ERCP是一种安全可靠的诊断方法选择,对IPMN的诊治具有重要作用.结合病理诊断,可为外科术前提供明确的诊断和可靠的证据.

  3. Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) after Anatrophic Nephrolithotomy.

    Science.gov (United States)

    Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Kato, Yoshitake; Ogawa, Takehiko; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-01-01

    Introduction. Open surgical anatrophic nephrolithotomy (ANL) had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN) and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS) was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL.

  4. Ureteroscopy-Assisted Retrograde Nephrostomy (UARN after Anatrophic Nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Takashi Kawahara

    2012-01-01

    Full Text Available Introduction. Open surgical anatrophic nephrolithotomy (ANL had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL.

  5. Ureteral retrograde brush biopsy

    Science.gov (United States)

    ... biopsy URL of this page: //medlineplus.gov/ency/article/003906.htm Ureteral retrograde brush biopsy To use ... minutes. A cystoscope is first placed through the urethra into the bladder. Cystoscope is a tube with a ... results may show cancer cells ( carcinoma ). This test is often used to ...

  6. Incidence of pancreatic fistula after distal pancreatectomy and efficacy of endoscopic therapy for its management: results from a tertiary care center.

    Science.gov (United States)

    Reddymasu, Savio C; Pakseresht, Kavous; Moloney, Brian; Alsop, Benjamin; Oropezia-Vail, Melissa; Olyaee, Mojtaba

    2013-01-01

    Pancreatic fistula is a known complication of distal pancreatectomy. Endotherapy with pancreatic duct stent placement and pancreatic sphincterotomy has been shown to be effective in its management; however, experience of endotherapy in the management of this complication has not been extensively reported from the United States. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent placement has also been proposed to prevent this complication after distal pancreatectomy. In our cohort of 59 patients who underwent distal pancreatectomy, 13 (22%) developed a pancreatic fistula in the immediate postoperative period, of whom 8 (14%) patients (5 female, mean age 52 years) were referred for an ERCP because of ongoing symptoms related to the pancreatic fistula. The pancreatic fistula resolved in all patients after a median duration of 62 days from the index ERCP. The median number of ERCPs required to document resolution of the pancreatic fistula was 2. Although a sizeable percentage of patients develop a pancreatic fistula after distal pancreatectomy, only a small percentage of patients require ERCP for management of this complication. Given the high success rate of endotherapy in resolving pancreatic fistula and the fact that the majority of patients who undergo distal pancreatectomy never require an ERCP, performing ERCP for prophylactic pancreatic duct stent prior to distal pancreatectomy might not be necessary.

  7. Incidence of Pancreatic Fistula after Distal Pancreatectomy and Efficacy of Endoscopic Therapy for Its Management: Results from a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Savio C. Reddymasu

    2013-08-01

    Full Text Available Pancreatic fistula is a known complication of distal pancreatectomy. Endotherapy with pancreatic duct stent placement and pancreatic sphincterotomy has been shown to be effective in its management; however, experience of endotherapy in the management of this complication has not been extensively reported from the United States. Preoperative endoscopic retrograde cholangiopancreatography (ERCP with pancreatic stent placement has also been proposed to prevent this complication after distal pancreatectomy. In our cohort of 59 patients who underwent distal pancreatectomy, 13 (22% developed a pancreatic fistula in the immediate postoperative period, of whom 8 (14% patients (5 female, mean age 52 years were referred for an ERCP because of ongoing symptoms related to the pancreatic fistula. The pancreatic fistula resolved in all patients after a median duration of 62 days from the index ERCP. The median number of ERCPs required to document resolution of the pancreatic fistula was 2. Although a sizeable percentage of patients develop a pancreatic fistula after distal pancreatectomy, only a small percentage of patients require ERCP for management of this complication. Given the high success rate of endotherapy in resolving pancreatic fistula and the fact that the majority of patients who undergo distal pancreatectomy never require an ERCP, performing ERCP for prophylactic pancreatic duct stent prior to distal pancreatectomy might not be necessary.

  8. A terapêutica endoscópica nas complicações biliares pós-transplante hepático Endoscopic management of biliary complications after liver transplantation

    Directory of Open Access Journals (Sweden)

    Jeany Borges e Silva Ribeiro

    2012-12-01

    cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient. Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment. Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.

  9. Early endoscopic ultrasonography in acute biliary pancreatitis: A prospective pilot study

    Science.gov (United States)

    Anderloni, Andrea; Galeazzi, Marianna; Ballarè, Marco; Pagliarulo, Michela; Orsello, Marco; Del Piano, Mario; Repici, Alessandro

    2015-01-01

    AIM: To investigate the clinical usefulness of early endoscopic ultrasonography (EUS) in the management of acute biliary pancreatitis (ABP). METHODS: All consecutive patients entering the emergency department between January 2010 and December 2012 due to acute abdominal pain and showing biochemical and/or radiological findings consistent with possible ABP were prospectively enrolled. Patients were classified as having a low, moderate, or high probability of common bile duct (CBD) stones, according to the established risk stratification. Exclusion criteria were: gastrectomy or patient in whom the cause of biliary obstruction was already identified by ultrasonography. All enrolled patients underwent EUS within 48 h of their admission. Endoscopic retrograde cholangiopancreatography was performed immediately after EUS only in those cases with proven CBD stones or sludge. The following parameters were investigated: (1) clinical: age, sex, fever; (2) radiological: dilated CBD; and (3) biochemical: bilirubin, AST, ALT, gGT, ALP, amylase, lipasis, PCR. Association between presence of CBD stone at EUS and the individual predictors were assessed by univariate logistic regression. Predictors significantly associated with CBD stones (P < 0.05) were entered in a multivariate logistic regression model. RESULTS: A total of 181 patients with pancreatitis were admitted to the emergency department between January 2010 and December 2012. After exclusion criteria a total of 71 patients (38 females, 53.5%, mean age 58 ± 20.12 years, range 27-89 years; 33 males, 46.5%, mean age 65 ± 11.86 years, range 41-91 years) were included in the present study. The probability of CBD stones was considered low in 21 cases (29%), moderate in 26 (37%), and high in the remaining 24 (34%). The 71 patients included in the study underwent EUS, which allowed for a complete evaluation of the target sites in all the cases. The procedure was completed in a mean time of 14.7 min (range 9-34 min), without

  10. Advanced endoscopic imaging of indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

    James; H; Tabibian; Kavel; H; Visrodia; Michael; J; Levy; Christopher; J; Gostout

    2015-01-01

    Endoscopic evaluation of indeterminate biliary stric-tures(IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography(ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition(i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demon-strated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.

  11. Retrogradation of rye starch pastes

    Directory of Open Access Journals (Sweden)

    Anna Nowotna

    2007-12-01

    Full Text Available The retrogradation susceptibility of starch determines consumer suitability of food products rich in this polymer. Starch isolated from flour obtained from rye variety ‘Amilo’, which displays very low amylolytic activity, contains highest amounts of amylose and exhibits strong retrogradation susceptibility. Flour from rye ‘Dańkowskie Złote’ and commercial rye flour type 720, that have higher amylolytic activity in comparison to ‘Amilo’, contain starch with lower amounts of amylose and reduced retrogradation susceptibility. Wheat starch displays lower degree of retrogradation in comparison to rye, because of larger amounts of phosphorus (phospholipids.

  12. Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

    Science.gov (United States)

    Sarawagi, Radha; Sundar, Shyam; Gupta, Sanjeev K.; Raghuwanshi, Sameer

    2016-01-01

    Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented. Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst. Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy. PMID:27313891

  13. [Endoscopic management of postoperative biliary fistulas].

    Science.gov (United States)

    Farca, A; Moreno, M; Mundo, F; Rodríguez, G

    1991-01-01

    Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

  14. Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula

    Directory of Open Access Journals (Sweden)

    Iskender Özcan

    2008-01-01

    Full Text Available Abstract Background Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF is difficult to treat with standard endoscopic techniques. Case presentation We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach. Conclusion Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.

  15. Impaction of a lithotripsy basket during endoscopic lithotomy of a common bile duct stone

    Institute of Scientific and Technical Information of China (English)

    Nobutada; Fukino; Takatsugu; Oida; Atsushi; Kawasaki; Kenji; Mimatsu; Youichi; Kuboi; Hisao; Kano; Sadao; Amano

    2010-01-01

    The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performe...

  16. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

    DEFF Research Database (Denmark)

    Halttunen, Jorma; Meisner, Søren; Aabakken, Lars;

    2014-01-01

    BACKGROUND: The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). AIMS: To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. PATIENTS AND METHODS: Prospective consecutive reco...

  17. Efficacy and safety of endoscopic papillary balloon dilation for the removal of bile duct stones: Data from a “real-life” multicenter study on Dilation-Assisted Stone Extraction

    Science.gov (United States)

    Di Mitri, Roberto; Mocciaro, Filippo; Pallio, Socrate; Pecoraro, Giulia Maria; Tortora, Andrea; Zulli, Claudio; Attardo, Simona; Maurano, Attilio

    2016-01-01

    AIM To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram). RESULTS Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography (P = 0.031), DASE as first approach (P = 0.032), and cannulation of major papilla followed by guidewire insertion (P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications (P = 0.01). CONCLUSION DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones. PMID:27803771

  18. Endoscopic management of hilar biliary strictures

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Hilar biliary strictures are caused by various benign andmalignant conditions. It is difficult to differentiate benignand malignant strictures. Postcholecystectomy benignbiliary strictures are frequently encountered. Endoscopicmanagement of these strictures is challenging.Anendoscopic method has been advocated that involvesplacement of increasing number of stents at regularintervals to resolve the stricture. Malignanthilar stricturesare mostly unresectable at the time of diagnosis and onlypalliation is possible.Endoscopic palliation is preferredover surgery or radiological intervention. Magneticresonance cholangiopancreaticographyis quite importantin the managementof these strictures. Metal stents aresuperior to plastic stents. The opinion is divided over theissue of unilateral or bilateral stenting.Minimal contrastor no contrast technique has been advocated duringendoscopicretrograde cholangiopancreatography ofthese patients. The role of intraluminal brachytherapy,intraductal ablation devices, photodynamic therapy, andendoscopic ultrasound still remains to be defined.

  19. Retrogradation of rye starch pastes

    OpenAIRE

    2007-01-01

    The retrogradation susceptibility of starch determines consumer suitability of food products rich in this polymer. Starch isolated from flour obtained from rye variety ‘Amilo’, which displays very low amylolytic activity, contains highest amounts of amylose and exhibits strong retrogradation susceptibility. Flour from rye ‘Dańkowskie Złote’ and commercial rye flour type 720, that have higher amylolytic activity in comparison to ‘Am...

  20. Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia

    OpenAIRE

    Chen, Chang-Hua; Wu, Shun-Sheng; Huang, Chieh-Chen

    2013-01-01

    Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Esch...

  1. Endoscopic cyclophotocoagulation

    Directory of Open Access Journals (Sweden)

    Leonard K Seibold

    2015-01-01

    Full Text Available In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP. In contrast, endoscopic cyclophotocoagulation (ECP lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.

  2. Endoscopic Management of Difficult Bile Duct Stones

    Directory of Open Access Journals (Sweden)

    Christian Ell

    1992-01-01

    Full Text Available More than 90% of all common bile duct concrements can be removed via the endoscopic retrograde route via endoscopic sphincterotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones, however, often still resist conventional endoscopic therapy. Promising new or improved approaches for the treatment of these stones are intracorporeal or extracorporeal shock wave lithotripsy. Shockwave lithotriptors for extracorporeal shockwave lithotripsy are currently available worldwide. However, for the waterbath first generation devices, general anesthesia is required since shockwaves are very painful. Furthermore, an x-ray localization system is essential to visualize the stones after having filled the bile duct over a nasobiliary catheter. An average of two shockwave treatments with additional two to four endoscopic sessions are required. ln tracorporeal lithotripsy promises more comfort and less effort for the patient. Shockwaves are generated either by means of the spark gap principle (electrohydraulic probes or by laser-induced plasma generation. Laser-induced shockwave lithotripsy appears to be more safer, since with dye and solid state lasers, athermal, well-controlled shockwaves can be generateJ without the risks for duct perfo ration (as described for the electrohydraulic system. Furthermore, a recently developed stone-tissue detection system integrated in a new dye laser system enchances the safety of laser-induced lithotripsy. ln consequence, lithotripsy without direct endoscopic control appears possible in selected cases.

  3. Biliary and pancreatic stenting: Devices and insertiontechniques in therapeutic endoscopic retrogradecholangiopancreatography and endoscopic ultrasonography

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Stents are tubular devices made of plastic or metal.Endoscopic stenting is the most common treatmentfor obstruction of the common bile duct or of the mainpancreatic duct, but also employed for the treatment ofbilio-pancreatic leakages, for preventing post- endoscopicretrograde cholangiopancreatography pancreatitis andto drain the gallbladder and pancreatic fluid collections.Recent progresses in techniques of stent insertionand metal stent design are represented by new, fullycoveredlumen apposing metal stents. These stentsare specifically designed for transmural drainage,with a saddle-shape design and bilateral flanges, toprovide lumen-to-lumen anchoring, reducing the riskof migration and leakage. This review is an updateof the technique of stent insertion and metal stentdeployment, of the most recent data available on stenttypes and characteristics and the new applications forbiliopancreatic stents.

  4. The significance of magnetic resonance cholangiopancreatography in acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kei; Fujita, Naotaka; Noda, Yutaka [Sendai City Medical Center (Japan)] [and others

    2000-12-01

    To clarify the significance of magnetic resonance cholangiopancreatography (MRCP) in the acute phase of acute cholecystitis, MRCP was carried out in forty-five patients with acute cholecystitis in their acute phase. The MR pericholecystic high signal was observed in 38 of the 45 patients (84%). Enlargement of the gallbladder, presence of gallstones, and impacted stones was seen in 71%, 53%, and 18%, respectively. The MR pericholecystic high signal was classified into four categories: type 0, not observed; type 1, a liner high signal; type 2, a band-like high signal; type 3, a radiating high signal. In patients who showed a type 3 MR pericholecystic high signal, 91% required percutaneous transhepatic gallbladder drainage, and most of the gallbladders were diagnosed as necrotic cholecystitis by histology. The accuracy of MRCP for the diagnosis of choledocholithiasis was 96%. It was suggested that MRCP for patients with acute cholecystitis in the acute phase provides useful information for planning the treatment. (author)

  5. Biliary ascariasis in a bile duct stones-removed female patient

    OpenAIRE

    2013-01-01

    Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic s...

  6. Laparoscopic retrograde (fundus first cholecystectomy

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2009-12-01

    Full Text Available Abstract Background Retrograde ("fundus first" dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy (LC it has not been widely practiced. LC is most simply carried out using antegrade dissection with a grasper to provide cephalad fundic traction. A series is presented to investigate the place of retrograde dissection in the hands of an experienced laparoscopic surgeon using modern instrumentation. Methods A prospective record of all LCs carried out by an experienced laparoscopic surgeon following his appointment in Bristol in 2004 was examined. Retrograde dissection was resorted to when difficulties were encountered with exposure and/or dissection of Calot's triangle. Results 1041 LCs were carried out including 148 (14% emergency operations and 131 (13% associated bile duct explorations. There were no bile duct injuries although conversion to open operation was required in six patients (0.6%. Retrograde LC was attempted successfully in 11 patients (1.1%. The age ranged from 28 to 80 years (mean 61 and there were 7 males. Indications were; fibrous, contracted gallbladder 7, Mirizzi syndrome 2 and severe kyphosis 2. Operative photographs are included to show the type of case where it was needed and the technique used. Postoperative stay was 1/2 to 5 days (mean 2.2 with no delayed sequelae on followup. Histopathology showed; chronic cholecystitis 7, xanthogranulomatous cholecystitis 3 and acute necrotising cholecystitis 1. Conclusions In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon.

  7. Endoscopic Microscopy

    Science.gov (United States)

    Sokolov, Konstantin; Sung, Kung-Bin; Collier, Tom; Clark, Anne; Arifler, Dizem; Lacy, Alicia; Descour, Michael; Richards-Kortum, Rebecca

    2002-01-01

    In vivo endoscopic optical microscopy provides a tool to assess tissue architecture and morphology with contrast and resolution similar to that provided by standard histopathology – without need for physical tissue removal. In this article, we focus on optical imaging technologies that have the potential to dramatically improve the detection, prevention, and therapy of epithelial cancers. Epithelial pre-cancers and cancers are associated with a variety of morphologic, architectural, and molecular changes, which currently can be assessed only through invasive, painful biopsy. Optical imaging is ideally suited to detecting cancer-related alterations because it can detect biochemical and morphologic alterations with sub-cellular resolution throughout the entire epithelial thickness. Optical techniques can be implemented non-invasively, in real time, and at low cost to survey the tissue surface at risk. Our manuscript focuses primarily on modalities that currently are the most developed: reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). However, recent advances in fluorescence-based endoscopic microscopy also are reviewed briefly. We discuss the basic principles of these emerging technologies and their current and potential applications in early cancer detection. We also present research activities focused on development of exogenous contrast agents that can enhance the morphological features important for cancer detection and that have the potential to allow vital molecular imaging of cancer-related biomarkers. In conclusion, we discuss future improvements to the technology needed to develop robust clinical devices. PMID:14646041

  8. Comparative study of conscious sedation and intravenous anesthesia used to endoscopic retrograde cholangio pancreatiography in treatment of extrahepatic bile duct stones%清醒镇静与静脉麻醉在内窥镜逆行胰胆管造影术治疗肝外胆管结石中的比较研究

    Institute of Scientific and Technical Information of China (English)

    胡辉; 荆绪斌; 邹细岩; 吴锦雄

    2014-01-01

    目的 探讨清醒镇静与静脉麻醉在内窥镜逆行胰胆管造影术(ERCP)治疗肝外胆管结石中的安全性、有效性.方法 将100例采用ERCP治疗的肝外胆管结石患者按入组顺序进行编号,50例奇数者采用静脉麻醉(静脉麻醉组),给予静脉注射丙泊酚;50例偶数者采用清醒镇静(清醒镇静组),给予肌肉注射地西泮及哌替啶.观察两组患者术中反应(拔镜行为、自行体位改变)、生命体征变化情况、操作时间、取石成功率及并发症发生情况.结果 清醒镇静组术中拔镜行为、自行体位改变发生率明显高于静脉麻醉组[24%(12/50)比2%(1/50)、18%(9/50)比0],差异均有统计学意义(P<0.01).两组用药后5min平均动脉压、心率均较术前明显降低,差异有统计学意义(P<0.05);进镜后10 min、术后清醒时与术前比较差异无统计学意义(P>0.05);两组脉搏血氧饱和度比较差异均无统计学意义(P>0.05).两组取石成功率均为98%(49/50).静脉麻醉组操作时间明显短于清醒镇静组[(38.2±6.3) min比(49.1±9.9) min],差异有统计学意义(P<0.01).两组并发症发生率比较差异无统计学意义(P>0.05).结论 静脉麻醉和清醒镇静均可用于ERCP治疗肝外胆管结石,但静脉麻醉能明显减轻患者不适,缩短操作时间.%Objective To evaluate the safety and effectiveness of conscious sedation and intravenous anesthesia used to endoscopic retrograde cholangio pancreatiography (ERCP) in treatment of extrahepatic bile duct stones.Methods A total of 100 cases of extrahepatic bile duct stones patients in treatment of ERCP were encoded by the group order,50 cases of odd used intravenous anesthesia (intravenous anesthesia group),intravenous injection of propofol; 50 cases of even used conscious sedation (conscious sedation group),muscle injection of diazepam and pethidine.Intraoperative reaction (extubation behavior,own postural changes),changes in vital signs

  9. Effect of indomethacin in preventing post-endoscopic retrograde cannulation pancreatitis in patients undergoing common bile duct cholecystolithotomy%吲哚美辛栓预防内镜逆行胆胰管造影术胆总管取石术后胰腺炎的研究

    Institute of Scientific and Technical Information of China (English)

    翟莉莉; 黄坤; 于久飞

    2016-01-01

    目的 探讨吲哚美辛栓预防内镜逆行胆胰管造影术(ERCP)胆总管取石术后胰腺炎的效果.方法 纳入2014年1-12月于民航总医院住院行ERCP胆总管取石术的胆总管结石患者51例,完全随机分为吲哚美辛组(26例)和对照组(25例).吲哚美辛组于ERCP术前60 min直肠内给予吲哚美辛栓100 mg,对照组不予吲哚美辛栓.比较2组患者术后2、6、24 h血清淀粉酶和ERCP术后胰腺炎(PEP)及高淀粉酶血症发生率.结果 吲哚美辛组术后6和24 h血清淀粉酶水平均低于对照组[(202±41) U/L比(409 ±77) U/L,(111±18) U/L比(264 ±56) U/L],差异均有统计学意义(均P<0.05),术后2h2组间比较差异无统计学意义[(128±20) U/L比(192 ±29) U/L,P>0.05].对照组25例患者中4例(16.0%)出现PEP,吲哚美辛组无一例出现PEP,组间差异有统计学意义(P<0.05);对照组12例(48.0%)、吲哚美辛组7例(26.9%)出现术后高淀粉酶血症,组间差异有统计学意义(P<0.05).结论 直肠应用吲哚美辛栓可以预防ERCP胆总管取石术后胰腺炎和高淀粉酶血症.%Objective To investigate the effect of indomethacin in preventing post-endoscopic retrograde cannulation (ERCP) pancreatitis (PEP) in patients undergoing common bile duct cholecystolithotomy.Methods Totally 51 patients with common bile duct stones who underwent ERCP common bile duct cholecystolithotomy from January 2014 to December 2014 were randomly divided into indomethacin group (26 cases) and control group (25 cases).Indomethacin group was rectally administrated with indomethacin (100 mg) 60 min before operation and control group was not given indomethacin.The serum amylase was detected 2,6 and 24 h after operation,the incidences of PEP and postoperative hyperamylasemia were compared between groups.Results The serum amylase level in indomethacin group was significantly lower than that in control group 6 and 24hafterERCP [(202±41) U/Lvs (409 ±77) U/L,(111±18) U/L vs (264 ±56) U

  10. Endoscopic case

    Directory of Open Access Journals (Sweden)

    Fernando Pereira

    2017-01-01

    Full Text Available We present the case of a ten-year-old female patient referred to Gastroenterolgy consultation for abdominal pain and cramping, usually worse after eating, recurring diarrhoea, hypochromic and microcytic anaemia with low serum iron and ferritin levels. Moderate to severe Crohn’s disease of the terminal ileum e right colon (L3 was diagnosed, based on endoscopic image and biopsy. The patient was treated with prednisone and azathioprine, but after one year of treatment she was steroids dependent and treatment was switched to infliximab. One year after beginning this treatment, the patient achieved remission (clinical and laboratorial parameters. A control colonoscopy showed mucosal healing with scars and deformation with stenosis of ileocecal valve (Figures 1-2. Surgical intervention will be probably necessary in near future.

  11. Retrograde Jejuno-gastric Intussusception

    Directory of Open Access Journals (Sweden)

    Sumitoj Singh

    2015-01-01

    Full Text Available Retrograde jejuno-gastric intussusception is a rare complication following gastric surgery. We present a case of retrograde jejuno-gastric intussusception in a 42-year-old female who presented with upper abdominal pain, vomiting and swelling in left hypochondruim. Intussusception was suspected on ultrasound of the abdomen and later confirmed with computed tomography scan. At laparotomy, efferent loop was intussuscepting into stomach. This was reduced and fixed to the abdominal wall and transverse mesocolon. It should be suspected in a patient with the previous history of gastric surgery as it is a rare complication. Early diagnosis and management can prevent further complications like bowel gangrene and its associated morbidity and mortality.

  12. Resonances in retrograde circumbinary discs

    CERN Document Server

    Nixon, Chris

    2015-01-01

    We analyse the interaction of an eccentric binary with a circular coplanar circumbinary disc that rotates in a retrograde sense with respect to the binary. In the circular binary case, no Lindblad resonances lie within the disc and no Lindblad resonant torques are produced, as was previously known. By analytic means, we show that when the binary orbit is eccentric, there exist components of the gravitational potential of the binary which rotate in a retrograde sense to the binary orbit and so rotate progradely with respect to this disc, allowing a resonant interaction to occur between the binary and the disc. The resulting resonant torques distinctly alter the disc response from the circular binary case. We describe results of three-dimensional hydrodynamic simulations to explore this effect and categorise the response of the disc in terms of modes whose strengths vary as a function of binary mass ratio and eccentricity. These mode strengths are weak compared to the largest mode strengths expected in the prog...

  13. Comparison of endoscopic stenting for malignant biliaryobstruction: A single-center study

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM: To evaluate the efficacy and safety of single-stependoscopic placement of self-expandable metallic stents(SEMS) for treatment of obstructive jaundice.METHODS: A retrospective study was performedamong 90 patients who underwent transpapillarybiliary metallic stent placement for malignant biliaryobstruction (MBO) between April 2005 and October2012. The diagnosis of primary disease and MBO wasbased on abdominal ultrasound, computed tomography,magnetic resonance imaging, endoscopic ultrasound,endoscopic retrograde cholangiopancreatography withbrush cytology, biopsy, and/or a combination of thesemodalities. The type of SEMS (covered or non-covered,8 mm or 10 mm in diameter) was determined by theendoscopist. Ninety patients were divided into twogroups: group 1 (49 patients) who underwent a singlestepSEMS placement and group 2 (41 patients) whounderwent a two-step SEMS placement. The technicalsuccess rate, complication rate, stent patency, andpatient survival rate were compared between thegroups. In addition, to identify the clinical prognosticfactors associated with patient survival, the followingvariables were evaluated in Cox-regression analysis:gender, age, etiology of MBO (pancreatic cancer or nonpancreaticcancer), clinical stage (Ⅳb; with distant metastases or Ⅳa 〉; without distant metastases),chemotherapy (with or without), patency of the stent,and the use of single-step or two-step SEMS.RESULTS: Immediate technical success was achievedin 93.9% (46/49) in group 1 and in 95.1% (39/41)in group 2, with no significant difference (P = 1.0).Similarly, there was no difference in the complicationrates between the groups (group 1, 4.1% and group 2,4.9%; P = 0.62). Stent failure was observed in 10 casesin group 1 (20.4%) and in 16 cases in group 2 (39.0%).The patency of stent and patient survival revealed nodifference between the two groups with Kaplan-Meieranalysis, with a mean patency of 111 ± 17

  14. Dietary fiber and retrograde starch.

    Science.gov (United States)

    Zivković, R

    1998-01-01

    The history of the recognition of the importance of dietary fiber, their current classification into water-soluble and water-insoluble fiber, and lignin, a single non-carbohydrate fiber, and the physiologic role of dietary fiber, with particular reference to retrograde starch resistance to small intestine digestion, are briefly presented. Dietary fiber are highly hygroscopic, thus they greatly contribute to stool voluminosity by binding water, decrease the glycemic index, and exert a protective action, via an as yet unknown mechanism, against the occurrence of colon cancer. It should be added that some dietary fiber decrease the concentration of cholesterol in the blood, i.e. in the human body. The importance of the methodology used for NSP determination is underlined, since some methods determine only some of the polysaccharides, other also measure some other substances, whereas Englyst's method determines NSP only.

  15. Migration of a biliary stent causing duodenal perforation and biliary peritonitis.

    Science.gov (United States)

    Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

    2013-10-16

    Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

  16. Migration of a biliary stent causing duodenal perforation and biliary peritonitis

    OpenAIRE

    Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

    2013-01-01

    Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

  17. Screening of seeds prepared from retrograded potato starch to increase retrogradation rate of maize starch.

    Science.gov (United States)

    Lian, Xijun; Liu, Lizeng; Guo, Junjie; Li, Lin; Wu, Changyan

    2013-09-01

    In this paper, retrograded potato starches treated by oxalic, hydrochloric and citric acids and/with amylase respectively, as seed crystals, are added into maize starch paste to increase maize starch retrogradation rate. The results show that addition of seed accelerates maize starch retrogradation greatly. Seed prepared from retrograded potato starch treated by oxalic acid increases maize starch retrogradation rate most, from 1.5% to 49%. The results of IR spectra of retrograded maize starch derived from different seeds show that double helix, not hydrogen bond, probably forms at stage of seed growth during retrogradation. The results of IR spectra, X-ray and SEM indicate that treatment of retrograded potato starch with oxalic acid leads to formation of more hydrogen bonds and an increase of seed crystal planes, which markedly promotes the growth of the seed. Retrogradation of maize starch by seeding method surely includes a stage of crystal growth through double helix in a way different from normal maize starch retrogradation.

  18. Retrogradation enthalpy does not always reflect the retrogradation behavior of gelatinized starch

    OpenAIRE

    2016-01-01

    Starch retrogradation is a term used to define the process in which gelatinized starch undergoes a disorder-to-order transition. A thorough understanding of starch retrogradation behavior plays an important role in maintaining the quality of starchy foods during storage. By means of DSC, we have demonstrated for the first time that at low water contents, the enthalpy change of retrograded starch is higher than that of native starch. In terms of FTIR and Raman spectroscopic results, we showed ...

  19. Retrogradation enthalpy does not always reflect the retrogradation behavior of gelatinized starch.

    Science.gov (United States)

    Wang, Shujun; Li, Caili; Zhang, Xiu; Copeland, Les; Wang, Shuo

    2016-02-10

    Starch retrogradation is a term used to define the process in which gelatinized starch undergoes a disorder-to-order transition. A thorough understanding of starch retrogradation behavior plays an important role in maintaining the quality of starchy foods during storage. By means of DSC, we have demonstrated for the first time that at low water contents, the enthalpy change of retrograded starch is higher than that of native starch. In terms of FTIR and Raman spectroscopic results, we showed that the molecular order of reheated retrograded starch samples is lower than that of DSC gelatinized starch. These findings have led us to conclude that enthalpy change of retrograded starch at low water contents involves the melting of recrystallized starch during storage and residual starch crystallites after DSC gelatinization, and that the endothermic transition of retrograded starch gels at low water contents does not fully represent the retrogradation behavior of starch. Very low or high water contents do not favor the occurrence of starch retrogradation.

  20. Endoscopic retrograde pancreatography (ERP) in acute alcoholic and biliary pancreatitis. Endoskopische retrograde Pankreatographie (ERP) bei akuter alkoholischer und biliaerer Pankreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Brambs, H.J. (Heidelberg Univ. (Germany, F.R.). Radiologische Klinik)

    1991-05-01

    An analysis of the ERP findings in 31 patients with acute pancreatitis enable us to define the terminology of the pancreatogram in these diseases. Irregularities of the ducts indicate previous damage to the organ. A frequent phenomenon is thinning of lateral branches, which can be explained by compression due to oedema. Early parenchymal staining indicates abnormal permeability of the duct epithelium. Cavities are an expression of acute pseudo-cysts. A sign characteristic of alcoholic pancreatitis is the presence of contrast defects due to protein plugs and due to increased viscosity of pancreatic secretions. These observations confirm the theory that protein precipitates due to abnormal secretions play an important role in acute pancreatitis. (orig.).

  1. Hepatic applications of endoscopic ultrasound

    DEFF Research Database (Denmark)

    Srinivasan, Indu; Tang, Shou-Jiang; Vilmann, Andreas S

    2015-01-01

    The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various...... of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role....

  2. Effect of Endoscopic Sphincterotomy for Suspected Sphincter of Oddi Dysfunction on Pain-Related Disability Following Cholecystectomy

    Science.gov (United States)

    Cotton, Peter B.; Durkalski, Valerie; Romagnuolo, Joseph; Pauls, Qi; Fogel, Evan; Tarnasky, Paul; Aliperti, Giuseppe; Freeman, Martin; Kozarek, Richard; Jamidar, Priya; Wilcox, Mel; Serrano, Jose; Brawman-Mintzer, Olga; Elta, Grace; Mauldin, Patrick; Thornhill, Andre; Hawes, Robert; Wood-Williams, April; Orrell, Kyle; Drossman, Douglas; Robuck, Patricia

    2015-01-01

    IMPORTANCE Abdominal pain after cholecystectomy is common and may be attributed to sphincter of Oddi dysfunction. Management often involves endoscopic retrograde cholangiopancreatography (ERCP) with manometry and sphincterotomy. OBJECTIVE To determine whether endoscopic sphincterotomy reduces pain and whether sphincter manometric pressure is predictive of pain relief. DESIGN, SETTING, AND PATIENTS Multicenter, sham-controlled, randomized trial involving 214 patients with pain after cholecystectomy without significant abnormalities on imaging or laboratory studies, and no prior sphincter treatment or pancreatitis randomly assigned (August 6, 2008-March 23, 2012) to undergo sphincterotomy or sham therapy at 7 referral medical centers. One-year follow-up was blinded. The final follow-up visit was March 21, 2013. INTERVENTIONS After ERCP, patients were randomized 2:1 to sphincterotomy (n = 141) or sham (n = 73) irrespective of manometry findings. Those randomized to sphincterotomy with elevated pancreatic sphincter pressures were randomized again (1:1) to biliary or to both biliary and pancreatic sphincterotomies. Seventy-two were entered into an observational study with conventional ERCP managemeny. MAIN OUTCOMES AND MEASURES Success of treatment was defined as less than 6 days of disability due to pain in the prior 90 days both at months 9 and 12 after randomization, with no narcotic use and no further sphincter intervention. RESULTS Twenty-seven patients (37%; 95%CI, 25.9%-48.1%) in the sham treatment group vs 32 (23%; 95%CI, 15.8%-29.6%) in the sphincterotomy group experienced successful treatment (adjusted risk difference, −15.6%; 95% CI, −28.0% to −3.3%; P = .01). Of the patients with pancreatic sphincter hypertension, 14 (30%; 95% CI, 16.7%-42.9%) who underwent dual sphincterotomy and 10 (20%; 95% CI, 8.7%-30.5%) who underwent biliary sphincterotomy alone experienced successful treatment. Thirty-seven treated patients (26%; 95% CI,19%-34%) and 25 patients

  3. Endoscopic Management of Esthesioneuroblastoma.

    Science.gov (United States)

    Roxbury, Christopher R; Ishii, Masaru; Gallia, Gary L; Reh, Douglas D

    2016-02-01

    Esthesioneuroblastoma is a rare malignant tumor of sinonasal origin. These tumors typically present with unilateral nasal obstruction and epistaxis, and diagnosis is confirmed on biopsy. Over the past 15 years, significant advances have been made in endoscopic technology and techniques that have made this tumor amenable to expanded endonasal resection. There is growing evidence supporting the feasibility of safe and effective resection of esthesioneuroblastoma via an expanded endonasal approach. This article outlines a technique for endoscopic resection of esthesioneuroblastoma and reviews the current literature on esthesioneuroblastoma with emphasis on outcomes after endoscopic resection of these malignant tumors.

  4. Diagnostic and treatment of retrograde ejaculation as a manifestation of urogenital form of autonomic diabetic polyneuropathy

    Directory of Open Access Journals (Sweden)

    Dmitry Gennadyevich Kurbatov

    2015-07-01

    Full Text Available Background. Retrograde ejaculation in patients with type 1 diabetes mellitus is a complication of autonomic neuropathy that causes excretory infertility. It can be partial (reduction of ejaculate or total (absence of ejaculate and occurs in 10%–20% of men with type 1 diabetes mellitus.Aim. The aim of the study was to assess the effectiveness of a new endoscopic method for retrograde ejaculation correction and antegrade ejaculation restoration.Materials and methods. We included 30 patients with type 1 diabetes mellitus who had spermatozoa present in their post-orgasmic urine and ultrasonographic evidence of impaired or absent bladder neck closure. The mean age of participants was 32 (30–35 years, mean duration of diabetes was 17 (12–22 years and mean preoperative glycated haemoglobin level was 7.4% (6.9%–8.0%. All participants had total retrograde ejaculation. We used conventional irrigated urethrocystoscopy under local anaesthesia. During urethroscopy, bladder neck gaping was observed in all cases. Biocompatible material was injected at three points under the mucous layer of the posterior urethra, reaching the closing of the opposite edges of the urethra. A spermiogram was examined 1 week after the operation.Results. Restoration of antegrade ejaculation was achieved for 22 patients (73%, and the effects persisted for a mean of 7 (2–12 months. The spouses of four men became pregnant after surgery. In one case, the pregnancy resulted in a spontaneous abortion at gestational week 8, but the other three cases continued normally.Conclusion.This new method provides a highly effective means of restoring the physiological passage of the ejaculate. The operation is a low-invasive endoscopic procedure that does not disrupt urination, and it is possible to receive ejaculate of sufficient.

  5. Cholangiographic Features in Opium-Addicted Patients at a Tertiary Hospital in Iran

    Directory of Open Access Journals (Sweden)

    Amir Houshang Mohammad Alizadeh

    2012-01-01

    Full Text Available Background/Aims. Destructive and metabolic changes in hepatobiliary system have been demonstrated following opium use; however, cholangiographic features of bile ducts in opium-addicted patients with sphincter of Oddi dysfunction are not clearly determined. We described these differences and assessed the effects of opium use on postendoscopic retrograde cholangiopancreatography complications. Methodology. One hundred and nineteen patients with the diagnosis of sphinctre of Oddi dysfunction according to the Geenen-Hogan classification were studied. Eight patients were confirmed opium-addicted and others were nonaddicted. Change of serum amylase concentrations after endoscopic retrograde cholangiopancreatography and clinical diagnosis of addicted and non-addicted patients were compared. Results. Serum concentrations of liver aminotransferases and alkaline phosphatase were similar between the two groups. Serum concentration of amylase before endoscopic retrograde cholangiopancreatography was similar between them, whereas concentration of this enzyme was higher in nonaddicted ones after endoscopic retrograde cholangiopancreatography. Regarding pathologic changes in papilla, opium addiction group in comparison with control group statistically showed more tumoral features (25.0% versus 5.4% and ulcerated changes (12.5% versus 0.0%. Conclusions. Opium use can increase probability of papilla ulcerative and tumoral changes in patients with sphinctre of Oddi dysfunction. Postendoscopic retrograde cholangiopancreatography serum amylase level may be reduced following opium addiction.

  6. Endoscopic treatment of gastroparesis.

    Science.gov (United States)

    McCarty, Thomas R; Rustagi, Tarun

    2015-06-14

    Gastroparesis has traditionally been a largely medically managed disease with refractory symptoms typically falling under the umbrella of the surgical domain. Surgical options include, but are not limited to, gastrostomy, jejunostomy, pyloromyotomy, or pyloroplasty, and the Food and Drug Administration approved gastric electrical stimulation implantation. Endoscopic management of gastroparesis most commonly involves intrapyloric botulinum toxin injection; however, there exists a variety of endoscopic approaches on the horizon that have the potential to radically shift standard of care. Endoscopic management of gastroparesis seeks to treat delayed gastric emptying with a less invasive approach compared to the surgical approach. This review will serve to highlight such innovative and potentially transformative, endoscopic interventions available to gastroenterologists in the management of gastroparesis.

  7. Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique.

    Science.gov (United States)

    Aygün, C; Peskircioglu, L; Tekin, M I; Dirim, A; Ozkardes, H

    2001-08-01

    Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.

  8. Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia.

    Science.gov (United States)

    Chen, Chang-Hua; Wu, Shun-Sheng; Huang, Chieh-Chen

    2013-05-14

    Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Escherichia coli, viridans streptococcus, and A. baumannii). After a literature review, we suggest that correct gastroendoscopy technique and skill in drainage procedures, as well as antibiotic prophylaxis, are of paramount importance in minimizing the risk of gastroendoscopy-associated bacteremia.

  9. Current applications of endoscopic suturing

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Endoscopic suturing had previously been consideredan experimental procedure only performed in afew centers and often by surgeons. Now, however,endoscopic suturing has evolved sufficiently to be easilyimplemented during procedures and is more commonlyused by gastroenterologists. We have employed theApollo OverStitch suturing device in a variety of waysincluding closure of perforations, closure of full thicknessdefects in the gastrointestinal wall created duringendoscopic full thickness resection, closure of mucosotomiesduring peroral endoscopic myotomy, stentfixation, fistula closure, post endoscopic submucosaldissection, endoscopic mucosal resection and NaturalOrifice Transluminal Endoscopic Surgery defect closures,post-bariatric surgery gastrojejunal anastomosis revisionand primary sleeve gastroplasty.

  10. Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection Comparação entre citologia por escovado endoscópico realizada antes e depois da dilatação das estenoses biliares para detecção de câncer

    Directory of Open Access Journals (Sweden)

    Laura Cotta Ornellas

    2006-03-01

    Full Text Available BACKGROUND: Confirmation of malignancy within biliary strictures is endoscopically challenging. Dilation of strictures has been reported to enhance cytological diagnosis. AIM: To compare brush cytology results before and after biliary stricture dilation. PATIENTS AND METHODS: Patients with extra-hepatic biliary stricture at endoscopic retrograde cholangiopancreatography were included in the study. Brushing was performed before and immediately after dilation using a 10 Fr dilating catheter. Cytology samples were classified as: negative for malignancy, presence of atypical cells, insufficient material, suspicious for malignancy or positive for malignancy. Final diagnosis was established by surgery, biopsy or follow-up. RESULTS: Biliary brush cytology was performed in 50 patients, with an overall sensitivity of 40% and 27.5%, before and after dilation, respectively. The combination of results increased cancer detection rate to 45%. There were 5/50 (10% minor complications and one death related to the procedure. CONCLUSIONS: Brush cytology performed before biliary stricture dilation has a similar cancer detection rate to that following dilation, although the combination of results enhances sensitivity.RACIONAL: A citologia por escovado apresenta baixa sensibilidade na detecção de câncer em estenoses biliares, mas manipulação endoscópica prévia poderia aumentar a esfoliação de células tumorais. OBJETIVO: Comparar os resultados dos escovados obtidos antes e depois da dilatação de estenoses biliares. PACIENTES E MÉTODOS: Pacientes com estenose biliar extra-hepática diagnosticada durante colangiopancreatografia endoscópica retrógada foram submetidos a citologia por escovado. Em seguida, a estenose foi dilatada com cateter de 10 French e o escovado foi repetido. A citologia foi classificada como: negativa para malignidade, presença de células atípicas, material insuficiente, suspeita para malignidade ou positiva para malignidade. O

  11. Recovery from retrograde amnesia: a learning process.

    Science.gov (United States)

    Schneider, A M; Tyler, J; Jinich, D

    1974-04-01

    Retrograde amnesia was produced in rats by electroconvulsive shock. Memory recovered if the animals were given repeated test trials. Memory did not recover if steps were taken to reduce the conditioning properties of the test trials; the manipulations included eliminating the response, altering the apparatus cues, or extinguishing conditioned "fear" by confining animals to the apparatus during the first test trial.

  12. Biliary ascariasis in a bile duct stones-removed female patient.

    Science.gov (United States)

    Wang, Jun; Pan, Yang-Lin; Xie, Yan; Wu, Kai-Chun; Guo, Xue-Gang

    2013-09-28

    Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.

  13. Retrograde Renal Cooling to Minimize Ischemia

    Directory of Open Access Journals (Sweden)

    Janet L. Colli

    2013-01-01

    Full Text Available Objective: During partial nephrectomy, renal hypothermia has been shown to decrease ischemia induced renal damage which occurs from renal hilar clamping. In this study we investigate the infusion rate required to safely cool the entire renal unit in a porcine model using retrograde irrigation of iced saline via dual-lumen ureteral catheter. Materials and Methods: Renal cortical, renal medullary, bowel and rectal temperatures during retrograde cooling in a laparoscopic porcine model were monitored in six renal units. Iced normal saline was infused at 300 cc/hour, 600 cc/hour, 1000 cc/hour and gravity (800 cc/hour for 600 seconds with and without hilar clamping. Results: Retrograde cooling with hilar clamping provided rapid medullary renal cooling and significant hypothermia of the medulla and cortex at infusion rates ≥ 600 cc/hour. With hilar clamping, cortical temperatures decreased at -0.9° C/min. reaching a threshold temperature of 26.9° C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.1° C over 600 seconds on average for combined data at infusion rates ≥ 600 cc/hour. The lowest renal temperatures were achieved with gravity infusion. Without renal hilum clamping, retrograde cooling was minimal at all infusion rates. Conclusions: Significant renal cooling by gravity infusion of iced cold saline via a duel lumen catheter with a clamped renal hilum was achieved in a porcine model. Continuous retrograde irrigation with iced saline via a two way ureteral catheter may be an effective method to induce renal hypothermia in patients undergoing robotic assisted and/or laparoscopic partial nephrectomy.

  14. Endoscopic resection of esthesioneuroblastoma.

    Science.gov (United States)

    Gallia, Gary L; Reh, Douglas D; Lane, Andrew P; Higgins, Thomas S; Koch, Wayne; Ishii, Masaru

    2012-11-01

    Esthesioneuroblastoma, or olfactory neuroblastoma, is an uncommon malignant tumor arising in the upper nasal cavity. Surgical approaches to this and other sinonasal malignancies involving the anterior skull base have traditionally involved craniofacial resections. Over the past 10 years to 15 years, there have been advances in endoscopic approaches to skull base pathologies, including malignant tumors. In this study, we review our experience with purely endoscopic approaches to esthesioneuroblastomas. Between January 2005 and February 2012, 11 patients (seven men and four women, average age 53.3 years) with esthesioneuroblastoma were treated endoscopically. Nine patients presented with newly diagnosed disease and two were treated for tumor recurrence. The modified Kadish staging was: A, two patients (18.2%); B, two patients (18.2%); C, five patients (45.5%); and D, two patients (18.2%). All patients had a complete resection with negative intraoperative margins. Three patients had 2-deoxy-2-((18)F)fluoro-d-glucose avid neck nodes on their preoperative positron emission tomography-CT scan. These patients underwent neck dissections; two had positive neck nodes. Perioperative complications included an intraoperative hypertensive urgency and pneumocephalus in two different patients. Mean follow-up was over 28 months and all patients were free of disease. This series adds to the growing experience of purely endoscopic surgical approaches in the treatment of skull base tumors including esthesioneuroblastoma. Longer follow-up on larger numbers of patients is required to clarify the utility of purely endoscopic approaches in the management of this malignant tumor.

  15. Endoscopic treatment of difficult extrahepatic bile ductstones, EPBD or EST: An anatomic view

    Institute of Scientific and Technical Information of China (English)

    Jun Ding; Fu Li; Hong-Yi Zhu; Xi-Wen Zhang

    2015-01-01

    Large bile duct stone (〉 10 mm) or multiple stones(≥ 3) are challenging for endoscopists. Endoscopicsphincterotomy (EST) is a routine therapeutic endoscopicretrograde cholangiopancreatography (ERCP) procedureusually used. It is safe and effective, but severeperforation or massive bleeding are the main causesof mortality. Because of the permanent destroy ofOddi sphincter, the use of EST is still controversial.Endoscopic papillary balloon dilation (EPBD) givesanother way to open the sphincter. Less incidence ofbleeding, perforation and partly preserving the Oddisphincter's function are the main advantages. Buthigh incidence of post-ERCP pancreatitis becomes apredominant problem. According to the anatomicalfeature of Oddi sphincter, limited EST + EPBD seems amore reasonable procedure. Compared to the formertwo procedures, it makes the stone extraction processmuch easier with lower incidences of short-term andlong-term complications.

  16. Retrograde Ender nailing for humerus shaft fractures.

    Science.gov (United States)

    Khurana, Ashish; Pendse, Anirudha; Modi, Hitesh; Diwanji, Sanket; Mathur, Hemant; Daveshwar, Rajiv

    2009-10-01

    Humerus fractures are common; their management remains controversial. Infection, neurovascular injury, joint problems and non-union are recognised complications of surgical treatment. These complications can be decreased by opting for a surgical treatment that is less invasive and safe. We present a series of 59 patients treated with retrograde Ender nailing; 56 healed in an average of 9.1 weeks, 2 had delayed union (> 15 weeks) and one went on to non-union, which healed after secondary plate fixation. Nail back out occurred in 8 cases, of which only 3 required nails repositioning. The mean Constant score at final follow-up (mean 19 months) was 91; it was significantly lower in patients over 50 years of age and in those with segmental fractures. In this series, Ender retrograde nailing gave overall satisfactory results and appeared as a safe and efficient technique.

  17. Retrograde ejaculation, painful ejaculation and hematospermia

    OpenAIRE

    Parnham, Arie; Serefoglu, Ege Can

    2016-01-01

    Although there has been an increased interest on premature ejaculation in the recent years, our understanding regarding the disorders of retrograde ejaculation, painful ejaculation and hematospermia remain limited. All three of these conditions require a keen clinical acumen and willingness to engage in thinking outside of the standard established treatment paradigm. The development of novel investigational techniques and treatments has led to progress in the management of these conditions sy...

  18. Partial beta-amylolysis retards starch retrogradation in rice products.

    Science.gov (United States)

    Yao, Yuan; Zhang, Jingmin; Ding, Xiaolin

    2003-07-02

    Starch retrogradation is the main cause of quality deterioration of starch-containing foods during storage. The current work investigated the effect of partial beta-amylolysis on the retrogradation of rice starch and the potential of beta-amylase in preparing rice products with extended shelf life. Isolated amylopectin, whole rice starch, and rice flour from a regular rice cultivar were partially hydrolyzed by either reagent-grade or food-grade beta-amylase. The degree of beta-amylolysis was expressed as average external chain length () for isolated amylopectin or the degree of hydrolysis (%) for other starch systems. Pulsed nuclear magnetic resonance was used to monitor starch retrogradation during storage at 4 degrees C. The results indicated that partial beta-amylolysis using reagent-grade beta-amylase retarded amylopectin retrogradation by shortening the of amylopectin. When was below DP 11.6, the amylopectin retrogradation was essentially inhibited. Partial beta-amylolysis had a similar effect on the amylopectin retrogradation in the whole starch system. The maltose produced in beta-amylolysis might slightly attenuate the retrogradation-retarding effect of partial beta-amylolysis. The effect of food-grade beta-amylase on starch retrogradation was also evident, although less effective than that of reagent-grade beta-amylase. The retrogradation-retarding effect of food-grade beta-amylase was also demonstrated in rice flour system, indicating a potential method for controlling the starch retrogradation of rice products.

  19. Cholangitis with septic shock caused by Raoultella planticola.

    Science.gov (United States)

    Yokota, Kazuhisa; Gomi, Harumi; Miura, Yoshimasa; Sugano, Kentaro; Morisawa, Yuji

    2012-03-01

    Raoultella planticola (formerly Klebsiella planticola) is a Gram-negative bacterium that has been rarely reported in association with human infection. Here we describe a case of cholangitis complicated with septic shock caused by R. planticola in an immunocompromised patient with advanced cancer who underwent endoscopic retrograde cholangiopancreatography to extract common bile duct stones. The infection was cleared by piperacillin-tazobactam treatment.

  20. Endobiliary brush biopsy

    DEFF Research Database (Denmark)

    Adamsen, Sven; Olsen, Marianne; Jendresen, Marianne Bille;

    2006-01-01

    OBJECTIVE: Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant disease is generally around 50% and specificity around 100%. The present study wa...

  1. Recurrent pancreatitis secondary to pancreatic ascariasis.

    Science.gov (United States)

    Lee, K H; Shelat, V G; Low, H C; Ho, K Y; Diddapur, R K

    2009-06-01

    Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides can occasionally cause biliary obstruction and result in obstructive jaundice or pancreatitis. We present a 34-year-old Bangladeshi woman with biliary ascariasis, resulting in recurrent pancreatitis. Her diagnosis was made with endoscopic retrograde cholangiopancreatography performed during an acute attack of pain.

  2. Current roles of endoscopy in the management of intraductal papillary mucinous neoplasm of the pancreas

    OpenAIRE

    Tanaka, Masao

    2015-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin‐producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to its histomorphological and immunohistochemical characteristics. Endoscopic retrograde cholangiopancreatography plays a crucial role in the evaluation of these features of IPMN. End...

  3. Various applications of endoscopic scissors in difficult endoscopic interventions.

    Science.gov (United States)

    Kee, Won-Ju; Park, Chang-Hwan; Chung, Kyoung-Myeun; Park, Seon-Young; Jun, Chung-Hwan; Ki, Ho-seok; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2014-05-01

    Endoscopic scissors offer a benefit over other devices by avoiding potential complications related to thermal and mechanical injury of surrounding structures. We describe our experience with endoscopic scissors in three difficult endoscopic interventions. A fishbone embedded in the esophageal wall penetrated very close to the pulsating aorta and the bronchus. The fishbone was cut in half by endoscopic scissors and removed without injury to adjacent organs. A gastric submucosal tumor with an insulated core that could not be resected by electrosurgical devices was cut using endoscopic scissors following endoloop placement. Extravascular coil migration after transcatheter arterial embolization resulted in a duodenal ulcer. The metallic coil on the duodenal ulcer was cut by endoscopic scissors without mechanical or thermal injury.

  4. Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation Estudo da eficácia e da reprodutibilidade da colangiopancreatografia por ressonância magnética na detecção das complicações biliares pós-transplantes hepáticos

    Directory of Open Access Journals (Sweden)

    Marcelo Moura Linhares

    2010-06-01

    Full Text Available PURPOSE: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP in the detection of biliary complications in liver transplanted patients. METHODS: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP. RESULTS: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6% and 82.1% of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100% of the exams, by both observers. Six biliary complications were detected (21.4%, all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804 for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000 for the detection of biliary complications. MRCP achieved 100% sensitivity, 95.45% specificity, 85.7% positive predictive value and 100% negative predictive value for the detection of biliary complications. CONCLUSIONS: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients.OBJETIVO: Medir a acurácia e reprodutibilidade da colangiopancreatografia por ressonância magnética (CPRM na avaliação da visibilização de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos. MÉTODOS: Realizado estudo

  5. STARCH RETROGRADATION AND PRODUCTION OF RESISTANT STARCH IN COOKED RICE

    OpenAIRE

    2008-01-01

    After rice cooking, retrogradation of starch in a cooked rice progresses quickly at under gelatinization temperature. Cold rice (aging rice) is tasteless, firm and digested slowly. My aim in this report is explained the relationship between cold rice tasteless and indexes of starch retrogradation. Starch gelatinization degree, starch whiteness index and resistant starch content that were indexes of starch retrogradation did not change remarkably of cold and aging rice that were very firm and ...

  6. Clinical evaluation of two different materials for retrograde root filling

    OpenAIRE

    Dimova, Cena; Papakoca, Kiro; Kovacevska, Ivona; Evrosimovska, Biljana; Georgiev, Zlatko

    2014-01-01

    BACKGROUND:Retrograde root filling is indicated when periapical inflammation cannot be resolved by conventional endodontic therapy. A retrograde filling should prevent flow of microorganisms and bacterial endotoxins from the root canal into periapical tissues. The aim was to evaluate the clinical and radiographic treatment outcome of two different materials for retrograde root filling (dentin-bonded resin nano composite and glass ionomer cement) using special preparation performance of re...

  7. Retrograde amnesia for semantic information in Alzheimer's disease.

    Science.gov (United States)

    Meeter, Martijn; Kollen, Ariane; Scheltens, Philip

    2005-01-01

    Patients with mild to moderate Alzheimer's disease and normal controls were tested on a retrograde amnesia test with semantic content (Neologism and Vocabulary Test, or NVT), consisting of neologisms to be defined. Patients showed a decrement as compared to normal controls, pointing to retrograde amnesia within semantic memory. No evidence for a gradient within this amnesia was found, although one was present on an autobiographic test of retrograde amnesia that had a wider time scale. Several explanations for these results are presented, including one that suggests that extended retrograde amnesia and semantic memory deficits are in fact one and the same deficit.

  8. Retrograde ejaculation, painful ejaculation and hematospermia.

    Science.gov (United States)

    Parnham, Arie; Serefoglu, Ege Can

    2016-08-01

    Although there has been an increased interest on premature ejaculation in the recent years, our understanding regarding the disorders of retrograde ejaculation, painful ejaculation and hematospermia remain limited. All three of these conditions require a keen clinical acumen and willingness to engage in thinking outside of the standard established treatment paradigm. The development of novel investigational techniques and treatments has led to progress in the management of these conditions symptoms; however, the literature almost uniformly is limited to small series and rare randomised trials. Further investigation and randomised controlled trials are needed for progress in these often challenging cases.

  9. Anterograde and Retrograde Amnesia following Bitemporal Infarction

    Directory of Open Access Journals (Sweden)

    A. Schnider

    1994-01-01

    Full Text Available A patient suffered very severe anterograde and retrograde amnesia following infarction of both medial temporal lobes (hippocampus and adjacent cortex and the left inferior temporo-occipital area. The temporal stem and the amygdala were intact; these structures do not appear to be critical for new learning in humans. Extension of the left-sided infarct into the inferior temporo-occipital lobe, an area critically involved in visual processing, appears to be responsible for our patient's loss of remote memories.

  10. New endoscopic approaches in IBD

    Institute of Scientific and Technical Information of China (English)

    Helmut Neumann; Markus F Neurath; Jonas Mudter

    2011-01-01

    Recent advances in endoscopic imaging techniques have revolutionized the diagnostic approach of patients with inflammatory bowel disease(IBD).New,emerging endoscopic imaging techniques visualized a plethora of new mucosal details even at the cellular and subcellular level.This review offers an overview about new endoscopic techniques,including chromoendoscopy,magnification endoscopy,spectroscopy,confocal laser endomicroscopy and endocytoscopy in the face of IBD.

  11. Endoscopic Intermetatarsal Ligament Decompression

    OpenAIRE

    Lui, Tun Hing

    2015-01-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic ...

  12. Peroral endoscopic myotomy.

    Science.gov (United States)

    Kumbhari, Vivek; Khashab, Mouen A

    2015-05-16

    Peroral endoscopic myotomy (POEM) incorporates concepts of natural orifice translumenal endoscopic surgery and achieves endoscopic myotomy by utilizing a submucosal tunnel as an operating space. Although intended for the palliation of symptoms of achalasia, there is mounting data to suggest it is also efficacious in the management of spastic esophageal disorders. The technique requires an understanding of the pathophysiology of esophageal motility disorders as well as knowledge of surgical anatomy of the foregut. POEM achieves short term response in 82% to 100% of patients with minimal risk of adverse events. In addition, it appears to be effective and safe even at the extremes of age and regardless of prior therapy undertaken. Although infrequent, the ability of the endoscopist to manage an intraprocedural adverse event is critical as failure to do so could result in significant morbidity. The major late adverse event is gastroesophageal reflux which appears to occur in 20% to 46% of patients. Research is being conducted to clarify the optimal technique for POEM and a personalized approach by measuring intraprocedural esophagogastric junction distensibility appears promising. In addition to esophageal disorders, POEM is being studied in the management of gastroparesis (gastric pyloromyotomy) with initial reports demonstrating technical feasibility. Although POEM represents a paradigm shift the management of esophageal motility disorders, the results of prospective randomized controlled trials with long-term follow up are eagerly awaited.

  13. Post–Endoscopic Retrograde Cholangiopancreaticography complications in liver transplanted patients, a single-center experience

    DEFF Research Database (Denmark)

    Ambrus, R B; Svendsen, Lars Bo; Hillingsø, J G

    2015-01-01

    patients during a 9-year period. RESULTS: A total of 292 ERCPs were included. Overall post-ERCP complications occurred in 24 procedures (8.2%): pancreatitis in 8 (2.7%), bleeding in 5 (1.7%), and cholangitis in 13 (4.5%) procedures. Simultaneous pancreatitis and cholangitis, and simultaneous bleeding...... and cholangitis occurred after two procedures, respectively. Multivariate analysis concerning overall complications identified biliary sphincterotomy (p = 0.006) and time since liver transplantation within 90 days postoperatively (p = 0.044) as risk factors for post-ERCP complications. Specifically concerning...... post-ERCP pancreatitis (PEP), it was found that pre-ERCP cholangitis was another independent risk factor for PEP (p = 0.026). Stent in the biliary tract prior to ERCP seemed to be protective (p = 0.041). CONCLUSIONS: Complications were of surprisingly mild degree. The rates of post-ERCP complications...

  14. Digitalised endoscopic retrograde pancreatography (D-ERP): A comparison with ERCP

    Energy Technology Data Exchange (ETDEWEB)

    Soimakallio, S.; Pirinen, A.; Suhonen, M.

    1988-06-01

    Cannulation of the papilla of Vater was successful in 49 out of 65 cases (75.4%) and digital imaging of the pancreas in 38% of cases. Visualisation of the pancreatic duct with D-ERP was comparable to that of conventional ERCP. Absent or faint opacification of the parenchyma was seen in 39.5% of patients. Both methods were equally effective for the diagnosis of pancreatic tumours. D-ERP was better than ERCP for the diagnosis of chronic pancreatitis. Two patients (4.1%) had clinical evidence of mild acute pancreatitis following pancreatic duct injections.

  15. Terminal retrograde turn of rolling rings

    Science.gov (United States)

    Jalali, Mir Abbas; Sarebangholi, Milad S.; Alam, Mohammad-Reza

    2015-09-01

    We report an unexpected reverse spiral turn in the final stage of the motion of rolling rings. It is well known that spinning disks rotate in the same direction of their initial spin until they stop. While a spinning ring starts its motion with a kinematics similar to disks, i.e., moving along a cycloidal path prograde with the direction of its rigid body rotation, the mean trajectory of its center of mass later develops an inflection point so that the ring makes a spiral turn and revolves in a retrograde direction around a new center. Using high speed imaging and numerical simulations of models featuring a rolling rigid body, we show that the hollow geometry of a ring tunes the rotational air drag resistance so that the frictional force at the contact point with the ground changes its direction at the inflection point and puts the ring on a retrograde spiral trajectory. Our findings have potential applications in designing topologically new surface-effect flying objects capable of performing complex reorientation and translational maneuvers.

  16. Cerebellar endocannabinoids: retrograde signaling from purkinje cells.

    Science.gov (United States)

    Marcaggi, Païkan

    2015-06-01

    The cerebellar cortex exhibits a strikingly high expression of type 1 cannabinoid receptor (CB1), the cannabinoid binding protein responsible for the psychoactive effects of marijuana. CB1 is primarily found in presynaptic elements in the molecular layer. While the functional importance of cerebellar CB1 is supported by the effect of gene deletion or exogenous cannabinoids on animal behavior, evidence for a role of endocannabinoids in synaptic signaling is provided by in vitro experiments on superfused acute rodent cerebellar slices. These studies have demonstrated that endocannabinoids can be transiently released by Purkinje cells and signal at synapses in a direction opposite to information transfer (retrograde). Here, following a description of the reported expression pattern of the endocannabinoid system in the cerebellum, I review the accumulated in vitro data, which have addressed the mechanism of retrograde endocannabinoid signaling and identified 2-arachidonoylglycerol as the mediator of this signaling. The mechanisms leading to endocannabinoid release, the effects of CB1 activation, and the associated synaptic plasticity mechanisms are discussed and the remaining unknowns are pointed. Notably, it is argued that the spatial specificity of this signaling and the physiological conditions required for its induction need to be determined in order to understand endocannabinoid function in the cerebellar cortex.

  17. Retrograde intrarenal surgery in pediatric patients.

    Science.gov (United States)

    Resorlu, Berkan; Sancak, Eyup Burak; Resorlu, Mustafa; Gulpinar, Murat Tolga; Adam, Gurhan; Akbas, Alpaslan; Ozdemir, Huseyin

    2014-11-01

    Urinary tract stone disease is seen at a level of 1%-2% in childhood (stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to today's advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.

  18. Outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes: What can we do to prevent infections?

    Science.gov (United States)

    Rutala, William A; Weber, David J

    2016-05-02

    Recent outbreaks with carbapenem-resistant Enterobacteriaceae (CRE) in patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) have raised concerns of whether current endoscope reprocessing guidelines are adequate to ensure a patient-safe endoscope. Unlike previous outbreaks, these CRE outbreaks occurred even though manufacturer's instructions and professional guidelines were followed correctly. This article reviews why outbreaks associated with endoscopes continue to occur; what alternatives exist that might improve the margin of safety associated with duodenoscope reprocessing; and how to prevent future outbreaks associated with ERCP procedures. The advantages and disadvantages for the proposed enhancements for reprocessing duodenoscopes are reviewed as well as future strategies to prevent GI endoscope-related outbreaks.

  19. Phytochrome and retrograde signalling pathways coverage to antogonistically regulate a light-induced transcription network

    Science.gov (United States)

    Plastid-to-nucleus retrograde signals emitted by dysfunctional chloroplasts impact photomorphogenic development, but the molecular link between retrograde and photosensory-receptor signaling has remained undefined. Here, we show that the phytochrome (phy) and retrograde signaling pathways converge a...

  20. Endoscopic surveillance strategy after endoscopic resection for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Nishida; Masahiko; Tsujii; Motohiko; Kato; Yoshito; Hayashi; Tomofumi; Akasaka; Hideki; Iijima; Tetsuo; Takehara

    2014-01-01

    Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and high-frequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection,a therapeutic option for gastric intraepithelial neoplasia.Consequently,short-term outcomes of endoscopic resection(ER)for EGC have improved.Therefore,surveillance with endoscopy after ER for EGC is becoming more important,but how to perform endoscopic surveillance after ER has not been established,even though the follow-up strategy for more advanced gastric cancer has been outlined.Therefore,a surveillance strategy for patients with EGC after ER is needed.

  1. Disrupting circadian rhythms in rats induces retrograde amnesia

    NARCIS (Netherlands)

    Fekete, Mátyás; Ree, J.M. van; Niesink, Raymond J.M.; Wied, D. de

    1985-01-01

    Disrupting circadian organization in rats by phase-shifting the illumination cycle or by exposure to a reversed day/night cycle or to continuous light, resulted in retrograde amnesia for passive avoidance behavior. This retrograde amnesia induced by phase-shifting lasted at least 2 days, and gradual

  2. Retrograde amnesia for semantic information in Alzheimer's disease

    NARCIS (Netherlands)

    Meeter, M.; Kollen, A.; Scheltens, P.

    2005-01-01

    Patients with mild to moderate Alzheimer's disease and normal controls were tested on a retrograde amnesia test with semantic content (Neologism and Vocabulary Test, or NVT), consisting of neologisms to be defined. Patients showed a decrement as compared to normal controls, pointing to retrograde am

  3. The role of imaging methods in identifying the causes of extrahepatic cholestasis.

    Science.gov (United States)

    Rogoveanu, Ion; Gheonea, Dan Ionut; Saftoiu, Adrian; Ciurea, Tudorel

    2006-09-01

    Transabdominal ultrasonography is the first choice examination used for the etiological diagnosis of extrahepatic cholestasis because it is a noninvasive, rapid method and presently widely accessible. In this article we discuss the accuracy of transabdominal ultrasonography, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) in detecting the main causes of extrahepatic colestasis. Although in bile duct pathology, and especially in the evaluation of patients with jaundice, transabdominal ultrasonography is the first choice exploration, helicoidal CT, ERCP and MRCP are often required to establish the local cause of jaundice, local and distant consequences evaluation, appreciation of surgical intervention opportunity and choice of the right therapeutic method.

  4. Robot-assisted endoscopic surgery

    NARCIS (Netherlands)

    Ruurda, J.P.

    2004-01-01

    During the last three years, robot-assisted surgery systems are increasingly being applied in endoscopic surgery. They were introduced with the objective to overcome the challenges of standard endoscopic surgery. With the improvements in manipulation and visualisation that robotic-assistance offers,

  5. Rinsability of Orthophthalaldehyde from Endoscopes

    Directory of Open Access Journals (Sweden)

    Norman Miner

    2012-01-01

    Full Text Available Orthophthalaldehyde high level disinfectants are contraindicated for use with urological instruments such as cystoscopes due to anaphylaxis-like allergic reactions during surveillance of bladder cancer patients. Allergic reactions and mucosal injuries have also been reported following colonoscopy, laryngoscopy, and transesophageal echocardiography with devices disinfected using orthophthalaldehyde. Possibly these endoscopes were not adequately rinsed after disinfection by orthophthalaldehyde. We examined this possibility by means of a zone-of-inhibition test, and also a test to extract residues of orthophthalaldehyde with acetonitrile, from sections of endoscope insertion tube materials, to measure the presence of alkaline glutaraldehyde, or glutaraldehyde plus 20% w/w isopropanol, or ortho-phthalaldehyde that remained on the endoscope materials after exposure to these disinfectants followed by a series of rinses in water, or by aeration overnight. Zones of any size indicated the disinfectant had not been rinsed away from the endoscope material. There were no zones of inhibition surrounding endoscope materials soaked in glutaraldehyde or glutaraldehyde plus isopropanol after three serial water rinses according to manufacturers' rinsing directions. The endoscope material soaked in orthophthalaldehyde produced zones of inhibition even after fifteen serial rinses with water. Orthophthalaldehyde was extracted from the rinsed endoscope material by acetonitrile. These data, and other information, indicate that the high level disinfectant orthophthalaldehyde, also known as 1,2-benzene dialdehyde, cannot be rinsed away from flexible endoscope material with any practical number of rinses with water, or by drying overnight.

  6. Endoscopic resection of subepithelial tumors

    Institute of Scientific and Technical Information of China (English)

    Arthur; Schmidt; Markus; Bauder; Bettina; Riecken; Karel; Caca

    2014-01-01

    Management of subepithelial tumors(SETs) remains challenging. Endoscopic ultrasound(EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.

  7. Review of diagnostic and therapeutic endoscopic retrogradecholangiopancreatography using several endoscopicmethods in patients with surgically altered gastrointestinalanatomy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    The endoscopic approach for biliary diseases in patientswith surgically altered gastrointestinal anatomy (SAGA)had been generally deemed impractical. However, it wasradically made feasible by the introduction of doubleballoon endoscopy (DBE) that was originally developedfor diagnosis and treatments for small-bowel diseases.Followed by the subsequent development of singleballoonendoscopy (SBE) and spiral endoscopy (SE),interventions using several endoscopes for biliary diseasein patients with SAGA widely gained an acceptance asa new modality. Many studies have been made on thisnew technique. Yet, some problems are to be solved.For instance, the mutual unavailability among devicesdue to different working lengths and channels, andunestablished standardization of procedural techniquescan be raised. Additionally, in an attempt to standardizeendoscopic procedures, it is important to evaluate biliarycannulating methods by case with existence of papilla ornot. A full comprehension of the features of respectivescope types is also required. However there are notmany papers written as a review. In our manuscript,we would like to evaluate and make a review of thepresent status of diagnostic and therapeutic endoscopicretrograde cholangiopancreatography applying DBE,SBE and SE for biliary diseases in patients with SAGA forestablishment of these modalities as a new technologyand further improvement of the scopes and devices.

  8. Hepatic involvement of Langerhans cell histiocytosis in children - imaging findings of computed tomography, magnetic resonance imaging and magnetic resonance cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Yingyan; Qiao, Zhongwei; Gong, Ying; Yang, Haowei; Li, Guoping; Pa, Mier [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Xia, Chunmei [Shanghai Medical College of Fudan University, Physiology and Pathophysiology Department, Shanghai (China)

    2014-06-15

    Langerhans cell histiocytosis is a rare disease that occurs mainly in children, and hepatic involvement is generally a poor prognostic factor. To describe CT and MRI findings of hepatic involvement of Langerhans cell histiocytosis in children, especially the abnormal bile duct manifestation on magnetic resonance cholangiopancreatography (MRCP). Thirteen children (seven boys, six girls; mean age 28.9 months) were diagnosed with disseminated Langerhans cell histiocytosis. They underwent CT (n = 5) or MRI (n = 4), or CT and MRI examinations (n = 4) to evaluate the liver involvement. Periportal abnormalities presented as band-like or nodular lesions on CT and MRI in all 13 children. The hepatic parenchymal lesions were found in the peripheral regions of the liver in seven children, including multiple nodules on MRI (n = 6), and cystic-like lesions on CT and MRI (n = 3). In 11 of the 13 children the dilatations of the bile ducts were observed on CT and MRI. Eight of the 13 children underwent MR cholangiopancreatography, which demonstrated stenoses or segmental stenoses with slight dilatation of the central bile ducts, including the common hepatic duct and its first-order branches. The peripheral bile ducts in these children showed segmental dilatations and stenoses. Stenosis of the central bile ducts revealed by MR cholangiopancreatography was the most significant finding of liver involvement in Langerhans cell histiocytosis in children. (orig.)

  9. Distant retrograde orbits for the Moon's exploration

    Science.gov (United States)

    Sidorenko, Vladislav

    We discuss the properties of the distant retrograde orbits (which are called quasi-satellite orbits also) around Moon. For the first time the distant retrograde orbits were described by J.Jackson in studies on restricted three body problem at the beginning of 20th century [1]. In the synodic (rotating) reference frame distant retrograde orbit looks like an ellipse whose center is slowly drifting in the vicinity of minor primary body while in the inertial reference frame the third body is orbiting the major primary body. Although being away the Hill sphere the third body permanently stays close enough to the minor primary. Due to this reason the distant retrograde orbits are called “quasi-satellite” orbits (QS-orbits) too. Several asteroids in solar system are in a QS-orbit with respect to one of the planet. As an example we can mention the asteroid 2002VE68 which circumnavigates Venus [2]. Attention of specialists in space flight mechanics was attracted to QS-orbits after the publications of NASA technical reports devoted to periodic moon orbits [3,4]. Moving in QS-orbit the SC remains permanently (or at least for long enough time) in the vicinity of small celestial body even in the case when the Hill sphere lies beneath the surface of the body. The properties of the QS-orbit can be studied using the averaging of the motion equations [5,6,7]. From the theoretical point of view it is a specific case of 1:1 mean motion resonance. The integrals of the averaged equations become the parameters defining the secular evolution of the QS-orbit. If the trajectory is robust enough to small perturbations in the simplified problem (i.e., restricted three body problem) it may correspond to long-term stability of the real-world orbit. Our investigations demonstrate that under the proper choice of the initial conditions the QS-orbits don’t escape from Moon or don’t impact Moon for long enough time. These orbits can be recommended as a convenient technique for the large

  10. Percutaneous transhepatic recanalization of malignant hilarobstruction: A possible rescue for early failure of endoscopic y-stenting

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Hoon; Kim, Chang Won; Lee, Tae Hong; Kim, Dong Uk [Pusan National University School of Medicine, Pusan National University Hospital, Busan (Korea, Republic of); Jeon, Ung Bae; Kang, Dae Hwan [Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Yangsan (Korea, Republic of)

    2013-11-15

    Endoscopic biliary stenting is well known as an optimal method of management of malignant hilar obstruction, but sometimes the result is not satisfactory, with early stent failure. Percutaneous transhepatic biliary drainage (PTBD) has a distinct advantage over endoscopic retrograde cholangiopancreatoscopy in that with ultrasound guidance one or more appropriate segments for drainage can be chosen. We evaluated the effectiveness of percutaneous transhepatic stenting as a rescue of early failure of endoscopic stenting. Ten patients (4 men, 6 women; age range, 52-78 years; mean age, 69 years) with inoperable biliary obstruction (2 patients with gall bladder cancer and hilar invasion, and 8 patients with Klatskin tumor) and with early endoscopic stent failure were included in our study. All of the patients underwent PTBD and percutaneous transhepatic biliary stenting. Metallic stents were placed in all patients for internal drainage. Percutaneous rescue stenting was successful in all the patients technically and clinically. Mean time for the development of biliary obstruction was 13.5 days after endoscopic stenting. The mean patency of the rescue stenting was 122 days. The mean survival time for percutaneous transhepatic rescue stenting was 226.3 days. In early failure of endoscopic biliary stenting, percutaneous transhepatic recanalization can be a possible solution.

  11. Learning endoscopic resection in the esophagus

    NARCIS (Netherlands)

    van Vilsteren, Frederike G. I.; Pouw, Roos E.; Herrero, Lorenza Alvarez; Bisschops, Raf; Houben, Martin; Peters, Frans T. M.; Schenk, B. E.; Weusten, Bas L. A. M.; Schoon, Erik J.; Bergman, Jacques J. G. H. M.

    2015-01-01

    Background: Endoscopic resection is the cornerstone of endoscopic management of esophageal early neoplasia. However, endoscopic resection is a complex technique requiring knowledge and expertise. Our aims were to identify the most important learning points in performing endoscopic resection in a tra

  12. Peroral endoscopic myotomy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Peroral endoscopic myotomy (POEM) incorporatesconcepts of natural orifice translumenal endoscopicsurgery and achieves endoscopic myotomy by utilizinga submucosal tunnel as an operating space.Although intended for the palliation of symptoms ofachalasia, there is mounting data to suggest it is alsoefficacious in the management of spastic esophagealdisorders. The technique requires an understanding ofthe pathophysiology of esophageal motility disorders aswell as knowledge of surgical anatomy of the foregut.POEM achieves short term response in 82% to 100% ofpatients with minimal risk of adverse events. In addition,it appears to be effective and safe even at the extremesof age and regardless of prior therapy undertaken.Although infrequent, the ability of the endoscopist tomanage an intraprocedural adverse event is critical asfailure to do so could result in significant morbidity. Themajor late adverse event is gastroesophageal refluxwhich appears to occur in 20% to 46% of patients.Research is being conducted to clarify the optimaltechnique for POEM and a personalized approach bymeasuring intraprocedural esophagogastric junctiondistensibility appears promising. In addition toesophageal disorders,POEM is being studied in themanagement of gastroparesis (gastric pyloromyotomy)with initial reports demonstrating technical feasibility.Although POEM represents a paradigm shift themanagement of esophageal motility disorders, theresults of prospective randomized controlled trials withlong-term follow up are eagerly awaited.

  13. Retrogradation of starches and maltodextrins of various origin

    Directory of Open Access Journals (Sweden)

    Joanna Sobolewska-Zielińska

    2010-03-01

    Full Text Available Background. The retrogradation which occurs during the processes food storage is an essential problem in food industry. In this study, the ability to retrogradate of native starches and maltodextrins of different botanical origin was analysed. Material and methods. The materials were starches of various botanical origin, including commercial samples: potato, tapioca, wheat, corn, waxy corn starches, and laboratory isolated samples: triticale and rice starches. The above starches were used as material for laboratory production of maltodextrins of medium dextrose equivalents (DE in the range from 8.27 to 12.75. Starches were analysed for amylose content, while the ratio of non-branched/long-chain-branched to short-chain-branched fractions of maltodextrins was calculated from gel permeation chromatography data. The susceptibility to retrogradation of 2% starch pastes and 2% maltodextrin solutions was evaluated according to turbidimetric method of Jacobson. Results. The greatest starch in turbidance of starch gels was observed within initial of the test. days. Initial retrogradation degree of cereal starches was higher than that of tuber and root starches. The waxy corn starch was the least prone to retrogradate. The increase in turbidance of maltodextrin solutions were minimal. Waxy corn maltodextrin was not susceptible to retrogradation. Among other samples, the lowest susceptibility to retrogradation after 14 days was found for rice maltodextrin, while the highest for wheat and triticale maltodextrin. Conclusions. On the basis of this study, the retrogradation dependence on the kind of starches and the maltodextrins was established and the author stated that all the maltodextrins have a much less ability to retrogradation than the native starches.

  14. The formation of retrograde planetary orbits by close stellar encounters

    Directory of Open Access Journals (Sweden)

    Ford E. B.

    2011-02-01

    Full Text Available We consider the growing number of observations of the RossiterMcLaughlin effect in transiting planets, which seem to suggest that ~30% of transiting planets are in highly inclined or retrograde orbits. We consider the dense cluster environment in which stars are born and investigate whether perturbations from passing stars can drive planetary systems into retrograde configurations. We find that fly-bys can result in significantly more inclination excitation than might naively be expected from impulse approximations, leading to several percent of stellar systems possessing planets in retrograde orbits.

  15. ENDOSCOPIC GROMMET INSERTION OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Balasubramanian Thiagarajan

    2012-03-01

    Full Text Available Grommet insertion the commonest surgical procedure next only to circumcision is usually performed using an operating microscope 1. Authors have been using 4 mm 0 degree nasalendoscopes to perform this procedure during the last 5 years. This is a report of their experience in using endoscope inlieu of microscope in performing this surgery. This study makes a comparative analysis of Endoscopic Grommet insertion viz a viz Microscopic Grommet insertion. For this comparative analysis one year (2009 data base of Government Stanley Medical College Chennai India was used. This study reveals that Endoscopic Grommet insertion compared favorably with Microscopic Grommet insertion in all aspects with certain obvious advantages.

  16. Guideline Implementation: Processing Flexible Endoscopes.

    Science.gov (United States)

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  17. Imaging of common bile duct by linear endoscopic ultrasound

    Institute of Scientific and Technical Information of China (English)

    Malay; Sharma; Amit; Pathak; Abid; Shoukat; Chittapuram; Srinivasan; Rameshbabu; Akash; Ajmera; Zeeshn; Ahamad; Wani; Praveer; Rai

    2015-01-01

    Imaging of common bile duct(CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound(EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations:(1) the fundus of stomach;(2) body of stomach;(3) duodenal bulb;(4) descending duodenum; and(5) antrum. Following down the upper 1/3rd of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3rd of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS.

  18. Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation.

    Science.gov (United States)

    Riordan, R D; Khonsari, M; Jeffries, J; Maskell, G F; Cook, P G

    2004-12-01

    The quality of magnetic resonance cholangiopancreatography (MRCP) images is frequently degraded by high signal from the gastrointestinal tract. The aim of this study is to evaluate pineapple juice (PJ) as an oral negative contrast agent in MRCP. Preliminary in vitro evaluation demonstrated that PJ shortened T(2) relaxation time and hence decreased T(2) signal intensity on a standard MRCP sequence to a similar degree to a commercially available negative contrast agent (ferumoxsil). Electrothermal atomic absorption spectrometry assay demonstrated a high manganese concentration in PJ of 2.76 mg dl(-1), which is likely to be responsible for its T(2) imaging properties. MRCP was subsequently performed in 10 healthy volunteers, before and at 15 min and 30 min following ingestion of 400 ml of PJ. Images were assessed blindly by two Consultant Radiologists using a standard grading technique based on contrast effect (degree of suppression of bowel signal), and image effect (diagnostic quality). There were statistically significant improvements in contrast and image effect between pre and post PJ images. There was particularly significant improvement in visualization of the pancreatic duct, but no significant difference between 15 min and 30 min post PJ images. Visualization of the ampulla, common bile duct, common hepatic and central intrahepatic ducts were also significantly improved at 15 min following PJ. Our results demonstrate that PJ, may be used as an alternative to commercially available negative oral contrast agent in MRCP.

  19. Biliary leakage after urgent cholecystectomy: Optimizationof endoscopic treatment

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To investigate the results of endoscopic treatmentof postoperative biliary leakage occurring after urgentcholecystectomy with a long-term follow-up.METHODS: This is an observational database studyconducted in a tertiary care center. All consecutivepatientswho underwent endoscopic retrograde cholangiography(ERC) for presumed postoperative biliaryleakage after urgent cholecystectomy in the periodbetween April 2008 and April 2013 were consideredfor this study. Patients with bile duct transection andbiliary strictures were excluded. Biliary leakage wassuspected in the case of bile appearance from eitherpercutaneous drainage of abdominal collection orabdominal drain placed at the time of cholecystectomy.Procedural and main clinical characteristics of allconsecutive patients with postoperative biliary leakageafter urgent cholecystectomy, such as indication forcholecystectomy, etiology and type of leakage, ERCfindings and post-ERC complications, were collectedfrom our electronic database. All patients in whomthe leakage was successfully treated endoscopicallywere followed-up after they were discharged from thehospital and the main clinical characteristics, laboratorydata and common bile duct diameter were electronicallyrecorded.RESULTS: During a five-year period, biliary leakagewas recognized in 2.2% of patients who underwenturgent cholecystectomy. The median time fromcholecystectomy to ERC was 6 d (interquartile range,4-11 d). Endoscopic interventions to manage biliaryleakage included biliary stent insertion with or withoutbiliary sphincterotomy. In 23 (77%) patients after firstendoscopic treatment bile flow through existing surgicaldrain ceased within 11 d following biliary therapeuticendoscopy (median, 4 d; interquartile range, 2-8 d).In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven(23%) patients repeat ERC was done within one tofourth week after their first ERC, depending on theextent

  20. Endoscopic third ventriculostomy

    Directory of Open Access Journals (Sweden)

    Yad Ram Yadav

    2012-01-01

    Full Text Available Endoscopic third ventriculostomy (ETV is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of

  1. Endoscopic surgery- exploring the modalities

    Institute of Scientific and Technical Information of China (English)

    Daniel; Jin; Keat; Lee; Kok-Yang; Tan

    2015-01-01

    The adoption of endoscopic surgery continues to expand in clinical situations with the recent natural orifice transluminal endoscopic surgery technique enabling abdominal organ resection to be performed without necessitating any skin incision. In recent years,the development of numerous devices and platforms have allowed for such procedures to be carried out in a safer and more efficient manner, and in some ways to better simulate triangulation and surgical tasks(e.g., suturing and dissection). Furthermore, new novel techniques such as submucosal tunneling, endoscopic full-thickness resection and hybrid endo-laparoscopic approaches have further widened its use in more advanced diseases. Nevertheless, many of these new innovations are still at their pre-clinical stage. This review focuses on the various innovations in endoscopic surgery, with emphasis on devices and techniques that are currently in human use.

  2. Endoscopic treatment of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option.Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless,new improvements were necessary: failures of pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted,indications are still debated.

  3. Contrast-enhanced endoscopic ultrasonography

    DEFF Research Database (Denmark)

    Reddy, Nischita K; Ioncica, Ana Maria; Saftoiu, Adrian;

    2011-01-01

    agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder...... sonography to depict tumor neovascularization can be increased by contrast agents. Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion. In the future, these techniques could potentially be used to quantify tumor perfusion, to assess...

  4. Endoscopic managements in pain of chronic pancreatitis%疼痛性慢性胰腺炎的内镜介入疗效

    Institute of Scientific and Technical Information of China (English)

    李兆申; 吴仁培; 许国铭; 王伟; 廖专; 邹多武; 金震东; 董元航; 刘枫; 王洛伟; 施新岗

    2008-01-01

    Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pan-creatography (ERCP) in treatment of pain of chronic pancreatitis (CP). Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed.The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of ther-apy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients ( 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years).The mean follow-up period was 41.9 months (12~131 months). Twenty-eight patients (13. 1% ) under-went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% (P >0. 05 ) respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14.9% (71/476) in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6%, mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub-sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.%目的 探讨内镜介入治疗疼痛性慢性胰腺炎的疗效.方法 以2002年亚太共识报告中提出的共识意见为慢性胰腺炎诊断标准,回顾分析1997年至2006年间经内镜介入治疗疼痛性慢性胰腺炎患者的临床资料,评价其治疗的疗效.结果 成功随访214例(84.6%),其中男女性别比约2.1:1,年龄6.5~78.0岁,平均40.5岁,随访12~131个月,平均41.9个月.28例(13.1%)经内镜治疗后又行手术.患者经单一内镜治疗或再接受手术治疗后,腹痛缓解率分别为83.9%和71.4%(P>0.05),总的内镜治疗后腹痛缓解率为73%.内镜治疗术后并发症71例次(14.9%),

  5. Physiology and Pathology of Endosome-to-Golgi Retrograde Sorting

    OpenAIRE

    Burd, Christopher G.

    2011-01-01

    Bi-directional traffic between the Golgi apparatus and the endosomal system sustains the functions of the trans Golgi network (TGN) in secretion and organelle biogenesis. Export of cargo from the TGN via the anterograde pathways depletes the organelle of sorting receptors, processing proteases, SNARE molecules, and other factors that are subsequently retrieved from endosomes via the retrograde pathway. Recent studies indicate that retrograde trafficking is vital to early metazoan development,...

  6. Retrograde Melting and Internal Liquid Gettering in Silicon

    Energy Technology Data Exchange (ETDEWEB)

    Hudelson, Steve; Newman, Bonna K.; Bernardis, Sarah; Fenning, David P.; Bertoni, Mariana I.; Marcus, Matthew A.; Fakra, Sirine C.; Lai, Barry; Buonassisi, Tonio

    2011-07-01

    Retrograde melting (melting upon cooling) is observed in silicon doped with 3d transition metals, via synchrotron-based temperature-dependent X-ray microprobe measurements. Liquid metal-silicon droplets formed via retrograde melting act as efficient sinks for metal impurities dissolved within the silicon matrix. Cooling results in decomposition of the homogeneous liquid phase into solid multiple-metal alloy precipitates. These phenomena represent a novel pathway for engineering impurities in semiconductor-based systems.

  7. [Endoscopic approaches to the orbit].

    Science.gov (United States)

    Cebula, H; Lahlou, A; De Battista, J C; Debry, C; Froelich, S

    2010-01-01

    During the last decade, the use of endoscopic endonasal approaches to the pituitary has increased considerably. The endoscopic endonasal and transantral approaches offer a minimally invasive alternative to the classic transcranial or transconjunctival approaches to the medial aspect of the orbit. The medial wall of the orbit, the orbital apex, and the optic canal can be exposed through a middle meatal antrostomy, an anterior and posterior ethmoidectomy, and a sphenoidotomy. The inferomedial wall of the orbit can be also perfectly visualized through a sublabial antrostomy or an inferior meatal antrostomy. Several reports have described the use of an endoscopic approach for the resection or the biopsy of lesions located on the medial extraconal aspect of the orbit and orbital apex. However, the resection of intraconal lesions is still limited by inadequate instrumentation. Other indications for the endoscopic approach to the orbit are the decompression of the orbit for Graves' ophthalmopathy and traumatic optic neuropathy. However, the optimal management of traumatic optic neuropathy remains very controversial. Endoscopic endonasal decompression of the optic nerve in case of tumor compression could be a more valid indication in combination with radiation therapy. Finally, the endoscopic transantral treatment of blowout fracture of the floor of the orbit is an interesting option that avoids the eyelid or conjunctive incision of traditional approaches. The collaboration between the neurosurgeon and the ENT surgeon is mandatory and reduces the morbidity of the approach. Progress in instrumentation and optical devices will certainly make this approach promising for intraconal tumor of the orbit.

  8. Evaluation of Sperm Parameters of Infertile Men with Retrograde Ejaculation

    Institute of Scientific and Technical Information of China (English)

    Hong-xing ZHONG; Wei-jie ZHU; Jing LI

    2006-01-01

    Objective To investigate sperm parameters of infertile men with retrograde ejaculation.Methods Twelve infertile men with retrograde ejaculation (group A) were enrolled into this study. Sperm samples were obtained from the postejaculation urine. After sperm recovery and washing procedure, sperm parameters were assessed. Twelve semen samples from normospermic donors were used as the control (group B).Results In all retrograde cases, motile sperm with forward movement were observed in the medium. Motility of group A was significantly lower than that of group B (P<0. 01).In group A, sperm motility ranged from 11% to 56%, sperm with intact both head and tail membranes was 42.2 ± 12.3%, sperm count ranged (13-85)×106/ml, and the sperm survival time was highly shortened. Sperm with normal morphology and intact acrosome were observed in retrograde specimens.Conclusion Sperm parameters recovered from retrograde specimens were highly variable between subjects. The toxicity of urine caused deleterious to sperm functions.Motile sperm could be collected by sperm recovery procedure. Sperm parameters could meet the requirement for the use of assisted reproductive techniques for treating infertile men with retrograde ejaculation.

  9. Endoscopic Septoplasty-Two Handed Technique with Endoscope Holder: A Novel Approach.

    Science.gov (United States)

    Khan, Mubarak M; Parab, Sapna R

    2016-12-01

    The popularity of endoscopes has been expanding not only in diagnostics but also in therapeutics. The traditional septal surgery also has come under the purview of endoscopic surgery in the last few decades. Endoscopic septoplasty has definitely many advantages over the conventional procedure. But the only disadvantage of endoscopic surgery is that it is a single handed technique as the other hand is used for holding the endoscope which may compromise the overall surgical time as the hemostasis and suctioning of the surgical field off the blood cannot be done simultaneously, in addition to the surgeon fatigue associated with holding the endoscope in the left hand. Endoscope holder allows both hands of the surgeon to be free for surgical manipulation and also imitates more or less same actions of the left hand. To report the preliminary use of Khan's endoscope holder for endoscopic septoplasty. Prospective Non Randomized Clinical Study. Khan's Endoscope Holder, which was primarily designed for endoscopic ear surgery, has been used for two handed technique of endoscopic septoplasty. The design of the Endoscope holder is described in detail. A total of 49 endoholder assisted endoscopic septoplasties were operated from Nov 2014 to Jan 2015 in MIMER Medical College and Sushrut ENT Hospital, Talegaon D, Pune, India. Our Endoscope Holder is a good option for two handed technique in Endoscopic Septoplasty due to its advantages. The study reports the successful usage and applicability of the endo holder for endoscopic Septoplasty. Level of evidence IV.

  10. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Min Yung; Kim, Man Deuk; Shin, Won Seon; Shin, Min Woo; Kim, Gyoung Min; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Tae Hwan [Dept. of Radiology, National Health Insurance Serivce Ilsan Hospital, Goyang (Korea, Republic of)

    2016-04-15

    To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

  11. Pancreatic changes in patients with primary sclerosing cholangitis: MR cholangiopancreatography and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ozkavukcu, Esra [Ankara University School of Medicine, Department of Radiology, Ankara Universitesi Tip Fakueltesi, Cebeci Hastanesi, Cebeci, Ankara 06100 (Turkey)], E-mail: eozkavukcu@gmail.com; Erden, Ayse; Erden, Ilhan [Ankara University School of Medicine, Department of Radiology, Ankara Universitesi Tip Fakueltesi, Cebeci Hastanesi, Cebeci, Ankara 06100 (Turkey)

    2009-04-15

    Purpose: To evaluate the possible pancreatic changes and their frequencies in patients with primary sclerosing cholangitis (PSC) on MR cholangiopancreatography (MRCP), and conventional abdominal MRI. Materials and Methods: Patient group consisted of 29 PSC (13 male, 16 female) cases, whereas cohort 1 consisted of 12 female patients with primary biliary cirrhosis, and cohort 2 consisted of 17 patients (6 male, 11 female) with non-immune chronic liver disease. Two radiologists retrospectively evaluated the MR examinations paying special attention to the pancreatic size (atrophy or enlargement), T1- and T2-signal intensity of the pancreas, focal pancreatic lesion, capsule-like rim, peripancreatic edema or fluid, fascial thickening, and pancreatic ducts (dilatation or narrowing). The results are expressed as percentages. Three groups were compared using Pearson chi-square test for each feature. However, only p-value for 'dilatation of the pancreatic duct' was determined, whereas p-value could not be calculated because of the insufficient number of subjects/sequences for the other features. Results: Twelve PSC patients (41.3%) had pancreatic abnormalities. The most common pancreatic changes in PSC patients were decreased T1-signal intensity (44%) and dilatation of the pancreatic duct (13.8%), respectively. Increased T2-signal intensity was also shown in 2 PSC patients (6.9%). Conclusion: Even PSC patients without any sign of pancreatitis, can show MR changes in the pancreatic parenchyma or the pancreatic duct. The etiologies of these changes, and whether they are unique to PSC, are still controversial. Histopathological studies bringing light to these pancreatic changes are needed.

  12. Efficacy of Black Tea as a Negative Oral Contrast Agent for MR Cholangiopancreatography (MRCP

    Directory of Open Access Journals (Sweden)

    Amir Hossein Jalali

    2010-05-01

    Full Text Available Background/Objective: Evaluation of the use of black tea as negative oral contrast agent in MR cholangiopancreatography (MRCP."nPatients and Methods: Thirty-five patients (mean age, 50.3±19.2 years, who were referred for MRCP, entered in this study. MRCP was performed before, after 5 minutes and after 15 minutes following consumption of 300 ml of black tea. Depiction of the gall bladder, cystic duct, proximal and distal parts of the common bile duct (CBD, intra hepatic ducts, ampula of Vater, main pancreatic duct (MPD and signal loss of the stomach and three different segments of the duodenum were investigated according to VAS and Lickert scores."nResults: Regarding visibility of seven different anatomical parts of the pancreatobiliary tree (gall bladder, cystic duct, CBD, common hepatic duct, intrahepatic duct, ampula of Vater and MPD, the post procedure images were better visualized only in the distal part of CBD, ampula of vater and MPD both in Lickert and VAS scoring (all Ps≤0.001."nThere was no significant difference between the images 5 and 15 minutes after tea consumption. Regarding the obliteration of high signal in the stomach and three different parts of the duodenum, all post tea images of the mentioned parts showed significant disappearance of high signal in Lickert and VAS scoring systems (all Ps≤0.001. "nConclusion: Black tea is an affordable, cheap, available, safe, and efficient oral negative contrast agent for MRCP which reduces the signal intensity of fluids in the gastrointestinal tract and is also efficient for better depiction of MPD, distal part of CBD and ampula.

  13. Continuous normothermic retrograde cardioplegia for valve surgery.

    Science.gov (United States)

    Martella, A T; Hoffman, D M; Nakao, T; Frater, R W

    1994-07-01

    We have studied warm heart surgery, deemed as continuous warm blood cardioplegia and normothermic cardiopulmonary bypass (CPB), as an alternative to the technique of intermittent cold cardioplegia for valvular surgery. Between August 1990 and January 1994, 137 consecutive patients underwent valve repair or replacement using normothermic CPB. Eighty-six of these patients received continuous normothermic retrograde blood cardioplegia via the coronary sinus (CNRC). Fifty-one patients received intermittent cold blood cardioplegia (ICBC). All procedures were performed by the same surgeon (RWMF). The two groups were matched for age, sex, NYHA class, preoperative ejection fraction, diagnosis, procedure and activated clotting time. Warm blood cardioplegia was delivered continuously via the coronary sinus after antegrade arrest (oxygenated blood 1:4 to 1:3, 37 degrees C, 250-300 ml/min, maintaining coronary sinus pressures of 40-60 mmHg. Perioperative myocardial infarction was significantly less prevalent (4.6 vs. 8.0%; p < 0.05) in the warm cardioplegia group. Cardiac output immediately after bypass was significantly higher than before bypass only in the CNRC group (4.1 +/- 0.8 to 5.2 +/- 0.9 L/min; p < 0.01). CNRC patients had significantly higher incidence of spontaneous resumption of sinus rhythm at cross-clamp removal (80 of 86, 93%) compared to the hypothermic patients (14 of 51, 27%, p < 0.001). The time from removal of the aortic cross-clamp to discontinuation of CPB (reperfusion time) was significantly shorter in the warm cardioplegia group (43 +/- 7.4 versus 75 +/- 10.2 min; p < 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Transoral endoscopic thyroidectomy: A case report

    Directory of Open Access Journals (Sweden)

    Vishwanath M. Pai

    2015-01-01

    Conclusion: Transoral endoscopic thyroidectomy is proving to be a feasible technique with little or no complications as compared to other endoscopic thyroid surgeries. It provides surgeons with easy access to the thyroid gland and patients with aesthetically pleasing results.

  15. ENDOSCOPIC DCR VERSUS EXTERNAL DCR

    Directory of Open Access Journals (Sweden)

    Rukma

    2015-04-01

    Full Text Available PURPOSE: To compare success rates of endoscopic dacryocystorhinostomy (DCR and external DCR for acquired nasolacrimal duct obstruction (NLDO. MATERIALS AND METHODS: A prospective comparative non randomized study of 64 patients who presented with acquired NLD obstruction to a tertiary hospital. They were fully evaluated to ascertain the site of obstruction and patients with distal obstruction were included in the study. 34 patients underwent endoscopic DCR and 30 patients underwent external DCR RESULTS: 64 patients were included in the study and 72 procedures carried out. Success was achieved in 65 cases and failure in 7. Of the 7 failed cases, anatomical obstruction at the fistula site was found in 3, whereas functional failure was found in 4. In our patients, endoscopic DCR had a significantly higher success rate than external DCR, 95.23% versus 83.33% (P = 0.03. CONCLUSIONS: The success rate of Endoscopic DCR for acquired NLDO in our group of patients was 95.23%, with endoscopic surgery showing better results.

  16. Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

    Institute of Scientific and Technical Information of China (English)

    Min Joung Kim; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang; Young Hwan Kim

    2012-01-01

    We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO),which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS).A 57-year-old man was admitted to the emergency room suffering from melena.He had undergone BRTO to treat gastric varix bleeding 5 mo before admission.Endoscopy and a computed tomography (cr) scan showed complete obliteration of the gastric varix,but the nodular varices in the second portion of the duodenum expanded after BRTO,and spurting blood was seen.TIPS was performed for treatment of duodenal variceal bleeding,because attempts at endoscopic varix ligation were unsuccessful.The postoperative course was uneventful and the patient was discharged without complications.A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices,but multinodular hepatocellular carcinoma had developed.He died of hepatic failure 28 mo after TIPS.

  17. Mercury Retrograde Effect in Capital Markets: Truth or Illusion?

    Directory of Open Access Journals (Sweden)

    Murgea Aurora

    2016-06-01

    Full Text Available From the most ancient times, the astrological beliefs have played an important role in human history, thinking, world-views, language and other elements of social culture. The practice of relating the movement of celestial bodies to events in financial markets is relatively newer but despite the inconsistency between financial astrology and standard economic or financial theory, it seems to be largely spread among capital market traders. This paper evaluates one of the astrological effects on the capital market, more precisely the Mercury retrograde effect on US capital market. Despite the fact that it is just an optical illusion the astrological tradition says that Mercury retrograde periods are characterized by confusion and miscommunications. The trades could be less effective, the individuals more prone to make mistakes so there is a long-held belief that it is better to avoid set plans during Mercury retrograde, signing contracts, starting new ventures or open new stock market positions. The main findings of this study are lower return’s volatilities in the Mercury retrograde periods, inconsistent with the astrologic theories assumptions but consistent with the idea that trader’s beliefs in Mercury retrograde effect could change the market volatility exactly in the opposite sense than the predicted one.

  18. Catheter-based photoacoustic endoscope

    Science.gov (United States)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-06-01

    We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

  19. Endoscopic management of diverticular bleeding.

    Science.gov (United States)

    Rustagi, Tarun; McCarty, Thomas R

    2014-01-01

    Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB) with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70-80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  20. Endoscopic Management of Diverticular Bleeding

    Directory of Open Access Journals (Sweden)

    Tarun Rustagi

    2014-01-01

    Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  1. Endoscopic duodenal biopsy in children

    Directory of Open Access Journals (Sweden)

    El Mouzan Mohammad

    2006-01-01

    Full Text Available Background: Biopsy of the small bowel is frequently obtained by endoscopic forceps instead of the classical suction capsule, yet reports from developing countries are scarce. Aim of the study: to report our experience on the diagnostic value of this procedure in our community. Patients and methods: A retrospective analysis of all endoscopic duodenal biopsies (EDB, performed on all patients below 18 years of age. Data retrieved from the records included age, gender, nationality, indication for biopsy, the endoscopic findings, and the results of histopathology. Results: From 1993 to 2002, 241 endoscopic biopsies were performed on 241 consecutive children. Most of the children (96% were Saudi nationals, the age range between six weeks to 18 years, and male to female ratio was 0.7: 1. All of the biopsy material was adequate for routine histopathology. The commonest indications for biopsy were short stature and chronic diarrhea in 116/241 (48% and 102/241 (43% of the children respectively. Refractory rickets accounted for 11/241 (5% of the indications. The prevalence of villous atrophy was highest in children presenting with chronic diarrhea (40%, compared to short stature (22%. Other less common, but important findings were villous atrophy in three unusual conditions (one refractory rickets, one unexplained anemia, and one polyendocrinopathy, two cases of intestinal Giardia lamblia infestation, three cases of intestinal lymphangiectasis and one case of Mycobacterium avium intracellulare. Unexpected endoscopic findings were documented in 34/241 (14% of the children. Conclusions: Endoscopic duodenal biopsy is adequate not only for the diagnosis of villous atrophy, but also for the detection of other gastroenteropathies. Accordingly, when expertise and equipments are available, EDB should be the procedure of choice not only in industrialized but also in developing countries.

  2. Training for advanced endoscopic procedures.

    Science.gov (United States)

    Feurer, Matthew E; Draganov, Peter V

    2016-06-01

    Advanced endoscopy has evolved from diagnostic ERCP to an ever-increasing array of therapeutic procedures including EUS with FNA, ablative therapies, deep enteroscopy, luminal stenting, endoscopic suturing and endoscopic mucosal resection among others. As these procedures have become increasingly more complex, the risk of potential complications has also risen. Training in advanced endoscopy involves more than obtaining a minimum number of therapeutic procedures. The means of assessing a trainee's competence level and ability to practice independently continues to be a matter of debate. The use of quality indicators to measure performance levels may be beneficial as more advanced techniques and procedures become available.

  3. Endoscopic brow lifts uber alles.

    Science.gov (United States)

    Patel, Bhupendra C K

    2006-12-01

    Innumerable approaches to the ptotic brow and forehead have been described in the past. Over the last twenty-five years, we have used all these techniques in cosmetic and reconstructive patients. We have used the endoscopic brow lift technique since 1995. While no one technique is applicable to all patients, the endoscopic brow lift, with appropriate modifications for individual patients, can be used effectively for most patients with brow ptosis. We present the nuances of this technique and show several different fixation methods we have found useful.

  4. Fundamental studies of retrograde reactions in direct liquefaction

    Energy Technology Data Exchange (ETDEWEB)

    Serio, M.A.; Solomon, P.R.; Kroo, E.; Charpenay, S.; Bassilakis, R.

    1991-12-17

    The overall objective of the program was to improve the understanding of retrograde reactions and their dependencies on coal rank and structure, and/or coal modifications and reaction conditions. Because retrograde reactions are competitive with bond breaking reactions, an understanding of both is required to shift the competition in favor of the latter. Related objectives were to clarify the conflicting observations reported in literature on such major topics as the role of oxygen groups in retrograde reactions and to provide a bridge from very fundamental studies on pure compounds to phenomenological studies on actual coal. This information was integrated into the FG-DVC model, which was improved and extended to the liquefaction context.

  5. Study of the prograde and retrograde Chandler excitation

    Science.gov (United States)

    Zotov, , L.; Bizouard, , C.

    2014-12-01

    Observed motion of the Earth's rotation axis consists of components at both positive and negative frequencies. New generalized equations of Bizouard, which takes into account triaxiality of the Earth and asymmetry of the ocean tide, show that retrograde and prograde excitations are coupled. In this work using designed narrow-band filter and inversion we reconstruct geodetic excitation at the prograde and retrograde Chandler frequencies. Then we compare it with geophysical excitation, filtered out from the series of the oceanic angular momentum (OAM) and atmospheric angular momentum (AAM) for 1960-2000 yrs. Their sum coincides well with geodetic excitation only in the prograde Chandler band. The retrograde excitation coincides worse, probably in result of amplification of observational noises.

  6. Results of Long-Duration Simulation of Distant Retrograde Orbits

    Directory of Open Access Journals (Sweden)

    Gary Turner

    2016-11-01

    Full Text Available Distant Retrograde Orbits in the Earth–Moon system are gaining in popularity as stable “parking” orbits for various conceptual missions. To investigate the stability of potential Distant Retrograde Orbits, simulations were executed, with propagation running over a thirty-year period. Initial conditions for the vehicle state were limited such that the position and velocity vectors were in the Earth–Moon orbital plane, with the velocity oriented such that it would produce retrograde motion about Moon. The resulting trajectories were investigated for stability in an environment that included the eccentric motion of Moon, non-spherical gravity of Earth and Moon, gravitational perturbations from Sun, Jupiter, and Venus, and the effects of radiation pressure. The results indicate that stability may be enhanced at certain resonant states within the Earth–Moon system.

  7. Comments on the paper "Terminal retrograde turn of rolling rings"

    CERN Document Server

    Borisov, Alexey V; Karavaev, Yury L

    2016-01-01

    Mir Abbas Jalali et al. [Phys. Rev. E 92, 032913(2015)] explained the retrograde turn of rings by aerodynamic phenomena due to the presence of a central hole in the ring as opposed to a disk. The results of our experiments suggest that the drag torque is not the main reason for the retrograde turn of the rings, and the results of theoretical research have shown that such a motion is possible for both the ring and the disk in the case of rolling without slipping.

  8. Endoscopic excision of cheek lipomas.

    Science.gov (United States)

    Pyon, Jai-Kyong; Park, Bum-Jin; Mun, Goo-Hyun; Cha, Myung-Kyu; Lim, So-Young; Bang, Sa-Ik; Oh, Kap-Sung

    2008-10-01

    Although the removal of forehead and brow benign tumors using an endoscopic technique has proven to be valuable, the efficacy of an endoscopic excision for cheek masses is unclear. A retrospective review was performed on 8 patients with a lipoma (7) and a foreign body granuloma (1) located at the cheek region. There were 7 men and 1 woman with a mean age of 34.8 years (range, 22-54 years). All the excisional procedures were performed with an endoscope through 2 small incisions, one on the hair-bearing sideburns and the other behind the earlobe. The masses varied from 0.7 x 0.7 cm to 4.0 x 3.0 cm in size. There were no intraoperative or postoperative complications, and no recurrence was detected after a 5- to 61-month follow-up. An endoscopically assisted excision of cheek lipomas is an effective procedure and might be a good alternative to the more conventional procedures.

  9. Transneuronal retrograde dual viral labelling of central autonomic circuitry : possibilities and pitfalls

    NARCIS (Netherlands)

    Ter Horst, GJ

    2000-01-01

    Viral retrograde transneuronal labelling has become an important neuroanatomical tract-tracing tool for characterization of Limbic neuronal networks. Recently, dual viral retrograde transneuronal labelling has been introduced; a method employing differential transgene expression of two genetically e

  10. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    NARCIS (Netherlands)

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    2010-01-01

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  11. Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Yogesh M Shastri; Nicolas M Hoepffner; Bora Akoglu; Christina Zapletal; Wolf O Bechstein; Wolfgang F Caspary; Dominik Faust

    2007-01-01

    AIA:To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy.METHODS: Patients who developed biliary complications were analysed in detail for the clinical information,laboratory tests, treatment offered, response to it,follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs152.7 ± 21.4 U/L, P =0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%).Sustained success was achieved in 26 (81%) patients.CONCLUSION: Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

  12. Arfaptin-1 negatively regulates Arl1-mediated retrograde transport.

    Directory of Open Access Journals (Sweden)

    Lien-Hung Huang

    Full Text Available The small GTPase Arf-like protein 1 (Arl1 is well known for its role in intracellular vesicular transport at the trans-Golgi network (TGN. In this study, we used differential affinity chromatography combined with mass spectrometry to identify Arf-interacting protein 1b (arfaptin-1b as an Arl1-interacting protein and characterized a novel function for arfaptin-1 (including the arfaptin-1a and 1b isoforms in Arl1-mediated retrograde transport. Using a Shiga-toxin subunit B (STxB transportation assay, we demonstrated that knockdown of arfaptin-1 accelerated the retrograde transport of STxB from the endosome to the Golgi apparatus, whereas Arl1 knockdown inhibited STxB transport compared with control cells. Arfaptin-1 overexpression, but not an Arl1 binding-defective mutant (arfaptin-1b-F317A, consistently inhibited STxB transport. Exogenous arfaptin-1 expression did not interfere with the localization of the Arl1-interacting proteins golgin-97 and golgin-245 to the TGN and vice versa. Moreover, we found that the N-terminal region of arfaptin-1 was involved in the regulation of retrograde transport. Our results show that arfaptin-1 acts as a negative regulator in Arl1-mediated retrograde transport and suggest that different functional complexes containing Arl1 form in distinct microdomains and are responsible for different functions.

  13. Water dynamics and retrogradation of ultrahigh pressurized wheat starch.

    Science.gov (United States)

    Doona, Christopher J; Feeherry, Florence E; Baik, Moo-Yeol

    2006-09-06

    The water dynamics and retrogradation kinetics behavior of gelatinized wheat starch by either ultrahigh pressure (UHP) processing or heat are investigated. Wheat starch completely gelatinized in the condition of 90, 000 psi at 25 degrees C for 30 min (pressurized gel) or 100 degrees C for 30 min (heated gel). The physical properties of the wheat starches were characterized in terms of proton relaxation times (T2 times) measured using time-domain nuclear magnetic resonance spectroscopy and evaluated using commercially available continuous distribution modeling software. Different T2 distributions in both micro- and millisecond ranges between pressurized and heated wheat starch gels suggest distinctively different water dynamics between pressurized and heated wheat starch gels. Smaller water self-diffusion coefficients were observed for pressurized wheat starch gels and are indicative of more restricted translational proton mobility than is observed with heated wheat starch gels. The physical characteristics associated with changes taking place during retrogradation were evaluated using melting curves obtained with differential scanning calorimetry. Less retrogradation was observed in pressurized wheat starch, and it may be related to a smaller quantity of freezable water in pressurized wheat starch. Starches comprise a major constituent of many foods proposed for commercial potential using UHP, and the present results furnish insight into the effect of UHP on starch gelatinization and the mechanism of retrogradation during storage.

  14. Selected properties of acetylated adipate of retrograded starch.

    Science.gov (United States)

    Zięba, T; Gryszkin, A; Kapelko, M

    2014-01-01

    Native potato starch (NS) and retrograded starch (R - obtained via freezing and defrosting of a starch paste) were used to prepare starch acetates: NS-A and R-A, and then acetylated distarch adipates: NS-ADA and R-ADA. The chemically-modified preparations produced from retrograded starch (R-A; R-ADA) were characterized by a higher degree of esterification compared to the modified preparations produced under the same conditions from native potato starch (NS-A; NS-ADA). Starch resistance to amylolysis was observed to increase (to 30-40 g/100 g) as a result of starch retrogradation and acetylation. Starch cross-linking had a significant impact on the increased viscosity of the paste in the entire course of pasting characteristics and on the increased values of rheological coefficients determined from the equations describing flow curves. The produced preparation of acetylated retrograded starch cross-linked with adipic acid (R-ADA) may be deemed an RS3/4 preparation to be used as a food thickening agent.

  15. Retrograde pylorogastric intussusception – Case report and review

    Directory of Open Access Journals (Sweden)

    Efrat Avinadav

    2016-07-01

    Full Text Available A case of gastric outlet obstruction in an infant due to retrograde intussusception of the pylorus into the stomach is presented. This anomaly is extremely rare, with almost no reports in the literature. The patient underwent formal Heineke-Mikulicz pyloroplasty with an uneventful recovery and resumed full enteral feeding.

  16. Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus

    DEFF Research Database (Denmark)

    Fedder, J; Kaspersen, Maja Døvling; Brandslund, I;

    2013-01-01

    Retrograde ejaculation (RE) and erectile dysfunction may be caused by diabetes mellitus (DM), but the prevalence of RE among DM patients is unknown. A prospective, blinded case-control study comparing men with DM with matched controls according to RE and erectile dysfunction was performed. Twenty...

  17. Retrograde transport of protein toxins through the Golgi apparatus

    DEFF Research Database (Denmark)

    Sandvig, Kirsten; Skotland, Tore; van Deurs, Bo

    2013-01-01

    at the cell surface, and they are endocytosed both by clathrin-dependent and clathrin-independent mechanisms. Sorting to the Golgi and retrograde transport to the endoplasmic reticulum (ER) are common to these toxins, but the exact mechanisms turn out to be toxin and cell-type dependent. In the ER...

  18. Techniques for endoscopic and non-endoscopic intracorporeal laser applications.

    Science.gov (United States)

    Fuchs, B; Philipp, C; Engel-Murke, F; Shaltout, J; Berlien, H P

    1993-08-01

    This article deals with various designs of CO2 and Nd:YAG lasers currently used in surgery. It is discussed how their wavelength and beampath characteristics can be utilized in either the contact or the non-contact method to achieve specific clinical aims. These may concern endoscopic procedures, e.g. palliative tumour destruction or haemangioma or cystic membrane coagulation, or non-endoscopic procedures, as exemplified by two case reports on treatment for a congenital vascular disorder and varicosis, respectively. As there is a certain overlap of laser and high-frequency applications, their respective advantages and drawbacks are compared in detail. The main safety concern in HF surgery is that of errant currents in the patient, whereas in laser applications the main hazard is to the operators' eyes. This hazard can be safely eliminated.

  19. Volvulus of the gall bladder diagnosed by ultrasonography, computed tomography, coronal magnetic resonance imaging and magnetic resonance cholangio-pancreatography

    Institute of Scientific and Technical Information of China (English)

    Nobuhisa Matsuhashi; Chihiro Tanaka; Atsushi Misao; Shinji Ogura; Shinichi Satake; Kazunori Yawata; Eri Asakawa; Takashi Mizoguchi; Masayuki Kanematsu; Hiroshi Kondo; Ichiro Yasuda; Kenichi Nonaka

    2006-01-01

    A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. Ultrasonography and computed tomography (CT) examination of the abdomen was obtained, which demonstrated a large dilatated cystic structure, measuring approximately 68.6 mm ×48.6 mm, with marked distension and inflammation.Additionally, the enhanced CT was characterized by the non-enhanced wall of the gallbladder. As the third examination in this study, magnetic resonance imaging(MRI), namely coronal MRI and magnetic resonance cholangio-pancreatography (MRCP), were performed.The MRCP demonstrated a dilatation of the gallbladder but detected no neck of the gallbladder. Simple cholecystectomy was performed. Macroscopic findings included a distended and gangrenous gallbladder, and closer examination revealed a counterclockwise torsion of 360 degrees on the gallbladder mesentery. Coronal MRI and MRCP showing characteristic radiography may be useful in making a definitive diagnosis.

  20. A prospective pilot study: Can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?

    Energy Technology Data Exchange (ETDEWEB)

    Siles, Pascale [La Timone Children' s Hospital, Department of Radiology, Marseille (France); Aschero, Audrey; Gorincour, Guillaume; Bourliere-Najean, Brigitte; Petit, Philippe [La Timone Children' s Hospital, Department of Pediatric Radiology, Marseille (France); Roquelaure, Bertrand [La Timone Children' s Hospital, Department of Pediatrics, Marseille (France); Delarue, Arnauld [La Timone Children' s Hospital, Department of Pediatric Surgery, Marseille (France)

    2014-09-15

    Magnetic resonance cholangiopancreatography (MRCP) could aid in the diagnosis of biliary atresia, a hepatic pathology with thin, irregular or interrupted biliary ducts. There is little published evidence of MRCP appearances in normal neonates and young infants. To assess the use of MR cholangiopancreatography in visualizing the biliary tree in neonates and infants younger than 3 months with no hepatobiliary disorder, and to assess this visibility in relationship to the child's age, weight, and sedation and fasting states. Between December 2008 and October 2010 our department performed MRI of the brain, orbits and face on 16 full-term neonates and infants. Each child was younger than 3 months (90 days) and without any hepatobiliary disorders. The children were scanned with a respiratory-gated 0.54 x 0.51 x 0.4-mm{sup 3} 3-D MRCP sequence. We used a reading grid to assess subjectively the visibility of the extrahepatic bile ducts along with extrahepatic bile duct confluence. The visibility of the extrahepatic bile duct confluence was assessed against age, weight, and sedation and fasting states. The extrahepatic bile duct confluence was seen in 10 children out of 16 (62.5%). In the neonate sub-group (corrected age younger than 30 days), the MRCP was technically workable and the extrahepatic bile duct confluence was seen in four cases out of eight (50%). This visualization was up to 75% in the subgroup older than 30 days. However, statistically there was no significant difference in visibility of the extrahepatic bile duct confluence in relationship to age, weight or MRCP performance conditions (feeding, fasting or sedation). The complete normal biliary system (extrahepatic bile duct confluence included) is not consistently visualized in infants younger than 3 months old on non-enhanced MRCP. Thus the use of MRCP to exclude a diagnosis of biliary atresia is compromised at optimal time of surgery. (orig.)

  1. Intuitive user interfaces increase efficiency in endoscope tip control

    NARCIS (Netherlands)

    Rozeboom, E.D.; Ruiter, Jeroen; Franken, Michel; Broeders, Ivo A.M.J.

    2014-01-01

    Background Flexible endoscopes are increasingly used to perform advanced intraluminal and transluminal interventions. These complex interventions demand accurate and efficient control, however, current endoscopes lack intuitiveness and ergonomic control of the endoscope tip. Alternative handheld con

  2. Studies of the retrogradation process for various starch gels using Raman spectroscopy.

    Science.gov (United States)

    Fechner, Petra M; Wartewig, Siegfried; Kleinebudde, Peter; Neubert, Reinhard H H

    2005-11-21

    The retrogradation of untreated wild-type starches (potato, maize, and wheat), waxy maize starches, and one pregelatinized, modified amylose-rich starch was investigated continuously using Raman spectroscopy. The method detects conformational changes due to the multi-stage retrogradation, the rate of which differs between the starches. The pregelatinized, modified amylose-rich starch shows all stages of retrogradation in the course of its Raman spectra. In comparison to amylose, the retrogradation of amylopectin is faster at the beginning of the measurements and slower in the later stages. The untreated starches can be ranked in the order of their rate of retrogradation as follows: potato>maize>wheat.

  3. Endoscopic management of brain abscesses

    Directory of Open Access Journals (Sweden)

    Yadav Yad

    2008-01-01

    Full Text Available Background: Treatment of brain abscess is still a subject of controversy. Simple therapeutic approaches like twist drill/burr hole aspiration with or without insertion of a drain are also quite effective. There are reports of encouraging results following endoscopic treatment. We are reporting our results of endoscopic approach on 24 patients. Materials and Methods: This is a prospective study on 24 patients of brain abscesses treated between January 2004 and January 2007. All the cases except those with small abscesses (less than 1.0 cm in diameter and multiloculated abscesses were included. Gabb 6-degree rigid endoscope was used. Repeat CT scan was done in all cases within 7 and 30 days after surgery. Ten patients (42% had small residual abscess on 7 th post-operative day′s CT scan, while 30 th post-operative day′s CT scan did not show any significant lesion in all the cases. Results: There were 23 patients of chronic otitis media and one of congenital cyanotic heart disease. Glasgow coma score (GCS was 3 in one patient, 13 in two cases, 14-15 in 21 cases. There were 14 cerebellar, 8 temporal and 1 frontal and thalamic abscess each. All the patients recovered completely except one who died (GCS 3. There was no procedure-related complication. Hospital stay ranged from 7 to 12 days with an average of 8.2 days. Follow-up ranged between 6 and 42 months. Conclusion: Endoscopic aspiration of brain abscess appears to be a safe and effective alternative method of treatment. There is direct visualization of abscess cavity, completeness of aspiration can be assessed, and perioperative bleeding can be controlled.

  4. Endoscopic diagnosis of Barrett's esophagus

    Institute of Scientific and Technical Information of China (English)

    Tomoyuki Akiyama; Yusuke Sekino; Hiroshi Iida; Shigeru Koyama; Eiji Gotoh; Shin Maeda; Atsushi Nakajima; Masahiko Inamori

    2012-01-01

    The Prague C and M Criteria have been developed for the objective endoscopic diagnosis of Barrett's esophagus (BE).BE arises between the squamocolumnar junction and the gastroesophageal junction at the proximal margin of the gastric folds.In this study,we reported that 43.0% of the subjects examined were diagnosed with BE based on the Prague C and M Criteria.Previous criticism by John Dent proposed that our data should be considered invalid because the prevalence of BE reported in our study was extraordinarily high and discordant with previous studies.Dent predicted that the position of the gastroesophageal junction in our study was judged to be lower than the actual position due to the effacement of the proximal ends of the gastric folds because of the routine use of a high degree of air distension during typical Japanese endoscopic examinations.The endoscopic evaluation of the superior gastric folds is certainly influenced by the degree of air distension of the esophagus.However,in our study,the proximal limit of the gastric mucosal folds was prospectively imaged while the oesophagus was minimally insufflated.Then,under a high level of air distension,the distal ends of the palisade-shaped longitudinal vessels were imaged because they are more easily observed when distended.In the majority of patients,the distal ends of the palisade-shaped longitudinal vessels correspond to the proximal limit of the gastric mucosal folds.Our endoscopic evaluation was appropriately performed according to the Prague C and M Criteria.We suspect that the high prevalence of BE in our study may be due to the inclusion of ultrashort-segment BE,which defines BE with an affected mucosal length under 5 mm,in our positive results.

  5. Endoscopic Aspects of Gastric Syphilis

    Directory of Open Access Journals (Sweden)

    Mariana Souza Varella Frazão

    2012-01-01

    Full Text Available Introduction. Considered as a rare event, gastric syphilis (GS is reported as an organic form of involvement. Low incidence of GS emphasizes the importance of histopathological analysis. Objective. We aim to characterize GS endoscopic aspects in an immunocompetent patient. Case Report. A 23-year-old man presented with epigastric pain associated with nausea, anorexia, generalized malaise and 11 kg weight loss that started 1 month prior to his clinical consultation. Physical examination was normal except for mild abdominal tenderness in epigastrium. Endoscopy observed diminished gastric expandability and diffuse mucosal lesions, from cardia to pylorus. Gastric mucosa was thickened, friable, with nodular aspect, and associated with ulcers lesions. Gastric biopsies were performed, and histopathological analysis resulted in dense inflammatory infiltration rich in plasmocytes. Syphilis serologies were positive for VDRL and Treponema pallidum reagents. Immunohistochemical tests were positive for Treponema pallidum and CD138. The patient was treated with penicillin, leading to resolution of his clinical complaints and endoscopic findings. Conclusion. Diagnosis suspicion of GS is important in view of its nonspecific presentation. Patients with gastric symptoms that mimic neoplastic disease should be investigated thoroughly based on the fact that clinical, endoscopic, and histological findings can easily be mistaken for lymphoma or plastic linitis.

  6. Gynecological endoscopic surgery in Cienfuegos.

    Directory of Open Access Journals (Sweden)

    Alberto Jorge Fernández

    2003-07-01

    Full Text Available Background: In the last few years less invasive techniques for patients have been developed and endoscopic surgery is important example. Objective: To determine the advantages of endoscopic surgery and to relate ultrasonographic findings with surgical diagnoses. Method: Case study of 73 surgeries performed by gynaecological endoscopic surgery at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from Cienfuegos province in the period January 1998- May 2002. urgencies and and Salpingoclasias were excluded from this search. The statistical study included tests of percentage, accumulated frequency, Kappla´s index, mean and standard deviation. Results: The most recent gynaecological pathologies were: Pelvic Inflammatory Disease, infertility and ovarian cyst. The relationship between ultrasonographic and surgical diagnosis was good for P.I.D and the intrauterine device in the abdominal cavity but not for endometritis. The most frequent laparoscopic procedures were salpingovariolasis and fimbrioplasty , ovarian cystectomy and contrasted laparoscopy. The two complications were bleeding which was controlled and facial subcutaneous emphysema.

  7. Endoscopically removed giant submucosal lipoma

    Directory of Open Access Journals (Sweden)

    Jovanović Ivan

    2007-01-01

    Full Text Available Background. Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. Case report. A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. Conclusion. Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.

  8. Esophageal papilloma: Flexible endoscopic ablation byradiofrequency

    Institute of Scientific and Technical Information of China (English)

    Gianmattia del Genio; Federica del Genio; Pietro Schettino; Paolo Limongelli; Salvatore Tolone; Luigi Brusciano; Manuela Avellino; Chiara Vitiello; Giovanni Docimo; Angelo Pezzullo; Ludovico Docimo

    2015-01-01

    Squamous papilloma of the esophagus is a rare benignlesion of the esophagus. Radiofrequency ablation is anestablished endoscopic technique for the eradication ofBarrett esophagus. No cases of endoscopic ablation ofesophageal papilloma by radiofrequency ablation (RFA)have been reported. We report a case of esophagealpapilloma successfully treated with a single sessionof radiofrequency ablation. Endoscopic ablation ofthe lesion was achieved by radiofrequency using anew catheter inserted through the working channelof endoscope. The esophageal ablated tissue wasremoved by a specifically designed cup. Completeablation was confirmed at 3 mo by endoscopy withbiopsies. This case supports feasibility and safety of asa new potential indication for BarrxTM RFA in patientswith esophageal papilloma.

  9. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

    Directory of Open Access Journals (Sweden)

    Nib Soehendra

    1998-01-01

    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  10. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers

    Directory of Open Access Journals (Sweden)

    Vien X Nguyen

    2010-11-01

    Full Text Available Vien X Nguyen1, Vi Thuy Le Nguyen2, Cuong C Nguyen11Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Pharmacy, Banner Baywood Medical Center, Mesa, AZ, USAAbstract: The field of endoscopy has revolutionized the diagnosis and treatment of ­gastrointestinal (GI diseases in recent years. Besides the ‘traditional’ endoscopic ­procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography, advances in imaging technology (endoscopic ultrasonography, ­wireless capsule endoscopy, and double balloon enteroscopy have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various ­endoscopic procedures and provides up-to-date endoscopic indications based on the ­recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.Keywords: endoscopy, endoscopic indications, endoscopic procedures, imaging, primary care, gastrointestinal disorders, appropriate use

  11. Effect of pullulan on the short-term and long-term retrogradation of rice starch.

    Science.gov (United States)

    Chen, Long; Ren, Fei; Zhang, Zipei; Tong, Qunyi; Rashed, Marwan M A

    2015-01-22

    The effect of pullulan (PUL) on the retrogradation of rice starch (RS) was investigated by means of rapid visco-analyzer (RVA), rotational rheometer, differential scanning calorimetry (DSC), and X-ray diffraction (XRD). RVA results showed that addition of pullulan significantly decreased the breakdown and setback values, which meant that the short-term retrogradation of RS was inhibited. The dynamic time sweep of samples also proved the retarding effect of pullulan on the retrogradation of RS. DSC curves showed clearly that pullulan significantly reduced the retrogradation enthalpy of amylopectin, and the kinetics of retrogradation was analyzed using the Avrami model. XRD results showed that recrystallinity of RS was reduced from 11.565% to 8.841% with the addition of pullulan and this was in line with the DSC results. It could be concluded that the addition of pullulan apparently influenced not only the short-term retrogradation of amylose, but also the long-term retrogradation of amylopectin.

  12. Demonstrated Anomalous Pancreaticobiliary Ductal Junction

    OpenAIRE

    Koçkar, Cem; ?ENOL, Altu?; BA?TÜRK, Abdulkadir; AYDIN, Bünyamin; Cüre, Erkan

    2015-01-01

    Anomalies of the pancreaticobiliary junction are rare. Clinically anomalies of the pancreaticobiliary junction are uncommonly symptomatic but may present themselves with associated conditions ranging from benign acute abdominal pain to carcinomas. A 52 years old man was admitted to gastroenterology service with complaints of fever, nausea, vomiting and recurrent epigastric pain. He was diagnosed with biliary pancreatitis. Endoscopic retrograde cholangiopancreato-graphy was performed. Papilla ...

  13. Percutaneous transhepatic biliary drainage in an infant with obstructive jaundice caused by neuroblastoma.

    Science.gov (United States)

    Saettini, Francesco; Agazzi, Roberto; Giraldi, Eugenia; Foglia, Carlo; Cavalleri, Laura; Morali, Laura; Fasolini, Giorgio; Spotti, Angelica; Provenzi, Massimo

    2015-04-01

    Neuroblastoma presenting with obstructive jaundice is a rare event. Management of this condition includes surgery, chemotherapy, radiotherapy, temporary cholecystostomy tube, endoscopic retrograde cholangiopancreatography (ERCP), and internal biliary drainage (IBD). We herein describe our experience with one infant affected by neuroblastoma presenting with jaundice, who successfully underwent percutaneous transhepatic biliary drainage (PTBD). This report introduces PTBD as a viable treatment option for neuroblastoma and obstructive jaundice and provides a review of the pertinent literature.

  14. Pancreaticoportal Fistula in Association with Antiphospholipid Syndrome Presenting as Ascites and Portal System Thrombosis

    Directory of Open Access Journals (Sweden)

    Li-Hsin Chang

    2002-01-01

    Full Text Available Fistulous communication between the pancreas and the portal venous system is extremely rare and is usually a complication of chronic pancreatitis or pancreatic pseudocysts. A patient who presented with abdominal pain and ascites secondary to a pancreaticoportal fistula and portal system thrombosis is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and confirmed by immediate postprocedure computed tomographic scanning. Laboratory studies identified concomitant antiphospholipid syndrome. The patient responded favourably to supportive medical therapy.

  15. Acute pancreatitis: etiology, clinical presentation, diagnosis, and therapy.

    Science.gov (United States)

    Cappell, Mitchell S

    2008-07-01

    Acute pancreatitis is a relatively common disease that affects about 300,000 patients per annum in America with a mortality of about 7%. About 75% of pancreatitis is caused by gallstones or alcohol. Other important causes include hypertriglyceridemia, medication toxicity, trauma from endoscopic retrograde cholangiopancreatography, hypercalcemia, abdominal trauma, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown after thorough investigation. This article discusses the causes, diagnosis, imaging findings, therapy, and complications of acute pancreatitis.

  16. The Klatskin Tumor That Wasn't: An Unusual Presentation of Sarcoidosis.

    Science.gov (United States)

    Farooq, Priya D; Potosky, Darryn R

    2016-08-01

    We present the case of a patient who presented with signs and symptoms associated with a Klatskin tumor. After endoscopic retrograde cholangiopancreatography (ERCP) and biopsy, she was found instead to have granulomatous infiltration of the extrahepatic biliary tree consistent with biliary sarcoidosis. The patient was treated successfully with systemic corticosteroids and azathioprine. She later developed cutaneous, lymphatic, and pulmonary granulomatous disease. Isolated biliary disease is a rare initial presentation of systemic sarcoidosis.

  17. The Klatskin Tumor That Wasn’t: An Unusual Presentation of Sarcoidosis

    Science.gov (United States)

    Potosky, Darryn R.

    2016-01-01

    We present the case of a patient who presented with signs and symptoms associated with a Klatskin tumor. After endoscopic retrograde cholangiopancreatography (ERCP) and biopsy, she was found instead to have granulomatous infiltration of the extrahepatic biliary tree consistent with biliary sarcoidosis. The patient was treated successfully with systemic corticosteroids and azathioprine. She later developed cutaneous, lymphatic, and pulmonary granulomatous disease. Isolated biliary disease is a rare initial presentation of systemic sarcoidosis. PMID:27761479

  18. Biliær papillomatose er en sjælden årsag til intermitterende obstruktiv ikterus

    DEFF Research Database (Denmark)

    Veedfald, Simon; Vainer, Ben; Wettergren, André

    2011-01-01

    Over a five-year period a 67 year-old male had been experiencing recurring bouts of biliary obstruction with occasional superimposed cholangitis. Renewed endoscopic retrograde cholangiopancreatography revealed amorphous filling defects and excessive mucinous discharge from the papilla of Vater....... Subsequent choledochoscopy demonstrated exophytic papillomatous lesions in the common and left hepatic bile duct. An extended left hemihepatectomy and resection of the common hepatic bile duct was performed. Histological examination revealed biliary papillomatosis - a rare lesion believed to be premalignant....

  19. Cholecystic fistula with atypical symptoms

    DEFF Research Database (Denmark)

    Bang, U.C.; Hasbak, P.; From, G.

    2008-01-01

    We report a patient with spontaneous cholecystocolonis fistula secondary to cholelithiasis. A 93 year-old woman was admitted because of weight loss, diarrhoea and upper abdominal pain. Ultrasound examination revealed air in the biliary tract and cholescientigraphy revealed a fistula between the g...... the gallbladder and right colon. Using endoscopic retrograde cholangiopancreatography a calculus was extracted from the bile duct and the symptoms disappeared Udgivelsesdato: 2008/1/14...

  20. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding patient

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Seong, Chang Kyu; Kim, Yong Joo; Park, Noh Hyuk [Kyungpook National University School of Medicine, Daegu (Korea, Republic of); Shin, Tae Beom [Dong-A University Medical Center, Pusan (Korea, Republic of); Choi, Jin Soo [Soonchunhyang University College of Medicine, Asan (Korea, Republic of)

    2003-03-01

    To evaluate the technical feasibility and clinical efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in the treatment of gastric variceal bleeding. Between September 2001 and March 2002, ten patients with gastric variceal bleeding and gastrorenal shunt, underwent BRTO. Three of the ten also had hepatic encephalopathy. To evaluated the gastrorenal shunt and exclude portal vein thrombosis, all patients underwent pre-procedural CT scanning. An occlusion balloon catheter was inserted from the right internal jugular vein and on ballooning was wedged into the left adrenal vein. A sclerosing agent (5% ethanolamine oleate-lipiodol mixture) was injected until the varices were completely filled. In four patients, the collateral veins seen at balloon-occluded adrenal venography were embolized with coils prior to sclerotherapy. Post-procedural follow-up CT (n=3) or endoscopy (n=8) was performed 1-4 weeks later, and both before and after the procedure, hepatic function was also monitored. Treatment was successful in nine cases: the failure involed rupture of the occlusion balloon during inflation, and a transjugular intrahepatic portosystemic shunt was performed. The cessation of bleeding was confirmed endoscopically or clinically; in three patients, follow-up CT showed complete obliteration of the varices. Hepatic function improved in eight patients, but three weeks after the procedure, one expired due to progressive infiltrative hepatoma. The clinical symptoms of the three patients with hepatic encephalopathy showed remarkable improvement. Although more extensive studies and long-term follow up are needed to overcome the limitations of our study, we believe that BRTO is a technically feasible and clinically effective treatment for gastric varices and hepatic encephalopathy.

  1. Prograde and Retrograde Black Holes: Whose Jet is More Powerful?

    CERN Document Server

    Tchekhovskoy, Alexander

    2012-01-01

    We study prograde and retrograde disc accretion on rapidly spinning black holes (BHs) via global 3D time-dependent non-radiative general relativistic magnetohydrodynamic simulations. Our discs contain more large-scale vertical magnetic flux than the accreting gas can push into the BH. As a result, the BH becomes saturated with flux, and strong centrally concentrated large-scale magnetic fields form that obstruct the accretion and lead to a magnetically arrested disc. We show that the efficiency with which such accretion systems generate steady outflows depends only on the dimensionless BH spin, a, and accretion disc angular thickness, h/r. Prograde BHs with thick discs (h/r ~ 0.3-0.6) generate jets and outflows several times more efficiently than retrograde BHs, for the same absolute value of spin. Both orientations can reach high values of outflow efficiency, eta ~ 100%, with higher efficiency values for thicker discs.

  2. WLS retrograde transport to the endoplasmic reticulum during Wnt secretion.

    Science.gov (United States)

    Yu, Jia; Chia, Joanne; Canning, Claire Ann; Jones, C Michael; Bard, Frédéric A; Virshup, David M

    2014-05-12

    Wnts are transported to the cell surface by the integral membrane protein WLS (also known as Wntless, Evi, and GPR177). Previous studies of WLS trafficking have emphasized WLS movement from the Golgi to the plasma membrane (PM) and then back to the Golgi via retromer-mediated endocytic recycling. We find that endogenous WLS binds Wnts in the endoplasmic reticulum (ER), cycles to the PM, and then returns to the ER through the Golgi. We identify an ER-targeting sequence at the carboxyl terminus of native WLS that is critical for ER retrograde recycling and contributes to Wnt secretory function. Golgi-to-ER recycling of WLS requires the COPI regulator ARF as well as ERGIC2, an ER-Golgi intermediate compartment protein that is also required for the retrograde trafficking of the KDEL receptor and certain toxins. ERGIC2 is required for efficient Wnt secretion. ER retrieval is an integral part of the WLS transport cycle.

  3. Ureteroscopy assisted retrograde nephrostomy for complete staghorn renal calculi.

    Science.gov (United States)

    Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Ogawa, Takehiko; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-09-01

    Complete staghorn calculi are typically managed with percutaneous nephrolithotomy (PCNL). However, dilating nephrostomy and inserting a nephro access sheath can be difficult to perform without hydronephrosis. We reported the procedure of ureteroscopy-assisted retrograde nephrostomy (UARN) during PCNL. UARN is effective without dilating the renal collecting system in cases of complete staghorn calculi. A 63-year old female with a left complete staghorn renal calculus was referred to our hospital. Under general and epidural anesthesia, the patient was placed in a modified-Valdivia position. A flexible ureteroscope was inserted and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible ureteroscope. The puncture wire was forwarded along the route from the renal pelvis to the exit skin. Calculus fragmentation was done using a pneumatic lithotripter and the Ho: YAG laser. UARN during PCNL was effective for the treatment of a complete staghorn calculus.

  4. [Successful recanalisation of RCA CTO using retrograde approach].

    Science.gov (United States)

    Król, Marek; Skwarna, Bartosz; Buszman, Paweł

    2009-03-01

    A 51-year-old female two years after CABG presented with unstable angina and inferior wall ischaemia. Coronary angiography revealed occluded graft to RCA and chronic total occlusion of RCA with good collateral flow from distal LAD to RCA. The CTO was successfully crossed and dilated through epicardial collaterals from distal LAD (retrograde approach). Finally, antegrade angioplasty with two stents implantation was performed achieving TIMI 3 flow.

  5. A retrograde co-orbital asteroid of Jupiter.

    Science.gov (United States)

    Wiegert, Paul; Connors, Martin; Veillet, Christian

    2017-03-29

    Recent theoretical work in celestial mechanics has revealed that an asteroid may orbit stably in the same region as a planet, despite revolving around the Sun in the sense opposite to that of the planet itself. Asteroid 2015 BZ509 was discovered in 2015, but with too much uncertainty in its measured orbit to establish whether it was such a retrograde co-orbital body. Here we report observations and analysis that demonstrates that asteroid 2015 BZ509 is indeed a retrograde co-orbital asteroid of the planet Jupiter. We find that 2015 BZ509 has long-term stability, having been in its current, resonant state for around a million years. This is long enough to preclude precise calculation of the time or mechanism of its injection to its present state, but it may be a Halley-family comet that entered the resonance through an interaction with Saturn. Retrograde co-orbital asteroids of Jupiter and other planets may be more common than previously expected.

  6. Anterograde and retrograde amnesia after lormetazepam and flunitrazepam.

    Science.gov (United States)

    Ott, H; Rohloff, A; Aufdembrinke, B; Fichte, K

    1988-01-01

    In a pharmacopsychological study, memory impairments after single oral doses of benzodiazepines or placebo were investigated in 40 healthy men aged 20-40 years. The study was designed as a double-blind and placebo-controlled trial. Four independent groups of 10 subjects randomly received either 1 mg lormetazepam, 2 mg lormetazepam, 2 mg flunitrazepam, or placebo. The tests consisted of word lists, picture tests, and syllable pairs (consonant-vowel-consonant trigrams). Tests were performed before drug ingestion, and 1, 2, 3, and 5 h after application. Different test versions were used on each occasion. The target variables were immediate recall (after presentation and a 10-s distraction task) and delayed recall and recognition (after 30 min). Recognition was also tested after 24 h for all five versions. A distinction must be made between anterograde amnesic effects and retrograde amnesic effects. The greatest anterograde memory impairments were observed after 2 mg flunitrazepam (p less than 0.05). Lormetazepam 2 mg produced less marked impairments than flunitrazepam. Results after 1 mg lormetazepam did not differ from those after placebo. Performance in the memory tests was better under benzodiazepines than under placebo as regards material learned before drug ingestion, i.e. the benzodiazepines had not negative retrograde amnestic effects, but rather "promnesic" effects. The results suggest that the extent of the benzodiazepines' amnesic effects--both negative (anterograde) and positive (retrograde)--depends on the dosage and type of substance.

  7. The effective use of acai juice, blueberry juice and pineapple juice as negative contrast agents for magnetic resonance cholangiopancreatography in children

    Energy Technology Data Exchange (ETDEWEB)

    Bittman, Mark E. [Cohen Children' s Medical Center of New York, North Shore Long Island Jewish Health System, Department of Radiology, New Hyde Park, NY (United States); Callahan, Michael J. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States)

    2014-07-15

    Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in the evaluation of known or suspected pancreaticobiliary disease in children. The administration of a negative oral contrast agent can improve the quality of the examination without significant additional cost. We describe our experience with certain brands of acai juice, blueberry juice and pineapple juice as negative oral contrast agents in children. We believe these fruit juices are safe, palatable and may improve MRCP image quality. (orig.)

  8. Towards automated visual flexible endoscope navigation

    NARCIS (Netherlands)

    Stap, van der N.; Heijden, van der F.; Broeders, I.A.M.J.

    2013-01-01

    Background: The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now

  9. Evaluation of robotically controlled advanced endoscopic instruments

    NARCIS (Netherlands)

    Reilink, Rob; Kappers, Astrid M.L.; Stramigioli, Stefano; Misra, Sarthak

    2013-01-01

    Background Advanced flexible endoscopes and instruments with multiple degrees of freedom enable physicians to perform challenging procedures such as the removal of large sections of mucosal tissue. However, these advanced endoscopes are difficult to control and require several physicians to cooperat

  10. Retrogradation behaviour of high-amylose rice starch prepared by improved extrusion cooking technology.

    Science.gov (United States)

    Zhang, Yanjun; Liu, Wei; Liu, Chengmei; Luo, Shunjing; Li, Ti; Liu, Yunfei; Wu, Di; Zuo, Yanna

    2014-09-01

    Native rice starch (NRS, amylose/28.9%) was gelatinized by improved extrusion cooking technology (IECT) and retrograded (RRS) after low temperature storage (4 °C). The retrogradation behaviour of RRS was changed to low retrogradation percentage and low retrogradation rate. The retrogradation resulted in a high compact morphology. The melt enthalpy change and percentage of retrogradation of RRS was 3.68 J/g and 37.7%, respectively, compared to those of NRS (9.75 J/g, 100%). The retrogradation percentage for RRS was low during storage as shown as a low retrogradation rate (0.21 d(-1)) and a high Avrami exponent (0.89). The pattern of rice starch changed from A-type to amorphous and B-type. Both the relative crystallinity of RRS (12.7%) by the X-ray diffractograms and the ratio of the band height (0.63) in the FTIR spectra were low. The analysis of retrogradation structure and short-range molecular order further confirmed the retrogradation behaviour of rice starch after IECT treatment.

  11. Endoscopic appearance of esophageal hematomas

    Institute of Scientific and Technical Information of China (English)

    Rodica Ouatu-Lascar; Gayatri Bharadhwaj; George Triadafilopoulos

    2000-01-01

    @@INTRODUCTION Esophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].

  12. Endoscopic ultrasound via the esophagus

    DEFF Research Database (Denmark)

    Bødtger, Uffe; Clementsen, Paul; Annema, Jouke

    2010-01-01

    Accurate, safe and fast mediastinal staging in lung cancer is pivotal to identifying patients who will benefit from surgical treatment. Imaging techniques have insufficient diagnostic power and in most cases do not abolish the need for invasive staging. A literature review using the search words...... "endoscopic ultrasound (EUS) and lung cancer" in PubMed was conducted. Invasive procedures (mediastinoscopy, thoracoscopy/-tomy) are the gold standard. The specificity of EUS was between 97 and 100%, and sensitivity 90 to 92%. The sensitivity was lower in studies published before 2000, and in computed...

  13. Integrated biophotonics in endoscopic oncology

    Science.gov (United States)

    Muguruma, Naoki; DaCosta, Ralph S.; Wilson, Brian C.; Marcon, Norman E.

    2009-02-01

    Gastrointestinal endoscopy has made great progress during last decade. Diagnostic accuracy can be enhanced by better training, improved dye-contrast techniques method, and the development of new image processing technologies. However, diagnosis using conventional endoscopy with white-light optical imaging is essentially limited by being based on morphological changes and/or visual attribution: hue, saturation and intensity, interpretation of which depends on the endoscopist's eye and brain. In microlesions in the gastrointestinal tract, we still rely ultimately on the histopathological diagnosis from biopsy specimens. Autofluorescence imaging system has been applied for lesions which have been difficult to morphologically recognize or are indistinct with conventional endoscope, and this approach has potential application for the diagnosis of dysplastic lesions and early cancers in the gastrointestinal tract, supplementing the information from white light endoscopy. This system has an advantage that it needs no administration of a photosensitive agent, making it suitable as a screening method for the early detection of neoplastic tissues. Narrow band imaging (NBI) is a novel endoscopic technique which can distinguish neoplastic and non-neoplastic lesions without chromoendoscopy. Magnifying endoscopy in combination with NBI has an obvious advantage, namely analysis of the epithelial pit pattern and the vascular network. This new technique allows a detailed visualization in early neoplastic lesions of esophagus, stomach and colon. However, problems remain; how to combine these technologies in an optimum diagnostic strategy, how to apply them into the algorithm for therapeutic decision-making, and how to standardize several classifications surrounding them. 'Molecular imaging' is a concept representing the most novel imaging methods in medicine, although the definition of the word is still controversial. In the field of gastrointestinal endoscopy, the future of

  14. Effects of chitin nano-whiskers on the gelatinization and retrogradation of maize and potato starches.

    Science.gov (United States)

    Ji, Na; Liu, Chengzhen; Zhang, Shuangling; Yu, Jing; Xiong, Liu; Sun, Qingjie

    2017-01-01

    Starch is very prone to retrogradation after gelatinization. Inhibition of starch retrogradation has been an important factor in improving the quality of food. For the first time, we investigated the effect of nano-materials, represented by chitin nano-whiskers (CNWs), on the short- and long-term retrogradation of maize and potato starches. Rapid Visco-Analyser results showed that the addition of CNWs significantly decreased the setback values of maize and potato starches, which suggested that CNWs could retard the short-term retrogradation of starch. Differential scanning calorimetry and X-ray diffraction results showed that the percentage of retrogradation of maize and potato starches significantly decreased (Pretrogradation. The CNWs could be used as a new inhibitor of starch retrogradation to develop starch-based food with longer shelf life.

  15. Endoscopic resection of tumors in the lower digestive tract

    Institute of Scientific and Technical Information of China (English)

    Shi-Lun; Cai; Qiang; Shi; Tao; Chen; Yun-Shi; Zhong; Li-Qing; Yao

    2015-01-01

    As endoscopic technology has developed and matured,the endoscopic resection of gastrointestinal tract polyps has become a widely used treatment. Colorectal polyps are the most common type of polyp, which are best managed by early resection before the polyp undergoes malignant transformation. Methods for treating colorectal tumors are numerous, including argon plasma coagulation, endoscopic mucosal resection, endoscopic submucosal dissection, and laparoscopic-endoscopic cooperative surgery. In this review, we will highlight several currently used clinical endoscopic resection methods and how they are selected based on the characteristics of the targeted tumor. Specifically, we will focus on laparoscopic-endoscopic cooperative surgery.

  16. Endoscopic retrieval of gastric trichophytobezoar

    Science.gov (United States)

    Zhao, Jiu-ling; Zhao, Wei-chuan; Wang, Yu-shui

    2017-01-01

    Abstract Rationale: Trichophytobezoars, which are composed of hair and plant fibers, are usually located in the stomach. They are often associated with trichophagia and trichotillomania. The most commonly reported methods of trichophytobezoar treatment are open surgery and laparoscopic retrieval; there are few reports of endoscopic removal of trichophytobezoars. Patient concerns and Diagnoses: Twelve-year-old girl presented with a 3-day history of increasing upper abdominal pain, anorexia, and postprandial emesis. She had a 3-year history of pulling out and eating her own hair. Endoscopic examination showed a large intragastric trichophytobezoar measuring 10.5 cm × 3.5 cm in size, with extension of a few hairs through the pylorus. Interventions and Outcomes: The trichophytobezoar was packed with hair fibers and contained a hard core of mixed hair and vegetable fibers. After the core was cut, the trichophytobezoar was fragmented into pieces with the alternating use of a polypectomy snare and argon plasma coagulation. A small amount of hair and nondigestible food fibers was removed with grasping forceps during the initial procedure. The remaining hairball was loosened with biopsy forceps and was injected with sodium bicarbonate solution. The trichophytobezoar was removed completely at repeat endoscopy 5 days later. After 6 months of psychological intervention, the patient had no recurrence of trichophagia or trichophytobezoar. Lessons: Endoscopy with sodium bicarbonate injection is an effective and minimally invasive method of retrieving a gastric trichophytobezoar. PMID:28099364

  17. Contrast-enhanced endoscopic ultrasonography

    Institute of Scientific and Technical Information of China (English)

    Nischita K Reddy; Ana Maria Ioncic(a); Adrian S(a)ftoiu; Peter Vilmann; Manoop S Bhutani

    2011-01-01

    Contrast agents are increasingly being used to characterize the vasculature in an organ of interest,to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures.We review the mechanisms of action of first,second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal tract.Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy,assessment of depth of invasion of esophageal,gastric and gall bladder cancers and visualization of the portal venous system and esophageal varices.In addition,contrast agents can be used to differentiate pancreatic lesions.The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies.The sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast agents.Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion.In the future,these techniques could potentially be used to quantify tumor perfusion,to assess and monitor the efficacy of antiangiogenic agents,to assist targeted drug delivery and allow molecular imaging.

  18. Retrogradation of Waxy Rice Starch Gel in the Vicinity of the Glass Transition Temperature

    OpenAIRE

    2013-01-01

    The retrogradation rate of waxy rice starch gel was investigated during storage at temperatures in the vicinity of the glass transition temperature of a maximally concentrated system (T g ′), as it was hypothesized that such temperatures might cause different effects on retrogradation. The T g ′ value of fully gelatinized waxy rice starch gel with 50% water content and the enthalpy of melting retrograded amylopectin in the gels were investigated using differential scanning calorimetry. Starch...

  19. The "Lantern" Procedure to Simplify Treatment of Retrograde Type A Dissection After Thoracic Endograft Stenting.

    Science.gov (United States)

    Tsai, Chung-Lin

    2016-04-01

    The emergency repair of retrograde type A aortic dissection after thoracic endovascular aortic repair is a complex and challenging surgical procedure and carries a surgical challenge. Previous studies have reported a significant mortality in the complex repair of retrograde type A aortic dissection after thoracic endovascular aortic repair. We devised a simplified hybrid method-the "Lantern" procedure-to solve this retrograde type A aortic dissection complication.

  20. Magnetic Resonance Cholangiopancreatography with Secretin Stimulation in the Diagnosis of Intraductal Papillary Mucinous Neoplasm: A Paradigmatic Case Report

    Directory of Open Access Journals (Sweden)

    Elsa Iannicelli

    2014-01-01

    Full Text Available Context. One of the characteristic findings of intraductal papillary mucinous neoplasms (IPMN is the presence of a direct communication between the lesion and the ductal pancreatic system and when magnetic resonance cholangiopancreatography (MRCP shows uncertain findings, it is useful to perform a MRCP after secretin stimulation (MRCP-S which provides a better visualization of the ductal system. Case Report. We present a case of 51-year-old man in whom, during a CT follow-up for a renal tumour, was found a cystic lesion of the pancreas. To better evaluate the lesion and its suspected communication with the pancreatic system, MR with gadolinium and MRCP and MRCP-S were performed. With the MRCP and MRI it was not possible to identify a clear communication between the cystic lesion and the ductal system. MRCP-S showed an increase in signal intensity of the lesion and its communication with the ductal system, allowing us to classify the cystic lesion as a main duct in intraductal papillary mucinous neoplasm. The patient underwent a surgical duodenal pancreatectomy. The histological result of the specimen confirmed the diagnosis of adenocarcinoma IPMN. Conclusion. In this case MRCP-S has allowed a clearer identification of the cystic lesion allowing a correct diagnosis and treatment.

  1. Physicochemical and release kinetics of natural and retrograded starch of Indian palmyrah shoots.

    Science.gov (United States)

    Kumar Varma, Ch Ashok; Panpalia, S G; Kumar, K Jayaram

    2014-05-01

    Starch was isolated from the shoots of Indian palmyrah (Borassus flabellifer L.) and it was subjected to the process of retrogradation. The influence of retrogradation on morphological, physicochemical and drug release properties was studied. Retrogradation of native starch changed its morphology from oval, elliptical to crystalline rods. Due to retrogradation there is an increase in amylose content and better hydration capacity, swelling and solubility power. The micromeritic properties of native and retrograded starch uncover its usage as excipients in tablet manufacturing. The retrograded starch showed better powder characteristics to that of native starch. The characteristic peaks for d-glucopyranosyl ring confirms the carbohydrate nature of starch. The TGA data reveals that the retrograded starch shows less bound water to that of native starch during the first decomposition step. In-vitro release study reveals that the retrograded starch attained a better release retardant property and was best explained by Hixson-Crowell model. The result showed that retrograded starches can be used for the preparation of sustained release tablets.

  2. Fallbericht: Perkutane transpopliteale retrograde Rekanalisation der A. femoralis superficialis

    Directory of Open Access Journals (Sweden)

    Wallner H

    2008-01-01

    Full Text Available bVorgeschichte/bbr Bei der 53 Jahre alten Patientin erfolgte bei Claudicatio- Beschwerden der rechten unteren Extremität eine auswärtige MR-Angiographie mit langstreckigem Verschluss der A. femoralis superficialis. Die Patientin wurde auch bei einer Gehstrecke von unter 100 m symptomatisch und der Knöchelarmindex betrug 0,7 auf der betroffenen Seite. An Risikofaktoren bestanden ein chronischer Nikotinabusus, eine behandelte arterielle Hypertonie und Hypercholesterinämie sowie ein pathologischer Glukosetoleranztest bei Adipositas. Nachdem angiomorphologisch kein Gefäßstumpf für eine antegrade Crossover-Rekanalisation erkennbar war, erfolgte die Durchführung einer perkutanen retrograden transpoplitealen Rekanalisation des betroffenen Gefäßes, da auch eine chirurgische Revaskularisation abgelehnt wurde. Nachdem ein arterieller Zugang (6-French-Schleuse über die rechte A. femoralis communis zur Kontrastmittelinjektion gelegt wurde, wurde die Patientin in Bauchlage gebracht und gezielt die rechte A. poplitea punktiert. Hierbei erfolgte die problemlose Drahtrekanalisation, anschließende Angioplastie und 2-fach-Stentimplantation des Gefäßes.br b Zusammenfassung/bbr Die endovaskuläre Therapie von Verschlüssen peripherer Gefäße nimmt bei verbesserter Technik und verbesserten Materialien einen immer größeren Stellenwert ein. Dargestellt ist die retrograde Rekanalisation der A. femoralis superficialis bei langstreckigem Verschluss und fehlendem Gefäßstumpf. Das Gefäß konnte erfolgreich retrograd transpopliteal eröffnet werden. Sollte bei der retrograden Rekanalisation und subintimaler Angioplastie ein Anschluss an das proximale offene Gefäßsegment nicht erzielt werden, ist der Einsatz eines Reentry- Katheters, eventuell Ultraschall-gestützt, hilfreich. Generell haben wir die Erfahrung gemacht, dass die retrograde Rekanalisation technisch deutlich einfacher ist als die antegrade Vorgehensweise.

  3. Retrograde Intrarenal Surgery for Small Renal Calyx Stones

    Directory of Open Access Journals (Sweden)

    Nevzat Sener

    2014-04-01

    Full Text Available Lower pole kidney stones are one of the most common problems is urology practice. For this group of patients, shock wave lithotripsy (SWL and retrograde intrarenal surgery (RIRS are established treatments with low morbidity and high efficacy. SWL has relatively lower success rates for lower pole stones. On the other hand, RIRS has as high as 100% success rates for lower pole stones. With advances in technology and experience we believe RIRS may be the first treatment option over SWL in the following years.

  4. Modified Technique of Retrograde Intubation in TMJ Ankylosis

    Directory of Open Access Journals (Sweden)

    Shaila Kamat

    2008-01-01

    Full Text Available We are presenting a case report on the anaesthetic management of a case of ankylosis of temporomandibular joint for corrective surgery in a 7 year old child. Anticipated difficult airway in paediatric population has always been a perplexing problem, awake fibreoptic intubation almost impossible due to obvious difficulties with co-operation. Here we are describing a new approach to this problem, in which the patients were kept under GA with spontaneous ventilation while retrograde intubation was done quite comfortably by the conventional method.

  5. ACTIVE ROBOTIC ENDOSCOPE FOR MINIMALLY INVASIVE SURGERY

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    A robotic endoscope is mainly composed of a tactile array sensor, soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The tactile array sensor can provide the information about magnitude and orientation of interacting forces between the robotic endoscope and the wall of gastrointestinal tracts. The soft mobile mechanism contacts gastrointestinal tracts with air-in inflatable balloons, so it has better soft and non-invasive properties. The turning mechanism can be actively bent by shape memory alloy components and conform to the complex shape of gastrointestinal tracts. The working principle of robotic endoscope is dealt with.

  6. Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions

    Science.gov (United States)

    Chapman, Christopher G.; Waxman, Irving; Siddiqui, Uzma D.

    2016-01-01

    Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD. PMID:27012290

  7. Endoscopic evaluation and biopsy collection of the gastrointestinal tract in the green moray eel (Gymnothorax funebris): application in a case of chronic regurgitation with gastric mucus gland hyperplasia.

    Science.gov (United States)

    Meegan, Jenny; Sidor, Inga F; Field, Cara; Roddy, Nicole; Sirpenski, Gayle; Dunn, J Lawrence

    2012-09-01

    A green moray eel (Gymnothorax funebris) was evaluated for chronic regurgitation. By using flexible endoscopy, the gastrointestinal tract was evaluated and revealed multifocal proliferative gastric masses and an intestinal ulcer. Biopsy specimens revealed gastric mucus gland hyperplasia, intestinal nematodiasis, and mild enteritis. Esophagoscopy and gastroscopy were performed by using a larger endoscope (length, 200 cm). A smaller endoscope (length, 100 cm) facilitated entering the intestinal tract in normograde or retrograde directions. A control eel was also evaluated, and no gross or histologic abnormalities were detected. The case eel was treated with metoclopramide and fenbendazole, responded well to therapy, and regurgitation decreased. A year later, the animal died of unrelated causes. Necropsy revealed coelomic gastric adhesions. The gastric proliferative lesions were associated with degeneration and necrosis of gastric pit mucosa without significant inflammation; etiology was unknown. Gastrointestinal endoscopy proved a useful diagnostic tool for evaluation and biopsy collection in this eel species.

  8. M-scope Endoscope is Superior to Traditional Endoscope for NOTES Procedures

    Institute of Scientific and Technical Information of China (English)

    LI Wen; SUN Gang; WANG Xiang-dong; XIAO Jian-guo; SUN Guo-hui; HUANG Xue-fei; Kantsevoy,Sergey V.

    2008-01-01

    @@ Background:Currently used regular dual channel endoscope was designed only for intralumenal Use inside the GI tract.Recently developed M-scope endoscope(GIF一2TQ260M,Olympus Optical LTD,Tokyo,Japan)has advantage of multibending option of its distal tip,which may be very useful for Natural Orifice Translumenal Endoscopic Surgery (NOTES) procedures inside the peritoneal cavity.

  9. Experience with endoscopic holmium laser in the pediatric population

    Science.gov (United States)

    Merguerian, Paul A.; Reddy, Pramod P.; Barrieras, Diego; Bagli, Darius J.; McLorie, Gordon A.; Khoury, Antoine E.

    1999-06-01

    Introduction: Due to the unavailability of suitable endoscopic instruments, pediatric patients have not benefited fully from the technological advances in the endoscopic management of the upper urinary tract. This limitation may be overcome with the Holmuim:Yttrium-Aluminum-Garnet(Ho:YAG) laser delivered via small instruments. To date, there is no published report on the use of this modality in children. Purpose: We evaluated the indications, efficacy, and complications of endourological Ho:YAG laser surgery in the treatment of pediatric urolithiasis, posterior urethral valves, ureterocele and ureteropelvic junction obstruction. Methods: The patient population included 10 children with renal, ureteral and bladder calculi, 2 children with posterior urethral valves, 2 children with obstructing ureteroceles, 2 children with ureteropelvic junction obstruction and 1 child with a urethral stricture. Access to the lesions was either antegrade via a percutaneous nephrostomy tract or retrograde via the urethra. A solid state Ho:YAG laser with maximum output of 30 watts (New Star lasers, Auburn, CA) was utilized as the energy source. Results: A total of 10 patients underwent laser lithotripsy. The means age of the patients was 9 yrs (5-13 yrs). The average surface area of the calculi as 425.2 mm2 (92-1645 mm2). 8 of the patients required one procedure to render them stone free, one patient had a staghorn calculus filling every calyx of a solitary kidney requiring multiple treatments and one other patient with a staghorn calculus required 2 treatments. There were no complications related to the laser lithotripsy. Two newborn underwent successful ablation of po sterious urethral valves. Two infants underwent incision of obstructing ureteroceles with decompression of the ureterocele on postoperative ultrasound. Two children underwent endypyelotomy for ureteropelvic junction obstruction. One was successful an done required an open procedure to correct the obstruction. One child

  10. Retrograde bilin signaling enables Chlamydomonas greening and phototrophic survival

    Science.gov (United States)

    Duanmu, Deqiang; Casero, David; Dent, Rachel M.; Gallaher, Sean; Yang, Wenqiang; Rockwell, Nathan C.; Martin, Shelley S.; Pellegrini, Matteo; Niyogi, Krishna K.; Merchant, Sabeeha S.; Grossman, Arthur R.; Lagarias, J. Clark

    2013-01-01

    The maintenance of functional chloroplasts in photosynthetic eukaryotes requires real-time coordination of the nuclear and plastid genomes. Tetrapyrroles play a significant role in plastid-to-nucleus retrograde signaling in plants to ensure that nuclear gene expression is attuned to the needs of the chloroplast. Well-known sites of synthesis of chlorophyll for photosynthesis, plant chloroplasts also export heme and heme-derived linear tetrapyrroles (bilins), two critical metabolites respectively required for essential cellular activities and for light sensing by phytochromes. Here we establish that Chlamydomonas reinhardtii, one of many chlorophyte species that lack phytochromes, can synthesize bilins in both plastid and cytosol compartments. Genetic analyses show that both pathways contribute to iron acquisition from extracellular heme, whereas the plastid-localized pathway is essential for light-dependent greening and phototrophic growth. Our discovery of a bilin-dependent nuclear gene network implicates a widespread use of bilins as retrograde signals in oxygenic photosynthetic species. Our studies also suggest that bilins trigger critical metabolic pathways to detoxify molecular oxygen produced by photosynthesis, thereby permitting survival and phototrophic growth during the light period. PMID:23345435

  11. Eclogites of the Dabie Region: Retrograde Metamorphism and Fluid Evolution

    Institute of Scientific and Technical Information of China (English)

    顾连兴; 杜建国; 翟建平; 赵成浩; 范建国; 张文兰

    2002-01-01

    Based upon fluid effects, retrograde metamorphism of eclogites in the Dabie region can be divided into the fluid-poor, fluid-bearing and fluid-rich stages. The fluid-poor stage is marked by polymorphic inversion, recrystallization and exsolution of solid solutions, and is thought to represent eclogite-facies retrograde environments. The fluid-bearing stage is likely to have occurred at the late stage of ecologite-facies diaphthorosis and is represented by kyanite porphyroblasts, rutile, and sodic pyroxene in association with high-pressure hydrous minerals such as phengite and zoisite (clinozoisite) without significant amount of hydrous minerals such as amphibole, epidote and biotite. The fluid-rich stage might have commenced concomitantly with lower amphibolite-facies diaphthoresis and persisted all the way towards the near-surface environment. The product of this stage is characterized by plentiful hydrous and volatile-bearing phases.The dissemination-type rutile mineralizations in eclogites might have formed by preferential shearing-induced pressure solution of gangue minerals at the fluid-bearing stage. The accompanying vein rutile was precipitated from fluids of this stage after local transport and concentration, and may hence represent proximal mobilization of titanium from the eclogite. Therefore, rutile veins can be used as an exploration indicator for dissemination-type rutile deposits.

  12. Endoscopic resection of superficial gastrointestinal tumors

    Institute of Scientific and Technical Information of China (English)

    Giovannini Marc; Cesar Vivian Lopes

    2008-01-01

    Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia.Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion,to palliate malignant obstruction, or to treat bleeding.Only endoscopic resection allows complete histologicalstaging of the cancer, which is critical as it allowss tratification and refinement for further treatment.Although other endoscopic techniques, such asablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen.Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

  13. An illumination system for endoscopic applications

    DEFF Research Database (Denmark)

    2013-01-01

    The present disclosure relates to an illumination system for endoscopic applications comprising at least one substantially monochromatic light source having a predefined central wavelength between 400 and 500 nm or between 500 and 550 nm, an optical transmission path adapted to guide light...... emanating from the light source to an endoscopic region of examination, and an optical band-rejection filter, wherein the illumination system is adapted to illuminate at least a part of the region of examination by generating autofluorescence in surrounding tissue, and the band-rejection filter is adapted...... to attenuate at least said light source wavelength to a viewer and wherein said light source is the single light source in the illumination system. A further embodiment relates to an endoscope for examining a body cavity comprising tissue, the endoscope comprising a source of light consisting...

  14. Diagnosis and management of iatrogenic endoscopic perforations

    DEFF Research Database (Denmark)

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc

    2014-01-01

    This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that ea...

  15. Endoscopic treatment of duodenal varices with cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Ana Mora-Soler

    2013-12-01

    Full Text Available Background: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control. Material and methods: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. Results: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding. Conclusion: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it.

  16. Microscopic Colitis with Macroscopic Endoscopic Findings

    OpenAIRE

    Atif Saleem; Brahmbhatt, Parag A.; Sarah Khan; Mark Young; LeSage, Gene D.

    2013-01-01

    Microscopic Colitis (MC) is characterized by chronic watery diarrhea, grossly normal appearing colonic mucosa during conventional white light endoscopy, and biopsy showing microscopic inflammation. We report a case of collagenous colitis with gross endoscopic findings.

  17. Endoscopic therapy of benign biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Joel R Judah; Peter V Draganov

    2007-01-01

    Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of postliver transplant anastomotic strictures and distal (Bismuth Ⅰ and Ⅱ) post-operative strictures. Strictures related to chronic pancreatitis have proven more difficult to treat,and endoscopic therapy is reserved for patients who are not surgical candidates. The preferred endoscopic approach is aggressive treatment with gradual dilation of the stricture and insertion of multiple plastic stents. The use of uncovered self expandable metal stents should be discouraged due to poor long-term results. Treatment with covered metal stents or bioabsorbable stents warrants further evaluation. This area of therapeutic endoscopy provides an ongoing opportunity for fresh research and innovation.

  18. Endoscopic ultrasonography findings in autoimmune pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Elisabetta Buscarini; Claudio De Angelis; Stefania De Lisi; Paolo Giorgio Arcidiacono; Maria Chiara Petrone; Arnaldo Fuini; Rita Conigliaro; Guido Manfredi; Raffaele Manta; Dario Reggio

    2011-01-01

    Endoscopic ultrasonography is an established diagnostic tool for pancreatic masses and chronic pancreatitis. In recent years there has been a growing interest in the worldwide medical community in autoimmune pancreatitis (AIP), a form of chronic pancreatitis caused by an autoimmune process. This paper reviews the current available literature about the endoscopic ultrasonographic findings of AIP and the role of this imaging technique in the management of this protean disease.

  19. Traumatic aniridia during endoscopic laser cycloablation.

    Science.gov (United States)

    Gayton, J L

    1998-01-01

    Endoscopic laser cycloablation can be effective in treating glaucoma. The Micro probe endoscopic laser permits excellent visualization of the ciliary processes. However, the surgeon can not simultaneously view through the probe and see the probe's location in the eye through the surgical microscope. An iris adhesion with the probe led to total aniridia in the case reported. Having an assistant watch the operative monitor or devising a system that allows the surgeon to watch both monitors could prevent this complication.

  20. Endoscopic treatment of the suprasellar arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Yadav Y

    2010-01-01

    Full Text Available Surgical options for suprasellar arachnoid cyst are cystoperitoneal shunt, craniotomy fenestration and endoscopic fenestration. Endoscopic management has been found to be safe and effective. We report our experience with endoscopic management in 12 (male five, female seven; age range 8 months to 42 years patients with suprasellar arachnoid cyst. The endoscopic procedure included lateral ventricle puncture by precoronal burr hole and superior and inferior wall of the cyst was communicated with the lateral ventricle and the interpeduncular cistern respectively. All patients had hydrocephalus. Four pediatric patients had macrocephaly. All adult patients had visual disturbances. One adult patient presented with psychomotor disturbance along with features of raised intracranial pressure. All cases improved following endoscopic treatment. There were no complications or death. One patient required VP shunt. Postoperative MRI showed significant reduction in cyst volume in 11 patients. Follow-up ranged from 6 months to 6 and a half years. Our study suggests that endoscopic technique is a safe and effective alternative treatment for suprasellar arachnoid cyst. It prevents complications such as subdural effusion and intracranial hematoma, which are not uncommon with craniotomy fenestration.

  1. Robotics and allied technologies in endoscopic surgery.

    Science.gov (United States)

    Buess, G F; Schurr, M O; Fischer, S C

    2000-02-01

    Endoscopic surgery was developed in the 1970s and 1980s, with initial work conducted by pioneering surgeons. After the development of laparoscopic cholecystectomy, the breakthrough of endoscopic surgery had a great effect on all surgical specialties. Starting with rather simple procedures, such as cholecystectomy, a rapid progression toward more complex procedures, such as reflux or colonic surgery, took place. It was realized at this time that the existing endoscopic instruments allowed only a limited preciseness when performing the procedures, and part of the information from inside the abdominal cavity was not available to the surgeon. This prompted a discussion with engineers concerning the development of more advanced technologies to give those performing endoscopic surgery the same quality of information and manipulation that surgeons have when performing open surgery. These qualities include (1) instruments and manipulators that allow surgical action under endoscopic control with all degrees of freedom; (2) devices that provide surgeons with tactile feedback; and (3) vision systems that provide surgeons with the same quality of visual information as with open surgery, namely, high resolution, excellent color quality, precise spatial information, and a constant clear view for optimal surgical action. At the end of 1999, some of the aforementioned quality concepts found their way into the surgical routine, but most of the concepts are still being developed. Another decade will pass before endoscopic surgery procedures will be closer to the technological goals.

  2. Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication

    Science.gov (United States)

    Sarawagi, Radha; Sundar, Shyam; Raghuvanshi, Sameer; Gupta, Sanjeev Kumar; Jayaraman, Gopal

    2016-01-01

    Summary Background Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population. Material/Methods This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations. Results The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects. Conclusions Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries. PMID:27298653

  3. Performance characteristics of retrograde single-balloon endoscopy: A single center experience

    Institute of Scientific and Technical Information of China (English)

    Kaci E Christian; Karan Kapoor; Eric M Goldberg

    2016-01-01

    AIM: To evaluate the technical success, diagnostic yield(DY) and therapeutic potential of retrograde single balloon enteroscopy(rS BE). METHODS: A retrospective review of 136 rS BE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding(GIB), evaluation for Crohn’s disease and abnormal imaging. Procedural characteristics including insertion depth(ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield(TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY. RESULTS: A total of 136 rS BE procedures were identified. Mean patient age was 57.5(± 16.2) years, 67(49.2%) were male, and 110(80.9%) procedures were performed on an outpatient basis. Indications for rS BE included GIB in 55(40.4%), evaluation of inflammatory bowel disease(IBD) in 29(21.3%), and imaging suggestive of pathology other than GIB or IBD in 43(31.6%). Nine(6.6%) rS BEs were performed for other indications. Mean ID was 68.3(± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7(± 15.5) min. Overall, 73(53.7%) cases were diagnostic and 25(18.4%) cases were therapeutic in which interventions(argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88(64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31(35.2%) cases. Follow up data was available in 93(68.4%) patients; 2(2.2%) reported post-procedural abdominal pain within 30 d

  4. Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study)

    NARCIS (Netherlands)

    F.J.C. van den Broek (Frank); E.J.R. de Graaf (Eelco); M.G.W. Dijkgraaf (Marcel); J.B. Reitsma (Johannes); J. Haringsma (Jelle); R. Timmer (Robin); B.L. Weusten (Bas); M.F. Gerhards (Michael); E.C. Consten (Esther); M.P. Schwartz (Matthijs); M.J. Boom (Maarten); E.J. Derksen (Erik); A.B. Bijnen (Bart); P.H.P. Davids (Paul); C. Hoff (Christiaan); H.M. van Dullemen (Hendrik); G.D.N. Heine (Dimitri); K. van der Linde (Klaas); J.M. Jansen (Jeroen); R.C.H. Mallant-Hent (Rosalie); R. Breumelhof (Ronald); H. Geldof (Han); J.C. Hardwick (James); P. Doornebosch (Pascal); A.C.T.M. Depla (Annekatrien); M.F. Ernst (Miranda); I.P. van Munster (Ivo); I.H.J.T. de Hingh (Ignace); E.J. Schoon (Erik); W.A. Bemelman (Willem); P. Fockens (Paul); E. Dekker (Evelien)

    2009-01-01

    textabstractBackground: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does no

  5. Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study)

    NARCIS (Netherlands)

    van den Broek, Frank J. C.; de Graaf, Eelco J. R.; Dijkgraaf, Marcel G. W.; Haringsma, Jelle; Timmer, Robin; Weusten, Bas L. A. M.; Gerhards, Michael F.; Consten, Esther C. J.; Schwartz, Matthijs P.; Boom, Maarten J.; Derksen, Erik J.; Bijnen, A. Bart; Davids, Paul H. P.; Hoff, Christiaan; van Dullemen, Hendrik M.; Heine, G. Dimitri N.; van der Linde, Klaas; Jansen, Jeroen M.; Mallant-Hent, Rosalie C. H.; Breumelhof, Ronald; Geldof, Han; Hardwick, James C. H.; Doornebosch, Pascal G.; Depla, Annekatrien C. T. M.; Ernst, Miranda F.; van Munster, Ivo P.; de Hingh, Ignace H. J. T.; Schoon, Erik J.; Bemelman, Willem A.; Fockens, Paul; Dekker, Evelien; Reitsma, J.

    2009-01-01

    Background: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require ex

  6. Inhibition of wheat starch retrogradation by tea derivatives.

    Science.gov (United States)

    Zhang, Haihua; Sun, Binghua; Zhang, Shikang; Zhu, Yuejin; Tian, Yaoqi

    2015-12-10

    The effect of four industrial tea derivatives (tea polyphenols [TPS], tea water-soluble extracts [TSE], tea polysaccharides [TSS], and green tea powder [GTP]), on the retrogradation of wheat starch was investigated using texture profile analysis (TPA), differential scanning calorimetry (DSC), rapid viscosity analysis (RVA), and the α-amylase-iodine method. The addition of the four tea derivatives resulted in decreased hardness and increased cohesiveness of the starch gel as shown by the TPA test. The DSC data demonstrated an increase in the enthalpy change of starch gelatinization and a decrease in the enthalpy change of starch recrystallite dissociation. The RVA results indicated that the peak viscosity, representing the intermolecular forces of wheat starch, was reduced after addition of TPS, TSE, and TSS, respectively, but was increased by GTP. Furthermore, the half crystallization time in the Avrami equation almost doubled after the separate addition of the tea derivatives.

  7. Retrograde versus Prograde Models of Accreting Black Holes

    Directory of Open Access Journals (Sweden)

    David Garofalo

    2013-01-01

    Full Text Available There is a general consensus that magnetic fields, accretion disks, and rotating black holes are instrumental in the generation of the most powerful sources of energy in the known universe. Nonetheless, because magnetized accretion onto rotating black holes involves both the complications of nonlinear magnetohydrodynamics that currently cannot fully be treated numerically, and uncertainties about the origin of magnetic fields that at present are part of the input, the space of possible solutions remains less constrained. Consequently, the literature still bears witness to the proliferation of rather different black hole engine models. But the accumulated wealth of observational data is now sufficient to meaningfully distinguish between them. It is in this light that this critical paper compares the recent retrograde framework with standard “spin paradigm” prograde models.

  8. Retrograde nailing for distal femur fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Giddie Jasdeep

    2015-01-01

    Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

  9. Retrograde femoral nailing in elderly patients: outcome and functional results.

    Science.gov (United States)

    Neubauer, Thomas; Krawany, Manfred; Leitner, Lukas; Karlbauer, Alois; Wagner, Michael; Plecko, Michael

    2012-06-01

    Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures.

  10. The global ocean circulation on a retrograde rotating earth

    Directory of Open Access Journals (Sweden)

    V. Kamphuis

    2010-11-01

    Full Text Available To understand the three-dimensional ocean circulation patterns that have occurred in past continental geometries, it is crucial to study the role of the present-day continental geometry and surface (wind stress and buoyancy forcing on the present-day global ocean circulation. This circulation, often referred to as the Conveyor state, is characterized by an Atlantic Meridional Overturning Circulation (MOC with deep water formation at northern latitudes and the absence of such deep water formation in the North Pacific. This MOC asymmetry is often attributed to the difference in surface freshwater flux: the North Atlantic is a basin with net evaporation, while the North Pacific receives net precipitation. This issue is revisited in this paper by considering the global ocean circulation on a retrograde rotating earth, computing an equilibrium state of the coupled atmosphere-ocean-land surface-sea ice model CCSM3. The Atlantic-Pacific asymmetry in surface freshwater flux is indeed reversed but the ocean circulation pattern is not an Inverse Conveyor state (with deep water formation in the North Pacific as there is strong and highly variable deep water formation in the North Atlantic. Using a fully-implicit, global ocean-only model also the stability properties of the Atlantic MOC on a retrograde rotating earth are investigated, showing a similar regime of multiple equilibria as in the present-day case. These results demonstrate that the present-day asymmetry in surface freshwater flux is not a crucial factor for the Atlantic-Pacific asymmetry in the global MOC.

  11. Endoscopic epilepsy surgery: Emergence of a new procedure

    Directory of Open Access Journals (Sweden)

    Sarat P Chandra

    2015-01-01

    Conclusion: The article emphasizes the role of endoscopic procedures for epilepsy surgery and provides a review of literature. This experience may subserve to coin the term "endoscopic epilepsy surgery" for a fast emerging subspeciality in the field of epilepsy surgery.

  12. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts

    DEFF Research Database (Denmark)

    Saftoiu, Adrian; Vilmann, Andreas; Vilmann, Peter

    2015-01-01

    Pancreatic pseudocysts are fluid collections in the peripancreatic tissues associated with acute or chronic pancreatitis. Endoscopic ultrasound (EUS)-guided drainage has become an established indication, having better results as compared to percutaneous drainage, nonguided endoscopic drainage...

  13. Sequelae of Endoscopic Inguinal Hernia Repair : Incidence, evaluation and management

    NARCIS (Netherlands)

    Burgmans, J.P.J.

    2015-01-01

    The endoscopic preperitoneal technique (TEP) is an appealing inguinal hernia repair technique, theoretically superior to other approaches. In practice some problems remain unsolved. Real incidences of chronic postoperative inguinal pain (CPIP) and other important sequelae of endoscopic hernia repair

  14. Endoscopic polypectomy in treatment of colon adenomatosis

    Directory of Open Access Journals (Sweden)

    Chalyk Yu.V.

    2012-03-01

    Full Text Available Objective: To study the value of endoscopic polypectomy in the treatment of family adenomatous polyposis of the colon. Materials and methods. A total of 7 patients with diffuse adenomatosis of the colon family, who were treated at the proctological department of Hospital № 8 in Saratov from 2004 to 2006 on the stage of diagnosis all patients underwent double-contrast irrigoscopy and fibrocolonoscopy with biopsy. Endoscopic removal of polyps performed by electroscission through fibrocolonoscope «Olympus CF-E3 L» with a standard loop diathermy and electrosurgical apparatus «Endothelial-1». Results. Total rehabilitation after endoscopic polyp from retained sections of the colon and adequate comprehensive preoperative patients are routinely carried out successfully three right-left-sided hemicolec-tomy and 4 on the diffuse polyposis of the colon, complicated by recurrent bleeding or malignancy of polyps. Conclusion. Non-radical surgery in combination with endoscopic polypectomy does not relieve the patient diffuse polyposis of the colon family of high risk of colorectal cancer. In the case of diffuse polyposis, endoscopic polypectomy family is of limited value, as not able to eliminate completely a potential substrate of the disease, which is the entire mucosa of the colon

  15. Ultrahigh-resolution endoscopic optical coherence tomography

    Science.gov (United States)

    Chen, Yu; Herz, Paul R.; Hsiung, Pei-Lin; Aguirre, Aaron D.; Mashimo, Hiroshi; Desai, Saleem; Pedrosa, Macos; Koski, Amanda; Schmitt, Joseph M.; Fujimoto, James G.

    2005-01-01

    Early detection of gastrointestinal cancer is essential for the patient treatment and medical care. Endoscopically guided biopsy is currently the gold standard for the diagnosis of early esophageal cancer, but can suffer from high false negative rates due to sampling errors. Optical coherence tomography (OCT) is an emerging medical imaging technology which can generate high resolution, cross-sectional images of tissue in situ and in real time, without the removal of tissue specimen. Although endoscopic OCT has been used successfully to identify certain pathologies in the gastrointestinal tract, the resolution of current endoscopic OCT systems has been limited to 10 - 15 m for clinical procedures. In this study, in vivo imaging of the gastrointestinal tract is demonstrated at a three-fold higher resolution (gastro-esophageal junction and colon on animal model display tissue microstructures and architectural details at high resolution, and the features observed in the OCT images are well-matched with histology. The clinical feasibility study is conducted through delivering OCT imaging catheter using standard endoscope. OCT images of normal esophagus, Barrett's esophagus, and esophageal cancers are demonstrated with distinct features. The ability of high resolution endoscopic OCT to image tissue morphology at an unprecedented resolution in vivo would facilitate the development of OCT as a potential imaging modality for early detection of neoplastic changes.

  16. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    Science.gov (United States)

    Watson, David I; Immanuel, Arul

    2010-04-01

    Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

  17. Physicochemical and release characteristics of acetylated Indian palmyrah retrograded shoot starch.

    Science.gov (United States)

    Kumar, K Jayaram; Varma, Ch Ashok Kumar; Panpalia, S G

    2014-08-01

    The aim of the present study is to determine the influence of serial modifications, including retrogradation followed by acetylation on morphological, physicochemical and drug release properties of retrograded Indian palmyrah (Borassus flabellifer L.) shoot starch. The acetylated retrograded starches prepared by using different concentrations of acetic anhydride were shown a degree of substitution (DS) in the range of 0.16-0.55. Acetylation of retrograded starch produced significant morphological changes from rough to smooth surface. The amylose content, water holding capacity, swelling and solubility power tend to increase with increase in DS. A strong peak at 1751 and 1032cm(-1) confirms the formation of acetylated retrograded starch. The TGA data reveal that with increase in DS there is an increased thermal stability and decreased bound water of starch. The elemental analysis also confirms the addition of acetyl groups because of increased carbon and hydrogen content. The matrix tablets of acetylated retrograded starch with high DS showed a delayed release in gastric pH and sustained release in simulated intestinal fluid. Overall, this result suggested that acetylated retrograded starch with high DS are thermally stable and can be used for formulating protein and peptide drugs for colon targeting.

  18. Identification of the main retrogradation-related properties of rice starch.

    Science.gov (United States)

    Lian, Xijun; Kang, Haiqi; Sun, Haibo; Liu, Lizeng; Li, Lin

    2015-02-11

    The retrogradation of rice in shelf life is the biggest barrier to the industrial production of traditional foods using rice as material. Many rice breeders have tried their best to screen low-retrogradation rice cultivars without a specific indicator. To identify the main retrogradation-related properties of rice, the starch, amylose, and amylopectin from 16 rice cultivars were extracted from rice powder and their physicochemical properties, such as visible absorbance, infrared, average molecule weight (amylopectin), chain-length distribution (amylopectin), X-ray diffraction, and differential scanning calorimetry, were determined. The correlation between starch retrogradation rates and those physicochemical properties was investigated. The results show that a significant positive correlation (R(2) = 0.85; r = 0.926; p 10] in amylopectin and the retrogradation rates of different rice starches. The findings in the paper offer a shortcut for rice breeders to screen cultivars with a low retrogradation rate. Because the genes related to the branching enzyme control the DP of amylopectin, they can be exploited as molecular markers to screen low-retrogradation rice cultivars.

  19. Effects of protein in wheat flour on retrogradation of wheat starch.

    Science.gov (United States)

    Xijun, Lian; Junjie, Guo; Danli, Wang; Lin, Li; Jiaran, Zhu

    2014-08-01

    Albumins, globulins, gliadins, and glutenins were isolated from wheat flour and the effects of those proteins on retrogradation of wheat starch were investigated. The results showed that only glutenins retarded retrogradation of wheat starch and other 3 proteins promoted it. The results of IR spectra proved that no S-S linkage formed during retrogradation of wheat starch blended with wheat proteins. Combination of wheat starch and globulins or gliadins through glucosidic bonds hindered the hydrolysis of wheat starch by α-amylase. The melting peak temperatures of retrograded wheat starch attached to different proteins were 128.46, 126.14, 132.03, 121.65, and 134.84 °C for the control with no protein, albumins, glutenins, globulins, gliadins groups, respectively, and there was no second melting temperature for albumins group. Interaction of wheat proteins and starch in retrograded wheat starch greatly decreased the endothermic enthalpy (△H) of retrograded wheat starch. Retrograded wheat starch bound to gliadins might be a new kind of resistant starch based on glycosidic bond between starch and protein.

  20. The Yeast Retrograde Response as a Model of Intracellular Signaling of Mitochondrial Dysfunction

    Directory of Open Access Journals (Sweden)

    S. Michal eJazwinski

    2012-05-01

    Full Text Available Mitochondrial dysfunction activates intracellular signaling pathways that impact yeast longevity, and the best known of these pathways is the retrograde response. More recently, similar responses have been discerned in other systems, from invertebrates to human cells. However, the identity of the signal transducers is either unknown or apparently diverse, contrasting with the well-established signaling module of the yeast retrograde response. On the other hand, it has become equally clear that several other pathways and processes interact with the retrograde response, embedding it in a network responsive to a variety of cellular states. An examination of this network supports the notion that the master regulator NFkB aggregated a variety of mitochondria-related cellular responses at some point in evolution and has become the retrograde transcription factor. This has significant consequences for how we view some of the deficits associated with aging, such as inflammation. The support for NFkB as the retrograde response transcription factor is not only based on functional analyses. It is bolstered by the fact that NFkB can regulate Myc-Max, which is activated in human cells with dysfunctional mitochondria and impacts cellular metabolism. Myc-Max is homologous to the yeast retrograde response transcription factor Rtg1-Rtg3. Further research will be needed to disentangle the pro-aging from the anti-aging effects of NFkB. Interestingly, this is also a challenge for the complete understanding of the yeast retrograde response.

  1. Endoscopic Treatment of Gastrointestinal Perforations, Leaks, and Fistulae.

    Science.gov (United States)

    Rustagi, Tarun; McCarty, Thomas R; Aslanian, Harry R

    2015-01-01

    Gastrointestinal leaks and fistulae are common postoperative complications, whereas intestinal perforation more commonly complicates advanced endoscopic procedures. Although these complications have classically been managed surgically, there exists an ever-expanding role for endoscopic therapy and the involvement of advanced endoscopists as part of a multidisciplinary team including surgeons and interventional radiologists. This review will serve to highlight the innovative endoscopic interventions that provide an expanding range of viable endoscopic approaches to the management and therapy of gastrointestinal perforation, leaks, and fistulae.

  2. Esthesioneuroblastoma: Good Local Control of Disease by Endoscopic and Endoscope Assisted Approach. Is it Possible?

    Science.gov (United States)

    Mohindra, Satyawati; Dhingra, Shruti; Mohindra, Sandeep; Kumar, Narendra; Gupta, Bhumika

    2014-09-01

    To present a short report on nine patients of esthesioneuroblastoma, managed endoscopically or endoscope assisted. To describe the technique and discuss the results at an average of 36.7 months of follow up. A retrospective study in a tertiary care centre. The present communication describes a series of 9 cases harbouring esthesioneuroblastoma, 6 managed endoscopically and 3 endoscope assisted between January 2005 and December 2009. All the nine patients remained free of disease at the primary site by endoscopic and radiological evaluation on an average of 36.7 months of follow up. One of the patients developed cutaneous and systemic metastasis for which she received chemotherapy and another one died during post-operative period due to unrelated causes. None of the patients showed recurrence or residual disease locally. Endoscopic and endoscope assisted approach provides a cosmetically better and surgically comparable outcome for local control of disease in early stages of esthesioneuroblastoma in expert hands without significant complications.

  3. [Extended endoscopic endonasal transsphenoidal approaches in skull base surgery].

    Science.gov (United States)

    Kalinin, P L; Fomichev, D V; Kutin, M A; Kadashev, B A; Faĭzullaev, R B

    2008-01-01

    The article deals with endoscopic endonasal transsphenoidal surgery, which has gained great interest among the modem trends of neurosurgery. Application of extended endoscopic endonasal transsphenoidal approaches significantly advances capabilities of transsphenoidal surgery. Pituitary adenomas and some other sellar tumors which traditionally require transcranial procedure now can be removed via endonasal route. The article describes several types of extended endoscopic endonasal transsphenoidal approaches.

  4. Endoscopic options for treatment of dysplasia in Barrett'sesophagus

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Recent advances in the endoscopic treatment of dysplasiain Barrett's esophagus (BE) have allowed endoscopists toprovide effective and durable eradication therapies. Thisreview summarizes the available endoscopic eradicationtechniques for dysplasia in patients with BE includingendoscopic mucosal resection, endoscopic submucosaldissection, photodynamic therapy, argon plasma coagulation,radiofrequency ablation and cryotherapy.

  5. Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

    Science.gov (United States)

    Girometti, Rossano; Pravisani, Riccardo; Intini, Sergio Giuseppe; Isola, Miriam; Cereser, Lorenzo; Risaliti, Andrea; Zuiani, Chiara

    2016-01-01

    AIM To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up. METHODS We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata (e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes. RESULTS We found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small (IPMN appearance (P > 0.01). CONCLUSION Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging follow-up should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy. PMID:27920477

  6. TCTEX1D2 mutations underlie Jeune asphyxiating thoracic dystrophy with impaired retrograde intraflagellar transport

    Science.gov (United States)

    Schmidts, Miriam; Hou, Yuqing; Cortés, Claudio R.; Mans, Dorus A.; Huber, Celine; Boldt, Karsten; Patel, Mitali; van Reeuwijk, Jeroen; Plaza, Jean-Marc; van Beersum, Sylvia E. C.; Yap, Zhi Min; Letteboer, Stef J. F.; Taylor, S. Paige; Herridge, Warren; Johnson, Colin A.; Scambler, Peter J.; Ueffing, Marius; Kayserili, Hulya; Krakow, Deborah; King, Stephen M.; Beales, Philip L.; Al-Gazali, Lihadh; Wicking, Carol; Cormier-Daire, Valerie; Roepman, Ronald; Mitchison, Hannah M.; Witman, George B.; Al-Turki, Saeed; Anderson, Carl; Anney, Richard; Antony, Dinu; Asimit, Jennifer; Ayub, Mohammad; Barrett, Jeff; Barroso, Inês; Bentham, Jamie; Bhattacharya, Shoumo; Blackwood, Douglas; Bobrow, Martin; Bochukova, Elena; Bolton, Patrick; Boustred, Chris; Breen, Gerome; Brion, Marie-Jo; Brown, Andrew; Calissano, Mattia; Carss, Keren; Chatterjee, Krishna; Chen, Lu; Cirak, Sebhattin; Clapham, Peter; Clement, Gail; Coates, Guy; Collier, David; Cosgrove, Catherine; Cox, Tony; Craddock, Nick; Crooks, Lucy; Curran, Sarah; Daly, Allan; Danecek, Petr; Smith, George Davey; Day-Williams, Aaron; Day, Ian; Durbin, Richard; Edkins, Sarah; Ellis, Peter; Evans, David; Farooqi, I. Sadaf; Fatemifar, Ghazaleh; Fitzpatrick, David; Flicek, Paul; Floyd, Jamie; Foley, A. Reghan; Franklin, Chris; Futema, Marta; Gallagher, Louise; Gaunt, Tom; Geschwind, Daniel; Greenwood, Celia; Grozeva, Detelina; Guo, Xiaosen; Gurling, Hugh; Hart, Deborah; Hendricks, Audrey; Holmans, Peter; Huang, Jie; Humphries, Steve E.; Hurles, Matt; Hysi, Pirro; Jackson, David; Jamshidi, Yalda; Jewell, David; Chris, Joyce; Kaye, Jane; Keane, Thomas; Kemp, John; Kennedy, Karen; Kent, Alastair; Kolb-Kokocinski, Anja; Lachance, Genevieve; Langford, Cordelia; Lee, Irene; Li, Rui; Li, Yingrui; Ryan, Liu; Lönnqvist, Jouko; Lopes, Margarida; MacArthur, Daniel G.; Massimo, Mangino; Marchini, Jonathan; Maslen, John; McCarthy, Shane; McGuffin, Peter; McIntosh, Andrew; McKechanie, Andrew; McQuillin, Andrew; Memari, Yasin; Metrustry, Sarah; Min, Josine; Moayyeri, Alireza; Morris, James; Muddyman, Dawn; Muntoni, Francesco; Northstone, Kate; O'Donovan, Michael; O'Rahilly, Stephen; Onoufriadis, Alexandros; Oualkacha, Karim; Owen, Michael; Palotie, Aarno; Panoutsopoulou, Kalliope; Parker, Victoria; Parr, Jeremy; Paternoster, Lavinia; Paunio, Tiina; Payne, Felicity; Perry, John; Pietilainen, Olli; Plagnol, Vincent; Quail, Michael A.; Quaye, Lydia; Raymond, Lucy; Rehnström, Karola; Brent Richards, J.; Ring, Sue; Ritchie, Graham R S; Savage, David B.; Schoenmakers, Nadia; Semple, Robert K.; Serra, Eva; Shihab, Hashem; Shin, So-Youn; Skuse, David; Small, Kerrin; Smee, Carol; Soler, Artigas María; Soranzo, Nicole; Southam, Lorraine; Spector, Tim; St Pourcain, Beate; St. Clair, David; Stalker, Jim; Surdulescu, Gabriela; Suvisaari, Jaana; Tachmazidou, Ioanna; Tian, Jing; Timpson, Nic; Tobin, Martin; Valdes, Ana; van Kogelenberg, Margriet; Vijayarangakannan, Parthiban; Wain, Louise; Walter, Klaudia; Wang, Jun; Ward, Kirsten; Wheeler, Ellie; Whittall, Ros; Williams, Hywel; Williamson, Kathy; Wilson, Scott G.; Wong, Kim; Whyte, Tamieka; ChangJiang, Xu; Zeggini, Eleftheria; Zhang, Feng; Zheng, Hou-Feng

    2015-01-01

    The analysis of individuals with ciliary chondrodysplasias can shed light on sensitive mechanisms controlling ciliogenesis and cell signalling that are essential to embryonic development and survival. Here we identify TCTEX1D2 mutations causing Jeune asphyxiating thoracic dystrophy with partially penetrant inheritance. Loss of TCTEX1D2 impairs retrograde intraflagellar transport (IFT) in humans and the protist Chlamydomonas, accompanied by destabilization of the retrograde IFT dynein motor. We thus define TCTEX1D2 as an integral component of the evolutionarily conserved retrograde IFT machinery. In complex with several IFT dynein light chains, it is required for correct vertebrate skeletal formation but may be functionally redundant under certain conditions. PMID:26044572

  7. Recent trends in endoscopic management of achalasia

    Institute of Scientific and Technical Information of China (English)

    Salvatore; Tolone; Paolo; Limongelli; Gianmattia; del; Genio; Luigi; Brusciano; Antonio; Russo; Lorenzo; Cipriano; Marco; Terribile; Giovanni; Docimo; Roberto; Ruggiero; Ludovico; Docimo

    2014-01-01

    Esophageal achalasia is a chronic and progressive motility disorder characterized by absence of esophageal body peristalsis associated with an impaired relaxation of lower esophageal sphincter(LES) and usually with an elevated LES pressure, leading to an altered passage of bolus through the esophago-gastric junction. A definitive cure for achalasia is currently unavailable. Palliative treatment options provide only food and liquid bolus intake and relief of symptoms. Endoscopic therapy for achalasia aims to disrupt or weaken the lower esophageal sphincter. Intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides superior results than botulinum toxin injection and a similar mediumterm efficacy almost comparable to that attained after surgery. Per oral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and further objective and long-term follow up. This article will review different endoscopic treatments in achalasia, and summarize the short-term and long-term outcomes.

  8. [Per-oral endoscopic myotomy in achalasia].

    Science.gov (United States)

    Ponds, Fraukje A M; Smout, André J P M; Bredenoord, Albert J; Fockens, Paul

    2015-01-01

    The treatment of patients with achalasia is complex due to a considerably high recurrence rate and risk of treatment-related complications. The per-oral endoscopic myotomy (POEM) is a new endoscopic technique that combines the benefits of a minimally invasive endoscopic procedure with the efficacy of a surgical myotomy. Implementation of the POEM technique may lead to fewer complications, a lower recurrence rate and reduced costs. During the procedure, a myotomy of the circular muscle layer of the oesophagus is performed after creating a submucosal tunnel in the oesophagus. The first studies of this new technique show promising results. Experienced therapeutic endoscopists can learn to perform the POEM technique relatively easily. Further studies are needed to compare this technique with the current standard treatments and to evaluate long-term effects.

  9. Compact stereo endoscopic camera using microprism arrays.

    Science.gov (United States)

    Yang, Sung-Pyo; Kim, Jae-Jun; Jang, Kyung-Won; Song, Weon-Kook; Jeong, Ki-Hun

    2016-03-15

    This work reports a microprism array (MPA) based compact stereo endoscopic camera with a single image sensor. The MPAs were monolithically fabricated by using two-step photolithography and geometry-guided resist reflow to form an appropriate prism angle for stereo image pair formation. The fabricated MPAs were transferred onto a glass substrate with a UV curable resin replica by using polydimethylsiloxane (PDMS) replica molding and then successfully integrated in front of a single camera module. The stereo endoscopic camera with MPA splits an image into two stereo images and successfully demonstrates the binocular disparities between the stereo image pairs for objects with different distances. This stereo endoscopic camera can serve as a compact and 3D imaging platform for medical, industrial, or military uses.

  10. [Laparoscopic endoscopy: a new type of combined technique for select patients].

    Science.gov (United States)

    Völgyi, Zoltán; Fischer, Tünde; Szenes, Mária; Tüske, György; Vattay, Péter; Gasztonyi, Beáta

    2010-06-20

    The authors report a new method which was introduced last year in their unit. In a significant part of cholecystolithiasis, choledocholithiasis also exists. The diagnosis is sometimes fairly difficult, in these cases newly developed imaging methods (magnetic resonance cholangiopancreatography, endoscopic ultrasonography) can help. In cases of choledocholithiasis, when preoperative endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful, laparoscopic endoscopy can be performed. Authors describe this method as well as discuss the international literature, and review the cases of their own ten cases with this method. They emphasize the advantages of the new method in a certain subgroup of patients against the traditional sequential approach (preoperative ERCP than laparoscopic cholecystectomy) and also share their technical experiences. Finally, they underline the importance of the team work which supposes the cooperation of the gastroenterologist, surgeon and anesthesiologist in the indication, organization and implementation of the intervention.

  11. The course of traumatic pancreatitis in a patient with pancreas divisum: a case report

    Directory of Open Access Journals (Sweden)

    Maris Thomas G

    2003-03-01

    Full Text Available Abstract Background The peculiar anatomy of pancreatic ducts in pancreas divisum (PD may interfere with the development of acute chronic pancreatitis. In the presented case, PD influenced the evolution of lesions after pancreatic trauma. Case presentation A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years. The first episode occurred four months after blunt abdominal trauma. Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Imaging of upper abdomen and Magnetic Resonance Cholangiopancreatography disclosed pancreas divisum, changes consistent with chronic pancreatitis in the dorsal pancreatic duct, atrophy in the body and tail of the pancreas and a pseudocyst in the pancreatic head, that was drained endoscopically. Conclusion Pancreas Divisum may interfere with the evolution of posttraumatic changes in the pancreas after blunt abdominal trauma.

  12. Percutaneous endoscopic gastrostomy in children

    Directory of Open Access Journals (Sweden)

    Jye Hae Park

    2011-01-01

    Full Text Available Purpose: Percutaneous endoscopic gastrostomy (PEG can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods: We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6 months. Results: Mean patient age was 9.4 (4.5 years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD. The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87% had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion: PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

  13. Advanced endoscopic imaging to improve adenomadetection

    Institute of Scientific and Technical Information of China (English)

    Helmut Neumann; Andreas N?gel; Andrea Buda

    2015-01-01

    Advanced endoscopic imaging is revolutionizing ourway on how to diagnose and treat colorectal lesions.Within recent years a variety of modern endoscopicimaging techniques was introduced to improveadenoma detection rates. Those include high-definitionimaging, dye-less chromoendoscopy techniques andnovel, highly flexible endoscopes, some of themequipped with balloons or multiple lenses in order toimprove adenoma detection rates. In this review wewill focus on the newest developments in the field ofcolonoscopic imaging to improve adenoma detectionrates. Described techniques include high-definitionimaging, optical chromoendoscopy techniques, virtualchromoendoscopy techniques, the Third Eye Retroscopeand other retroviewing devices, the G-EYE endoscopeand the Full Spectrum Endoscopy-system.

  14. Endoscopic palliation of malignant biliary stricture

    Institute of Scientific and Technical Information of China (English)

    Sanjay M Salgado; Monica Gaidhane; Michel Kahaleh

    2016-01-01

    Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies.

  15. ENDOSCOPIC TECHNOLOGIES IN EARLY RECTAL CANCER TREATMENT

    Directory of Open Access Journals (Sweden)

    D. V. Samsonov

    2015-01-01

    Full Text Available Total mesorectal excision is the “golden standard” of surgical treatment for rectal cancer. Development of endoscopic technologies allowed to implement the benefits of minimally invasive surgery in early rectal cancer treatment, decrease morbidity and mortality, improve functional outcome and quality of life. Oncological safety of this method is still a subject for discussion due to lack of lymph node harvest. Endoscopic operations for early rectal cancer are being actively implemented in daily practice, but lack of experience does not allow to include this method in national clinical prac-tice guidelines.

  16. Role of Malabsorptive Endoscopic Procedures in Obesity Treatment

    Science.gov (United States)

    Park, Jae Myung

    2017-01-01

    The incidence of obesity is increasing, and more definitive treatment modalities are needed. Endoluminal procedures, including restrictive endoscopic procedures, endoscopic gastroplasty, and malabsorptive endoscopic procedures, can reduce weight in obese patients and control obesity-related comorbidities. Malabsorptive endoscopic interventions also offer the potential for an ambulatory procedure that may be safer and more cost-effective compared with laparoscopic surgery. Malabsorptive endoscopic intervention can induce weight reduction and improve obesity-related metabolic parameters, despite complications such as device migration, obstruction, and abdominal pain. Improvement in technique will follow the development of new devices. PMID:28147470

  17. Retrograde intrarenal surgery (RIRS, regular and small sized percutaneous nephrolithotomy (PCNL in daily practice: European Association of Urology Section of Urolithiasis (EULIS Survey

    Directory of Open Access Journals (Sweden)

    Stefano Paolo Zanetti

    2016-10-01

    Full Text Available Objective: A wide selection of both anterograde and retrograde mini-invasive procedures exist for stones’ treatment. The 2016 European Association of Urology (EAU guidelines still don’t univocally define a best option. Our purpose is to give an overview on some European Stone Centers’ customs and to compare real life clinical practice with statements of opinion leaders and Guidelines. Materials and Methods: In 2015 we performed a survey in 3 step about the spread of retrograde intrarenal surgery (RIRS and percutaneous nephrolithotomy (PCNL techniques among EAU Section of Urolithiasis (EULIS members. The 1st and 2nd steps dealt with the definition of EULIS urologist and department by collecting personal opinions about the endoscopic techniques. The third step was about clinical results. This paper presents data from the first two steps. Results: Ninety-one people answered. Out of them, 80% are European and 42% work in Centres fully dedicated to stone treatment. In particular, 50% of responders perform more than 80 RIRS/year, 25% more than 80 PCNL/year, 48% more than 100 extracorporeal shock wave lithotripsy (SWL/year. RIRS is mainly used to treat stones < 2 cm both as primary treatment and after SWL failure. 73% don’t perform routine pre-stenting and 66% ordinarily use a ureteral sheath. Hospital stay for RIRS is 24h for 70% of responders. Regular PCNL is performed by 87% of the responders, MiniPCNL by 58%, Ultra-MiniPCNL by 23% and MicroPCNL by 28%. Pneumatic balloon dilation is the favourite dilation technique (49%. 37% of responders perform PCNL always in the supine position, 21% always in the prone one. Almost all the responders agree about using Mini, Ultra-Mini and MicroPCNL for 1-2 cm stones. Approximately 50% also use MiniPCNL for stones > 2 cm. Conclusion: our survey confirms the great heterogeneity existing in stones’ treatment techniques in daily practice.

  18. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Masau Sekiguchi; Haruhisa Suzuki; Ichiro Oda; Shigetaka Yoshinaga; Satoru Nonaka; Makoto Saka; Hitoshi Katai

    2012-01-01

    Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

  19. Effect of cross-linking degree on selected properties of retrograded starch adipate.

    Science.gov (United States)

    Kapelko, M; Zięba, T; Michalski, A; Gryszkin, A

    2015-01-15

    The aim of this study was to determine the effects of the concentration of paste used to produce retrograded starch, and esterification degree, on selected properties of the resultant distarch adipate. Starch paste was prepared from native potato starch (1, 4, 10, 18 or 30 g/100g), frozen, defrosted and dried. Thus produced preparations of retrograded starch were cross-linked with various doses of a cross-linking agent (0.125, 0.25, 0.5, 1.0 or 2.0 ml per 100g of starch). Properties of the produced adipates depended on both the concentration of paste used to produce retrograded starch and the degree of substitution with adipic acid residues. Solubility in water and swelling power of the cross-linked preparations of retrograded starch, as well as pasting temperature and viscosity of produced pastes, all decreased along with the increasing degree of substitution with adipic acid residues.

  20. A photographic approach to the possible mechanism of retrogradation of sweet potato starch.

    Science.gov (United States)

    Lian, Xijun; Zhao, Shuyi; Liu, Qinsheng; Zhang, Xu

    2011-01-01

    Although the subject of starch retrogradation has been studied for about 20 years, the mechanism of starch retrogradation seems not yet to be completely established. In this paper, the possible retrogradation mechanism of sweet potato starch was postulated from four optical micrographs at the stages of melting of the starch granules, autoclaving treatment and aging. The possible process of retrogradation consists of three stages. Firstly, starch granules was swelled and melted with loss of X-ray crystallinity and formation of both crystalline and amorphous lamellae; secondly, in crystalline lamellae, amylopectin began to form nucleation when they were autoclaved; finally, the nucleus grew up to great rod-like crystals as the result of congregating of amylose on plates which were composed of and prolongated by amylopectin.

  1. Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

    Directory of Open Access Journals (Sweden)

    Ahmed Amro

    2016-01-01

    Full Text Available Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA intervention complications. Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent. Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

  2. The 'SAFARI' Technique Using Retrograde Access Via Peroneal Artery Access

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Kun Da, E-mail: zkunda@gmail.com [Singapore General Hospital, Interventional Radiology Centre (Singapore); Tan, Seck Guan [Singapore General Hospital, Department of General Surgery (Singapore); Tay, Kiang Hiong [Singapore General Hospital, Interventional Radiology Centre (Singapore)

    2012-08-15

    The 'SAFARI' technique or subintimal arterial flossing with antegrade-retrograde intervention is a method for recanalisation of chronic total occlusions (CTOs) when subintimal angioplasty fails. Retrograde access is usually obtained via the popliteal, distal anterior tibial artery (ATA)/dorsalis pedis (DP), or distal posterior tibial artery (PTA). Distal access via the peroneal artery has not been described and has a risk of continued bleeding, leading to compartment syndrome due to its deep location. We describe our experience in two patients with retrograde access via the peroneal artery and the use of balloon-assisted hemostasis for these retrograde punctures. This approach may potentially give more options for endovascular interventions in lower limb CTOs.

  3. Reconsidering the nature and mode of action of metabolite retrograde signals from the chloroplast

    Directory of Open Access Journals (Sweden)

    Gonzalo Martín Estavillo

    2013-01-01

    Full Text Available Plant organelles produce retrograde signals to alter nuclear gene expression in order to coordinate their biogenesis, maintain homeostasis or optimize their performance under adverse conditions. Many signals of different chemical nature have been described in the past decades, including chlorophyll intermediates, reactive oxygen species and adenosine derivatives. While the effects of retrograde signalling on gene expression are well understood, the initiation and transport of the signals and their mode of action have either not been resolved, or are a matter of speculation. Moreover, retrograde signalling should be consider as part of a broader cellular network, instead of as separate pathways, required to adjust to changing physiologically relevant conditions. Here we summarize current plastid retrograde signalling models in plants, with a focus on new signalling pathways, SAL1-PAP, MEcPP and β- cyclocitral, and outline missing links or future areas of research that we believe need to be addressed to have a better understanding of plant intracellular signalling networks.

  4. Reducing retrogradation and lipid oxidation of normal and glutinous rice flours by adding mango peel powder.

    Science.gov (United States)

    Siriamornpun, Sirithon; Tangkhawanit, Ekkarat; Kaewseejan, Niwat

    2016-06-15

    Green and ripe mango peel powders (MPP) were added to normal rice flour (NRF) and glutinous rice flour (GRF) at three levels (400, 800 and 1200 ppm) and their effects on physicochemical properties and lipid oxidation inhibition were investigated. Overall, MPP increased the breakdown viscosity and reduced the final viscosity in rice flours when compared to the control. Decreasing in retrogradation was observed in both NRF and GRF with MPP added of all levels. MPP addition also significantly inhibited the lipid oxidation of all flours during storage (30 days). Retrogradation values were strongly negatively correlated with total phenolic and flavonoid contents, but not with fiber content. The hydrogen bonds and hydrophilic interactions between phenolic compounds with amylopectin molecule may be involved the decrease of starch retrogradation, especially GRF. We suggest that the addition of MPP not only reduced the retrogradation but also inhibited the lipid oxidation of rice flour.

  5. Correlation between Histopathological and Endoscopic Findings of Stomach Growth.

    Science.gov (United States)

    Mahmuda, S; Bashar, M F; Yesmin, N; Khatun, M A

    2016-01-01

    This study was carried out in the Department of Pathology of Islami Bank Hospital, Barisal to correlate between histopathological and endoscopic diagnosis of suspected malignant gastric lesions. A total of sixty six endoscopic biopsies were studied retrospectively, during the period from February 2011 to January 2014. The biopsies were retrieved using video-endoscope. These were transferred to a bottle containing 10% neutral formalin, processed and stained routinely with Haematoxylin and Eosin. Out of 66(100%) gastric endoscopic biopsies, 29(44%) were malignant. The correlation of endoscopic and histopathological diagnosis of these gastric lesions was 44%. Endoscopic examination and biopsy is a convenient procedure for accurate objective assessment of patients with symptoms of gastrointestinal tract. Endoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of endoscopically detected lesions.

  6. Statistical mechanical description of supercritical fluid extraction and retrograde condensation

    Science.gov (United States)

    Park, S. J.; Kwak, T. Y.; Mansoori, G. A.

    1987-07-01

    The phenomena of supercritical fluid extraction (SFE) and its reverse effect, which is known as retrograde condensation (RC), have found new and important applications in industrial separation of chemical compounds and recovery and processing of natural products and fossil fuels. Full-scale industrial utilization of SFE/RC processes requires knowledge about thermodynamic and transport characteristics of the asymmetric mixtures involved and the development of predictive modeling and correlation techniques for performance of the SFE/RC system under consideration. In this report, through the application of statistical mechanical techniques, the reasons for the lack of accuracy of existing predictive approaches are described and they are improved. It is demonstrated that these techniques also allow us to study the effect of mixed supercritical solvents on the solubility of heavy solutes (solids) at different compositions of the solvents, pressures, and temperatures. Fluid phase equilibrium algorithms based on the conformal solution van der Waals mixing rules and different equations of state are presented for the prediction of solubilities of heavy liquid in supercritical gases. It is shown that the Peng-Robinson equation of state based on conformal solution theory can predict solubilites of heavy liquid in supercritical gases more accurately than the van der Waals and Redlich-Kwong equations of state.

  7. Are retrograde resonances possible in multi-planet systems?

    CERN Document Server

    Gayon, Julie

    2008-01-01

    Most of multi-planetary systems detected until now are characterized by hot-Jupiters close to their central star and moving on eccentric orbits. Hence, from a dynamical point of view, compact multi-planetary systems form a particular class of the general N-body problem (with N >3). Moreover, extrasolar planets are up to now found in prograde orbital motions about their host star and often in mean motion resonances (MMR). In the present paper, we investigate theoretically in a first step a new stabilizing mechanism particularly suitable for compact two-planet systems. Such a mechanism involves counter-revolving orbits forming a retrograde MMR. In a second step, we study the feasibility of planetary systems to host counter-revolving planets. In order to characterize dynamical behaviors of multi-dimensional planetary systems in the vicinity of observations, we apply our technique of global dynamics analysis based on the MEGNO indicator (Mean Exponential Growth factor of Nearby Orbits) that provides the fine stru...

  8. Fluorescence Imaging of Fast Retrograde Axonal Transport in Living Animals

    Directory of Open Access Journals (Sweden)

    Dawid Schellingerhout

    2009-11-01

    Full Text Available Our purpose was to enable an in vivo imaging technology that can assess the anatomy and function of peripheral nerve tissue (neurography. To do this, we designed and tested a fluorescently labeled molecular probe based on the nontoxic C fragment of tetanus toxin (TTc. TTc was purified, labeled, and subjected to immunoassays and cell uptake assays. The compound was then injected into C57BL/6 mice (N = 60 for in vivo imaging and histologic studies. Image analysis and immunohistochemistry were performed. We found that TTc could be labeled with fluorescent moieties without loss of immunoreactivity or biologic potency in cell uptake assays. In vivo fluorescent imaging experiments demonstrated uptake and retrograde transport of the compound along the course of the sciatic nerve and in the spinal cord. Ex vivo imaging and immunohistochemical studies confirmed the presence of TTc in the sciatic nerve and spinal cord, whereas control animals injected with human serum albumin did not exhibit these features. We have demonstrated neurography with a fluorescently labeled molecular imaging contrast agent based on the TTc.

  9. Failure of conventional retrograde cystography to detect bladder ruptures in pelvic trauma

    OpenAIRE

    Berber, O.; Emeagi, C.; Perry, M; Rickman, M. S.

    2010-01-01

    Conventional retrograde cystography is often used to investigate patients with suspected bladder ruptures in pelvic trauma. Clinical indicators suggestive of a rupture include haematuria and suprapubic tenderness and should increase the suspicion of bladder and urinary tract injury and prompt the clinician to undertake further investigations. Two patients with high-energy pelvic fractures had bladder ruptures detected intraoperatively despite normal preoperative retrograde cystogram. Both pat...

  10. Evaluation of Black Tea Polyphenol Extract Against the Retrogradation of Starches from Various Plant Sources

    OpenAIRE

    2012-01-01

    The effects of black tea polyphenol extract (BTPE) on the retrogradation of starches from different plant sources were studied using differential scanning calorimetry (DSC) and X-ray diffraction (XRD). DSC analysis shows that the gelatinization temperature of maize starch and starches from different rice varieties increased with increasing BTPE level. After storage at 4 °C, BTPE at a concentration of 15% markedly retarded the retrogradation of maize starch and starches from different rice var...

  11. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

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    Abdul-rahman R. Abdel-karim

    2016-01-01

    Full Text Available Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO percutaneous coronary interventions (PCI with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome.

  12. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Science.gov (United States)

    Abdel-karim, Abdul-rahman R.; Main, Michael L.

    2016-01-01

    Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome. PMID:27668097

  13. Brachial Artery Flow-mediated Dilation Following Exercise with Augmented Oscillatory and Retrograde Shear Rate

    Directory of Open Access Journals (Sweden)

    Johnson Blair D

    2012-08-01

    Full Text Available Abstract Background Acute doses of elevated retrograde shear rate (SR appear to be detrimental to endothelial function in resting humans. However, retrograde shear increases during moderate intensity exercise which also enhances post-exercise endothelial function. Since SR patterns differ with the modality of exercise, it is important to determine if augmented retrograde SR during exercise influences post-exercise endothelial function. This study tested the hypothesis that (1 increased doses of retrograde SR in the brachial artery during lower body supine cycle ergometer exercise would attenuate post-exercise flow-mediated dilation (FMD in a dose-dependent manner, and (2 antioxidant vitamin C supplementation would prevent the attenuated post-exercise FMD response. Methods Twelve men participated in four randomized exercise sessions (90 W for 20 minutes on separate days. During three of the sessions, one arm was subjected to increased oscillatory and retrograde SR using three different forearm cuff pressures (20, 40, 60 mmHg (contralateral arm served as the control and subjects ingested placebo capsules prior to exercise. A fourth session with 60 mmHg cuff pressure was performed with 1 g of vitamin C ingested prior to the session. Results Post-exercise FMD following the placebo conditions were lower in the cuffed arm versus the control arm (arm main effect: P P > 0.05. Following vitamin C treatment, post-exercise FMD in the cuffed and control arm increased from baseline (P P > 0.05. Conclusions These results indicate that augmented oscillatory and retrograde SR in non-working limbs during lower body exercise attenuates post-exercise FMD without an evident dose–response in the range of cuff pressures evaluated. Vitamin C supplementation prevented the attenuation of FMD following exercise with augmented oscillatory and retrograde SR suggesting that oxidative stress contributes to the adverse effects of oscillatory and

  14. Retrograde solubility of formamidinium and methylammonium lead halide perovskites enabling rapid single crystal growth

    KAUST Repository

    Saidaminov, Makhsud I.

    2015-10-20

    Here we show the retrograde solubility of various hybrid perovskites through the correct choice of solvent(s) and report their solubility curves. Retrograde solubility enables to develop inverse temperature crystallization of FAPbX3 (FA = HC(NH2)2+, X = Br−/I−). FAPbI3 crystals exhibit a 1.4 eV bandgap – considerably narrower than their polycrystalline counterparts.

  15. Anterior Cruciate Ligament Femoral Socket Drilling With a Retrograde Reamer: Lessons From the Learning Curve

    OpenAIRE

    2013-01-01

    Whereas “anatomic” anterior cruciate ligament reconstruction may improve clinical results, the technique has introduced new technical challenges. The purpose of this technical note and video is to explore tips and tricks that improve femoral socket drilling with a retrograde reamer, bone–patellar tendon–bone graft passage, and interference screw fixation. The techniques for retrograde femoral socket drilling in an inside-out direction, bone–patellar tendon–bone graft passage, and interference...

  16. Endoscopic management of gastrointestinal smooth muscle tumor

    Institute of Scientific and Technical Information of China (English)

    Xiao-Dong Zhou; Nong-Hua Lv; Hong-Xia Chen; Chong-Wen Wang; Xuan Zhu; Ping Xu; You-Xiang Chen

    2007-01-01

    AIM: To systematically evaluate the efficacy and safety of endoscopic resection of gastrointestinal smooth muscle tumors (SMTs, including leiomyoma and leiomyosarcoma) and to review our preliminary experiences on endoscopic diagnosis of gastrointestinal SMTs.METHODS: A total of 69 patients with gastrointestinal SMT underwent routine endoscopy in our department.Endoscopic ultrasonography (EUS) was also performed in 9 cases of gastrointestinal SMT. The sessile submucosal gastrointestinal SMTs with the base smaller than 2 cm in diameter were resected by "pushing" technique or "grasping and pushing" technique while the pedunculated SMTs were resected by polypectomy. For those SMTs originating from muscularis propria or with the base size ≥ 2 cm, ordinary biopsy technique was performed in tumors with ulcers while the "Digging" technique was performed in those without ulcers.RESULTS: 54 cases of leiomyoma and 15 cases of leiomyosarcoma were identified. In them, 19 cases of submucosal leiomyoma were resected by "pushing"technique and 10 cases were removed by "grasping and pushing" technique. Three cases pedunculated submucosal leiomyoma were resected by polypectomy.No severe complications developed during or after the procedure. No recurrence was observed. The diagnostic accuracy of ordinary and the "Digging" biopsy technique was 90.0% and 94.1%, respectively.CONCLUSION: Endoscopic resection is a safe and effective treatment for leiomyomas with the base size ≤2 cm. The "digging" biopsy technique would be a good option for histologic diagnosis of SMTs.

  17. Palliative Endoscopic Therapy of Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    H.Schaefer; A.H.Hoelscher

    2004-01-01

    Patients with locally unresectable esophageal cancer or distant metastasis are usually treated with definite radiotherapy or radiochemotherapy. Dysphagia of these patients should further be treated by endoscopic therapy in order to maintain swallowing and oral food intake as long as possible. The same situation is present in patients with local recurrence of esophageal cancer after surgery or radiochemotherapy.

  18. Shaft-Guidance for Flexible Endoscopes

    NARCIS (Netherlands)

    Loeve, A.J.

    2012-01-01

    Flexible endoscopes (long, slender, flexible instruments with a camera and light at the distal end, having working channels to introduce flexible instruments) are used for diagnostic and therapeutic interventions inside the human digestive system and inside the abdomen. Though used for their flexibi

  19. Application of fibrin glue on endoscopic liposuction

    Institute of Scientific and Technical Information of China (English)

    CHEN Zhong-cun; YANG Jia-feng; CHEN Qian-qian

    2001-01-01

    @@ OBJECTIVE To deserve the effects of FG (Fibrin Glue)on endoscopic liposuction. Methods:From Oct. 1998 to Aug. 2000 forty cases were undergoing for the liposuction. Atthe aids of tumescent teachnique, endoscopy and FG were used, of which 20 casesoperation on their abdominal walls, 8 cases upper abdomen walls and 12 cases ownerabdominal.

  20. Holographic high-resolution endoscopic image recording

    Science.gov (United States)

    Bjelkhagen, Hans I.

    1991-03-01

    Endoscopic holography or endoholography combines the features of endoscopy and holography. The purpose of endoholographic imaging is to provide the physician with a unique means of extending diagnosis by providing a life-like record of tissue. Endoholographic recording will provide means for microscopic examination of tissue and in some cases may obviate the need to excise specimens for biopsy. In this method holograms which have the unique properties of three-dimensionality large focal depth and high resolution are made with a newly designed endoscope. The endoscope uses a single-mode optical fiber for illumination and single-beam reflection holograms are recorded in close contact with the tissue at the distal end of the endoscope. The holograms are viewed under a microscope. By using the proper combinations of dyes for staining specific tissue types with various wavelengths of laser illumination increased contrast on the cellular level can be obtained. Using dyes such as rose bengal in combination with the 514. 5 nm line of an argon ion laser and trypan blue or methylene blue with the 647. 1 nm line of a krypton ion laser holograms of the stained colon of a dog showed the architecture of the colon''s columnar epithelial cells. It is hoped through chronological study using this method in-vivo an increased understanding of the etiology and pathology of diseases such as Crohn''s diseases colitis proctitis and several different forms of cancer will help

  1. High-resolution imaging using endoscopic holography

    Science.gov (United States)

    Bjelkhagen, Hans I.

    1990-08-01

    Endoscopic holography or endoholography combines the features of endoscopy and holography. The purpose of endoholographic imaging is to provide the physician with a unique means of extending diagnosis by providing a life-like record of tissue. Endoholographic recording will provide means for microscopic examination of tissue and in some cases may obviate the need to excise specimens for biopsy. In this method holograms which have the unique properties of three-dimensionality large focal depth and high resolution are made with a newly designed endoscope. The endoscope uses a single-mode optical fiber for illumination and single-beam reflection holograms are recorded in close contact with the tissue at the distal end of the endoscope. The holograms are viewed under a microscope. By using the proper combinations of dyes for staining specific tissue types with various wavelengths of laser illumination increased contrast on the cellular level can be obtained. Using dyes such as rose bengal in combination with the 514. 5 nm line of an argon ion laser and trypan blue or methylene blue with the 647. 1 nm line of a krypton ion laser holograms of the stained colon of a dog showed the architecture of the colon''s columnar epithelial cells. It is hoped through chronological study using this method in-vivo an increased understanding of the etiology and pathology of diseases such as Crohn''s diseases colitis proctitis and several different forms of cancer will help to their control. 1.

  2. A Confocal Endoscope for Cellular Imaging

    Directory of Open Access Journals (Sweden)

    Jiafu Wang

    2015-09-01

    Full Text Available Since its inception, endoscopy has aimed to establish an immediate diagnosis that is virtually consistent with a histologic diagnosis. In the past decade, confocal laser scanning microscopy has been brought into endoscopy, thus enabling in vivo microscopic tissue visualization with a magnification and resolution comparable to that obtained with the ex vivo microscopy of histological specimens. The major challenge in the development of instrumentation lies in the miniaturization of a fiber-optic probe for microscopic imaging with micron-scale resolution. Here, we present the design and construction of a confocal endoscope based on a fiber bundle with 1.4-μm lateral resolution and 8-frames per second (fps imaging speed. The fiber-optic probe has a diameter of 2.6 mm that is compatible with the biopsy channel of a conventional endoscope. The prototype of a confocal endoscope has been used to observe epithelial cells of the gastrointestinal tracts of mice and will be further demonstrated in clinical trials. In addition, the confocal endoscope can be used for translational studies of epithelial function in order to monitor how molecules work and how cells interact in their natural environment.

  3. Visual SLAM for Handheld Monocular Endoscope.

    Science.gov (United States)

    Grasa, Óscar G; Bernal, Ernesto; Casado, Santiago; Gil, Ismael; Montiel, J M M

    2014-01-01

    Simultaneous localization and mapping (SLAM) methods provide real-time estimation of 3-D models from the sole input of a handheld camera, routinely in mobile robotics scenarios. Medical endoscopic sequences mimic a robotic scenario in which a handheld camera (monocular endoscope) moves along an unknown trajectory while observing an unknown cavity. However, the feasibility and accuracy of SLAM methods have not been extensively validated with human in vivo image sequences. In this work, we propose a monocular visual SLAM algorithm tailored to deal with medical image sequences in order to provide an up-to-scale 3-D map of the observed cavity and the endoscope trajectory at frame rate. The algorithm is validated over synthetic data and human in vivo sequences corresponding to 15 laparoscopic hernioplasties where accurate ground-truth distances are available. It can be concluded that the proposed procedure is: 1) noninvasive, because only a standard monocular endoscope and a surgical tool are used; 2) convenient, because only a hand-controlled exploratory motion is needed; 3) fast, because the algorithm provides the 3-D map and the trajectory in real time; 4) accurate, because it has been validated with respect to ground-truth; and 5) robust to inter-patient variability, because it has performed successfully over the validation sequences.

  4. Endoscopic endonasal management of cerebrospinal fluid rhinorrhea.

    Science.gov (United States)

    Ozturk, Ozmen; Polat, Senol; Uneri, Cuneyd

    2012-07-01

    The authors review their 5 years' experience with endonasal endoscopic repair of the anterior skull base fistulas presenting with cerebrospinal fluid (CSF) rhinorrhea. A total of 12 patients were managed endoscopically between 2004 and 2008. Seven patients (58.3%) had nonsurgical posttraumatic CSF rhinorrhea, 2 patients (16.7%) had CSF rhinorrhea due to surgical/iatrogenic trauma, and 3 patients (25%) had spontaneous onset of CSF rhinorrhea. Radiosurgical correlation for CSF fistula identification was positive in all patients. The most common site of leak was the fovea ethmoidalis. The repair method consisted of an extradural underlay closure of a defect with fascia lata. The largest diameter of a defect to be closed was 15 mm. Immediate results were good in all patients, but later in the follow-up, CSF rhinorrhea recurred in 2 patients, and each patient had a revision 2 times. In the first revisions, transcranial approach was used, whereas in the second revisions endonasal endoscopic route was resorted. The primary closure rate was 83.3%, and the overall closure rate was 100%. The average follow-up period thus far is 21 months. Endonasal endoscopic technique well known to otolaryngologists should be considered as the first choice of surgery in the repair of CSF rhinorrhea because of low morbidity and a higher closure rate. The possibility of revision with the same technique makes this approach ideal for the repair of cranionasal osteodural defects.

  5. Endoscopic biopsy: Duodenal ulcer penetrating into liver

    Institute of Scientific and Technical Information of China (English)

    Baybora Kircali; Tülay Saricam; Aysegul Ozakyol; Eser Vardareli

    2005-01-01

    @@ TO THE EDITOR We have read with interest the recent report by E Kayacetin and S Kayacetin of Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy[1] since we diagnosed the duodenal ulcer which penetrated into liver similarly. This is a rather unusual case because of the fifth case in the literature and responding to medical therapy.

  6. Endoscopic hemoclip treatment for bleeding peptic ulcer

    Institute of Scientific and Technical Information of China (English)

    Yung Chih Lai; Sien Sing Yang; Chi Hwa Wu; Tzen Kwan Chen

    2000-01-01

    AIM To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and reclipping was performed if necessary and feasible.RESULTS Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2- 5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8 ). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device,the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.

  7. ENDOSCOPIC TREATMENT OF THE HYPOPHARYNGEAL (ZENKERS) DIVERTICULUM

    NARCIS (Netherlands)

    WOUTERS, B; VANOVERBEEK, JJM

    1992-01-01

    Over the years the techniques for endoscopic treatment of Zenker's diverticulum have been improved. Initially, in 1964, we used the electrocoagulation technique as described by Dohlman, but currently we prefer to sever the tissue bridge between the diverticulum and esophagus with the CO2 laser under

  8. Transanal Endoscopic Microsurgery: Current and Future Perspectives.

    Science.gov (United States)

    Gilshtein, Hayim; Duek, Simon-Daniel; Khoury, Wisam

    2016-06-01

    Transanal endoscopic microsurgery is part of the colorectal surgeons' armamentarium for over 2 decades. Since its first implementation for the resection of benign and T1 malignant lesions in the rectum several new indications were developed and it carries additional promise for further extension in upcoming years. Herein we review the technique, its current indications, novel implications, and future perspectives.

  9. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Hiroyuki Kon

    2014-01-01

    Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

  10. Endoscopic management of chronic radiation proctitis.

    Science.gov (United States)

    Rustagi, Tarun; Mashimo, Hiroshi

    2011-11-01

    Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.

  11. Update on the endoscopic treatments for achalasia.

    Science.gov (United States)

    Uppal, Dushant S; Wang, Andrew Y

    2016-10-21

    Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. High-resolution manometry allows for definitive diagnosis and classification of achalasia, with type II being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation (PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy (POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient's clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

  12. Endoscopic management of chronic radiation proctitis

    Institute of Scientific and Technical Information of China (English)

    Tarun Rustagi; Hiroshi Mashimo

    2011-01-01

    Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications.This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.

  13. Analysis of the color rendition of flexible endoscopes

    Science.gov (United States)

    Murphy, Edward M.; Hegarty, Francis J.; McMahon, Barry P.; Boyle, Gerard

    2003-03-01

    Endoscopes are imaging devices routinely used for the diagnosis of disease within the human digestive tract. Light is transmitted into the body cavity via incoherent fibreoptic bundles and is controlled by a light feedback system. Fibreoptic endoscopes use coherent fibreoptic bundles to provide the clinician with an image. It is also possible to couple fibreoptic endoscopes to a clip-on video camera. Video endoscopes consist of a small CCD camera, which is inserted into gastrointestinal tract, and associated image processor to convert the signal to analogue RGB video signals. Images from both types of endoscope are displayed on standard video monitors. Diagnosis is dependent upon being able to determine changes in the structure and colour of tissues and biological fluids, and therefore is dependent upon the ability of the endoscope to reproduce the colour of these tissues and fluids with fidelity. This study investigates the colour reproduction of flexible optical and video endoscopes. Fibreoptic and video endoscopes alter image colour characteristics in different ways. The colour rendition of fibreoptic endoscopes was assessed by coupling them to a video camera and applying video colorimetric techniques. These techniques were then used on video endoscopes to assess how the colour rendition of video endoscopes compared with that of optical endoscopes. In both cases results were obtained at fixed illumination settings. Video endoscopes were then assessed with varying levels of illumination. Initial results show that at constant luminance endoscopy systems introduce non-linear shifts in colour. Techniques for examining how this colour shift varies with illumination intensity were developed and both methodology and results will be presented. We conclude that more rigorous quality assurance is required to reduce colour error and are developing calibration procedures applicable to medical endoscopes.

  14. Retrogradation of Waxy Rice Starch Gel in the Vicinity of the Glass Transition Temperature

    Directory of Open Access Journals (Sweden)

    Sanguansri Charoenrein

    2013-01-01

    Full Text Available The retrogradation rate of waxy rice starch gel was investigated during storage at temperatures in the vicinity of the glass transition temperature of a maximally concentrated system (, as it was hypothesized that such temperatures might cause different effects on retrogradation. The value of fully gelatinized waxy rice starch gel with 50% water content and the enthalpy of melting retrograded amylopectin in the gels were investigated using differential scanning calorimetry. Starch gels were frozen to −30°C and stored at 4, 0, −3, −5, and −8°C for 5 days. The results indicated that the value of gelatinized starch gel annealed at −7°C for 15 min was −3.5°C. Waxy rice starch gels retrograded significantly when stored at 4°C with a decrease in the enthalpy of melting retrograded starch in samples stored for 5 days at −3, −5, and −8°C, respectively, perhaps due to the more rigid glass matrix and less molecular mobility facilitating starch chain recrystallization at temperatures below . This suggests that retardation of retrogradation of waxy rice starch gel can be achieved at temperature below .

  15. Retrogradation of Waxy Rice Starch Gel in the Vicinity of the Glass Transition Temperature.

    Science.gov (United States)

    Charoenrein, Sanguansri; Udomrati, Sunsanee

    2013-01-01

    The retrogradation rate of waxy rice starch gel was investigated during storage at temperatures in the vicinity of the glass transition temperature of a maximally concentrated system (T g '), as it was hypothesized that such temperatures might cause different effects on retrogradation. The T g ' value of fully gelatinized waxy rice starch gel with 50% water content and the enthalpy of melting retrograded amylopectin in the gels were investigated using differential scanning calorimetry. Starch gels were frozen to -30°C and stored at 4, 0, -3, -5, and -8°C for 5 days. The results indicated that the T g ' value of gelatinized starch gel annealed at -7°C for 15 min was -3.5°C. Waxy rice starch gels retrograded significantly when stored at 4°C with a decrease in the enthalpy of melting retrograded starch in samples stored for 5 days at -3, -5, and -8°C, respectively, perhaps due to the more rigid glass matrix and less molecular mobility facilitating starch chain recrystallization at temperatures below T g '. This suggests that retardation of retrogradation of waxy rice starch gel can be achieved at temperature below T g '.

  16. Impaired motoneuronal retrograde transport in two models of SBMA implicates two sites of androgen action.

    Science.gov (United States)

    Kemp, Michael Q; Poort, Jessica L; Baqri, Rehan M; Lieberman, Andrew P; Breedlove, S Marc; Miller, Kyle E; Jordan, Cynthia L

    2011-11-15

    Spinal and bulbar muscular atrophy (SBMA) impairs motor function in men and is linked to a CAG repeat mutation in the androgen receptor (AR) gene. Defects in motoneuronal retrograde axonal transport may critically mediate motor dysfunction in SBMA, but the site(s) where AR disrupts transport is unknown. We find deficits in retrograde labeling of spinal motoneurons in both a knock-in (KI) and a myogenic transgenic (TG) mouse model of SBMA. Likewise, live imaging of endosomal trafficking in sciatic nerve axons reveals disease-induced deficits in the flux and run length of retrogradely transported endosomes in both KI and TG males, demonstrating that disease triggered in muscle can impair retrograde transport of cargo in motoneuron axons, possibly via defective retrograde signaling. Supporting the idea of impaired retrograde signaling, we find that vascular endothelial growth factor treatment of diseased muscles reverses the transport/trafficking deficit. Transport velocity is also affected in KI males, suggesting a neurogenic component. These results demonstrate that androgens could act via both cell autonomous and non-cell autonomous mechanisms to disrupt axonal transport in motoneurons affected by SBMA.

  17. Focal retrograde amnesia: voxel-based morphometry findings in a case without MRI lesions.

    Directory of Open Access Journals (Sweden)

    Bernhard Sehm

    Full Text Available Focal retrograde amnesia (FRA is a rare neurocognitive disorder presenting with an isolated loss of retrograde memory. In the absence of detectable brain lesions, a differentiation of FRA from psychogenic causes is difficult. Here we report a case study of persisting FRA after an epileptic seizure. A thorough neuropsychological assessment confirmed severe retrograde memory deficits while anterograde memory abilities were completely normal. Neurological and psychiatric examination were unremarkable and high-resolution MRI showed no neuroradiologically apparent lesion. However, voxel-based morphometry (VBM-comparing the MRI to an education-, age-and sex-matched control group (n = 20 disclosed distinct gray matter decreases in left temporopolar cortex and a region between right posterior parahippocampal and lingual cortex. Although the results of VBM-based comparisons between a single case and a healthy control group are generally susceptible to differences unrelated to the specific symptoms of the case, we believe that our data suggest a causal role of the cortical areas detected since the retrograde memory deficit is the preeminent neuropsychological difference between patient and controls. This was paralleled by grey matter differences in central nodes of the retrograde memory network. We therefore suggest that these subtle alterations represent structural correlates of the focal retrograde amnesia in our patient. Beyond the implications for the diagnosis and etiology of FRA, our results advocate the use of VBM in conditions that do not show abnormalities in clinical radiological assessment, but show distinct neuropsychological deficits.

  18. Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports

    Directory of Open Access Journals (Sweden)

    Kawahara Takashi

    2012-07-01

    Full Text Available Abstract Introduction We previously reported on the effectiveness of ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy and report two cases of lower calyx calculi in horseshoe kidney that were successfully treated with ureteroscopy-assisted retrograde nephrostomy. During the ureteroscopy-assisted retrograde nephrostomy procedure, a ureteroscope is advanced in the desired calyx and a Lawson retrograde nephrostomy puncture wire is inserted. The wire is advanced through the calyx to exit the skin. The wire is then used for the percutaneous dilation. Case presentation Case 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19 × 15mm, 7 × 5mm, and 7 × 3mm in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10 × 8mm in horseshoe kidney. Conclusions Both patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.

  19. Retrogradation of Waxy Rice Starch Gel in the Vicinity of the Glass Transition Temperature

    Science.gov (United States)

    Charoenrein, Sanguansri; Udomrati, Sunsanee

    2013-01-01

    The retrogradation rate of waxy rice starch gel was investigated during storage at temperatures in the vicinity of the glass transition temperature of a maximally concentrated system (Tg′), as it was hypothesized that such temperatures might cause different effects on retrogradation. The Tg′ value of fully gelatinized waxy rice starch gel with 50% water content and the enthalpy of melting retrograded amylopectin in the gels were investigated using differential scanning calorimetry. Starch gels were frozen to −30°C and stored at 4, 0, −3, −5, and −8°C for 5 days. The results indicated that the Tg′ value of gelatinized starch gel annealed at −7°C for 15 min was −3.5°C. Waxy rice starch gels retrograded significantly when stored at 4°C with a decrease in the enthalpy of melting retrograded starch in samples stored for 5 days at −3, −5, and −8°C, respectively, perhaps due to the more rigid glass matrix and less molecular mobility facilitating starch chain recrystallization at temperatures below Tg′. This suggests that retardation of retrogradation of waxy rice starch gel can be achieved at temperature below Tg′. PMID:26904602

  20. Magnetic Resonance Cholangiopancreatography (MRCP)

    Science.gov (United States)

    ... any kind, including allergies to food or drugs, hay fever, hives or allergic asthma. However, the contrast ... not limited to: artificial heart valves implanted drug infusion ports artificial limbs or metallic joint prostheses implanted ...

  1. Magnetic Resonance Cholangiopancreatography (MRCP)

    Science.gov (United States)

    ... receive injections of gadolinium contrast material except when absolutely necessary for medical treatment. See the Safety page ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ...

  2. [Duodenal complications of rheumatoid purpura. Endoscopic aspects].

    Science.gov (United States)

    Chapoy, P; Guidon, M J; Louchet, E

    1984-01-01

    The aim of this work was to describe the endoscopic features and clinical outcome of the duodenal complications in anaphylactoid purpura. Over a 3-year period, 20 patients were hospitalized in our unit because of purpura rheumatica. Duodenal complications occurred in 5 cases warranting endoscopic assessment. All patients had bilious vomiting and epigastric pain, constantly associated with low-grade purpuric rash. Plasma factor XIII concentrations were always decreased. The duodenal complication was suspected radiologically in 2 cases when "thumbprint" impressions were seen. Petechiae, oedema and intramural hematoma with superficial erosions were present endoscopically in 3 cases. The lesions were severe and extensive, involving the entire duodenum in 3 cases and the jejunum in one case. In one patient, there was a stricture of the upper part of the second duodenum. Treatment consisted of parenteral nutrition (using a central catheter: 3 cases, or a peripheral vein: 2 cases) and cimetidine (30 mg/kg.bw). The clinical outcome was favorable in 4 patients; the symptoms vanished and the endoscopic lesions were reversible (including the stricture) with restitutio ad integrum after 10 days. The last patient died the 8th day of treatment, 3 days after digestive improvement; the cause of death was probably iatrogenic and related to accidental migration of the central catheter. These results suggest that endoscopic examination should be performed in all patients with anaphylactoid purpura presenting with bilious vomiting. Endoscopy seems to be of great value in deciding if parenteral nutrition is indicated--or not--and perhaps in order to contraindicate the use of steroid therapy in the case of ulcerated hematomas.

  3. Update on endoscopic pancreatic function testing

    Institute of Scientific and Technical Information of China (English)

    Tyler Stevens; Mansour A Parsi

    2011-01-01

    Hormone-stimulated pancreatic function tests (PFTs) are considered the gold standard for measuring pancreatic exocrine function. PFTs involve the administration of intravenous secretin or cholecystokinin, followed by collection and analysis of pancreatic secretions. Because exocrine function may decline in the earliest phase of pancreatic fibrosis, PFTs are considered accurate for diagnosing chronic pancreatitis. Unfortunately, these potentially valuable tests are infrequently performed except at specialized centers, because they are time consuming and complicated. To overcome these limitations, endoscopic PFT methods have been developed which include aspiration of pancreatic secretions through the suction channel of the endoscope. The secretin endoscopic pancreatic function test (ePFT) involves collection of duodenal aspirates at 15, 30, 45 and 60 min after secretin stimulation. A bicarbonate concentration greater than 80 mmol/L in any of the samples is considered a normal result. The secretin ePFT has demonstrated good sensitivity and specificity compared with various reference standards, including the "Dreiling tube" secretin PFT, endoscopic ultrasound, and surgical histology. Furthermore, a standard autoanalyzer can be used for bicarbonate analysis, which allows the secretin ePFT to be performed at any hospital. The secretin ePFT may complement imaging tests like endoscopic ultrasound (EUS) in the diagnosis of early chronic pancreatitis.This paper will review the literature validating the use of ePFT in the diagnosis of exocrine insufficiency and chronic pancreatitis. Newer developments will also be discussed, including the feasibility of combined EUS/ePFT, the use of cholecystokinin alone or in combination with secretin, and the discovery of new protein and lipid pancreatic juice biomarkers which may complement traditionalfluid analysis.

  4. Radiological findings after endoscopic incision of ureterocele

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Cheon, Jung Eun [Chungmu General Hospital, Chungmu (Korea, Republic of); Seok, Eul Hye [Seran General Hospital, Seoul (Korea, Republic of); Cha, Joo Hee [Green General Hospital, Seoul(Korea, Republic of); Choi, Guk Myung [Halla General Hospital, Cheju (Korea, Republic of)

    2001-01-01

    Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required.

  5. Endoscope-assisted microneurosurgery for intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Renato Juan Galzio

    2013-12-01

    Full Text Available Background:The endovascular techniques has widely changed the treatment of intracranial aneurysms.However surgery still represent the best therapeutic option in case of broad-based and complex lesions.The combined use of endoscopic and microsurgical techniques (EAM may improve surgical results. Objective:The purpose of our study is to evaluate the advantages and limits of EAM for intracranial aneurysms.Methods:Between January 2002 and December 2012,173 patients,harbouring 206 aneurysms were surgically treated in our department with the EAM technique.157 aneurysms were located in the anterior circulation and 49 were in the posterior circulation.Standard tailored approaches,based on skull base surgery principles,were chosen.The use of the endoscope included three steps:initial inspection,true operative time and final inspection.For each procedure,an intraoperative video and an evaluation schedule were prepared,to report surgeons’ opinions about the technique itself.In the first cases,we always used the endoscope during surgical procedures in order to get an adequate surgical training.Afterwards we became aware in selecting cases in which to apply the endoscopy,as we started to become familiar with its advantages and limits.Results:After clipping,all patients were undergone postoperative cerebral angiography.No surgical mortality related to EAM were observed.Complications directly related to endoscopic procedures were rare.Conclusions:Our retrospective study suggests that endoscopic efficacy for aneurysms is only scarcely influenced by the preoperative clinical condition (Hunt-Hess grade,surgical timing,presence of blood in the cisterns (Fisher grade and/or hydrocephalus.However the most important factors contributing to the efficacy of EAM are determined by the anatomical locations and sizes of the lesions.Furthermore,the advantages are especially evident using dedicated scopes and holders,after an adequate surgical training to increase the

  6. Retrograde degeneration of retinal ganglion cells in homonymous hemianopsia

    Directory of Open Access Journals (Sweden)

    Herro AM

    2015-06-01

    Full Text Available Angela M Herro, Byron L Lam Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA Background: The aim of this study was to demonstrate the relationship between topographic reduction in macular ganglion cell complex (GCC thickness as detected with spectral-domain optical coherence tomography and visual field defects caused by ischemic occipital cortical injury.Methods: This study was a retrospective review of all patients who presented to our eye institution between January 2012 and July 2014 with visual field defects secondary to ischemic cortical injury. The visual field defect pattern and mean deviation were analyzed. Retinal nerve fiber layer (RNFL and macular GCC were both assessed with spectral-domain optical coherence tomography. Patients with any ocular pathology that could affect these measurements were excluded. The topographic relationship of visual field defect to reduction in GCC was specifically analyzed. Results: Nine patients met the inclusion criteria. Their average age was 65 (57–73 years; eight were men and six had right hemianopsias. The laterality of the visual field defect was used to assign an affected and unaffected side of analysis for RNFL and GCC layer thickness. A right hemianopsia meant that the nasal fibers of the right eye and temporal fibers of the left eye were assigned as the “affected side”, and the temporal fibers of the right eye and nasal fibers of the left eye were assigned as “unaffected”. There was no statistically significant difference between affected and unaffected RNFL. However, there was a significant difference in GCC layer reduction between the affected and unaffected sides (P=0.029.Conclusion: There is evidence of retrograde trans-synaptic retinal ganglion cell loss in patients with homonymous hemianopsias from cortical visual impairment. This relationship is reflected in thinning of the GCC and maintains the topographic

  7. Effects of soy protein hydrolysates on maize starch retrogradation studied by IR spectra and ESI-MS analysis.

    Science.gov (United States)

    Lian, Xijun; Zhu, Wei; Wen, Yan; Li, Lin; Zhao, Xiaoshuang

    2013-08-01

    Starch retrogradation is the main cause of quality deterioration of starch-containing foods during storage. The purpose of this study is to find out whether certain soy protein polypeptide in hydrolysates will retard maize starch retrogradation. The results show that all soy protein hydrolysates retard maize starch retrogradation to a certain extent. The IR spectra of hydrolysates and the blends of hydrolysates and maize starch show that the polypeptides might act with reducing end of maize starch during retrogradation. The results of electrospray ionization-mass spectrometry [ESI-MS] show that the polypeptide (m/z 863) is present in all three hydrolysates remarkedly retarding maize starch retrogradation and its relative abundence is also the highest. So the polypeptide containing seven amino acids probably is the key component to significantly inhibit maize starch retrogradation.

  8. On remembering and forgetting our autobiographical pasts: retrograde amnesia and Andrew Mayes's contribution to neuropsychological method.

    Science.gov (United States)

    Kopelman, M D; Bright, P

    2012-11-01

    Andrew Mayes's contribution to the neuropsychology of memory has consisted in steadily teasing out the nature of the memory deficit in the amnesic syndrome. This has been done with careful attention to matters of method at all stages. This particularly applies to his investigations of forgetting rates in amnesia and to his studies of retrograde amnesia. Following a brief outline of his work, the main current theories of retrograde amnesia are considered: consolidation theory, episodic-to-semantic shift theory, and multiple trace theory. Findings across the main studies in Alzheimer dementia are reviewed to illustrate what appears to be consistently found, and what is much more inconsistent. A number of problems and issues in current theories are then highlighted--including the nature of the temporal gradient, correlations with the extent of temporal lobe damage, what we would expect 'normal' remote memory curves to look like, how they would appear in focal retrograde amnesia, and whether we can pinpoint retrograde amnesia to hippocampal/medial temporal damage on the basis of existing studies. A recent study of retrograde amnesia is re-analysed to demonstrate temporal gradients on recollected episodic memories in hippocampal/medial temporal patients. It is concluded that there are two requirements for better understanding of the nature of retrograde amnesia: (i) a tighter, Mayesian attention to method in terms of both the neuropsychology and neuroimaging in investigations of retrograde amnesia; and (ii) acknowledging that there may be multiple factors underlying a temporal gradient, and that episodic and semantic memory show important interdependencies at both encoding and retrieval. Such factors may be critical to understanding what is remembered and what is forgotten from our autobiographical pasts.

  9. Design of embedded endoscopic ultrasonic imaging system

    Science.gov (United States)

    Li, Ming; Zhou, Hao; Wen, Shijie; Chen, Xiodong; Yu, Daoyin

    2008-12-01

    Endoscopic ultrasonic imaging system is an important component in the endoscopic ultrasonography system (EUS). Through the ultrasonic probe, the characteristics of the fault histology features of digestive organs is detected by EUS, and then received by the reception circuit which making up of amplifying, gain compensation, filtering and A/D converter circuit, in the form of ultrasonic echo. Endoscopic ultrasonic imaging system is the back-end processing system of the EUS, with the function of receiving digital ultrasonic echo modulated by the digestive tract wall from the reception circuit, acquiring and showing the fault histology features in the form of image and characteristic data after digital signal processing, such as demodulation, etc. Traditional endoscopic ultrasonic imaging systems are mainly based on image acquisition and processing chips, which connecting to personal computer with USB2.0 circuit, with the faults of expensive, complicated structure, poor portability, and difficult to popularize. To against the shortcomings above, this paper presents the methods of digital signal acquisition and processing specially based on embedded technology with the core hardware structure of ARM and FPGA for substituting the traditional design with USB2.0 and personal computer. With built-in FIFO and dual-buffer, FPGA implement the ping-pong operation of data storage, simultaneously transferring the image data into ARM through the EBI bus by DMA function, which is controlled by ARM to carry out the purpose of high-speed transmission. The ARM system is being chosen to implement the responsibility of image display every time DMA transmission over and actualizing system control with the drivers and applications running on the embedded operating system Windows CE, which could provide a stable, safe and reliable running platform for the embedded device software. Profiting from the excellent graphical user interface (GUI) and good performance of Windows CE, we can not

  10. Engineering aspects of a fully mirrored endoscope

    Energy Technology Data Exchange (ETDEWEB)

    Terra, A., E-mail: a.terra@fz-juelich.de [Institute for Energy and Climate Research IEK-4 (Plasma Physics), Forschungszentrum Jülich GmbH, Assoc. EURATOM-FZJ, Member of the Trilateral Euregio Cluster, D-52425 Jülich (Germany); Huber, A.; Schweer, B.; Mertens, Ph. [Institute for Energy and Climate Research IEK-4 (Plasma Physics), Forschungszentrum Jülich GmbH, Assoc. EURATOM-FZJ, Member of the Trilateral Euregio Cluster, D-52425 Jülich (Germany); Arnoux, G.; Balshaw, N. [Euratom-CCFE Fusion Association, Culham Science Centre, Abingdon, OX14 3DB (United Kingdom); Brezinsek, S. [Institute for Energy and Climate Research IEK-4 (Plasma Physics), Forschungszentrum Jülich GmbH, Assoc. EURATOM-FZJ, Member of the Trilateral Euregio Cluster, D-52425 Jülich (Germany); Egner, S.; Hartl, M.; Kampf, D. [Kayser-Threde GmbH, D-81379 Munich (Germany); Klammer, J. [KRP-Mechatec Engineering GbR, D-85748 Garching (Germany); Lambertz, H.T. [Institute for Energy and Climate Research IEK-4 (Plasma Physics), Forschungszentrum Jülich GmbH, Assoc. EURATOM-FZJ, Member of the Trilateral Euregio Cluster, D-52425 Jülich (Germany); Morlock, C.; Murari, A. [EFDA-CSU, D-85748 Garching (Germany); Reindl, M. [KRP-Mechatec Engineering GbR, D-85748 Garching (Germany); Sanders, S. [Euratom-CCFE Fusion Association, Culham Science Centre, Abingdon, OX14 3DB (United Kingdom); Sergienko, G. [Institute for Energy and Climate Research IEK-4 (Plasma Physics), Forschungszentrum Jülich GmbH, Assoc. EURATOM-FZJ, Member of the Trilateral Euregio Cluster, D-52425 Jülich (Germany); Spencer, G. [Euratom-CCFE Fusion Association, Culham Science Centre, Abingdon, OX14 3DB (United Kingdom); and others

    2013-10-15

    Highlights: ► Replacement of JET diagnostics to match the new ITER-like Wall. ► The endoscope test ITER-like design with only mirror based optics. ► Withstanding and diagnostic capability during Plasma operation and disruptions. ► Engineering process from design to installation and procurement. -- Abstract: The development of optical diagnostics, like endoscopes, compatible with the ITER environment (metallic plasma facing components, neutron proof optics, etc.) is a challenge, but current tokamaks such as JET provide opportunities to test fully working concepts. This paper describes the engineering aspects of a fully mirrored endoscope that has recently been designed, procured and installed on JET. The system must operate in a very strict environment with high temperature, high magnetic fields up to B = 4 T and rapid field variations (∂B/∂t ∼ 100 T/s) that induce high stresses due to eddy currents in the front mirror assembly. It must be designed to withstand high mechanical loads especially during disruptions, which lead to acceleration of about 7 g at 14 Hz. For the JET endoscope, when the plasma thermal loading, direct and indirect, was added to the assumed disruption loads, the reserve factor, defined as a ratio of yield strength over summed up von Mises stresses, was close to 1 for the mirror components. To ensure reliable operation, several analyses were performed to evaluate the thermo-mechanical performance of the endoscope and a final validation was obtained from mechanical and thermal tests, before the system's final installation in May 2011. During the tests, stability of the field of view angle variation was kept below 1° despite the high thermal gradient on endoscope head (∂T/∂x ∼ 500 K/m). In parallel, to ensure long time operation and to prevent undesirable performance degradation, a shutter system was also implemented in order to reduce impurity deposition on in-vessel mirrors but also to allow in situ transmission

  11. Military Readiness: DOD Needs to Incorporate Elements of a Strategic Management Planning Framework into Retrograde and Reset Guidance

    Science.gov (United States)

    2016-05-01

    departmental documents used to inform budget estimates on retrograde and reset costs , Congress may not receive consistent and accurate information to make...not align with DOD-wide goals and strategies for retrograde and reset, reset-related maintenance costs may not be consistently included, and...the Department of Defense (DOD) is in the process of reconstituting, retrograding, and resetting forces, equipment, and materiel to meet current and

  12. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery.

    Science.gov (United States)

    Campo, Rudi; Wattiez, Arnaud; Tanos, Vasilis; Di Spiezio Sardo, Attilio; Grimbizis, Grigoris; Wallwiener, Diethelm; Brucker, Sara; Puga, Marco; Molinas, Roger; O'Donovan, Peter; Deprest, Jan; Van Belle, Yves; Lissens, Ann; Herrmann, Anja; Tahir, Mahmood; Benedetto, Chiara; Siebert, Igno; Rabischong, Benoit; De Wilde, Rudy Leon

    2016-04-01

    In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.

  13. Pancreatic sphincterotomy: Technique, indications, and complications

    Institute of Scientific and Technical Information of China (English)

    Jonathan M Buscaglia; Anthony N Kalloo

    2007-01-01

    Pancreatic sphincterotomy serves as the cornerstone of endoscopic therapy of the pancreas. Historically,its indications have been less well-defined than those of endoscopic biliary sphincterotomy, yet it plays a definite and useful role in diseases such as chronic pancreatitis and pancreatic-type sphincter of Oddi dysfunction. In the appropriate setting, it may be used as a single therapeutic maneuver, or in conjunction with other endoscopic techniques such as pancreatic stone extraction or stent placement. The current standard of practice utilizes two different methods of performing pancreatic sphincterotomy: a pull-type sphincterotome technique without prior stent placement, and a needleknife sphincterotome technique over an existing stent. The complications associated with pancreatic sphincterotomy are many, although acute pancreatitis appears to be the most common and the most serious of the early complications. As such, it continues to be reserved for those endoscopists who perform a relatively high-volume of therapeutic pancreaticobiliary endoscopic retrograde cholangio-pancreatography.

  14. Endoscopic treatment of vesicoureteral reflux in pediatric patients

    Directory of Open Access Journals (Sweden)

    Jong Wook Kim

    2013-04-01

    Full Text Available Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR. Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

  15. The retrogradation properties of glutinous rice and buckwheat starches as observed with FT-IR, 13C NMR and DSC.

    Science.gov (United States)

    Lian, Xijun; Wang, Changjun; Zhang, Kunsheng; Li, Lin

    2014-03-01

    The experiment was conducted to study the retrogradation properties of glutinous rice and buckwheat starch with wavelengths of maximum absorbance, FT-IR, (13)C NMR, and DSC. The results show that the starches in retrograded glutinous rice starch and glutinous rice amylopectin could not form double helix. The IR results show that protein inhabits in glutinous rice and maize starches in a different way and appearance of C-H symmetric stretching vibration at 2852 cm(-1) in starch might be appearance of protein. Retrogradation untied the protein in glutinous amylopectin. Enthalpies of sweet potato and maize granules are higher than those of their retrograded starches. The (13)C NMR results show that retrogradation of those two starches leads to presence of β-anomers and retrogradation might decompose lipids in glutinous rice amylopectin into small molecules. Glutinous rice starch was more inclined to retrogradation than buckwheat starch. The DSC results show that the second peak temperatures for retrograded glutinous rice and buckwheat starches should be assigned to protein. The SEM results show that an obvious layer structure exists in retrograded glutinous rice amylopectin.

  16. The use of a cutting balloon in contemporary reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique.

    Science.gov (United States)

    Nakabayashi, Keisuke; Okada, Hisayuki; Oka, Toshiaki

    2016-07-11

    The key concept of reverse controlled antegrade and retrograde tracking (CART) technique is retrograde puncture with a tapered wire to an antegrade balloon (contemporary reverse CART) or new connections between the antegrade and retrograde subintimal space (classical reverse CART). In our case, a 75-year-old man with severe chronic total occlusion of the right coronary artery, reverse CART with conventional balloons could not be accomplished. Externalization wiring was completed by contemporary reverse CART using a cutting balloon as an antegrade balloon to improve the fenestration force of the retrograde guidewire. Thus, the use of a cutting balloon for contemporary reverse CART might be promising.

  17. Eosinophilic esophagitis-endoscopic distinguishing findings

    Institute of Scientific and Technical Information of China (English)

    Ana Célia Caetano; Raquel Gon(c)alves; Carla Rolanda

    2012-01-01

    Eosinophilic esophagitis (EE) is the most frequent condition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases.The hypothetical pathophysiological mechanism is related to a hypersensitivity reaction.Gastroesophageal reflux disease-like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impaction are likely presentations of EE.Due to its unclear pathogenesis and unspecific symptoms,it is difficult to diagnose EE without a strong suspicion.Although histological criteria are necessary to diagnosis EE,there are some characteristic endoscopic features.We present the case of a healthy 55-year-old woman with dysphagia and several episodes of esophageal food impaction over the last six months.This case report stresses the most distinguishing endoscopic findings-mucosa rings,white exudative plaques and linear furrows-that can help in the prompt recognition of this condition.

  18. Endoscopic submucosal dissection for gastrointestinal neoplasms

    Institute of Scientific and Technical Information of China (English)

    Naomi Kakushima; Mitsuhiro Fujishiro

    2008-01-01

    Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion,cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms.Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

  19. Endoscopic imaging of Barrett’s esophagus

    Institute of Scientific and Technical Information of China (English)

    Mariam Naveed; Kerry B Dunbar

    2016-01-01

    The incidence of esophageal adenocarcinoma(EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett’s esophagus(BE),a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC,GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE.

  20. Pediatric endoscopic surgery: pride and prejudice.

    Science.gov (United States)

    Delarue, A; Guys, J M; Louis-Borrione, C; Simeoni, J; Esposito, C

    1994-12-01

    82 endoscopic surgical procedures (abdominal: 77; thoracic: 5) were performed by the same surgeon on 75 children aged from 1 month to 17 years (median 8.1 years) during the two-year period from January 1991 to December 1992. Due to the multispecialization of the Children's Hospital, a variety of pathologies were explored or treated with appendectomy accounting for 33% (27/82). There were no perioperative deaths. Three major complications occurred (1 post-appendectomy peritonitis, 1 hemorrhage during splenectomy and 1 post-operative occlusion). 14 patients required conversion to open surgery. Indications for endoscopic exploration of advanced lesions, prospective indications, and policy when confronted with a healthy appendix are discussed.