Endoscopic treatment of vesicoureteral reflux in pediatric patients

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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.

Fabrication of Shatter-Proof Metal Hollow-Core Optical Fibers for Endoscopic Mid-Infrared Laser Applications

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Katsumasa Iwai

2018-04-01

Full Text Available A method for fabricating robust and thin hollow-core optical fibers that carry mid-infrared light is proposed for use in endoscopic laser applications. The fiber is made of stainless steel tubing, eliminating the risk of scattering small glass fragments inside the body if the fiber breaks. To reduce the inner surface roughness of the tubing, a polymer base layer is formed prior to depositing silver and optical-polymer layers that confine light inside the hollow core. The surface roughness is greatly decreased by re-coating thin polymer base layers. Because of this smooth base layer surface, a uniform optical-polymer film can be formed around the core. As a result, clear interference peaks are observed in both the visible and mid-infrared regions. Transmission losses were also low for the carbon dioxide laser used for medical treatments as well as the visible laser diode used for an aiming beam. Measurements of bending losses for these lasers demonstrate the feasibility of the designed fiber for endoscopic applications.

Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis.

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Jiang, Li; Ning, Deng; Cheng, Qi; Chen, Xiao-Ping

2018-04-21

Endoscopic therapy and surgery are both conventional treatments to remove pancreatic duct stones that developed during the natural course of chronic pancreatitis. However, few studies comparing the effect and safety between surgery drainage and endoscopic drainage (plus Extracorporeal Shock Wave Lithotripsy, ESWL).The aim of this study was to compare the benefits between endoscopic and surgical drainage of the pancreatic duct for patients with calcified chronic pancreatitis. A total of 86 patients were classified into endoscopic/ESWL (n = 40) or surgical (n = 46) treatment groups. The medical records of these patients were retrospectively analyzed. Pain recurrence and hospital stays were similar between the endoscopic/ESWL treatment and surgery group. However, endoscopic/ESWL treatment yielded significantly lower medical expense and less complications compared with the surgical treatment. In selective patients, endoscopic/ESWL treatment could achieve comparable efficacy to the surgical treatment. With lower medical expense and less complications, endoscopic/ESWL treatment would be much preferred to be the initial treatment of choice for patients with calcified chronic pancreatitis. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Endoscopic approaches to treatment of achalasia

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Friedel, David; Modayil, Rani; Iqbal, Shahzad; Grendell, James H.

2013-01-01

Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy. PMID:23503707

Analysis of opto-thermal interaction of porcine stomach tissue with 808-nm laser for endoscopic submucosal dissection

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Seongjun Kim

2015-11-01

Full Text Available In endoscopic submucosal dissection (ESD, the narrow gastrointestinal space can cause difficulty in surgical interventions. Tissue ablation apparatuses with high-power CO2 lasers or Nd:YAG lasers have been developed to facilitate endoscopic surgical procedures. We studied the interaction of 808-nm laser light with a porcine stomach tissue, with the aim of developing a therapeutic medical device that can remove lesions at the gastrointestinal wall by irradiating a near-infrared laser light incorporated in an endoscopic system. The perforation depths at the porcine fillet and the stomach tissues linearly increased in the range of 2–8 mm in proportion to the laser energy density of 63.7–382 kJ/cm2. Despite the distinct structural and compositional difference, the variation of the perforation depth between the stomach and the fillet was not found at 808-nm wavelength in our measurement. We further studied the laser–tissue interaction by changing the concentration of the methyl blue solution used conventionally as a submucosal fluidic cushion (SFC in ESD procedures. The temperature of the mucosal layer increased more rapidly at higher concentration of the methyl blue solution, because of enhanced light absorption at the SFC layer. The insertion of the SFC would protect the muscle layer from thermal damage. We confirmed that more effective laser treatment should be enabled by tuning the opto-thermal properties of the SFC. This study can contribute to the optimization of the driving parameters for laser incision techniques as an alternative to conventional surgical interventions.

EXPERIENCE WITH ROBOTIC LUMЕNIS CO LASER IN ENDOSCOPIC LARYNGEAL SURGERY

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E. N. Novozhilova

2014-01-01

Full Text Available  2 The paper describes the first experience in using robotic CO laser at the Department of Head and Neck Tumors, Moscow City Cancer Hospital Sixty-Two. With advances in endoscopic techniques and anesthesiology, there have been new possibilities of usingdirect (rigid larygoscopy in conjunction with laser systems.The Lumеnis laser assembly consists of three interconnected components: a videocamera, an operating microscope, and directly CO laser. It includes a computer system that sets a program to perform an operation.The heart of the laser system is a scanning Digital Acu Blade micromanipulator. This unique assembly makes itpossible to control the area and depth of incision, to cut intricate shapes in relation to the surface anatomy, and to precisely control ablation and hemostasis. The effect of tissue carbonization during surgery is minimal at the expense of the physical characteristics and different modes of radiation. It is noted that this system allows organ-sparing treatment in cancer patients and their prompt rehabilitation after surgical interventions.

Endoscopic removal of laser-cut covered self-expandable metallic biliary stents: A report of six cases.

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Tanisaka, Yuki; Ryozawa, Shomei; Kobayashi, Masanori; Harada, Maiko; Kobatake, Tsutomu; Omiya, Kumiko; Iwano, Hirotoshi; Arai, Shin; Nonaka, Kouichi; Mashimo, Yumi

2018-02-01

Covered self-expandable metallic stents (CSEMS) may provide palliative drainage for unresectable distal malignant biliary strictures. Laser-cut CSEMS allows easy positioning due to its characteristic of minimal stent shortening. Endoscopic stent removal is sometimes recommended for recurrent biliary obstruction (RBO). However, there are no previous reports of endoscopic removal of laser-cut CSEMS. The current study presents data from 6 patients who were placed a laser-cut CSEMS for unresectable distal malignant biliary strictures, and later endoscopic stent removal was attempted for RBO at the present institute. The duration of stent placement, the procedural success rate, the procedural duration, and accidental complications were evaluated. The mean duration of stent placement was 156±37.9 days (range, 117-205). The procedural success rate was 100%. The mean procedural duration was 11.8±7.5 min (range, 5-24). No complications were reported. Laser-cut CSEMS were safely removed from all patients. The present case report is the first to demonstrate that Endoscopic stent removal of laser-cut CSEMS was safely performed.

Diode laser assisted minimal invasive sphenoidotomy for endoscopic transphenoidal pituitary surgery: our technique and results.

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Lee, Jih-Chin; Lai, Wen-Sen; Ju, Da-Tong; Chu, Yueng-Hsiang; Yang, Jinn-Moon

2015-03-01

During endoscopic sinus surgery (ESS), intra-operative bleeding can significantly compromise visualization of the surgical field. The diode laser that provides good hemostatic and vaporization effects and excellent photocoagulation has been successfully applied in endoscopic surgery with several advantages. The current retrospective study demonstrates the feasibility of diode laser-combined endoscopic sinus surgery on sphenoidotomy. The patients who went through endoscopic transphenoidal pituitary surgery were enrolled. During the operation, the quality of the surgical field was assessed and graded by the operating surgeon using the scale proposed by Boezaart. The mean operation time was 37.80 ± 10.90 minutes. The mean score on the quality of surgical field was 1.95. A positive correlation between the lower surgical field quality score and the shorter surgical time was found with statistical significance (P diode laser-assisted sphenoidotomy is a reliable and safe approach of pituitary gland surgery with minimal invasiveness. It is found that application of diode laser significantly improved quality of surgical field and shortened operation time. © 2015 Wiley Periodicals, Inc.

Complications of endoscopic CO2 laser surgery for laryngeal cancer and concepts of their management.

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Prgomet, Drago; Bačić, Antun; Prstačić, Ratko; Janjanin, Saša

2013-01-01

Endoscopic CO 2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly re- ported advantages of ELS are good oncologic results with low incidence of complications. Although less common if com- pared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood tra...

Side effects of endobronchial laser treatment

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Dierkesmann, R.; Huzly, A.

1985-03-01

Side effects that have occurred in over 250 endobronchial laser treatments are reported. The laser has been used in severe tracheal and in bronchial obstructions. In two cases significant bleeding had to be treated with tamponade. In one patient an emphysema of the mediastinum developed, in 2 further patients a small pneumothorax. Perforation of the airway was not detected and no special treatment was necessary. Three patients with life-threatening tracheal stenoses and one patient with severe stenosis of both the mainstem bronchi due to metastasis in the bifurcation lymph node had a large defect in the tracheal or bronchial wall with a deep necrosis five to twelve weeks after laser treatment; all these patients had extensive radiotherapy in addition. One patient died due to severe respiratory insufficiency, probably caused by smoke intoxication. After the laser treatment, rubber-like fibrin-rich plaques may develop, which can lead to life-threatening obstructions of the airway. It is recommended that laser bronchoscopy should be performed with the rigid bronchoscope. After treatment of tracheal lesion an endoscopic check must be performed within 24 hours. The combination of laser treatment and radiotherapy seems to involve a certain risk of large defects in the bronchial wall due to necrosis of the tumor.

Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review

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Francisco Botelho

2012-01-01

Full Text Available Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction.

Endoscopic treatment of esophageal achalasia.

Science.gov (United States)

Esposito, Dario; Maione, Francesco; D'Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D

2016-01-25

Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.

Endoscopic treatment of esophageal achalasia

Science.gov (United States)

Esposito, Dario; Maione, Francesco; D’Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D

2016-01-01

Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies. PMID:26839644

Modelling of a laser-pumped light source for endoscopic surgery

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Nadeau, Valerie J.; Elson, Daniel S.; Hanna, George B.; Neil, Mark A. A.

2008-09-01

A white light source, based on illumination of a yellow phosphor with a fibre-coupled blue-violet diode laser, has been designed and built for use in endoscopic surgery. This narrow light probe can be integrated into a standard laparoscope or inserted into the patient separately via a needle. We present a Monte Carlo model of light scattering and phosphorescence within the phosphor/silicone matrix at the probe tip, and measurements of the colour, intensity, and uniformity of the illumination. Images obtained under illumination with this light source are also presented, demonstrating the improvement in illumination quality over existing endoscopic light sources. This new approach to endoscopic lighting has the advantages of compact design, improved ergonomics, and more uniform illumination in comparison with current technologies.

Utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.

Science.gov (United States)

Jayarao, Mayur; Devaiah, Anand K; Chin, Lawrence S

2011-01-01

This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery. A retrospective chart review identified 16 patients who underwent laser-assisted transsphenoidal surgery. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates. Sixteen pituitary lesions (pituitary adenomas, 12; Rathke cleft cyst, 2; pituitary cyst and craniopharyngioma, 1 each) with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal transsphenoidal surgery. Of the adenomas, 8 were nonsecreting and 4 were secreting (3 prolactinomas and 1 ACTH secreting). Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients (100%) after a mean follow-up of 19.3 months. Postoperative complications occurred in 3 patients (18.75%): 2 patients developed transient diabetes insipidus (DI) and 1 developed a CSF leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions. We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

Photoactive dye enhanced tissue ablation for endoscopic laser prostatectomy

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Ahn, Minwoo; Nguyen, Trung Hau; Nguyen, Van Phuc; Oh, Junghwan; Kang, Hyun Wook

2015-02-01

Laser light has been widely used as a surgical tool to treat benign prostate hyperplasia with high laser power. The purpose of this study was to validate the feasibility of photoactive dye injection to enhance light absorption and eventually to facilitate tissue ablation with low laser power. The experiment was implemented on chicken breast due to minimal optical absorption Amaranth (AR), black dye (BD), hemoglobin powder (HP), and endoscopic marker (EM), were selected and tested in vitro with a customized 532-nm laser system with radiant exposure ranging from 0.9 to 3.9 J/cm2. Light absorbance and ablation threshold were measured with UV-VIS spectrometer and Probit analysis, respectively, and compared to feature the function of the injected dyes. Ablation performance with dye-injection was evaluated in light of radiant exposure, dye concentration, and number of injection. Higher light absorption by injected dyes led to lower ablation threshold as well as more efficient tissue removal in the order of AR, BD, HP, and EM. Regardless of the injected dyes, ablation efficiency principally increased with input parameter. Among the dyes, AR created the highest ablation rate of 44.2+/-0.2 μm/pulse due to higher absorbance and lower ablation threshold. Preliminary tests on canine prostate with a hydraulic injection system demonstrated that 80 W with dye injection yielded comparable ablation efficiency to 120 W with no injection, indicating 33 % reduced laser power with almost equivalent performance. In-depth comprehension on photoactive dye-enhanced tissue ablation can help accomplish efficient and safe laser treatment for BPH with low power application.

Combined endoscopic approaches to the cardiac sphincter achalasia treatment

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V. N. Klimenko

2015-12-01

Full Text Available Aim. To assess combined endoscopic approaches to the cardiac sphincter achalasia treatment. Results. There are preliminary results of treatment and methods of carrying out of combined endoscopic pneumocardiodilatation and injections of botulotoxin type A ‘Disport’ at achalasia cardia are described in the article. Aethio-pathogenetic aspects in the development of achalasia cardia, action of botulotoxin type A and balloon pneumocardiodilatation of the esophagus, were described. And modern roentgen-endoscopic classification of achalasia cardia was given. Prognostic estimation scale of possibility to implement further combined endoscopic or surgical treatment is defined and is being in subsequent working out. Conclusion. Described clinical cases most brightly demonstrate variety of clinical achalasia cardia manifestations and also determine of the earlier display of surgical treatment.

In-Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative.

Science.gov (United States)

Anderson, Jennifer; Bensoussan, Yael; Townsley, Richard; Kell, Erika

2018-05-01

Objective To review complications of in-office endoscopic laryngeal laser procedures after implementation of standardized safety protocol. Methods A retrospective review was conducted of the first 2 years of in-office laser procedures at St Michaels Hospital after the introduction of a standardized safety protocol. The protocol included patient screening, procedure checklist with standardized reporting of processes, medications, and complications. Primary outcomes measured were complication rates of in-office laryngeal laser procedures. Secondary outcomes included hemodynamic changes, local anesthetic dose, laser settings, total laser/procedure time, and incidence of sedation. Results A total of 145 in-office KTP procedures performed on 65 patients were reviewed. In 98% of cases, the safety protocol was fully implemented. The overall complication rate was 4.8%. No major complications were encountered. Minor complications included vasovagal episodes and patient intolerance. The rate of patient intolerance resulting early termination of anticipated procedure was 13.1%. Total local anesthetic dose averaged 172.9 mg lidocaine per procedure. The mean amount of laser energy dispersed was 261.2 J, with mean total procedure time of 48.3 minutes. Sixteen percent of patients had preprocedure sedation. Vital signs were found to vary modestly. Systolic blood pressure was lower postprocedure in 13.8% and symptomatic in 4.1%. Discussion The review of our standardized safety protocol has revealed that in-office laser treatment for laryngeal pathology has extremely low complication rates with safe patient outcomes. Implications for Practice The trend of shifting procedures out of the operating room into the office/clinic setting requires new processes designed to promote patient safety.

Palliation of oesophagogastric neoplasms with Nd:YAG laser treatment

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Schulze, S.; Fischerman, K. (Rigshospitalet, Copenhagen (Denmark))

1990-01-01

The palliative effect of endoscopic Nd:YAG laser treatment of malignant strictures of the oesophagus and cardia was prospectively evaluated in 30 patients. Most were primarily treated for dysphagia, and swallowing was improved in 21 and normalized in 14 of these patients. Two patients were successfully treated for bleeding. Six patients developed complications (including two perforations), and four of these were fatal. The median survival was four months. It is concluded that in a great number of patients with inoperable cancer of the oesophagus and cardia, laser treatment is better than other palliative procedures. 23 refs., 2 tabs.

Laser tumor treatment in oral and maxillofacial surgery

Science.gov (United States)

Neukam, F. W.; Stelzle, F.

Cancer treatment is an integral part of oral and maxillofacial surgery. Oral cancer in particular is a highly prevalent neoplasm. Standard treatment for most of the tumors is radical surgery combined with stage-based neo-/adjuvant therapy. Laser surgery has become a reliable treatment option for oral cancer as well as for precancerous lesions. Widely used lasers in oral and maxillofacial tumor surgery are the CO2 laser, the Er:YAG laser, the Nd:YAG laser and the KTM laser. The use of lasers in tumor surgery has several advantages: remote application, precise cutting, hemostasis, low cicatrization, reduced postoperative pain and swelling, can be combined with endoscopic, microscopic and robotic surgery. However, laser surgery has some major drawbacks: In contrast to conventional incisions with scalpels, the surgeon gets no feedback during laser ablation. There is no depth sensation and no tissue specificity with a laser incision, increasing the risk of iatrogenic damage to nerves and major blood vessels. Future prospects may solve these problems by means of an optical feedback mechanism that provides a tissue-specific laser ablation. First attempts have been made to perform remote optical tissue differentiation. Additionally, real time optical tumor detection during laser surgery would allow for a very precise and straight forward cancer resection, enhancing organ preservation and hence the quality of life for patients with cancer in the head and neck region.

Diagnosis and treatment with endoscopic retrograde cholangiopancreatography

International Nuclear Information System (INIS)

Soendenaa, K.; Horn, A.; Viste, A.

1994-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out for the first time in 1968. Five years later endoscopic sphincterotomy was performed. Since then both modalities have become established as necessary adjuncts in the diagnosis and treatment of patients with pathology in the bile duct or pancreas. The main indication is common bile duct stone, and as a consequence of this treatment fewer patients are now treated surgically. Patients with malignant bile duct obstruction can be given reasonable palliation of both jaundice and pruritus and therefore improved quality of life. Some reports indicate that endoscopic drainage may be useful for pancreatic stenosis. Complications are few, but vigilance and prompt treatment is necessary to keep morbidity at a minimum. Follow-up after several years shows that sphincterotomy is successful also in the long term. The authors discuss the present diagnostic and therapeutic situation. 31 refs., 2 tabs

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.

Endoscopic treatment of large vesical calculi

International Nuclear Information System (INIS)

Rauf, A.; Ahmed, I.; Rauf, M.H.; Rauf, M.

2015-01-01

Objective: To determine the efficiency and safety of endoscopic treatment of large vesical calculi with the available modern endoscopic instruments. Methology: In case series, patients were collected randomly from 2007 to 2014. Patients were diagnosed with ultrasound and Nephroscope with Swiss pneumatic lithoclast, lithotrite and stone punch were used for treatment. Results: Majority of the patient could be managed with the method adopted. Stone size, hardness or softness, gender were the factors affecting treatment. Associated prostate pathology was seen in four patients. Postoperative complications included hemorrhage, perforation, residual stone and transurethral resection of prostate syndrome. Conclusion: Overall, it is a safe procedure except in patients with large enlarged prostate and large vesical calculi. Very hard vesical calculus may need vesicolithotomy. (author)

New developments in endoscopic treatment of chronic pancreatitis.

Science.gov (United States)

Didden, P; Bruno, M; Poley, J W

2012-12-01

The aim of endoscopic therapy of chronic pancreatitis (CP) is to treat pain by draining the pancreatic duct or managing loco-regional complications. Recent decennia were characterized by continuous improvement of endoscopic techniques and devices, resulting in a better clinical outcome. Novel developments now also provide the opportunity to endoscopically treat refractory CP-related complications. Especially suboptimal surgical candidates could potentially benefit from these new developments, consequently avoiding invasive surgery. The use of fully covered self-expandable metal stents (SEMS) has been explored in pancreatic and CP-related biliary duct strictures, resistant to conventional treatment with plastic endoprotheses. Furthermore, endosonography-guided transmural drainage of the main pancreatic duct via duct-gastrostomy is an alternative treatment option in selected cases. Pancreatic pseudocysts represent an excellent indication for endoscopic therapy with some recent case series demonstrating effective drainage with the use of a fully covered SEMS. Although results of these new endoscopic developments are promising, high quality randomized trials are required to determine their definite role in the management of chronic pancreatitis.

Endoscopic treatment of early colorectal cancer – just a competition with surgery?

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Ebigbo Alanna

2017-11-01

Full Text Available The endoscopic treatment of cancerous and precancerous lesions in the gastrointestinal (GI tract has experienced major breakthroughs in the past years. Endoscopic mucosal resection (EMR is a simple and efficient method for the treatment of most benign lesions in the GI tract. However, with the introduction of endoscopic submucosal dissection (ESD and endoscopic full-thickness resection (EFTR, the scope of lesions eligible for endoscopic treatment has been widened significantly even in the colon. These methods are now being used routinely not just for the treatment of benign lesions but also in the curative en bloc resection of early colorectal cancers. The quick, efficient, and noninvasive character of these endoscopic procedures make them not just an alternative to surgery but, in many cases, the methods of choice for the treatment of most early colon cancers and some rectal cancers.

Surgical versus endoscopic treatment of bile duct stones

DEFF Research Database (Denmark)

Martin, D J; Vernon, D R; Toouli, J

2006-01-01

10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery.......10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery....

ENDOSCOPIC TECHNOLOGIES IN EARLY RECTAL CANCER TREATMENT

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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.

Evaluation of endoscopic laser excision of polypropylene mesh/sutures following anti-incontinence procedures.

LENUS (Irish Health Repository)

Davis, N F

2012-11-01

We reviewed our experience with and outcome of the largest series to our knowledge of patients who underwent endoscopic laser excision of eroded polypropylene mesh or sutures as a complication of previous anti-incontinence procedures.

Comparison of endoscopic Nd:YAG laser therapy and oesophageal tube in palliation of oesophagogastric malignancy

Energy Technology Data Exchange (ETDEWEB)

Hahl, J.; Salo, T.; Ovaska, J.; Haapiainen, R.; Kalima, T.; Schroeder, T. (Helsinki Univ. Central Hospital (Finland). Meilahti Clinic)

1991-01-01

The clinical results of 96 patients with upper gastrointestinal malignancy have been evaluated retrospectively. 69 patients with a mean age of 72 years (35 men and 34 women) were treated with endoscopic laser therapy, and 27 patients with a mean age of 67 years (16 men and 11 women) with insertion of an oesophageal tube. After laser therapy the bulk of the tumour was reduced in 87%, and in 55% clear signs of relieved dysphagia were seen. The insertion of an esophageal tube was successful in 89%. In the laser group no fatal complications occurred, and the overall complication risk was 8.7%. The first-year survival in all laser patients was 12%, and in patients with impassable tumour stenosis the survival was 6%. The mortality related to the insertion of an oesophageal tube was 11%, and complications occurred in 48% of the patients. The first-year survival of the tube group was nil. It is concluded that endoscopic laser therapy and insertion of oesophageal tube are both effective methods in palliation of oesophagogastric malignancy, but the mortality and risk for complications were markedly lower after laser therapy. 20 refs., 1 fig., 3 tabs.

Treatment of extensive urethral hemangioma with KTP/532 laser.

Science.gov (United States)

Lauvetz, R W; Malek, R S; Husmann, D A

1996-01-01

Urethral hemangiomas are rare. They vary in size from pinpoint masses to extensive honeycomb-shape deformities leading to significant hematuria. For extensive lesions, therapeutic options have included extensive surgical resection and reconstruction or multistaged neodymium:yttrium-aluminum-garnet (Nd:YAG) laser photocoagulation. We report our experience with the use of potassium titanyl phosphate (KTP/532) laser for treatment of the extensive form. A 7-year-old boy presented with a 2-week history of urethral bleeding. He had extensive hemangiomas of the genital and perineal regions. Cystourethroscopy disclosed diffusely scattered honeycomb-shape hemangiomatous malformation of the anterior urethra. KTP/532 laser energy was delivered transurethrally to the hemangiomatous areas until they blanched. The Foley catheter was removed 24 hours postoperatively, and the patient voided clear urine without difficulty. He has remained trouble-free for more than 2 years. Judicious endoscopic single-stage therapy with KTP/532 laser may obviate open surgical intervention in most cases of extensive and symptomatic urethral hemangiomas. In view of our observation and the literature, KTP/532 laser therapy should be considered the first line of treatment.

PULMONARY HEMORRHAGE. ENDOSCOPIC DIAGNOSIS AND TREATMENT

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A. M. Gasanov

2016-01-01

Full Text Available In the article, we report the incidence and etiology of pulmonary hemorrhage, and modern classifications according to the literature data. Methods of endoscopic diagnosis and treatment of pulmonary hemorrhage are analyzed.

Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children

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Andrew J. Kirsch

2008-06-01

Full Text Available Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR in children. Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT. This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy. Results. While most contemporary series report cure rates of greater than 85% for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available, the indication for endoscopic treatment may exceed the scope of primary VUR. Conclusions. Endoscopic injection is emerging as the treatment of choice for VUR in children.

Update on the endoscopic treatments for achalasia

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Uppal, Dushant S; Wang, Andrew Y

2016-01-01

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. PMID:27818585

Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones

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Rimon, Uri; Kleinmann, Nir; Bensaid, Paul; Golan, Gil; Garniek, Alexander; Khaitovich, Boris; Winkler, Harry

2011-01-01

Purpose: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-μm holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy, to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. Results: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive “balloon push” (n = 4) and “rendezvous” (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. Conclusion: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.

Treatment of nonseptic bursitis with endoscopic surgery

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Azad Yıldırım

2015-09-01

Full Text Available Objective: The aim of this study was to show that endoscopic surgery is a simple and acceptable method for various problems associated with wounds, range of motion and that such surgery ensures an early return to work after treatment of nonresponding nonseptic bursitis. Methods: Thirty-two patients with nonseptic bursitis caused by repeated minor trauma that did not respond to medical treatment from 2008 to 2012 were included in this study. Radiographic [anteroposterior and lateral], ultrasound, macro and microscopic analyses of drainage liquid and aerobic and anaerobic cultures were obtained from the patients for the diagnosis. Results: The mean age was 40.8 years. Fifteen patients had prepatellar bursitis, 13 had olecranon bursitis and 4 had ankle bursitis. Two patients had a history of falling on their knee. The other patients had a history of repetitive stimulation .The mean follow up period was 2.6 years [range. 2-5 years] and no medical complications occurred after the endoscopic surgery; such as scarring, loss of sensation and infection. One recurrence in response to medical treatment was observed. Conclusion: Endoscopic bursectomy is a short and acceptable procedure with excellent results in terms of returning to work early and minimal wound related problems. J Clin Exp Invest 2015; 6 (3: 220-223

Ex vivo evaluation of femtosecond pulse laser incision of urinary tract tissue in a liquid environment: implications for endoscopic treatment of benign ureteral strictures.

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Liang, Jun-Hao; Kang, Jian; Pan, Yu-Long; Zhang, Liang; Qi, Jun

2011-08-01

The femtosecond (FS) pulse laser incises soft tissues with minimal peripheral damage and is a promising cutting tool for ureteroscopic endoureterotomy of benign ureteral strictures. To evaluate the feasibility of applying the FS laser to ureteroscopic endoureterotomy. A commercial Ti:Sapphire regenerative amplifier system (Coherent, RegA 9050, USA) was used in this study. Normal saline, 5% glucose solution, 4% mannitol solution, distilled water, and a 1% (v/v) suspension of whole blood with each of these solutions were tested for their attenuation rate (AR) of the FS laser's power. Bladder specimens from Sprague-Dawley (SD) rats were used as a surrogate model. The laser incised slots of 2 mm in length at bladder samples using three power grades (5×, 10×, and 20× the threshold power) combined with five effective pulse rates (40, 20, 10, 5, and 2.5 kHz), both in air and in normal saline. After samples were processed with standard hematoxylin-eosin staining procedures, the incision depth and collateral damage range were determined microscopically. The ARs of blood suspensions with each of the three isosmotic solutions were significantly higher than the other five solutions (P laser's cutting depth and the collateral damage were increased with the laser power or power density but the collateral damages were less than 100 µm. Microbubble formation was detected in the liquid environments tested and influenced the effective laser power. Endoscopic application of the FS laser is feasible. Microbubble formation with the laser incision, however, may influence cutting effects. Proposed methods to address these issues include increasing the irrigation rate, using distilled water as irrigation or using gas insufflation instead of irrigation. It is necessary to evaluate these methods, as well as the long-term biologic response to laser incision, on living animal models in endoscopic settings before use on humans. Copyright © 2011 Wiley-Liss, Inc.

Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

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Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

2010-01-01

Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future. PMID:20101764

Laser scanning endoscope via an imaging fiber bundle for fluorescence imaging

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Yeboah, Lorenz D.; Nestler, Dirk; Steiner, Rudolf W.

1994-12-01

Based on a laser scanning endoscope via an imaging fiber bundle, a new approach for a tumor diagnostic system has been developed to assist physicians in the diagnosis before the actual PDT is carried out. Laser induced, spatially resolved fluorescence images of diseased tissue can be compared with images received by video endoscopy using a white light source. The set- up is required to produce a better contrast between infected and healthy tissue and might serve as a constructive diagnostic help for surgeons. The fundamental idea is to scan a low-power laser beam on an imaging fiber bundle and to achieve a spatially resolved projection on the tissue surface. A sufficiently high laser intensity from the diode laser is concentrated on each single spot of the tissue exciting fluorescence when a dye has previously been accumulated. Subsequently, video image of the tissue is recorded and stored. With an image processing unit, video and fluorescence images are overlaid producing a picture of the fluorescence intensity in the environment of the observed tissue.

Endoscopic Laser-Based 3D Imaging for Functional Voice Diagnostics

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Marion Semmler

2017-06-01

Full Text Available Recently, we reported on the in vivo application of a miniaturized measuring device for 3D visualization of the superior vocal fold vibrations from high-speed recordings in combination with a laser projection unit (LPU. As a long-term vision for this proof of principle, we strive to integrate the further developed laserendoscopy as a diagnostic method in daily clinical routine. The new LPU mainly comprises a Nd:YAG laser source (532 nm/CW/2 ω and a diffractive optical element (DOE generating a regular laser grid (31 × 31 laser points that is projected on the vocal folds. By means of stereo triangulation, the 3D coordinates of the laser points are reconstructed from the endoscopic high-speed footage. The new design of the laserendoscope constitutes a compromise between robust image processing and laser safety regulations. The algorithms for calibration and analysis are now optimized with respect to their overall duration and the number of required interactions, which is objectively assessed using binary classifiers. The sensitivity and specificity of the calibration procedure are increased by 40.1% and 22.3%, which is statistically significant. The overall duration for the laser point detection is reduced by 41.9%. The suggested semi-automatic reconstruction software represents an important stepping-stone towards potential real time processing and a comprehensive, objective diagnostic tool of evidence-based medicine.

Endoscopic Treatment of Intrasheath Peroneal Tendon Subluxation

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Frederick Michels

2013-01-01

Full Text Available Intrasheath subluxation of the peroneal tendons within the peroneal groove is an uncommon problem. Open exploration combined with a peroneal groove-deepening procedure and retinacular reefing is the recommended treatment. This extensive lateral approach needs incision of the intact superior peroneal retinaculum and repair afterwards. We treated three patients with a painful intrasheath subluxation using an endoscopic approach. During this tendoscopy both tendons were inspected. The distal muscle fibers of the peroneus brevis tendon were resected in two patients. A partial tear was debrided in the third patient. All patients had a good result. No wound-healing problems or other complications occurred. Early return to work and sports was possible. An endoscopic approach was successful in treatment of an intrasheath subluxation of the peroneal tendons.

ENDOSCOPIC ENUCLEATION OF THE PROSTATE – A NEW STANDARD IN SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

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D. V. Enikeev

2017-01-01

Full Text Available The latest guideline of the European Association of Urology (2016 for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH.Objective: to compare the methods of electroenucleation and laser enucleation (holmium and thulium of the prostate according to the literature data and own observations.Materials and methods. A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP, 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP. All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS, patients’ quality of life (QoL, peak flow rate (Qmax, and residual urine volume prior to surgery and 1 month after it.Results. Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.

Successful endoscopic treatment of gastric phytobezoar: A case report.

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Ugenti, Ippazio; Travaglio, Elisabetta; Lagouvardou, Elpiniki; Caputi Iambrenghi, Onofrio; Martines, Gennaro

2017-01-01

Gastric bezoars are a rare condition associated with situations of gastric dysmotility and prior gastric surgery, though sometimes they can present without any risk factor. We describe the first successful treatment in medical literature of a large gastric bezoar in the outpatient setting through endoscopic fragmentation. A 76-year-old man was referred to our outpatient endoscopy clinic because of dyspepsia and epigastric pain. Upper GI endoscopy with a standard endoscope revealed a 10-cm-diameter gastric phytobezoar with necrotic pressure ulcer of the angulus. We fragmentized the bezoar into smaller pieces, with complete dissolution and without any complication. The patient was then promptly discharged home with a medical therapy. Follow-up endoscopy at 6 months showed the total disappearance of any residual fibers. Different types of bezoars are described in literature, of which phyto- and trychobezoars are the most frequent. They can be absolutely asymptomatic or can arise with epigastric pain, pressure ulcer bleeding, gastrointestinal perforation or small bowel obstruction. The treatment is debated though endoscopic removal or fragmentation with the help of Coca-Cola lavages has showed the best success rate. The main experiences in literature concern hospitalized patients or describe treatment techniques which require overnight stays. An effective and rapid treatment in the outpatient setting is described in our experience, without short- or long-term complications. The endoscopic fragmentation of large gastric bezoars in the outpatient setting is safe with a good clinical course. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Surgical management of failed endoscopic treatment of pancreatic disease.

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Evans, Kimberly A; Clark, Colby W; Vogel, Stephen B; Behrns, Kevin E

2008-11-01

Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.

Endoscopic bronchial valve treatment: patient selection and special considerations

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Eberhardt R

2015-10-01

Full Text Available Ralf Eberhardt,1,2 Daniela Gompelmann,1,2 Felix JF Herth,1,2 Maren Schuhmann1 1Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, 2Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany Abstract: As well as lung volume reduction surgery, different minimally invasive endoscopic techniques are available to achieve lung volume reduction in patients with severe emphysema and significant hyperinflation. Lung function parameters and comorbidities of the patient, as well as the extent and distribution of the emphysema are factors to be considered when choosing the patient and the intervention. Endoscopic bronchial valve placement with complete occlusion of one lobe in patients with heterogeneous emphysema is the preferred technique because of its reversibility. The presence of high interlobar collateral ventilation will hinder successful treatment; therefore, endoscopic coil placement, polymeric lung volume reduction, or bronchoscopic thermal vapor ablation as well as lung volume reduction surgery can be used for treating patients with incomplete fissures. The effect of endoscopic lung volume reduction in patients with a homogeneous distribution of emphysema is still unclear and this subgroup should be treated only in clinical trials. Precise patient selection is necessary for interventions and to improve the outcome and reduce the risk and possible complications. Therefore, the patients should be discussed in a multidisciplinary approach prior to determining the most appropriate treatment for lung volume reduction. Keywords: lung emphysema, valve treatment, collateral ventilation, patient selection, outcome

Endoscopic Treatment of Ewing Sarcoma of the Sinonasal Tract.

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Lepera, Davide; Volpi, Luca; Facco, Carla; Turri-Zanoni, Mario; Battaglia, Paolo; Bernasconi, Barbara; Piski, Zalán; Freguia, Stefania; Castelnuovo, Paolo; Bignami, Maurizio

2016-06-01

The extra-skeletal form is an unusual type of Ewing sarcoma (ES) arising from soft tissue and in the literature there are reports of less than 50 patients describing the tumor in the paranasal sinuses and skull base. The histological diagnosis is crucial to plan the correct treatment and the molecular confirmation is mandatory in equivocal patients. A multimodality treatment with chemotherapy, surgery and radiotherapy improved the outcomes of these diseases during the last decades and a free-margin resection with the endoscopic transnasal technique is one of the most recent ways to manage these pathologies in selected patients, reducing the morbidities of the external approaches and preserving the quality of life of the patient.Here, the authors present the first patient of primary sinonasal ES free from disease after 5 years of follow-up and treated with an endoscopic endonasal approach and a second patient of sinonasal metastases of ES treated with and endoscopic transnasal approach.

Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia

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Diego Palladino

2016-01-01

Full Text Available Purpose. Aim of the study is to evaluate the efficacy of the endoscopic (pneumatic dilation versus surgical (Heller myotomy treatment in patients affected by esophageal achalasia using barium X-ray examination of the digestive tract performed before and after the treatment. Materials and Methods. 19 patients (10 males and 9 females were enrolled in this study; each patient underwent a barium X-ray examination to evaluate the esophageal diameter and the height of the barium column before and after endoscopic or surgical treatment. Results. The mean variation of oesophageal diameter before and after treatment is −2.1 mm for surgery and 1.74 mm for pneumatic dilation (OR 0.167, CI 95% 0.02–1.419, and P: 0.10. The variations of all variables, with the exception of the oesophageal diameter variation, are strongly related to the treatment performed. Conclusions. The barium X-ray study of the digestive tract, performed before and after different treatment approaches, demonstrates that the surgical treatment has to be considered as the treatment of choice of achalasia, reserving endoscopic treatment to patients with high operative risk and refusing surgery.

Laser in urology. Laser i urologien

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Breisland, H.O. (Aker Sykehus, Oslo (Norway))

1991-09-01

The neodymium YAG laser is particularly suited for endoscopic urologic surgery because the YAG laser light can be conducted in flexible fibers. Superficial bladder tumours can be treated under local anaesthesia in the outpatient department. The frequency of local recurrences is low, significantly lower than after electrosection or electrocoagulation. Selected cases of T2-muscle invasive bladder tumours can be cured with laser coagulation applied subsequently to transurethral resection. Combined treatment with electrosection and laser coagulation of localized prostatic cancer is a promising method which compares favourably with results obtained by other treatment modalities. Tumours in the upper urinary tract can be laser-treated through ureteroscopes or nephroscopes, but the treatment should be limited to low stage, low grade tumours. Laser is the treatment of choice for intraurethral condylomatas. Laser treatment of penil carcinoma gives excellent cosmetic and functional results and few local recurrences. Laser lithotripsy is a new technique for treatment of ureteric stones and photodynamic laser therapy is a promising tecnique for treatment of carcinoma in situ in the bladder empithelium. However, neither of these techniques are available for clinical use in Norway as yet. 17 refs., 3 figs., 1 tabs.

Quantitative evaluation of the safety of mucosal incision and submucosal dissection for colon during endoscopic submucosal dissection using carbon dioxide laser

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Noguchi, Takuma; Honda, Norihiro; Hazama, Hisanao; Morita, Yoshinori; Awazu, Kunio

2018-02-01

Since the increase in the overall mortality rate in patients with colon cancer is remarkably high in recent years, early treatment is required. For this reason, endoscopic submucosal dissection (ESD) has been at the forefront of international attention as a low invasive treatment for early digestive cancer. In current ESD procedure, an electrosurgical knife is used for mucosal incision and subsequent submucosal dissection. However, the perforation has been reported to occur by approximately 5%. Thus, to enhance the tissue selectivity of this modality, we focused on the application of laser for ESD. A carbon dioxide laser was chosen as a surgical knife because the saline or a sodium hyaluronate solution injected into the submucosal layer in current ESD procedure has a high absorption coefficient at the wavelength of the carbon dioxide laser. In this research, ex vivo experiment was performed at the output power of 3-7 W and discuss the optimum irradiation power of laser. As a result of ex vivo experiment using extracted porcine colon tissues, mucosal incision and submucosal dissection were safely and less invasively performed in every output power, without reaching the thermal damage to a muscular layer. This is because a carbon dioxide laser is strongly absorbed by saline injected into submucosa. ESD using a carbon dioxide laser is a safer method for the treatment of early colon cancer. We are planning to measure and compare the optical and thermal properties of porcine colon with those of human colon.

Effectiveness comparison of endoscopic methods of non-varicose upper gastrointestinal bleeding treatment

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Kujawski, Krzysztof; Stasiak, Magdalena; Stępień, Mariusz; Rysz, Jacek

2010-01-01

Introduction In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the trea...

Case series: Endoscopic management of fourth branchial arch anomalies.

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Watson, G J; Nichani, J R; Rothera, M P; Bruce, I A

2013-05-01

Fourth branchial arch anomalies represent branchial anomalies and present as recurrent neck infections or suppurative thyroiditis. Traditionally, management has consisted of treatment of the acute infection followed by hemithyroidectomy, surgical excision of the tract and obliteration of the opening in the pyriform fossa. Recently, it has been suggested that endoscopic obliteration of the sinus tract alone using laser, chemo or electrocautery is a viable alternative to open surgery. To determine the results of endoscopic obliteration of fourth branchial arch fistulae in children in our institute. Retrospective case note review of all children undergoing endoscopic treatment of fourth branchial arch anomalies in the last 7 years at the Royal Manchester Children's Hospital. Patient demographics, presenting symptoms, investigations and surgical technique were analysed. The primary and secondary outcome measures were resolution of recurrent infections and incidence of surgical complications, respectively. In total 5 cases were identified (4 females and 1 male) aged between 3 and 12 years. All presented with recurrent left sided neck abscesses. All children underwent a diagnostic laryngo-tracheo-bronchoscopy which identified a sinus in the apex of the left pyriform fossa. This was obliterated using electrocautery in 1 patient, CO₂ laser/Silver Nitrate chemocautery in 2 patients and Silver Nitrate chemocautery in a further 2 patients. There were no complications and no recurrences over a mean follow-up period of 25 months (range 11-41 months). Endoscopic obliteration of pyriform fossa sinus is a safe method for treating fourth branchial arch anomalies with no recurrence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Endonasal versus trans-canalicular endoscopic dacriocystorhinostomy using diode laser. Surgical techniques and outcomes].

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Piédrola Maroto, David; Franco Sánchez, Javier; Reyes Eldblom, Robin; Monje Vega, Elena; Conde Jiménez, Manuel; Ortiz Rueda, Manuel

2008-01-01

To evaluate the benefits and disadvantages of the endoscopic endonasal versus transcanalicular approaches using diode laser, and to compare their clinical outcomes. A total of 127 patients were operated on, 80 of them with the endonasal approach (Group I) and 47 with the transcanalicular technique (Group II). Epiphora improved completely in 67 patients in Group I (83.7 %) while the other 13 (16.2 %) continued to present the same symptoms. In Group II, a successful result was achieved in 39 patients (82.9 %) and 8 (17 %) of them had to be re-operated because of the persistence of epiphora. The surgical outcomes are similar with both laser techniques. The main advantages of using diode laser are that it does not require general anaesthesia, the lower intra- and peri-operative morbidity, the lack of nasal packing and the greater ease of performing additional interventions if it fails. The only real disadvantage of laser procedures is the high cost.

Endoscopic surgery and photodynamic therapy for behign and malignant neoplasms of colon

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А. А. Razzhivina

2013-01-01

Full Text Available The review of literature for current methods of endoscopic treatment for colon epithelial neoplasms is represented. Such types of endoscopic interventions as loop electroresection, submucosal dissection, coagulation and destruction of tumors and combination of several options depending on efficiency of previous therapy is analyzed. Limitations of every method, its special aspects and possible complications are described. Special focus is on specifics of neoplasms for which selected methods may be the most effective. Thus, hot biopsy and destruction using high-energy laser is efficient for small flat neoplasms, endoscopic electroexcision – far small pedunculated lesions, and fragmentation is adequate for exophytic tumors more than 2.0 cm. Long-term results of endoscopic treatment, recurrence rates after different options are represented. The literature for photodynamic therapy consists mostly articles about development (on pre-clenecal stage of new photosensitizers which are effective for colon cancer, new methods of treatment including combination with hyperthermia in low-dose light irradiation etc. The literature data shows the prospectivity of subsequent developments in this field. 

Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

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Robert Enns

2010-01-01

Full Text Available Eosinophilic esophagitis (EE is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

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NISHIOKA, Hiroshi

2017-01-01

For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors. PMID:28239067

Peroral Endoscopic Myotomy for the Treatment of Achalasia: An Analysis

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Dennis Yang

2013-01-01

Full Text Available Achalasia is a motility disorder of the esophagus, characterized by aperistalsis of the esophageal body and incomplete relaxation of the lower esophageal sphincter (LES. Treatment of achalasia is currently aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM is an emerging novel endoscopic procedure for the treatment of achalasia with initial data suggesting an acceptable safety profile, excellent short-term symptom resolution, low incidence of postprocedural gastroesophageal reflux (GER, and improvement in manometric outcomes. Further prospective randomized trials are required to evaluate the long-term effectiveness of this promising technique compared to other treatment modalities for achalasia. In this review we outline the technical aspects of POEM, summarize the available data on safety and outcomes, and suggest future directions for further advancement of this minimally invasive approach for the treatment of achalasia.

Lumbar endoscopic percutaneous discolisis, with Holmium YAG laser - four years of experience

International Nuclear Information System (INIS)

Ramirez L, Jorge Felipe; Rugeles O, Jose G

2001-01-01

we have designed a prospective study over 220 patients with lumbar hernia. our purpose is to show the results that we have obtained with endoscopic percutaneous holmium YAG laser lumbar disc decompression. In all cases, ambulatory surgery was performed using local anesthesia, follow up based on Mac Nab criteria was made with excellent and good results in 75% of patients this is a useful safety outpatient procedure with good results, fewer complications, reduced costs and with the same or better results than traditional procedures

Treatment of recurrent sigmoid volvulus in Parkinson's disease by percutaneous endoscopic colostomy

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Toebosch, Susan; Tudyka, Vera; Masclee, Ad; Koek, Ger

2012-01-01

The exact aetiology of sigmoid volvulus in Parkinson's disease (PD) remains unclear. A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients. Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus. Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion. If feasible, secondary sigmoidal resection should be performed. However, if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery, percutaneous endoscopic colostomy (PEC) should be considered. We describe an elderly PD patient who presented with sigmoid volvulus. She was treated conservatively with endoscopic detorsion. Surgery was consistently refused by the patient. After recurrence of the sigmoid volvulus a PEC was placed. PMID:23155325

Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

OpenAIRE

Gubler, Christoph; Bauerfeind, Peter

2014-01-01

OBJECTIVE: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. MATERIAL AND METHODS: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy o...

NEW TECHNOLOGIES IN CRYOSURGERY ENDOSCOPIC TREATMENT OF TUMORS OF THE RESPIRATORY TRACT

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V. V. Sokolov

2017-01-01

Full Text Available The article presents the history of the development of the cryosurgery method from antiquity to the present day, materials of the clinical use of cryosurgery for endoscopic diagnosis and treatment of tumors of respiratory tract at the present stage, features of modern equipment for cryosurgery. Also the article presents the first clinical experience of using cryorecanalization in stenosing tumors of the tracheobronchial tree inRussiawith the help of the medical device of the latest generation ERBECRYO 2. Three clinical examples of cryorecanalization are given. Preliminary results of clinical studies show that, in comparison with cryosurgery on older devices, cryorecanalization using the latest generation of m edical eq uipment and a new cryosondond model is an effective method of recanalization to restore airway patency, which can be used in combination with electrodestruction, argon-plasma And laser coagulation.

Endoscopic treatments for Barrett's esophagus: a systematic review of safety and effectiveness compared to esophagectomy

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Lau Darren

2010-09-01

Full Text Available Abstract Background Recently, several new endoscopic treatments have been used to treat patients with Barrett's esophagus with high grade dysplasia. This systematic review aimed to determine the safety and effectiveness of these treatments compared with esophagectomy. Methods A comprehensive literature search was undertaken to identify studies of endoscopic treatments for Barrett's esophagus or early stage esophageal cancer. Information from the selected studies was extracted by two independent reviewers. Study quality was assessed and information was tabulated to identify trends or patterns. Results were pooled across studies for each outcome. Safety (occurrence of adverse events and effectiveness (complete eradication of dysplasia were compared across different treatments. Results The 101 studies that met the selection criteria included 8 endoscopic techniques and esophagectomy; only 12 were comparative studies. The quality of evidence was generally low. Methods and outcomes were inconsistently reported. Protocols, outcomes measured, follow-up times and numbers of treatment sessions varied, making it difficult to calculate pooled estimates. The surgical mortality rate was 1.2%, compared to 0.04% in 2831 patients treated endoscopically (1 death. Adverse events were more severe and frequent with esophagectomy, and included anastomotic leaks (9.4%, wound infections (4.1% and pulmonary complications (4.1%. Four patients (0.1% treated endoscopically experienced bleeding requiring transfusions. The stricture rate with esophagectomy (5.3% was lower than with porfimer sodium photodynamic therapy (18.5%, but higher than aminolevulinic acid (ALA 60 mg/kg PDT (1.4%. Dysphagia and odynophagia varied in frequency across modalities, with the highest rates reported for multipolar electrocoagulation (MPEC. Photosensitivity, an adverse event that occurs only with photodynamic therapy, was experienced by 26.4% of patients who received porfimer sodium. Some

Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser

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Rodgers John B

2002-06-01

Full Text Available Abstract Background Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk. Case presentation We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula. Conclusion We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

Endoscopic treatment of prepatellar bursitis.

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Huang, Yu-Chih; Yeh, Wen-Lin

2011-03-01

Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory.

[Endoscopic sclerotherapy in the combined treatment of portal hypertension in children].

Science.gov (United States)

Ul'rikh, E V; Korolev, M P; Kupatadze, F D; Sevriugov, B L; Nabokov, V V

1992-01-01

The authors have performed 28 sessions of endoscopic sclerotherapy of dilated esophagus veins in children. The 70% ethyl alcohol was used. Six sessions were carried out in patients with gastroesophageal hemorrhage. In 22 patients the sclerotherapy was carried on according to plan. The fiber gastroscope with a standard injector was used. A conclusion is made of expediency of using endoscopic sclerotherapy in complex treatment of portal hypertension in children.

Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

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John Robotis

2014-07-01

Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

Does performance status influence the outcome of Nd:YAG laser therapy of proximal esophageal tumors?

NARCIS (Netherlands)

Alexander, G. L.; Wang, K. K.; Ahlquist, D. A.; Viggiano, T. R.; Gostout, C. J.; Balm, R.

1994-01-01

The value of endoscopic palliative therapy for malignant obstruction in the proximal esophagus has been questioned. To assess the importance of pre-treatment performance status on treatment outcome, we reviewed the records of patients with tumors of the proximal esophagus undergoing endoscopic laser

Laser in urology

International Nuclear Information System (INIS)

Breisland, H.O.

1991-01-01

The neodymium YAG laser is particularly suited for endoscopic urologic surgery because the YAG laser light can be conducted in flexible fibers. Superficial bladder tumours can be treated under local anaesthesia in the outpatient department. The frequency of local recurrences is low, significantly lower than after electrosection or electrocoagulation. Selected cases of T2-muscle invasive bladder tumours can be cured with laser coagulation applied subsequently to transurethral resection. Combined treatment with electrosection and laser coagulation of localized prostatic cancer is a promising method which compares favourably with results obtained by other treatment modalities. Tumours in the upper urinary tract can be laser-treated through ureteroscopes or nephroscopes, but the treatment should be limited to low stage, low grade tumours. Laser is the treatment of choice for intraurethral condylomatas. Laser treatment of penil carcinoma gives excellent cosmetic and functional results and few local recurrences. Laser lithotripsy is a new technique for treatment of ureteric stones and photodynamic laser therapy is a promising tecnique for treatment of carcinoma in situ in the bladder empithelium. However, neither of these techniques are available for clinical use in Norway as yet. 17 refs., 3 figs., 1 tabs

Tension pneumothorax during peroral endoscopic myotomy for treatment of esophageal achalasia under general anesthesia

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Tsung-Shih Li

Full Text Available Abstract More and more endoscopically gastrointestinal procedures require anesthesiologists to perform general anesthesia, such as "peroral endoscopic myotomy". Peroral endoscopic myotomy is a novel invasive treatment for the primary motility disorder of esophagus, called esophageal achalasia. Despite of its minimally invasive feature, there are still complications during the procedure which develop to critical conditions and threat patients’ lives. Herein we describe a case about tension pneumothorax subsequent to esophageal rupture during peroral endoscopic myotomy. The emergent management of the complication is stated in detail. The pivotal points of general anesthesia for patients undergoing peroral endoscopic myotomy are emphasized and discussed. Also, intraoperative and post-operative complications mentioned by literature are integrated.

Current Innovations in Endoscopic Therapy for the Management of Colorectal Cancer: From Endoscopic Submucosal Dissection to Endoscopic Full-Thickness Resection

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Shintaro Fujihara

2014-01-01

Full Text Available Endoscopic submucosal dissection (ESD is accepted as a minimally invasive treatment for colorectal cancer. However, due to technical difficulties and an increased rate of complications, ESD is not widely used in the colorectum. In some cases, endoscopic treatment alone is insufficient for disease control, and laparoscopic surgery is required. The combination of laparoscopic surgery and endoscopic resection represents a new frontier in cancer treatment. Recent developments in advanced polypectomy and minimally invasive surgical techniques will enable surgeons and endoscopists to challenge current practice in colorectal cancer treatment. Endoscopic full-thickness resection (EFTR of the colon offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to current endoscopic techniques. However, closure is necessary after EFTR and natural transluminal endoscopic surgery (NOTES. Innovative methods and new devices for EFTR and suturing are being developed and may potentially change traditional paradigms to achieve minimally invasive surgery for colorectal cancer. The present paper aims to discuss the complementary role of ESD and the future development of EFTR. We focus on the possibility of achieving EFTR using the ESD method and closing devices.

[Left postpneumonectomy syndrome: early endoscopic treatment].

Science.gov (United States)

Rombolá, Carlos A; León Atance, Pablo; Honguero Martínez, Antonio Francisco; Rueda Martínez, Juan Luis; Núñez Ares, Ana; Vizcaya Sánchez, Manuel

2009-12-01

Postpneumonectomy syndrome is characterized by postoperative bronchial obstruction caused by mediastinal shift. The syndrome is well documented in the medical literature as a late complication of right pneumonectomy; however, it rarely occurs following resection of the left lung, and only 10 cases have been published. The pathophysiology, clinical manifestations, prognosis, and treatment are similar for both sides of the lung. We present the case of an adult patient who underwent left pneumonectomy and developed postpneumonectomy syndrome 15 months later. Stenosis of the intermediate bronchus occurred between the vertebral body and the right pulmonary artery. Endoscopic treatment with a self-expanding metal stent was successful, and complete remission was observed over the 6 months of follow-up.

Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett’s Esophagus

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Chihiro Iwashita

2017-01-01

Full Text Available Barrett’s adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE, blue laser imaging (BLI, and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett’s adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett’s esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett’s adenocarcinoma.

Unicameral bone cyst of the calcaneus - minimally invasive endoscopic surgical treatment. Case report.

Science.gov (United States)

Stoica, Ioan Cristian; Pop, Doina Mihaela; Grosu, Florin

2017-01-01

The role of arthroscopic surgery for the treatment of various orthopedic pathologies has greatly improved during the last years. Recent publications showed that benign bone lesion may benefit from this minimally invasive surgical method, in order to minimize the invasiveness and the period of immobilization and to increase visualization. Unicameral bone cysts may be adequately treated by minimally invasive endoscopic surgery. The purpose of the current paper is to present the case report of a patient with a unicameral bone cyst of the calcaneus that underwent endoscopically assisted treatment with curettage and bone grafting with allograft from a bone bank, with emphasis on the surgical technique. Unicameral bone cyst is a benign bone lesion, which can be adequately treated by endoscopic curettage and percutaneous injection of morselized bone allograft in symptomatic patients.

Endoscopic treatment of Morel-Lavallee lesion.

Science.gov (United States)

Kim, Sunghoon

2016-05-01

Morel-Lavallee lesion is a closed degloving soft tissue injury in which subcutaneous tissue is torn from the underlying muscular fascia. The tear leads to venolymphatic leak, and concomitant adipose tissue necrosis from the force of the trauma causes swelling and possible infection at the site of injury. The traditional treatment for the lesion is surgical drainage and debridement. In this report, an endoscopic method is described, which achieves the goal of an open surgical debridement but minimizes surgical morbidity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Endoscopic Ultrasonography in the Diagnosis and Treatment Strategy Choice of Esophageal Leiomyoma

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Ling-Jia Sun

Full Text Available OBJECTIVES: Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions. METHODS: Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis. RESULTS: One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (p<0.05. SMA (smooth muscle antibody (97.2% and desmin (94.5% were positive in the majority of patients. In terms of treatments, patients preferred endoscopic therapies, which led to less adverse events (e.g., intraoperative bleeding, local infection, pleural effusion than surgical operations (p<0.05. The superficial leiomyomas presented less adverse events and better recovery (p<0.05 than deep leiomyomas. CONCLUSION: Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely

Dermatological laser treatment

International Nuclear Information System (INIS)

Moerk, N.J.; Austad, J.; Helland, S.; Thune, P.; Volden, G.; Falk, E.

1991-01-01

The article reviews the different lasers used in dermatology. Special emphasis is placed on the treatment of naevus flammeus (''portwine stain'') where lasers are the treatment of choice. Argon laser and pulsed dye laser are the main lasers used in vascular skin diseases, and the article focuses on these two types. Copper-vapour laser, neodymium-YAG laser and CO 2 laser are also presented. Information is provided about the availability of laser technology in the different health regions in Norway. 5 refs., 2 figs

[Intraluminal/endoscopic procedures in the treatment of obesity].

Science.gov (United States)

Martínez-Ortega, Antonio Jesús; Aliaga-Verdugo, Alberto; Pereira-Cunill, José Luis; Jiménez-Varo, Ignacio; Romero-Lluch, Ana R; Sobrino-Rodríguez, Salvador; Belda-Laguna, Ovidio; García-Luna, Pedro Pablo

2014-05-01

Few effective therapeutic tools are currently available to fight the increasing prevalence of obesity and its associated comorbidities. Bariatric surgery is the only treatment with proven long-term effectiveness, but is associated to a high surgical risk and significant economic costs because of its technical complexity and the characteristics of patients. This is leading to development of new endoscopic procedures with less clinical risks and economic costs, while maintaining the benefits in terms of morbidity and mortality, which could even serve as a bridging element before surgery in cases where this is unavoidable, allowing for preoperative weight loss and control of comorbidities in order to improve anesthetic risks and possible complications. The purpose of this review was to analyze the most relevant and promising endoscopic techniques currently available. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Treatment countermeasures for common problems in dacryocystorhinostomy under nasal endoscope

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Zhong-Ling Luo

2014-04-01

Full Text Available AIM: To discuss the common problems and treatment countermeasures in dacryocystorhinostomy under nasal endoscope.METHODS: The clinical data of 37 cases(43 eyesof postoperative dacryocystorhinostomy under nasal endoscope, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods were reviewed in our hospital from Mar. 2011 to June. 2013. The effects of surgery were observed, and the intraoperative common questions and the treatments were discussed.RESULTS: In the 37 cases(43 eyes, 42 eyes(97.7%were cured, and 1 eye was improved, and the total efficiency was 100%. All operations were successfully completed without any serious complications during surgery.CONCLUSION: The common complication in dacryocystorhinostomy under nasal endoscope are effectively treated and the success rates of surgery are improved, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods. These methods are worthy of application and promotion.

Clinical observation of the treatment for chronic dacryocystitis under lacrimal endoscope

Directory of Open Access Journals (Sweden)

Hong-Ling Lü

2013-08-01

Full Text Available AIM:To evaluate the clinical efficacy of lacrimal dredge under lacrimal endoscope for treating chronic dacryocystitis. METHODS: Sixty patients(64 eyeswith chronic dacryocystitis were examined and treated by lacrimal endoscope combined with full lacrimal intubation. All patients were followed up for 3-6 months postoperatively. RESULTS: Forty-five eyes of 64 eyes were cured, no tears, irrigation of lacrimal passage unobstructed. Thirteen eyes get partly recover, but there were still mild overflow tears, and although lacrimal passages can be flushed, but there were still partly lacrimal duct obstruction. The rest 6 eyes were invalid and still tears, irrigation of lacrimal passage obstructed. The total effective rate was 90.6%. CONCLUSION: The diagnosis and treatment of nasolacrimal duct obstruction under lacrimal endoscope is a safe and effective way.

Photoactive dye-enhanced tissue ablation for endoscopic laser prostatectomy.

Science.gov (United States)

Ahn, Minwoo; Hau, Nguyen Trung; Van Phuc, Nguyen; Oh, Junghwan; Kang, Hyun Wook

2014-11-01

Laser light has been widely used as a surgical tool to treat benign prostate hyperplasia (BPH) over 20 years. Recently, application of high laser power up to 200 W was often reported to swiftly remove a large amount of prostatic tissue. The purpose of this study was to validate the feasibility of photoactive dye injection to enhance light absorption and eventually to facilitate tissue vaporization with low laser power. Chicken breast tissue was selected as a target tissue due to minimal optical absorption at the visible wavelength. Four biocompatible photoactive dyes, including amaranth (AR), black dye (BD), hemoglobin powder (HP), and endoscopic marker (EM), were selected and tested in vitro with a customized 532 nm laser system with radiant exposure ranging from 0.9 to 3.9 J/cm(2) . Light absorbance and ablation threshold were measured with UV-Vis spectrometer and Probit analysis, respectively, and compared to feature the function of the injected dyes. Ablation performance with dye-injection was evaluated in light of radiant exposure, dye concentration, and number of injection. Higher light absorption by injected dyes led to lower ablation threshold as well as more efficient tissue removal in the order of AR, BD, HP, and EM. Regardless of the injected dyes, ablation efficiency principally increased with radiant exposure, dye concentration, and number of injection. Among the dyes, AR created the highest ablation rate of 44.2 ± 0.2 µm/pulse due to higher absorbance and lower ablation threshold. High aspect ratios up to 7.1 ± 0.4 entailed saturation behavior in the tissue ablation injected with AR and BD, possibly resulting from plume shielding and increased scattering due to coagulation. Preliminary tests on canine prostate with a hydraulic injection system demonstrated that 80 W with dye injection yielded comparable ablation efficiency to 120 W with no injection, indicating 33% reduced laser power with almost equivalent performance. Due to

[Sachse internal urethrotomy: endoscopic treatment of urethral strictures].

Science.gov (United States)

Pfalzgraf, D; Häcker, A

2013-05-01

The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy (DVUI) method according to Sachse. It is an effective short-term treatment, but the long-term success rate is low. A number of factors influence the outcome of DVUI including stricture location, spongiofibrosis and previous endoscopic stricture treatment. Multiple urethrotomy has a negative impact on the success rate of subsequent urethroplasty. A thorough preoperative diagnostic work-up including combined retrograde urethrogram/voiding cystourethrogram (RUG/VCUG) and urethrocystoscopy is, therefore, mandatory to allow for patient counselling regarding the risk of stricture recurrence and other treatment options. After a failed primary DVUI, subsequent urethrotomy cannot be expected to be curative.

Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures.

Science.gov (United States)

You, H-J; Moon, K-C; Yoon, E-S; Lee, B-I; Park, S-H

2016-03-01

Fractures of the mandibular condyle are one of the most common craniofacial fractures. However, the diagnosis and treatment of these fractures is controversial because of the multiple surgical approaches available. The purposes of this study were to identify surgery-related technical tips for better outcomes and to evaluate the results as well as complications encountered during 7 years of endoscope use to supplement the limited intraoral approach in the treatment of mandibular condylar fractures. Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-assisted reduction surgery. Postoperative facial bone computed tomography and panoramic radiography demonstrated adequate reduction of the condylar fractures in all patients. No condylar resorption was detected, and most patients displayed a satisfactory functional and structural recovery. There was no facial nerve damage or transitory hypoesthesia, and there were no visible scars after the surgery. Transoral endoscope-assisted treatment is a challenging but reliable method with lower morbidity and a rapid recovery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Endoscopic Ultrasonography in the Diagnosis and Treatment Strategy Choice of Esophageal Leiomyoma.

Science.gov (United States)

Sun, Ling-Jia; Chen, Xin; Dai, Yi-Ning; Xu, Cheng-Fu; Ji, Feng; Chen, Li-Hua; Chen, Hong-Tan; Chen, Chun-Xiao

2017-04-01

Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions. Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis. One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (pleiomyomas presented less adverse events and better recovery (pleiomyomas. Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely avoid misdiagnosis, so combining it with other examinations may be a good strategy to solve this problem.

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

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. 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. 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. 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.

Dextranomer Based Implant (Deflux) for Endoscopic Treatment of Post-Prostatectomy Incontinence

International Nuclear Information System (INIS)

Abu-El-Azayem, Khaled M.; Abdel-Meguid, Taha A.; Soliman, S.

2006-01-01

Endoscopic treatment for post-prostatectomy urinary incontinence has gained popularity using several inject-able bulking materials. The current study reports our experience with endoscopic submucosal injection of dextranomer/hyaluronic acid copolymer for treatment of post-prostatectomy incontinence due to sphincteric deficiency. A total of 14 patients with post-prostatectomy urinary incontinence; 13 post-trans urethral resection of prostate (TURP) and 1 post-open prostatectomy, were enrolled. The patients aged between 59-85 years. Preoperative evaluation included multi-channel video urodynamics. Patients who had verified intrinsic sphincteric deficiency, adequate bladder capacity, absent unhibited detrusor contractions and minimal or no post void residual (PVR) urine were selected for injection therapy. The standard 4 quadrant sub-mucosal injection technique was utilized. Follow-up was scheduled at 1 month after each injection and at 6-months interval thereafter. A total of 25 procedures were done. Seven patients (50%) received single injection, 3 patients (21.4%) required 2 injections and 4 patients (28.6%) needed 3 injections. The mean volume of injected material was 3.7 mL per procedure (range 2-8). The mean operative time was 30 minutes (range 15-60). The procedure was performed without intraoperative adverse events or significant postoperative complications. The overall cure rate, significant improvement rate and failure rate were 28.6%, 35.7% and 35.7%.respectively, with a total of 64.3% considered as success (cured or significantly improved). At 1 year of follow-up, 71.4% of the patients (cured or improved) demonstrated persistence of the favourable outcome. Endoscopic treatment of post prostatectomy incontinence due sphinteric deficiency is a minimally invasive, safe and successful procedure. Endoscopic submucosal injection of dextranomer has shown a durable favorable outcome at 1 year of follow-up. (author)

Current Status of Peroral Endoscopic Myotomy

Science.gov (United States)

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders. PMID:29397656

Current Status of Peroral Endoscopic Myotomy.

Science.gov (United States)

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

Current Status of Peroral Endoscopic Myotomy

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Young Kwan Cho

2018-01-01

Full Text Available Peroral endoscopic myotomy (POEM has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

[Observing effect of treatment of the second branchial fistula with endoscopic resection].

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Jiang, Jiping; Wang, Shuyun; Tong, Kang

2014-03-01

To explore synergic effect of treatment of the second branchial fistula with endoscopic resection. All patients of the second branchial fistula were scanned in neck with CT (computed tomography), we injected ioversol-320 from the entrance of the second branchial fistula in front of sternocleidomastiod into the second branchial fistula, then scanned the neck with CT (computed tomography), and rebuilding the picture of the second branchial fistula, to prepare for the operation. 9 patients of the second branchial fistula were operated under general anesthesia with endoscopic resection. All of 9 patients were cured. no one recurred after follow-up of 6 months. It is minimally invasive and complete to resect the second branchial with endoscopic resection, the operation is simply and easy to promote.

Application of a 980-nanometer diode laser in neuroendoscopy: a case series.

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Reis, Rodolfo Casimiro; Teixeira, Manoel Jacobsen; Mancini, Marilia Wellichan; Almeida-Lopes, Luciana; de Oliveira, Matheus Fernandes; Pinto, Fernando Campos Gomes

2016-02-01

Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded. Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.

Outcomes After Conservative, Endoscopic, and Surgical Treatment of Groove Pancreatitis: A Systematic Review.

Science.gov (United States)

Kager, Liesbeth M; Lekkerkerker, Selma J; Arvanitakis, Marianna; Delhaye, Myriam; Fockens, Paul; Boermeester, Marja A; van Hooft, Jeanin E; Besselink, Marc G

2017-09-01

Groove pancreatitis (GP) is a focal form of chronic pancreatitis affecting the paraduodenal groove area, for which consensus on diagnosis and management is lacking. We performed a systematic review of the literature to determine patient characteristics and imaging features of GP and to evaluate clinical outcomes after treatment. Eight studies were included reporting on 335 GP patients with a median age of 47 years (range, 34 to 64 y), with 90% male, 87% smokers, and 87% alcohol consumption, and 47 months (range, 15 to 122 mo) of follow-up. Most patients presented with abdominal pain (91%) and/or weight loss (78%). Imaging frequently showed cystic lesions (91%) and duodenal stenosis (60%).Final treatment was conservative (eg, pain medication) in 29% of patients. Endoscopic treatment (eg, pseudocyst drainage) was applied in 19% of patients-34% of these patients were subsequently referred for surgery. Overall, 59% of patients were treated surgically (eg, pancreatoduodenectomy). Complete symptom relief was observed in 50% of patients who were treated conservatively, 57% who underwent endoscopic treatment, and 79% who underwent surgery. GP is associated with male gender, smoking, and alcohol consumption. The vast majority of patients presents with abdominal pain and with cystic lesions on imaging. Although surgical treatment seems to be the most effective, both conservative and endoscopic treatment are successful in about half of patients. A stepwise treatment algorithm starting with the least invasive treatment options seems advisable.

The clinical and endoscopic spectrum of the watermelon stomach

NARCIS (Netherlands)

Gostout, C. J.; Viggiano, T. R.; Ahlquist, D. A.; Wang, K. K.; Larson, M. V.; Balm, R.

1992-01-01

The watermelon stomach is an uncommon but treatable cause of chronic gastrointestinal bleeding. We report our experience with the clinical and endoscopic features of 45 consecutive patients treated by endoscopic Nd:YAG laser coagulation. The prototypic patient was a woman (71%) with an average age

ENDOSCOPIC SURGICAL TREATMENT OF RECURRENT BAKER’S CYSTS

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A. K. Dulaev

2014-01-01

Full Text Available Purpose of the study - to study the causes of synovitis in patients with recurrent Baker’s cyst, to evaluate the effectiveness of endoscopic treatment of popliteal cysts . Materials and methods. From 2009 till 2013 we observed 34 patients with Baker's cyst. In 18 (52.9% patients of the main group endoscopic technique was applied, in 16 (47.1% patients of the comparison group a cystic bag was isolated and dissected with open technique, and then cystic gate was sutured. Results. In 10 (55,6% patients of the main group the pain disappeared in the first postoperative day (p<0,05, the average hospital stay was 3,5±0,6 days (p<0,05, and the knee function completely recovered in 16 (88.9% patients in 2 weeks postoperatively (p<0,05. A year later in 1 (5.6% patients of the main group the signs of knee function disorders of 1 degree on a Rauschning & Lindgren scale were revealed, and in the comparison group - in 6 (37.5% patients - disorders of varying severity (p <0.05. In 4 (25,0% patients of the comparison group the recurrence of Baker’s cyst developed that required arthroscopic treatment, followed by complete recovery. Conclusions: Formation of Baker’s cyst is associated with an excess formation and accumulation of a synovial fluid in the knee joint owing to chronic damage of the meniscus and synovial membrane disease (p <0,05. Endoscopic technique allows to eliminate the causes of synovitis and the valve mechanism of fluid flow in the gastrocnemius-semimembranosus bag, to stop pain at earlier date, to restore the amplitude of active movement in the knee, to reduce the hospital stay and the risk of cyst recurrence, to prevent scarring in popliteal region (p <0,05.

Advanced esophageal cancer and esophageal stenosis endoscopic treatment

International Nuclear Information System (INIS)

Piazze, A. E mail: apiazze@hc.edu.uy

2005-01-01

Advanced esophageal cancer (AEC) is diagnosed during those stages in which surgery is possible, it is palliative for disphagia, with high morbimortality.In inoperable or irresectable cases, resorting to alternative treatment such as radiotherapy or endoscopy may palliate dsphagia.Endoscopically it is possible to place a transtumoral nasogastric catheter (NGC) for preoperative nutrition or branchial therapy (intratumoral iridium).It is possible to dilate the tumor and place and indwelling plastic or auto expandable prosthesis or to inject absolute intratumoral alcohol.There is and evaluation of results and morbimortality of personal case material through the retrospective study of 54 patients in whom 120 procedures such as those referred to above were carried out.The series includes 41 men and 13 women (3-1), 79.5% of which were of ages between 61 and 90.Optic fiber endoscopes or video endoscopes, coaxial dilators, hydro-pneumatic balloons, metallic guides and non industrial and autoexpandable plastic prosthesis were used; 34.1% of procedures were performed under used; 34.1% of procedures were performed under radioscopy.Eleven patient (8 for nutritional purposes and 3 for brachiotherapy)form part of Groups 1 and 2 of NGC.Group 3 consist of:dilations of radicular stenosis with or without neopasic recurrence, or neoplasic infiltration of esophagus, 6 patient; Group 4: 14 patients for the purpose of dilation of esophageal neoplasm; Group 5:prosthesis, 12 patients; Group 6: 11 patients with anastomotic stenosis.In patients in Group 1-2-3 solution was achieved.In Group 3 there was 1 perforation.In Group 4, out of 14 patient 13 were dilated.In Group 5 it proved impossible to place prosthesis in 2 patient, (3.7%).The conclusion arrived at is that various endoscopic techniques may palliate disphagia in patient with AEC, collaborate with preoperative nutrition through enteral path, with brachioterapy or by treating post surgical stenosis, with low mortality

Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts.

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Bang, Ji Young; Wilcox, C Mel; Trevino, Jessica M; Ramesh, Jayapal; Hasan, Muhammad; Hawes, Robert H; Varadarajulu, Shyam

2014-10-01

Transmural stents are placed at endoscopy to drain pancreatic fluid collections. This study evaluated the relationship between stent placement and treatment outcomes in patients undergoing endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. This is a retrospective study of all patients who underwent endoscopic drainage of uncomplicated pancreatic pseudocysts over a 10-year period. After dilating the transmural tracts in the range of 8-15 mm, single or multiple, 7 or 10Fr double-pigtail plastic stents were deployed. The main outcome measure was to evaluate the relationship between stent characteristics and the number of endoscopic interventions required to achieve resolution of the pancreatic pseudocyst (treatment success). Of 122 patients, 45 (36.9%) had 10Fr stents of which 30 patients (66.7%) had more than one stent; the remaining 77 (63.1%) patients had 7Fr stents of which 56 (72.7%) had more than one stent. The overall treatment success was 94.3%. Treatment was successful in 102 patients (83.6%) with one intervention; 13 patients (10.7%) required re-intervention for successful drainage and 7 patients (5.7%) failed endoscopic treatment. There was no significant difference in the number of interventions required for treatment success between patients with 7 or 10Fr stents (one intervention required in 87.7 vs. 90.5%, respectively; p = 0.766) and between patients with 1 or >1 stent (one intervention required in 88.9 vs. 88.6%, respectively; p = 0.999). On multiple logistic regression analysis, the stent size (OR 1.54; 95% CI 0.23-10.4) and number (OR 1.15; 95% CI 0.25-5.25) were not associated with the number of interventions required for treatment success when adjusted for pseudocyst size, location, drainage modality, the presence or absence of pancreatic duct stent and luminal compression. There appears to be no relationship between the number of interventions required for treatment success and stent characteristics in patients undergoing

Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

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V. V. Izbitsky

2013-06-01

Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

Band ligation of gastric antral vascular ectasia is a safe and effective endoscopic treatment.

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Keohane, John; Berro, Wael; Harewood, Gavin C; Murray, Frank E; Patchett, Stephen E

2013-07-01

Gastric antral vascular ectasia (GAVE) or 'watermelon stomach' is a rare and often misdiagnosed cause of occult upper gastrointestinal bleeding. Treatment includes conservative measures such as transfusion and endoscopic therapy. A recent report suggests that endoscopic band ligation (EBL) offers an effective alternative treatment. The aim of the present study is to demonstrate our experiences with this novel technique, and to compare argon plasma coagulation (APC) with EBL in terms of safety and efficacy. A retrospective analysis of all endoscopies with a diagnosis of GAVE was carried out between 2004 and 2010. Case records were examined for information pertaining to the number of procedures carried out, mean blood transfusions, mean hemoglobin, and complications. A total of 23 cases of GAVE were treated. The mean age was 73.9 (55-89) years. Female to male ratio was 17:6 and mean follow up was 26 months. Eight patients were treated with EBL with a mean number of treatments of 2.5 (1-5). This resulted in a statistically significant improvement in the endoscopic appearance and a trend towards fewer transfusions. Of the eight patients treated with EBL, six (75%) patients had previously failed APC treatment despite having a mean of 4.7 sessions. Band ligation was not associated with any short- or medium-term complications. The 15 patients who had APC alone had a mean of four (1-11) treatments. Only seven (46.7%) of these patients had any endoscopic improvement with a mean of four sessions. EBL represents a safe and effective treatment for GAVE. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

Per-oral endoscopic myotomy: Major advance in achalasia treatment and in endoscopic surgery

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Friedel, David; Modayil, Rani; Stavropoulos, Stavros N

2014-01-01

Per-oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgery (NOTES) approach to laparoscopy Heller myotomy (LHM). POEM is arguably the most successful clinical application of NOTES. The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM. Initial efficacy, safety and acid reflux data suggest at least equivalence of POEM to LHM, the previous gold standard for achalasia therapy. Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM. The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis. PMID:25548473

Possibilities of Using Endoscopic Equipment in the Treatment of Post-Traumatic Urethral Strictures in Children

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D.V. Shevchuk

2016-10-01

Full Text Available Background. Damage to the urethra in damaged pelvic bones in children is marked less than in adults (less than 1 % (Tarman G.J. et al., 2002. Post-traumatic urethral stricture in children is a quite rare and complex urologic pathology. Due to anatomical features, treatment for urethral stricture in children is different from its treatment in adults (Onen A. et al., 2005; Nerli R.B. et al., 2008; Ranjan P. et al., 2011. M.M. Koraitim (2012 described the experience of treating 20 patients with complications after transperyneal urethral plasty. The author noted that in the absence of need for reconstruction of the bladder neck, it is quite effective to use endoscopic incision of urethral stricture. T.E. Helmy, A.T. Hafez (2013 also described the results of the successful application of endoscopic equipment (direct visual urethrotomia after open urethroplasty. The important point that leads to finding effective minimally invasive treatments for post-traumatic urethral strictures in children is the development of erectile dysfunction in the future, the incidence of which, according to some authors, (Koraitim M.M., 2014 is up to 47 %. The aim of the study: based on the available published data and own treatment outcomes in children with posterior urethral strictures, to establish the role of endoscopic treatment of this complex pathology as a method of prevention and treatment of neuromuscular dysfunction of the bladder. Materials and methods. At the premises of the surgical departments of Zhytomyr Regional Children’s Clinical Hospital, there were widely implemented invasive endoscopic methods for the diagnosis and treatment of pathologies of the lower urinary tract. Available equipment enables to carry out diagnostic procedures from 1 month old. A variety of endoscopic surge­ries on the lower urinary tract is being performed, namely — the removal of calculi, incision of valves and strictures of the posterior urethra, dissection of urethral cysts

[Choledocholithiasis and pregnancy. Hybrid laparo-endoscopic treatment in one step].

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Valadez-Caballero, David; González-Santamaría, Roberto; Soto-Mendoza, Héctor; Alberto Blanco-Figueroa, Jorge; Flores-Pantoja, Juan Manuel

2014-01-01

Complications associated with choledocholithiasis are uncommon during pregnancy. However, when it occurs, the morbidity and mortality related for the product and the mother increases, so a proper treatment is imperative in these patients. A 25-year-old pregnant woman on her second trimester. The current condition was started four days prior to the hospital admission with abdominal pain in the right upper quadrant with nausea and vomit.Twenty-four hours later jaundice and dark urine is observed. Physical examination shows scleral jaundice, right upper quadrant abdominal pain without peritoneal irritation. Uterus at umbilicus level without uterine activity. Uterus at umbilicus level without uterine activity. Laboratory tests showed elevated bilirubin and transaminases without leukocytosis; ultrasound reported live intrauterine unique product, with a heart rate of 128 beats per minute, gallbladder with multiple images inside that cast acoustic shadowing, and a 10 mm common bile duct dilated bile duct with dilatation of intrahepatic bile ducts. It was perform laparoscopic cholecystectomy with intraoperative cholangiography and placement of a transcystic jaguar guide for selective cannulation of the common bile duct. Intraoperative endoscopic retrograde cholangiopancreatography was performed with endoscopic stone extraction. The outcome was satisfactory with a hospital discharge at 48 hours. Current evidence has shown that the combined use of laparoscopy and therapeutic endoscopic cholangiography in one step is effective for the treatment of choledocholithiasis, decreasing the risk of complications associated with cannulation of the bile duct.

Quality of life and fear of cancer recurrence after endoscopic and surgical treatment for early neoplasia in Barrett's esophagus

NARCIS (Netherlands)

Rosmolen, W. D.; Boer, K. R.; de Leeuw, R. J.; Gamel, C. J.; van Berge Henegouwen, M. I.; Bergman, J. J.; Sprangers, M. A.

2010-01-01

Background and study aims: Endoscopic treatment of early neoplasia in Barrett's esophagus preserves the esophagus and is minimally invasive compared with surgical treatment. However, the influence of endoscopic therapy on quality of life (QOL) and fear of cancer recurrence is unknown. We explored

Application of percutaneous endoscopic RF/holmium laser lumbar discectomy in the lumbar disc herniation (attach 160 cases reported)

International Nuclear Information System (INIS)

Zhao Zhengxu; Hu Tongzhou; He Jun; Jiang Zenghui; Wang Weiqi; Lin Hang

2010-01-01

Objective: To evaluate the efficacy of endoscopic discectomy for the lumbar disc herniation and to determine the prognostic factors affecting surgical outcome. Methods: In the group of 160 cases, posterolateral and trans-interlaminar endoscopic Ho: YAG laser and radio frequency-assisted disc excisions were performed under local anesthesia. Results: In 160 patients with post-surgical follow-up period was 15 months on average (7 ∼ 24 months). Based on the MacNab criteria, there were 117 cases in which result was excellent, in 19 cases good, in 12 cases fair, and in 12 cases poor, and successful rate was 85%. Conclusion: Percutaneous endoscopy lumbar discectomy is effective for recurrent disc herniation in the selected. In applies in particular to the traditional open surgery of lumbar disc herniation in patients with recurrent. (authors)

Endoscopic management of bleeding peptic ulcers

International Nuclear Information System (INIS)

Farooqi, J.I.; Farooqi, R.J.

2001-01-01

Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection.

Science.gov (United States)

Gubler, Christoph; Bauerfeind, Peter

2014-09-01

Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated. Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent. Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.

Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis

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Diogo Gil-Sousa

2015-05-01

Full Text Available Studer's neobladder lithiasis is a rare but important long term complication of this orthotopic bladder substitute technique. We report a case of a 45 year-old male patient, submitted to a radical cystoprostatectomy with a Studer's orthotopic neobladder 4 years before, presenting bad compliance to recommended urinary habits, increased production of mucus and high post voiding residue. CT scan and urethrocystography showed a distended pouch with 2 major sacculations with narrow communication and a stone in each sacculation. A minimally invasive endoscopic technique was successfully used in the treatment of the 2 small calculus.

Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis

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Hirokazu Honda

2017-11-01

Full Text Available Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO or gastric pneumatosis (GP. In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis.

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Honda, Hirokazu; Ikeya, Takashi; Kashiwagi, Erika; Okada, Shuichi; Fukuda, Katsuyuki

2017-01-01

Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

Endoscopic therapy of neoplasia related to Barrett's esophagus and endoscopic palliation of esophageal cancer.

Science.gov (United States)

Vignesh, Shivakumar; Hoffe, Sarah E; Meredith, Kenneth L; Shridhar, Ravi; Almhanna, Khaldoun; Gupta, Akshay K

2013-04-01

Barrett's esophagus (BE) is the most important identifiable risk factor for the progression to esophageal adenocarcinoma. This article reviews the current endoscopic therapies for BE with high-grade dysplasia and intramucosal cancer and briefly discusses the endoscopic palliation of advanced esophageal cancer. The diagnosis of low-grade or high-grade dysplasia (HGD) is based on several cytologic criteria that suggest neoplastic transformation of the columnar epithelium. HGD and carcinoma in situ are regarded as equivalent. The presence of dysplasia, particularly HGD, is also a risk factor for synchronous and metachronous adenocarcinoma. Dysplasia is a marker of adenocarcinoma and also has been shown to be the preinvasive lesion. Esophagectomy has been the conventional treatment for T1 esophageal cancer and, although debated, is an appropriate option in some patients with HGD due to the presence of occult cancer in over one-third of patients. Endoscopic ablative modalities (eg, photodynamic therapy and cryoablation) and endoscopic resection techniques (eg, endoscopic mucosal resection) have demonstrated promising results. The significant morbidity and mortality of esophagectomy makes endoscopic treatment an attractive potential option.

Endoscopic excavation for the treatment of small esophageal subepithelial tumors originating from the muscularis propria.

Science.gov (United States)

Ye, Li-ping; Zhu, Lin-hong; Zhou, Xian-bin; Mao, Xin-li; Zhang, Yu

2015-01-01

This study was designed to evaluate the safety and efficacy of endoscopic excavation for esophageal subepithelial tumors originating from the muscularis propria. Forty-five patients with esophageal subepithelial tumors originating from the muscularis propria were treated with endoscopic excavation between January 2010 and June 2012. The key steps were: (1) making several dots around the tumor; (2) incising the mucosa along with the marker dots, and then seperating the tumor from the muscularis propria by using a hook knife or an insulated-tip knife; (3) closing the artificial ulcer with clips after the tumor was removed. The mean tumor diameter was 1.1 ± 0.6 cm. Endoscopic excavation was successfully performed in 43 out of 45 cases (95.6%), the other 2 cases were ligated with nylon rope. During the procedure perforation occurred in 4 (8.9%) patients, who recovered after conservative treatment. No massive bleeding or delayed bleeding occurred. Histologic diagnosis was obtained from 43 (95.6%) patients. Pathological diagnoses of these tumors were leiomyomas (38/43) and gastrointestinal stromal tumors (5/43). Endoscopic excavation is a safe and effective method for the treatment of small esophageal subepithelial tumors originating from the muscularis propria.

Advances in Lasers for the Treatment of Stones-a Systematic Review.

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Kronenberg, Peter; Somani, Bhaskar

2018-05-17

Laser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year. Variable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and "cleaving only" fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology. Laser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.

Endoscopic versus surgical treatment of ampullary adenomas: a systematic review and meta-analysis

Science.gov (United States)

Mendonça, Ernesto Quaresma; Bernardo, Wanderley Marques; de Moura, Eduardo Guimarães Hourneaux; Chaves, Dalton Marques; Kondo, André; Pu, Leonardo Zorrón Cheng Tao; Baracat, Felipe Iankelevich

2016-01-01

The aim of this study is to address the outcomes of endoscopic resection compared with surgery in the treatment of ampullary adenomas. A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For this purpose, the Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and data considering endoscopic treatment compared with surgery. The entire analysis was based on a fixed-effects model. Five retrospective cohort studies were selected (466 patients). All five studies (466 patients) had complete primary resection data available and showed a difference that favored surgical treatment (risk difference [RD] = -0.24, 95% confidence interval [CI] = -0.44 to -0.04). Primary success data were identified in all five studies as well. Analysis showed that the surgical approach outperformed endoscopic treatment for this outcome (RD = -0.37, 95% CI = -0.50 to -0.24). Recurrence data were found in all studies (466 patients), with a benefit indicated for surgical treatment (RD = 0.10, 95% CI = -0.01 to 0.19). Three studies (252 patients) presented complication data, but analysis showed no difference between the approaches for this parameter (RD = -0.15, 95% CI = -0.53 to 0.23). Considering complete primary resection, primary success and recurrence outcomes, the surgical approach achieves significantly better results. Regarding complication data, this systematic review concludes that rates are not significantly different. PMID:26872081

Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy.

Science.gov (United States)

Al-Ashhab, Mohamed Ebrahim; Elbegawy, Hossam El-Dein A; Hasan, Hala Ali Abed

Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Role of Confocal Laser Endomicroscopy in Detection of Residual Barrett's Esophagus after Radiofrequency Ablation

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Giorgio Diamantis

2011-01-01

Full Text Available Endoscopic endoluminal radiofrequency ablation (RFA is a novel and promising modality for Barrett's esophagus (BE treatment. Actually the only surveillance method after the ablation treatment is random biopsies throughout the whole treated area. Confocal laser endomicroscopy (CLE is a new endoscopic imaging tool that permits high-resolution microscopic examination of the gastrointestinal tract. The technology has garnered increasing attention because of its ability to provide real-time “optical” biopsy specimens, with a very high sensitivity and specificity. This paper summarize the potential application of CLE in the surveillance of the reepithelialization of BE, after endoscopic RFA.

Laser scanning dental probe for endodontic root canal treatment

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Blank, Molly A. B.; Friedrich, Michal; Hamilton, Jeffrey D.; Lee, Peggy; Berg, Joel; Seibel, Eric J.

2011-03-01

Complications that arise during endodontic procedures pose serious threats to the long-term integrity and health of the tooth. Potential complexities of root canals include residual pulpal tissue, cracks, mesial-buccal 2 and accessory canals. In the case of a failed root canal, a successful apicoectomy can be jeopardized by isthmuses, accessory canals, and root microfracture. Confirming diagnosis using a small imaging probe would allow proper treatment and prevent retreatment of endodontic procedures. An ultrathin and flexible laser scanning endoscope of 1.2 to 1.6mm outer diameter was used in vitro to image extracted teeth with varied root configurations. Teeth were opened using a conventional bur and high speed drill. Imaging within the opened access cavity clarified the location of the roots where canal filing would initiate. Although radiographs are commonly used to determine the root canal size, position, and shape, the limited 2D image perspective leaves ambiguity that could be clarified if used in conjunction with a direct visual imaging tool. Direct visualization may avoid difficulties in locating the root canal and reduce the number of radiographs needed. A transillumination imaging device with the separated illumination and light collection functions rendered cracks visible in the prepared teeth that were otherwise indiscernible using reflected visible light. Our work demonstrates that a small diameter endoscope with high spatial resolution may significantly increase the efficiency and success of endodontic procedures.

Per-oral Endoscopic Myotomy (POEM): A safe and effective treatment for achalasia in geriatric

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Hernández-Mondragón, Oscar Víctor; Solórzano-Pineda, Omar Michel; Blancas-Valencia, Juan Manuel; González-Martínez, Marina Alejandra

2017-01-01

Esophageal achalasia is a primary motor disorder of the esophagus characterized by impair relaxation of the lower esophageal sphincter and absent of esophageal peristalsis. Per-oral endoscopic myotomy is an alternative treatment to surgical Heller myotomy in patients over 65 years old. The aim of this paper was to describe the results of peroral endoscopic myotomy (POEM) or the treatment of achalasia in geriatric patients. We included patients over 65 years old with POEM, from retrospective cohort review, in which POEM was performed with a standardized technique in our department. 12 patients were included, the procedure was successful in 98% of patients, minor adverse events occurred without mortality. POEM is a safe and effective technique for the treatment of achalasia, the results of the study are similar to those reported in The literature.

Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum.

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Yamamoto, Natsuyo; Isayama, Hiroyuki; Sasahira, Naoki; Tsujino, Takeshi; Nakai, Yousuke; Miyabayashi, Koji; Mizuno, Suguru; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

2014-08-01

A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla. Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a pancreatic stent or a nasal pancreatic drainage catheter was placed for 1 week. If a stricture or obstruction was evident, it was treated with balloon dilation followed by long-term stent placement (1 year). When an outflow of pancreatic juice was disturbed by a pancreatic stone, endoscopic stone extraction was performed. Balloon dilation and stent placement were achieved and were successful in all the cases (16/16; 100%). Clinical improvement was achieved in 7 (84.7%) of the 9 patients with recurrent acute pancreatitis and in 6 (85.7%) of the 7 patients with chronic pancreatitis. Early complications were observed in 1 (6.3%) patient. Pancreatitis or bleeding related to balloon dilation was not observed. Endoscopic balloon dilation for the minor papilla is feasible for the management of symptomatic pancreas divisum.

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula

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Andre Ramos Sorgi Macedo

2013-07-01

Full Text Available Purpose The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. Materials and Methods: A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. Results The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts.

Endoscopic management of colorectal adenomas.

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Meier, Benjamin; Caca, Karel; Fischer, Andreas; Schmidt, Arthur

2017-01-01

Colorectal adenomas are well known precursors of invasive adenocarcinoma. Colonoscopy is the gold standard for adenoma detection. Colonoscopy is far more than a diagnostic tool, as it allows effective treatment of colorectal adenomas. Endoscopic resection of colorectal adenomas has been shown to reduce the incidence and mortality of colorectal cancer. Difficult resection techniques are available, such as endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full-thickness resection. This review aims to provide an overview of the different endoscopic resection techniques and their indications, and summarizes the current recommendations in the recently published guideline of the European Society of Gastrointestinal Endoscopy.

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center.

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Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Ferraz, Tania

2010-10-01

Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Endoscopic transsphenoidal surgery represents an effective option for treatment of patients

Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

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Ankur Jhanwar

Full Text Available ABSTRACT Objective: To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients. Materials and methods: Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder was performed to assess stone free status. Results: A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38. Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87. Conclusion: Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative.

The electrosurgical knife in an optimized intermittent cutting mode for the endoscopic treatment of benign web-like tracheobronchial stenosis.

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Amat, Beatriz; Esselmann, Albert; Reichle, Guenther; Rohde, Hans-Juergen; Westhoff, Michael; Freitag, Lutz

2012-01-01

The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue. To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser. Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode. All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157 ± 93 days. There was an overall decrease observed in mean obstruction (Pbenign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anti-coagulation effect. Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.

Endoscope-assisted conservative condylectomy combined with orthognathic surgery in the treatment of mandibular condylar osteochondroma.

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Yu, Hongbo; Jiao, Feifei; Li, Biao; Zhang, Lei; Shen, Steve Guofang; Wang, Xudong

2014-07-01

Mandibular condylar osteochondroma (OC) results in asymmetric prognathism with facial morphologic and functional disturbance. The aim of this study was to explore the feasibility of endoscope-assisted conservative condylectomy combined with simultaneous orthognathic surgery in the treatment of condylar OC. Thirteen patients with OC of the mandibular condyle were enrolled in this study. With the aid of endoscope, condylar OC resection and conservative condylectomy were carried out via intraoral approach. A direct vision of the magnified and illuminated operative field was realized. Simultaneous orthognathic surgery was used to correct facial asymmetry and malocclusion. All patients healed uneventfully. No facial nerve injury and salivary fistula occurred. Facial symmetry and morphology were greatly improved, and stable occlusion was obtained in all cases. The patients showed no signs of recurrence and temporomandibular joint ankylosis in the 16 to 54 months of follow-up. Endoscope-assisted tumor resection and condylectomy combined with simultaneous orthognathic surgery provide us a valuable option in the treatment of mandibular condylar OC.

Complex rectal polyps: other treatment modalities required when offering a transanal endoscopic microsurgery service.

LENUS (Irish Health Repository)

Joyce, Myles R

2011-09-01

Complex rectal polyps may present a clinical challenge. The study aim was to assess different treatment modalities required in the management of patients referred for transanal endoscopic microsurgery.

Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.

Science.gov (United States)

Dillon, John P; Freedman, Ilan; Tan, James S M; Mitchell, David; English, Shaun

2012-07-01

Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery. We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36 years (23-68 years). The average hospital stay was 6 days (4-9 days). No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18 days (7-22 days). We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.

Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia

OpenAIRE

Diego Palladino; Andrea Mardighian; Marilina D’Amora; Luca Roberto; Francesco Lassandro; Claudia Rossi; Gianluca Gatta; Mariano Scaglione; Guglielmi Giuseppe

2016-01-01

Purpose. Aim of the study is to evaluate the efficacy of the endoscopic (pneumatic dilation) versus surgical (Heller myotomy) treatment in patients affected by esophageal achalasia using barium X-ray examination of the digestive tract performed before and after the treatment. Materials and Methods. 19 patients (10 males and 9 females) were enrolled in this study; each patient underwent a barium X-ray examination to evaluate the esophageal diameter and the height of the barium column before a...

Endoscopic Devices for Obesity.

Science.gov (United States)

Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I

2016-06-01

The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.

Per rectal endoscopic myotomy for the treatment of adult Hirschsprung's disease: First human case (with video).

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Bapaye, Amol; Wagholikar, Gajanan; Jog, Sameer; Kothurkar, Aditi; Purandare, Shefali; Dubale, Nachiket; Pujari, Rajendra; Mahadik, Mahesh; Vyas, Viral; Bapaye, Jay

2016-09-01

Hirschsprung's disease (HD) is a congenital disorder characterized by the absence of intrinsic ganglion cells in submucosal and myenteric plexuses of the hindgut; and presents with constipation, intestinal obstruction and/or megacolon. HD commonly involves the rectosigmoid region (short segment HD), although shorter and longer variants of the disease are described. Standard treatment involves pull-through surgery for short segment HD or posterior anorectal myotomy in selected ultrashort segment candidates. Third space endoscopy has evolved during the past few years. Per oral endoscopic myotomy and per oral pyloromyotomy are described for treatment of achalasia cardia and refractory gastroparesis, respectively. Using the same philosophy of muscle/sphincter disruption for spastic bowel segments, per rectal endoscopic myotomy could be considered as a treatment option for short segment HD. A 24-year-old male patient presented with refractory constipation since childhood, and habituated to high-dose laxative combinations. Diagnosis was confirmed as adult short segment HD by barium enema, colonoscopic deep suction mucosal biopsies and anorectal manometry. Histopathology confirmed aganglionosis in the distal 15 cm. By implementing principles of third space endoscopy, per rectal endoscopic myotomy 20 cm in length was successfully carried out. At 24-week follow up, the patient reported significant relief of constipation and associated symptoms. Sigmoidoscopy, anorectal manometry and barium enema confirm improved rectal distensibility and reduced rectal pressures. The present case report describes the first human experience of per rectal endoscopic myotomy for successful treatment of adult short segment HD. © 2016 Japan Gastroenterological Endoscopy Society.

Efficacy and Safety of Semirigid Ureteroscopy Combined with Holmium: YAG Laser in the Treatment of Upper Urinary Tract Calculi: Is it a Good Alternative Treatment Option of Flexible Ureteroscopy for Developing Countries

International Nuclear Information System (INIS)

Bibi, S.; Siddiqui, T. R.; Ahmed, W.; Alam, S. E.; Shah, S. A.; Soomro, I. A.; Qureshi, S.

2015-01-01

Objective: To assess the success rates of endoscopic management of upper ureteral stones using semirigid ureterorenoscopy and holmium: YAG laser lithotripters. Method: A total of 74 patients with an established diagnosis of upper ureteric stone and scheduled for endoscopic ureteral stone treatment were retrospectively evaluated. Failure was defined as the inability to contact or fragment the stone, migration of the stone into the renal pelvis and difficulty in visualizing the stone for the second time. Success rates and influencing factors as for stone-free state were investigated. Results: Mean age of our patients was 45.99±15.00 (range: 24-82) years. In 14 of 74 patients procedural failure was observed. Double J stents were implanted in 65 percent of the patients and ureteral catheterization was performed on 20 percent of them. The total success rate was 81.1 percent. Major complication rate was 1.1 percent. Factors effecting the success rate as gender, age, body mass index, grade of hydronephrosis and stone size were evaluated and only age was found to be statistically significant. Conclusion: Despite some potential risks, semirigid ureterorenoscopic stone extraction and holmium: YAG laser lithotripters are still safe and effective treatment alternatives for management of upper ureteral stones. (author)

Differences in Recurrence Rate and De Novo Incontinence after Endoscopic Treatment of Vesicourethral Stenosis and Bladder Neck Stenosis

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Jennifer Kranz

2017-08-01

Full Text Available ObjectivesThe objective of this study was to compare the recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral stenosis (VUS after radical prostatectomy (RP and for bladder neck stenosis (BNS after transurethral resection of the prostate (TURP.MethodsRetrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups.ResultsA total of 147 patients underwent endoscopic therapy for VUS (59.2% or BNS (40.8%. Mean age was 68.3 years (range 44–86, mean follow-up 27.1 months (1–98. Mean time to recurrence after initial therapy was 23.9 months (1–156, mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1–159. Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p = 0.006 and the recurrence rate was significantly higher (59.8 vs. 41.7%; p = 0.031. The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p = 0.031. The mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p = 0.011. After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p = 0.091, whereas the rate of de novo incontinence (13.8 for VUS vs. 0% for BNS; p = 0.005 stayed significantly higher in patients treated for VUS.ConclusionMost patients with BNS are successfully treated endoscopically. In patients with

Endoscopic Management of an Intramural Sinus Leak After Per- Oral Endoscopic Myotomy

Science.gov (United States)

Al Taii, Haider; Confer, Bradley; Gabbard, Scott; Kroh, Matthew; Jang, Sunguk; Rodriguez, John; Parsi, Mansour A.; Vargo, John J.; Ponsky, Jeffrey

2016-01-01

Per-oral endoscopic myotomy (POEM) was developed less than a decade ago for the treatment of achalasia. Its minimally invasive approach and the favorable short-term outcome have led to rapid adoption of the technique throughout the world. As with any new technique, there will be adverse events, and it is important that effective treatments for these adverse events be discussed. We present a case of successful endoscopic management of an intramural sinus leak after a POEM procedure using tandem fully covered esophageal stents. PMID:27921057

Hospitalization, frequency of interventions, and quality of life after endoscopic, surgical, or conservative treatment in patients with chronic pancreatitis.

Science.gov (United States)

Rutter, Karoline; Ferlitsch, A; Sautner, T; Püspök, A; Götzinger, P; Gangl, A; Schindl, M

2010-11-01

Patients with chronic pancreatitis usually have a long and debilitating history of disease with frequent hospital admissions, episodes of intractable pain and multiple interventions. The sequences of treatment at initial presentation, endoscopy, surgery, or conservative treatment may affect the time course and admissions needed for disease control, thereby determining quality of life and overall outcome. A total of 292 patients with initial endoscopic, surgical, or conservative pharmacological treatment were retrospectively analyzed regarding frequency of interventions, days in hospital, symptom-free intervals, morbidity, and mortality. Quality of life (QoL) at the latest follow-up was measured by two standardized quality of life questionnaires (EORTC C30 and PAN26). Endoscopic treatment was initially performed in 150 (51.4%) patients, whereas 99 (33.9%) underwent surgery and 43 (14.7%) patients were treated conservatively at their initial presentation. Patients who underwent surgery had a significantly shorter time in the hospital (25.3 ± 24.6, 34.4 ± 35.1, 61.1 ± 37.9; P surgical treatment (P ≤ 0.001), whereas patients after endoscopic intervention developed acute or chronic pancreatitis or pseudocyst formation (P = 0.023). Patients who undergo surgery as their initial treatment for chronic pancreatitis require less consecutive interventions, a shorter hospital stay, and have a better quality of life compared with any other treatment. Surgery should therefore be considered early for the treatment of chronic pancreatitis, when endoscopic or conservative treatment fails and patients require further intervention.

Endoscopic Rectus Abdominis and Prepubic Aponeurosis Repairs for Treatment of Athletic Pubalgia.

Science.gov (United States)

Matsuda, Dean K; Matsuda, Nicole A; Head, Rachel; Tivorsak, Tanya

2017-02-01

Review of the English orthopaedic literature reveals no prior report of endoscopic repair of rectus abdominis tears and/or prepubic aponeurosis detachment. This technical report describes endoscopic reattachment of an avulsed prepubic aponeurosis and endoscopic repair of a vertical rectus abdominis tear immediately after endoscopic pubic symphysectomy for coexistent recalcitrant osteitis pubis as a single-stage outpatient surgery. Endoscopic rectus abdominis repair and prepubic aponeurosis repair are feasible surgeries that complement endoscopic pubic symphysectomy for patients with concurrent osteitis pubis and expand the less invasive options for patients with athletic pubalgia.

Transanal endoscopic microsurgery.

Science.gov (United States)

Smart, Christopher J; Cunningham, Chris; Bach, Simon P

2014-02-01

Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research. Copyright © 2014. Published by Elsevier Ltd.

Endoscopic modified medial maxillectomy for treatment of inverted papilloma originating from the maxillary sinus.

Science.gov (United States)

Erbek, Selim S; Koycu, Alper; Buyuklu, Fuat

2015-05-01

Endoscopic approaches have become an alternative to external approaches in the treatment of sinonasal inverted papillomas (IPs) in recent years. The aim of this study was to analyze the outcomes of endoscopic modified medial maxillectomy preserving the nasolacrimal duct and the inferior turbinate in selected IP cases. Medical charts of patients diagnosed with IP originating from the maxillary sinus between July 2008 and August 2013 were reviewed. Eight patients who had undergone endoscopic modified medial maxillectomy were included in the study. Attachment of IP was located on the medial wall of the maxillary sinus in all cases. The nasolacrimal duct was preserved in all of the patients. The inferior turbinate was completely preserved in 5 patients, and the anterior part of the inferior turbinate was preserved in 3 patients. The mean follow-up period of the patients was 30.8 months (12-60  mo). None of the patients had recurrence or major complications. The postoperative complaints were minor hemorrhagic discharge and crusting for the first few weeks. Endoscopic modified medial maxillectomy preserving the nasolacrimal duct and the inferior turbinate provides good surgical and functional outcomes in selected IP cases.

Asymptomatic Esophageal Varices Should Be Endoscopically Treated

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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.

COMPLICATIONS OF NON-ENDOSCOPIC DISCECTOMY: A RETROSPECTIVE STUDY OF TWENTY-ONE YEARS

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Jorge Felipe Ramírez León

Full Text Available ABSTRACT Objective: To report and compare the number and grade of major complications presented with non-endoscopic thermal discectomy and nucleoplasty for the treatment of discogenic axial lumbar pain using laser and radiofrequency. Methods: A 21 years retrospective study was conducted of the clinical charts of patients whose reason for consultation was axial lumbar pain from degenerative disc disease, and who underwent surgery using non-endoscopic discectomy and nucleoplasty (NEDN. Two groups were established; the first, NEDN with laser, and second, NEDN with radiofrequency. The number and types of complications reported in the case-series were counted, and their statistical differences determined. Results: The inclusion criteria were fulfilled by 643 of the medical charts. 26 complications were reported, the most common being radiculitis (n=12. Statistically significant differences were found between the complications occurring in the two groups (p=0.01. Conclusion: The number of complications showed statistically significant difference. The severity of the complications and adverse outcomes provide an argument for choosing one technology over the other. Training and the learning curve stage are important factors to be taken into account, to avoid complications.

Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study

NARCIS (Netherlands)

von Renteln, Daniel; Fuchs, Karl-Hermann; Fockens, Paul; Bauerfeind, Peter; Vassiliou, Melina C.; Werner, Yuki B.; Fried, Gerald; Breithaupt, Wolfram; Heinrich, Henriette; Bredenoord, Albert J.; Kersten, Jan F.; Verlaan, Tessa; Trevisonno, Michael; Rösch, Thomas

2013-01-01

Pilot studies have indicated that peroral endoscopic myotomy (POEM) might be a safe and effective treatment for achalasia. We performed a prospective, international, multicenter study to determine the outcomes of 70 patients who underwent POEM at 5 centers in Europe and North America. Three months

Current Status of Peroral Endoscopic Myotomy

OpenAIRE

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic ...

Ling classification describes endoscopic progressive process of achalasia and successful peroral endoscopy myotomy prevents endoscopic progression of achalasia.

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Zhang, Wen-Gang; Linghu, En-Qiang; Chai, Ning-Li; Li, Hui-Kai

2017-05-14

To verify the hypothesis that the Ling classification describes the endoscopic progressive process of achalasia and determine the ability of successful peroral endoscopic myotomy (POEM) to prevent endoscopic progression of achalasia. We retrospectively reviewed the endoscopic findings, symptom duration, and manometric data in patients with achalasia. A total of 359 patients (197 women, 162 men) with a mean age of 42.1 years (range, 12-75 years) were evaluated. Symptom duration ranged from 2 to 360 mo, with a median of 36 mo. Patients were classified with Ling type I ( n = 119), IIa ( n = 106), IIb ( n = 60), IIc ( n = 60), or III ( n = 14), according to the Ling classification. Of the 359 patients, 349 underwent POEM, among whom 21 had an endoscopic follow-up for more than 2 years. Pre-treatment and post-treatment Ling classifications of these 21 patients were compared. Symptom duration increased significantly with increasing Ling classification (from I to III) ( P achalasia and may be able to serve as an endoscopic assessment criterion for achalasia. Successful POEM (Eckardt score ≤ 3) seems to have the ability to prevent endoscopic evolvement of achalasia. However, studies with larger populations are warranted to confirm our findings.

Endoscopic full-thickness resection: Current status.

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Schmidt, Arthur; Meier, Benjamin; Caca, Karel

2015-08-21

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.

Endoscopic palliation of malignant dysphagia: a challenging task in inoperable oesophageal cancer

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Mylvaganam S

2006-07-01

Full Text Available Abstract Background The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery. Patients and methods All the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation. Results Overall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35 – 93. The median number of sessions per patient was 2 (range 1 – 13 sessions. Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5–83 months and the median survival from 1st palliation was 5 months (range 0.5–68.5 months. Conclusion Endoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.

Per-oral endoscopic myotomy (POEM) for esophageal achalasia.

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Pescarus, Radu; Shlomovitz, Eran; Swanstrom, Lee L

2014-01-01

Per-oral endoscopic myotomy (POEM) is a new minimally invasive endoscopic treatment for achalasia. Since the first modern human cases were published in 2008, around 2,000 cases have been performed worldwide. This technique requires advanced endoscopic skills and a learning curve of at least 20 cases. POEM is highly successful with over 90 % improvement in dysphagia while offering patients the advantage of a low impact endoscopic access. The main long-term complication is gastroesophageal reflux (GER) with an estimated incidence of 35 %, similar to the incidence of GER post-laparoscopic Heller with fundoplication. Although POEM represents a paradigm shift in the treatment of achalasia, more long-term data are clearly needed to further define its role in the treatment algorithm of this rare disease.

Efficacy and safety of minor endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation in treatment of elderly patients with multiple large common bile duct stones

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HE Yongfeng

2018-02-01

Full Text Available Objective To investigate the clinical effect and safety of minor endoscopic sphincterotomy (mEST combined with endoscopic papillary large balloon dilation (EPLBD in the treatment of elderly patients with multiple large common bile duct stones. MethodsA retrospective analysis was performed for 229 patients with multiple large common bile duct stones who underwent endoscopic retrograde cholangiopancreatography (ERCP in Endoscopy Center, Ankang Municipal Central Hospital, from January 2012 to December 2016, and the surgical procedure was selected based on the size of stones and the morphology of the common bile duct. According to the endoscopic surgical procedure, the patients were divided into mEST+EPLBD group (treatment group with 136 patients and endoscopic phincterotomy (EST group (control group with 93 patients. The two groups were compared in terms of the success rate of first stone removal, use rate of mechanical lithotripsy (ML, time spent on stone removal, and the incidence rate of complications. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThere was no significant difference in the success rate of first stone removal between the treatment group and the control group (91.17% vs 87.10%, χ2=0.980, P＞0.05, while there were significant differences in the time spent on stone removal (18.2±4.3 min vs 37.4±6.7 min, χ2=37.1526, P＜0.01 and use rate of ML (6.71% vs 40.00%, t=24.411, P＜0.01. There were no significant differences in the incidence rates of pancreatitis (2.94% vs 6.45%, χ2=1.630, P＞0.05 and bleeding (2.21% vs 2.15%, χ2=0.001, P＞0.05 between the two groups, and no patient experienced perforation or infection. ConclusionmEST+EPLBD has a good clinical effect in the treatment of elderly patients with multiple large common bile duct stones and can effectively shorten the time spent on stone removal, reduce the

[Clinical Results of Endoscopic Treatment of Greater Trochanteric Pain Syndrome].

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Zeman, P; Rafi, M; Skala, P; Zeman, J; Matějka, J; Pavelka, T

2017-01-01

PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (ppain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of

Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases

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van Halsema, Emo E.; Wong Kee Song, Louis M.; Baron, Todd H.; Siersema, Peter D.; Vleggaar, Frank P.; Ginsberg, Gregory G.; Shah, Pari M.; Fleischer, David E.; Ratuapli, Shiva K.; Fockens, Paul; Dijkgraaf, Marcel G. W.; Rando, Giacomo; Repici, Alessandro; van Hooft, Jeanin E.

2013-01-01

Temporary placement of self-expandable stents has been increasingly used for the management of benign esophageal diseases. To evaluate the safety of endoscopic removal of esophageal self-expandable stents placed for the treatment of benign esophageal diseases. Multicenter retrospective study. Six

Laser treatment of infantile hemangiomas

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Michelle Si Ying Ng

2017-01-01

Full Text Available Infantile hemangiomas (IHs are the most common benign soft tissue tumor of infancy and childhood. Many patients seek early treatment to halt progression of tumor growth and accelerate regression to achieve quick resolution with good cosmetic outcomes. We reviewed literature through PubMed search on the treatment strategies for IH and share our experience in the field of laser treatment of IH. Treatment strategies for IH include both pharmacological, laser, and surgical interventions depending on the stage and severity of the lesion. Various laser beams have been attempted with varying effects and effectiveness. The 595-nm pulsed dye laser therapy has been most widely utilized owing to its great efficacy but minimal adverse effects. It works by targeting oxyhemoglobin chromophore in blood vessels located within the dermis, causing photothermal damage of these target vessels stimulating quick involution without damaging surrounding healthy skin. It is especially useful in treating ulcerated superficial facial hemangiomas that necessitate rapid healing to avoid unsightly scarring. It has a good safety profile but small risk of epidermal burn, blistering, postinflammatory pigment changes, and scarring remains in those with darker skin types treated with higher fluences and short-pulsed duration. Combination treatment with 1064 nm neodymium-doped yttrium aluminum garnet laser, oral propranolol, and even corticosteroids remains an option, especially in treatment of deep, large, and functionally threatening IH. Careful consideration in consultation with the child's parents given the complexities and potential complications surrounding treatment should always be considered. Laser treatment remains an appropriate treatment for rapidly growing IH in exposed locations at early presentation.

Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic versus Open.

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Yao, Christopher M; Kahane, Alyssa; Monteiro, Eric; Gentili, Fred; Zadeh, Gelareh; de Almeida, John R

2017-08-01

Objectives  The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design  The time trade-off technique was used to derive health utility scores. Setting  Healthy individuals without skull base tumors were surveyed. Main Outcome Measures  Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs. Results  There were 51 participants. The endoscopic approach was associated with higher utility scores compared with an open craniotomy approach (0.88 vs. 0.74; p  < 0.001) and watchful waiting (0.88 vs.0.74; p  = 0.002). If recurrence occurred, revision endoscopic resection continued to have a higher utility score compared with revision open craniotomy (0.68; p  = 0.008). On multivariate analysis, older individuals were more likely to opt for watchful waiting ( p  = 0.001), whereas participants from higher income brackets were more likely to rate stereotactic radiosurgery with higher utility scores ( p  = 0.017). Conclusion  The endoscopic approach was associated with higher utility scores than craniotomy for primary and revision cases. The present utilities can be used for future cost-utility analyses.

Early endoscopic treatment of blunt traumatic pancreatic injury.

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Björnsson, Bergthor; Kullman, Eric; Gasslander, Thomas; Sandström, Per

2015-01-01

Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.

[Bath Plug Closure Method for Cerebrospinal Fluid Leakage by Endoscopic Endonasal Approach:Cooperative Treatment by Neurosurgeons and Otolaryngologists].

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Kawaguchi, Tomohiro; Arakawa, Kazuya; Nomura, Kazuhiro; Ogawa, Yoshikazu; Katori, Yukio; Tominaga, Teiji

2017-12-01

Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.

Experimental microendoscopic photoablative laser goniotomy as a surgical model for the treatment of dysgenetic glaucoma.

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Jacobi, P C; Dietlein, T S; Krieglstein, G K

1996-11-01

The aim of this study was to investigate the feasibility of photoablative Er:YAG laser goniotomy under microendoscopic control in a surgical cloudy corneal model of primary infantile glaucoma. Pectinate ligaments of 12 freshly enucleated cadaver porcine eyes were treated by ab interno single-pulse (5 mJ, 200 microseconds) Er:YAG laser (2.94 microns) photoablation. Through a clear corneal incision near the limbus an ophthalmic microendoscope (18 and 20 gauge) was inserted into the anterior chamber. Internal structures were observed and photoablative laser goniotomy was conducted under video guidance. Following treatment all eyes were prepared for light and scanning electron microscopy. Anterior chamber angle structures and tissue photoablation were clearly visualized on the videoscreen using ophthalmic microendoscopy. Energy settings of 5 mJ per pulse proved to be sufficient for reproducible photoablation of pectinate ligaments, accompanied by the root of the iris falling back and exposing trabecular meshwork. This was confirmed histopathologically. Scatter thermal damage was less than 30 microns. This new therapeutic modality, which combines endoscopic visualization of the internal structures with photoablative laser goniotomy, can be effective in the management of dysgenetic glaucoma in the presence of a cloudy cornea. High reproducibility of contact laser photoablation enabled sufficient control of incision depth and was not accompanied by inadvertent tissue damage to adjacent intraocular structures.

Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

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Nie, Hong-Fei; Liu, Kai-Xuan

2013-01-01

Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery. PMID:24455232

Is endoscopic therapy the treatment of choice in all patients with chronic pancreatitis?

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Jabłońska, Beata

2013-01-07

Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas characterized by destruction of the pancreatic parenchyma with subsequent fibrosis that leads to pancreatic exocrine and endocrine insufficiency. Abdominal pain and local complications (bile duct or duodenal stenosis and pancreatic tumor) secondary to CP are indications for therapy. At the beginning, medical therapy is used. More invasive treatment is recommended for patients with pancreatic duct stones (PDS) and pancreatic obstruction in whom standard medical therapy is not sufficient. Recently, Clarke et al assessed the long-term effectiveness of endoscopic therapy (ET) in CP patients. The authors compared ET with medical treatment. They reported that ET was clinically successful in 50% of patients with symptomatic CP. In this commentary, current CP treatment, including indications for ET and surgery in CP patients, is discussed. Recommendations for endoscopic treatment of CP according to the European Society of Gastrointestinal Endoscopy Clinical Guidelines are reviewed. Different surgical methods used in the treatment of CP patients are also discussed. ET is the most useful in patients with large PDS, pancreatic duct obstruction and dilation. It should be the first-line option because it is less invasive than surgery. Surgery should be the first-line option in patients in whom ET has failed or in those with a pancreatic mass with suspicion of malignancy. ET is a very effective and less invasive procedure, but it cannot be recommended as the treatment of choice in all CP patients.

Advances in the endoscopic management of pancreatic collections.

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Ruiz-Clavijo, David; de la Higuera, Belen González; Vila, Juan J

2015-04-16

Treatment of pancreatic collections has experienced great progress in recent years with the emergence of alternative minimally invasive techniques comparing to the classic surgical treatment. Such techniques have been shown to improve outcomes of morbidity vs surgical treatment. The recent emergence of endoscopic drainage is noteworthy. The advent of endoscopic ultrasonography has been crucial for treatment of these specific lesions. They can be characterized, their relationships with neighboring structures can be evaluated and the drainage guided by this technique has been clearly improved compared with the conventional endoscopic drainage. Computed tomography is the technique of choice to characterize the recently published new classification of pancreatic collections. For this reason, the radiologist's role establishing and classifying in a rigorously manner the collections according to the new nomenclature is essential to making therapeutic decisions. Ideal scenario for comprehensive treatment of these collections would be those centers with endoscopic ultrasound and interventional radiology expertise together with hepatobiliopancreatic surgery. This review describes the different types of pancreatic collections: acute peripancreatic fluid collection, pancreatic pseudocysts, acute necrotic collection and walled-off necrosis; the indications and the contraindications for endoscopic drainage, the drainage technique and their outcomes. The integrated management of pancreatic collections according to their type and evolution time is discussed.

Endoscopic findings and treatment outcome in cases presenting with dysphagia.

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Hafeez, Muhammad; Salamat, Amjad; Saeed, Farrukh; Zafar, Hafiz; Hassan, Fayyaz; Farooq, Asif

2011-01-01

Dysphagia results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Among the malignant lesions, carcinoma of oesophagus is the commonest cause. Our objective was to find out the frequency of different endoscopic lesions and outcome of the endoscopic therapeutic interventions in patients presenting with dysphagia. This descriptive study was conducted at Department of Gastroenterology, Military Hospital Rawalpindi from June 2008 to May 2009. Patients of dysphagia after their consent were interviewed about the symptoms. Relevant biochemical investigations were done. Barium swallow and upper Gastrointestinal (GI) Endoscopy were carried out. Benign strictures were dilated with Savary Gilliard Dilators. Malignant strictures were further evaluated to decide treatment plan. In patients considered to have oesophageal dysmotility, pressure manometery was done before specific therapy. Seventy nine patients were enrolled. Twenty-five had malignant strictures, out of those commonest was adenocarcinoma 14 (56%). Twenty-nine had benign strictures the commonest being Gastro-oesophageal Reflux Disease (GERD) related peptic stricture 9 (31%). Fifteen had oesophageal dysmotility, and achalasia was present in 10 out of them. After evaluation 12 out of 25 patients with malignant strictures were considered fit for surgery. Self-expanding metal stents (SEMS) were passed in 5. All benign strictures were dilated with Savary-Gillard dilators. Pneumatic balloon dilation was done in patients of achalasia. The commonest malignant lesion resulting in dysphagia was adenocarcinoma while in benign it was GERD related peptic stricture. Achalasia was most frequent in oesophageal motility disorders. Standard of treatment for early oesophageal malignancy is surgical resection. SEMS is a reliable way to allay dysphagia in inoperable cases. Savary Gillard dilatation in benign, and pneumatic balloon achalasia dilatations are effective ways of treatment.

[Endoscopic treatment of intestinal malrotation in newborns and infants].

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Kozlov, Yu A; Novozhilov, V A; Rasputin, A A; Us, G P; Kuznetsova, N N; Pakelchuk, A

To compare treatment of intestinal malrotation in newborns and infants using laparoscopy and laparotomy. For the period from January 2004 to December 2013 34 Ladd's procedures were performed. Children were divided into 2 groups by 17 patients: laparoscopic (group I) and open treatment (group II). Both groups had similar demographic and other preoperative parameters. There were significant differences in duration of operation between both groups (61 vs. 70 minutes). Nutrition was initiated earlier after mini-invasive treatment (1.5 days vs. 3 days) and the time need for full enteral nutrition was also less (4.2 days vs. 6.9 days). Hospital-stay was shorter in group I (7.7 vs. 10.2 days). Number of early postoperative complications was similar in groups. Incidence of remote complications was higher in laparotomy group but the differences were not significant. Our results showed that endoscopic correction of congenital anomalies of intestinal rotation provides better postoperative results than open surgery and can be widely used in young children.

Embolization of Acute Nonvariceal Upper Gastrointestinal Hemorrhage Resistant to Endoscopic Treatment: Results and Predictors of Recurrent Bleeding

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Loffroy, Romaric; Rao, Pramod; Ota, Shinichi; Lin Mingde; Kwak, Byung-Kook; Geschwind, Jean-Francois

2010-01-01

Acute nonvariceal upper gastrointestinal (UGI) hemorrhage is a frequent complication associated with significant morbidity and mortality. The most common cause of UGI bleeding is peptic ulcer disease, but the differential diagnosis is diverse and includes tumors; ischemia; gastritis; arteriovenous malformations, such as Dieulafoy lesions; Mallory-Weiss tears; trauma; and iatrogenic causes. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, severe bleeding despite conservative medical treatment or endoscopic intervention occurs in 5-10% of patients, requiring surgery or transcatheter arterial embolization. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. Endovascular management using superselective catheterization of the culprit vessel, occlusion, or blind embolization has emerged as an alternative to emergent operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic treatment. Indeed, many published studies have confirmed the feasibility of this approach and its high technical and clinical success rates, which range from 69 to 100% and from 63 to 97%, respectively, even if the choice of the best embolic agent among coils, cyanaocrylate glue, gelatin sponge, or calibrated particles remains a matter of debate. However, factors influencing clinical outcome, especially predictors of early rebleeding, are poorly understood, and few studies have addressed this issue. This review of the literature will attempt to define the role of embolotherapy for acute nonvariceal UGI hemorrhage that fails to respond to endoscopic hemostasis and to summarize data on factors predicting angiographic and embolization failure.

The role of lasers in modern urology

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Dołowy, Łukasz; Dembowski, Janusz; Zdrojowy, Romuald; Kołodziej, Anna

2015-01-01

Introduction The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. Material and methods Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. Results Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. Conclusions There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards. PMID:26251737

New techniques in gastrointestinal endoscopic surgery

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Rafael Antonio Luengas Tello

2012-09-01

Full Text Available Gastrointestinal endoscopic surgery has been making great progress since the seventies in the management paradigms of conditions such as gastrointestinal bleeding, polyp resection and diagnostic and therapeutic management of the biliary tract. The current challenge is the development of techniques that allow endoscopic treatment of emerging diseases such as cancer, morbid obesity, gastro-esophageal reflux and achalasia. This article reports on new techniques and expectations for the future in the endoscopic management of these diseases.

Effect of endoscopic injection of cyanoacrylate in treatment of acute esophageal and gastric variceal bleeding in children

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ZHANG Xiaoxing

2016-05-01

Full Text Available ObjectiveTo investigate the effect and safety of endoscopic injection of cyanoacrylate in the treatment of esophageal and gastric variceal bleeding (EGVB in children. MethodsThe clinical data of 35 children with acute EGVB who were treated with endoscopic injection of cyanoacrylate in Children′s Hospital of Baoji Maternal and Child Health Care Hospital from August 2010 to August 2015 were analyzed retrospectively. The emergency response rate, rebleeding rate, and incidence of complications after the treatment were analyzed statistically. ResultsThirty-five patients received 46 times of endoscopic injection of cyanoacrylate in total. The response rate to the initial injection was 95.6% (44/46. The volume of cyanoacrylate injected was 0.2-0.6 ml, with a mean volume of 0.4±0.2 ml. The emergency hemostasis rate was 93.4% (43/46, the rebleeding rate was 11.4% (4/35, and the cycle for 4 patients with the recurrence of bleeding to be cured was 1.2-23.0 months (mean 121±10.9 months. One patient experienced abdominal pain, and no patients experienced ectopic embolism. Two patients died after injection. ConclusionFrequent, small-volume endoscopic injection of cyanoacrylate is an effective and convenient therapeutic method for EGVB in children, has few complications, and holds promise for clinical application.

[Submucosal endoscopic dissection in the treatment of early esophageal cancer].

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Ughelli, Liliana; Miranda, Carolina; Galeano, Carlos; Blasco, María Del Carmen; Boselli, Guliano; Cubilla, Antonio; Sakai, Paulo; Blasco, Carmelo

2017-01-01

We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.

Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

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Kim, Young-Il

2015-01-01

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

Endoscopic surgery versus conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage (ECMOH: study protocol for a randomized controlled trial

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Zan Xin

2012-06-01

Full Text Available Abstract Background Spontaneous intracerebral hemorrhage is a disease with high morbidity, high disability rate, high mortality, and high economic burden. Whether patients can benefit from surgical evacuation of hematomas is still controversial, especially for those with moderate-volume hematomas in the basal ganglia. This study is designed to compare the efficacy of endoscopic surgery and conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage. Methods Patients meet the criteria will be randomized into the endoscopic surgery group (endoscopic surgery for hematoma evacuation and the best medical treatment or the conservative treatment group (the best medical treatment. Patients will be followed up at 1, 3, and 6 months after initial treatment. The primary outcomes include the Extended Glasgow Outcome Scale and the Modified Rankin Scale. The secondary outcomes consist of the National Institutes of Health Stroke Scale and the mortality. The Barthel Index(BI will also be evaluated. The sample size is 100 patients. Discussion The ECMOH trial is a randomized controlled trial designed to evaluate if endoscopic surgery is better than conservative treatment for patients with moderate-volume hematomas in the basal ganglia. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-11001614 (http://www.chictr.org/en/proj/show.aspx?proj=1618

Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy

Directory of Open Access Journals (Sweden)

Harith M. Alkhateeb

2015-01-01

Conclusions: (1 Following endoscopic retrograde cholangiopancreatography, a patient’s complaints should not be ignored. (2 A massive biloma can occur due to such procedures. (3 Conservative treatment with minimal invasive technique can prove to be effective.

Laser in caries treatment--patients' experiences and opinions.

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Sarmadi, R; Hedman, E; Gabre, P

2014-02-01

The aim of this study was to obtain a deeper understanding of patient's experiences and perspectives after dental caries treatment with Er:YAG laser technology. Twelve patients aged 15-30 years who had undergone at least one laser caries excavation agreed to participate in an interview study. All the interviews were tape recorded and transcribed by a transcription agency. The transcribed texts were analysed using manifest and latent qualitative content analysis. The categories in this study were identified as choosing laser, understanding laser, encouraging dental care and my oral health. The motivation for laser treatment was described as dental fear in general, specific fear of needles or discomfort with the drill. The informants described the dentist's role as initiators of treatment and willing or unwilling facilitators. Laser treatment was described as safer and more carefully considered treatment. They felt generally safe with laser and were able to relax during the treatment. All interviewers described a positive impression of the laser, and words like 'up to date' and 'future-oriented' were used to describe laser. Laser treatment was considered less painful. The results indicate that patients find laser a feasible and convenient treatment option. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Endoscopic Management of Bile Leakage after Liver Transplantation

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Oh, Dongwook; Lee, Sung Koo; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Seo, Dong-Wan; Kim, Myung-Hwan

2015-01-01

Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Methods Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. Results In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. Conclusions ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients. PMID:25717048

Endoscopic management of peripancreatic fluid collections.

Science.gov (United States)

Goyal, Jatinder; Ramesh, Jayapal

2015-07-01

Peripancreatic fluid collections are a well-known complication of pancreatitis and can vary from fluid-filled collections to entirely necrotic collections. Although most of the fluid-filled pseudocysts tend to resolve spontaneously with conservative management, intervention is necessary in symptomatic patients. Open surgery has been the traditional treatment modality of choice though endoscopic, laparoscopic and transcutaneous techniques offer alternative drainage approaches. During the last decade, improvement in endoscopic ultrasound technology has enabled real-time access and drainage of fluid collections that were previously not amenable to blind transmural drainage. This has initiated a trend towards use of this modality for treatment of pseudocysts. In this review, we have summarised the existing evidence for endoscopic drainage of peripancreatic fluid collections from published studies.

Endoscopic diode-laser applications in airway surgery

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Pankratov, Michail M.; Wang, Zhi; Rebeiz, Elie E.; Perrault, Donald F., Jr.; Shapshay, Stanley M.; Gleich, Lyon L.

1994-09-01

A technique was developed to secure small mucosal grafts onto the airway wound with fibrin/albumin tissue adhesive mixed with ICG dye and irradiated with a 810 nm diode laser. An in vitro study of the tensile strength produced strong mucosal soldering which was adequate to fix grafts in place. In vivo studies showed that wounds with mucosal grafts were completely covered by regenerated squamous cells in 1 week and by ciliated epithelium in 2 weeks. Excellent healing was observed at 6 and 14 days postoperatively and the histology at 28 days found normal epithelium over the vocal cord lesion. This soldering technique is a less traumatic treatment for patients with extensive lesions of the larynx of various origin. Diode laser soldering with ICG-doped fibrin tissue adhesive was evaluated in tracheal anastomosis as a substitute for absorbable sutures. In vitro studies demonstrated strong anastomoses with minimal tissue damage. In vivo animal study showed that these anastomoses had less fibrosis and tissue damage than control animals repaired with sutures only.

[Current Status of Endoscopic Resection of Early Gastric Cancer in Korea].

Science.gov (United States)

Jung, Hwoon Yong

2017-09-25

Endoscopic resection (Endoscopic mucosal resection [EMR] and endoscopic submucosal dissection [ESD]) is already established as a first-line treatment modality for selected early gastric cancer (EGC). In Korea, the number of endoscopic resection of EGC was explosively increased because of a National Cancer Screening Program and development of devices and techniques. There were many reports on the short-term and long-term outcomes after endoscopic resection in patients with EGC. Long-term outcome in terms of recurrence and death is excellent in both absolute and selected expanded criteria. Furthermore, endoscopic resection might be positioned as primary treatment modality replacing surgical gastrectomy. To obtain these results, selection of patients, perfect en bloc procedure, thorough pathological examination of resected specimen, accurate interpretation of whole process of endoscopic resection, and rational strategy for follow-up is necessary.

Optical transfection using an endoscope-like system.

Science.gov (United States)

Ma, Nan; Gunn-Moore, Frank; Dholakia, Kishan

2011-02-01

Optical transfection is a powerful method for targeted delivery of therapeutic agents to biological cells. A tightly focused pulsed laser beam may transiently change the permeability of a cell membrane to facilitate the delivery of foreign genetic material into cells. We report the first realization of an endoscope-like integrated system for optical transfection. An imaging fiber (coherent optical fiber bundle) with ∼ 6000 cores (pixels) embedded in a fiber cladding of ∼ 300 μm in diameter, produces an image circle (area) of ∼ 270 μm diam. This imaging fiber, with an ordered axicon lens array chemically etched at its exit face, is used for the delivery of a femtosecond laser to the cell membrane for optical transfection along with subcellular resolution imaging. A microcapillary-based microfluidic system for localized drug delivery was also combined in this miniature, flexible system. Using this novel system, a plasmid transfection efficiency up to ∼ 72% was obtained for CHO-K1 cells. This endoscope-like system opens a range of exciting applications, in particular, in the targeted in vivo optical microsurgery area.

The role of collateral veins detected by endosonography in predicting the recurrence of esophageal varices after endoscopic treatment: a systematic review.

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Masalaite, Laura; Valantinas, Jonas; Stanaitis, Juozas

2014-07-01

Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of varices is still common following endoscopic treatment. The aim was to identify predictive factors for variceal recurrence detected by endosonography. We performed a systematic review of studies published prior to June 2013. Studies analyzing gastroesophageal collateral veins as risk factors for variceal recurrence after endoscopic treatment were included. The primary outcome was to identify predictive factors for variceal recurrence investigated by endosonography. After a full-text review, 13 studies were included in our analysis. Analysis of risk factors was not possible for all studies included. Perforating veins and periesophageal collateral veins were related to a higher risk of variceal recurrence (OR = 3.93; 95 % CI 1.06-14.51; I (2) = 96 %; OR = 2.29; 95 % CI 1.58-3.33; I (2) = 55 %). Analysis of cardiac intramural veins and paragastric/cardiac collateral veins showed the same trend, but without reaching statistical significance because of the small group size and wide CI (OR = 3.72; 95 % CI 0.14-101.53; I (2) = 91 %; OR = 1.85; 95 % CI 0.84-4.07; I (2) = 0 %). Analysis of other collateral veins as risk factors for variceal recurrence and analysis of risk factors with regard to the endoscopic treatment method was not possible because of the limited number of cases and different methodologies. A positive association between variceal recurrence and type and grade of collateral veins, investigated by endosonography, was demonstrated. Endosonography is a promising tool for predicting recurrence of esophageal varices following endoscopic treatment. These findings should be interpreted with caution because of the heterogeneity of the studies.

Advances in endoscopic retrograde cholangiopancreatography

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WANG Xiangping

2018-03-01

Full Text Available Endoscopic retrograde cholangiopancreatography (ERCP is a well-established advanced endoscopic technique for the diagnosis and treatment of pancreatobiliary diseases. New advances have been made in the treatment concept and techniques of ERCP in recent years. This article elaborates on the recent advances in ERCP, including the application of pancreatic duct stent, non-steroidal anti-inflammatory drugs, and aggressive hydration to prevent postoperative pancreatitis, covered metal stent for the treatment of benign bile duct stenosis, intraluminal radiofrequency ablation for malignant bile duct stenosis, extracorporeal shockwave lithotripsy and covered metal stent for the treatment of chronic pancreatitis, peroral choledochoscopy for qualitative diagnosis of bile duct stenosis and huge refractory stones, definition of difficult intubation, timing of pre-cut technique, and ERCP after gastrointestinal reconstruction.

Gastric Bezoar Treatment by Endoscopic Fragmentation in Combination with Pepsi-Cola® Administration.

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Iwamuro, Masaya; Yunoki, Naoko; Tomoda, Jun; Nakamura, Kazuhiro; Okada, Hiroyuki; Yamamoto, Kazuhide

2015-07-10

Although bezoar dissolution by Coca-Cola® has been described in case reports and case series, to the best of our knowledge, the usefulness of other cola products such as Pepsi-Cola® has never been reported in the English literature. An 86-year-old Taiwanese man was diagnosed with a gastric bezoar. Endoscopic fragmentation with a polypectomy snare was attempted twice but failed to remove the bezoar. Subsequently, 500 mL of Pepsi NEX Zero® was administered daily for 4 days via nasogastric tube. The bezoar was softened and successfully fragmented by the polypectomy snare and needle-knife devices on the third attempt. This report presents the first case of a gastric bezoar successfully treated by endoscopic fragmentation in combination with Pepsi-Cola® administration, suggesting the possible utility of cola beverages in bezoar treatment, regardless of product brands.

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.

Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer

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Tokunaga Mari

2010-06-01

Full Text Available Abstract Background There have been no reports discussing which imaging procedures are truly necessary before treatment of endoscopically-diagnosed early gastric cancer (eEGC. The aim of this pilot study was to show which imaging examinations are essential to select indicated treatment or appropriate strategy in patients with eEGC. Methods In 140 consecutive patients (95 men, 45 women; age, 66.4 +/- 11.3 years [mean +/- standard deviation], range, 33-90 with eEGC which were diagnosed during two years, the pre-treatment results of ultrasonography (US and contrast-enhanced computed tomography (CT of the abdomen, barium enema (BE and chest radiography (CR were retrospectively reviewed. Useful findings that might affect indication or strategy were evaluated. Results US demonstrated useful findings in 13 of 140 patients (9.3%: biliary tract stones (n = 11 and other malignant tumors (n = 2. Only one useful finding was demonstrated on CT (pancreatic intraductal papillary mucinous tumor but not on US (0.7%; 95% confidential interval [CI], 2.1%. BE demonstrated colorectal carcinomas in six patients and polyps in 10 patients, altering treatment strategy (11.4%; 95%CI, 6.1-16.7%. Of these, only two colorectal carcinomas were detected on CT. CR showed three relevant findings (2.1%: pulmonary carcinoma (n = 1 and cardiomegaly (n = 2. Seventy-nine patients (56% were treated surgically and 56 patients were treated by endoscopic intervention. The remaining five patients received no treatment due to various reasons. Conclusions US, BE and CR may be essential as pre-treatment imaging examinations because they occasionally detect findings which affect treatment indication and strategy, although abdominal contrast-enhanced CT rarely provide additional information.

Safety and efficacy of allogeneic adipose tissue-derived mesenchymal stem cells for treatment of dogs with inflammatory bowel disease: Endoscopic and histological outcomes.

Science.gov (United States)

Pérez-Merino, E M; Usón-Casaús, J M; Duque-Carrasco, J; Zaragoza-Bayle, C; Mariñas-Pardo, L; Hermida-Prieto, M; Vilafranca-Compte, M; Barrera-Chacón, R; Gualtieri, M

2015-12-01

Systemic administration of mesenchymal stem cells (MSCs) has been shown to be safe and efficacious in humans with Crohn's disease. The aim of this study was to evaluate the safety of an intravenous (IV) infusion of adipose tissue-derived mesenchymal stem cells (ASCs) and to assess macroscopic and histological effects in the digestive tract of dogs with inflammatory bowel disease (IBD). Eleven dogs with confirmed IBD received a single ASC infusion (2 × 10(6) cells/kg bodyweight). Full digestive endoscopic evaluation was performed pre-treatment and between 90 and 120 days post-treatment with mucosal changes being assessed using a fit-for-purpose endoscopic scale. Endoscopic biopsies from each digestive section were evaluated histologically according to the World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group criteria. The pre- and post-treatment canine IBD endoscopic index (CIBDEI) and histological score (HS) were calculated and compared using the Wilcoxon test. Remission was defined as a reduction of >75% of the CIBDEI and HS compared with pre-treatment. No acute reactions to ASC infusion or side effects were reported in any dog. Significant differences between pre- and post-treatment were found in both the CIBDEI (P = 0.004) and HS (P = 0.004). Endoscopic remission occurred in 4/11 dogs with the remaining dogs showing decreased CIBDEI (44.8% to 73.3%). Histological remission was not achieved in any dog, with an average reduction of the pre-treatment HS of 27.2%. In conclusion, a single IV infusion of allogeneic ASCs improved gastrointestinal lesions as assessed macroscopically and slightly reduced gastrointestinal inflammation as evaluated by histopathology in dogs with IBD. Copyright © 2015 Elsevier Ltd. All rights reserved.

Molecular confocal laser endomicroscopy

DEFF Research Database (Denmark)

Karstensen, John Gásdal; Klausen, Pia Helene; Saftoiu, Adrian

2014-01-01

While flexible endoscopy is essential for macroscopic evaluation, confocal laser endomicroscopy (CLE) has recently emerged as an endoscopic method enabling visualization at a cellular level. Two systems are currently available, one based on miniprobes that can be inserted via a conventional...... during on-going endoscopy), a novel world of molecular evaluation opens up. The method of molecular CLE could potentially be used for estimating the expression of important receptors in carcinomas, subsequently resulting in immediate individualization of treatment regimens, but also for improving...

Efficacy of endoscopic histoacryl injection in treatment of gastric variceal bleeding caused by regional portal hypertension

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TANG Shanhong

2015-08-01

Full Text Available Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis-related portal hypertension. Between-group comparison of categorical data was made by Fisher′s test. Results In patients with regional portal hypertension, five of them had severe isolated gastric varices (IGV and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis-related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short-term response rate (1/6 vs 6/6, P=0.015 and long-term response rate (0/6 vs 5/6, P=0.015. Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

[Endoscopic realignment for post-traumatic rupture of posterior urethra].

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Tazi, Hicham; Ouali, Mohammed; Lrhorfi, My Hfid; Moudouni, Saïd; Tazi, Karim; Lakrissa, Ahmed

2003-12-01

To analyse the long-term results of treatment of posterior urethral disruptions with endoscopic realignment, and to assess the efficacy, simplicity and benefit of this technique. Between 1989 and 2001, thirty six patients were treated by endoscopic realignment for traumatic rupture of the posterior urethra. The analysis of the results took in consideration the quality of urinary stream, the continence and the erectile function. With a mean follow-up of thirty four months (12 to 72 months), the 36 patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output. This result was obtained after internal urethrotomy in 13 patients (36.1%), and after transperineal urethroplasty in two patients. Only 7 patients (19.4%) developed an impotence. The endoscopic realignment can be considered like initial treatment of all post-traumatic rupture of the posterior urethra. This simple and little aggressive technique doesn't compromise the recourse to another type of ulterior treatment and resulted in negligible morbidity. The secondary urethral strictures are short and accessible to an endoscopic urethrotomy.

Simple fibre based dispersion management for two-photon excited fluorescence imaging through an endoscope

DEFF Research Database (Denmark)

Dimopoulos, Konstantinos; Marti, Dominik; Andersen, Peter E.

2018-01-01

We want to implement two-photon excitation fluorescence microscopy (TPEFM) into endoscopes, since TPEFM can provide relevant biomarkers for cancer staging and grading in hollow organs, endoscopically accessible through natural orifices. However, many obstacles must be overcome, among others...... the delivery of short laser pulses to the distal end of the endoscope. To this avail, we present imaging results using an all-fibre dispersion management scheme in a TPEFM setup. The scheme has been conceived by Jespersen et al. in 20101 and relies on the combination of a single mode fibre with normal...

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

Science.gov (United States)

Vladimirov, B; Petkov, R; Viiachki, I; Damianov, D; Iarŭmov, N

1996-01-01

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

Nonablative laser treatment of facial rhytides

Science.gov (United States)

Lask, Gary P.; Lee, Patrick K.; Seyfzadeh, Manouchehr; Nelson, J. Stuart; Milner, Thomas E.; Anvari, Bahman; Dave, Digant P.; Geronemus, Roy G.; Bernstein, Leonard J.; Mittelman, Harry; Ridener, Laurie A.; Coulson, Walter F.; Sand, Bruce; Baumgarder, Jon; Hennings, David R.; Menefee, Richard F.; Berry, Michael J.

1997-05-01

The purpose of this study is to evaluate the safety and effectiveness of the New Star Model 130 neodymium:yttrium aluminum garnet (Nd:YAG) laser system for nonablative laser treatment of facial rhytides (e.g., periorbital wrinkles). Facial rhytides are treated with 1.32 micrometer wavelength laser light delivered through a fiberoptic handpiece into a 5 mm diameter spot using three 300 microsecond duration pulses at 100 Hz pulse repetition frequency and pulse radiant exposures extending up to 12 J/cm2. Dynamic cooling is used to cool the epidermis selectively prior to laser treatment; animal histology experiments confirm that dynamic cooling combined with nonablative laser heating protects the epidermis and selectively injures the dermis. In the human clinical study, immediately post-treatment, treated sites exhibit mild erythema and, in a few cases, edema or small blisters. There are no long-term complications such as marked dyspigmentation and persistent erythema that are commonly observed following ablative laser skin resurfacing. Preliminary results indicate that the severity of facial rhytides has been reduced, but long-term follow-up examinations are needed to quantify the reduction. The mechanism of action of this nonablative laser treatment modality may involve dermal wound healing that leads to long- term synthesis of new collagen and extracellular matrix material.

Endoscopic Submucosal Dissection. A more effective procedure compared to mucosectomy for the treatment of Early Gastric Cancer

International Nuclear Information System (INIS)

Emura, Fabian; Oda, Ichiro; Hiroyuki, Ono

2007-01-01

The new development in endoscopic techniques like endoscopic submucosal dissection (ESD) has revolutionized the minimally invasive treatment of gastric cancer. Different to conventional surgery, now it is possible treat large and ulcerative lesion with ESD and with low morbimortality. ESD constitutes a new development that allows direct visualization and cutting of the submucosal layer using el IT-Knife. Although mucosectomy is minimally invasive and safe, it is limited for the treatment of lesions ≥ 15 mm. Evidence suggests that if larger lesions are treated by this technique the resection will probably be a piecemeal resection due to limitations of standard mucosectomy. The largest series has reported 1033 ESD using the IT-knife in 945 patients. The en-block resection rate was 98% (1008/1033) and the rate en-block resection and negative margins was 93% (957/1033). In spite of these promising results, the complications rate is higher than that of standard mucosectomy since ESD needs high levels of endoscopic skills and experience. In addition evaluation of long term results is still ongoing. A detailed histological analysis along with adhesion to strict inclusion criteria are determinant for the reproducibility of success of DES in the west

Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma.

Science.gov (United States)

Uppal, Dushant S; Wang, Andrew Y

2015-06-25

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral (or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy (PDT) or radiofrequency ablation (RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCP-directed RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy.

[Endoscopic ultrasound guided rendezvous for biliary drainage].

Science.gov (United States)

Knudsen, Marie Høxbro; Vilmann, Peter; Hassan, Hazem; Karstensen, John Gésdal

2015-04-27

Endoscopic retrograde cholangiography (ERCP) is currently standard treatment for biliary drainage. Endoscopic ultrasound guided rendezvous (EUS-RV) is a novel method to overcome an unsuccessful biliary drainage procedure. Under endoscopic ultrasound guidance a guidewire is passed via a needle from the stomach or duodenum to the common bile duct and from there on to the duodenum enabling ERCP. With a relatively high rate of success EUS-RV should be considered as an alternative to biliary drainage and surgical intervention.

Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

Science.gov (United States)

Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo

2016-07-01

In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.

Research advances in the prevention and treatment of pancreatitis after endoscopic retrograde cholangiopancreatography

Directory of Open Access Journals (Sweden)

ZHANG Weifeng

2018-03-01

Full Text Available Endoscopic retrograde cholangiopancreatography (ERCP is an important technique for the diagnosis and treatment of biliary and pancreatic diseases and post-ERCP pancreatitis (PEP is the most common complication of ERCP. Since the birth of ERCP, the prevention and treatment of PEP has become the focus of international research. In recent years, much progress has been made in the aspects of risk factors, pharmacological prevention, and prophylactic stent implantation in the pancreatic duct. Since these research findings are not consistent, further clinical studies are needed to demonstrate such findings.

Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring.

Science.gov (United States)

Lee, J H; Kim, B K; Seol, D C; Byun, S J; Park, K H; Sung, I K; Park, H S; Shim, C S

2013-06-01

Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10 % - 15 % of cases. The mortality rate can be as high as 25 % when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86 %: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible. © Georg Thieme Verlag KG Stuttgart · New York.

A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys.

Directory of Open Access Journals (Sweden)

Pauline M L Hennus

Full Text Available BACKGROUND: Posterior urethral valves (PUV may cause subtle to severe obstruction of the urethra, resulting in a broad clinical spectrum. PUV are the most common cause of chronic renal disease in boys. Our purpose was to report the incidences of kidney and bladder dysfunction in boys treated with endoscopic valve resection for PUV. METHODOLOGY: We searched MEDLINE and EMBASE databases until 1st of July 2011, to identify original papers that described outcome of endoscopic valve resection (EVR in boys. We extracted information on (1 patient characteristics and clinical presentation of PUV related to outcomes and (2 the post-treatment absolute risks for kidney and bladder dysfunction. PRINCIPAL FINDINGS: Thirty-four studies describing renal function, vesicoureteral reflux (VUR, incontinence, and urodynamic bladder function after EVR in 1474 patients were retrieved. Patients treated for PUV show high percentages of chronic kidney disease (CKD or end stage renal disease (ESRD, 22% (0-32% and 11% (0-20%, respectively. Elevated nadir serum creatinine was the only independent factor associated with renal failure. Before treatment, VUR was present in 43% of boys and after EVR, VUR was present in 22%. Post treatment, 19% (0-70% was reported to suffer from urinary incontinence. Urodynamic bladder dysfunction was seen in many patients (55%, 0-72% after treatment of PUV. CONCLUSIONS: The reported cumulative incidence of renal and bladder dysfunction in patients with PUV after endoscopic PUV treatment varies widely. This may reflect a broad clinical spectrum, which relates to the lack of a standardised quantification of obstruction and its severity. Moreover, the risk of bias is rather high, and therefore we put little confidence in the reported estimates of effect. We found elevated nadir serum creatinine as a predictor for renal dysfunction. In order to be able to predict outcomes for patients with PUV, an objective classification of severity of

[Endoscopic full-thickness resection].

Science.gov (United States)

Meier, B; Schmidt, A; Caca, K

2016-08-01

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

Accuracy of endoscopic intraoperative assessment of urologic stone size.

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Patel, Nishant; Chew, Ben; Knudsen, Bodo; Lipkin, Michael; Wenzler, David; Sur, Roger L

2014-05-01

Endoscopic treatment of renal calculi relies on surgeon assessment of residual stone fragment size for either basket removal or for the passage of fragments postoperatively. We therefore sought to determine the accuracy of endoscopic assessment of renal calculi size. Between January and May 2013, five board-certified endourologists participated in an ex vivo artificial endoscopic simulation. A total of 10 stones (pebbles) were measured (mm) by nonparticipating urologist (N.D.P.) with electronic calibers and placed into separate labeled opaque test tubes to prevent visualization of the stones through the side of the tube. Endourologists were blinded to the actual size of the stones. A flexible digital ureteroscope with a 200-μm core sized laser fiber in the working channel as a size reference was placed through the ureteroscope into the test tube to estimate the stone size (mm). Accuracy was determined by obtaining the correlation coefficient (r) and constructing an Altman-Bland plot. Endourologists tended to overestimate actual stone size by a margin of 0.05 mm. The Pearson correlation coefficient was r=0.924, with a p-valuestones (stones (≥4 mm), r=0.911 vs r=0.666. Altman-bland plot analysis suggests that surgeons are able to accurately estimate stone size within a range of -1.8 to +1.9 mm. This ex vivo simulation study demonstrates that endoscopic assessment is reliable when assessing stone size. On average, there was a slight tendency to overestimate stone size by 0.05 mm. Most endourologists could visually estimate stone size within 2 mm of the actual size. These findings could be generalized to state that endourologists are accurately able to intraoperatively assess residual stone fragment size to guide decision making.

Evaluation of the results of treatment of morbid obesity by the endoscopic intragastric balloon implantation method.

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Żurawiński, Wojciech; Sokołowski, Dariusz; Krupa-Kotara, Karolina; Czech, Elżbieta; Sosada, Krystyn

2017-01-01

Overweight and obesity are ranked in the fifth place among the risk factors responsible for the greatest number of deaths in the world. To assess the effects of treatment of patients with morbid obesity using endoscopic intragastric balloon (IGB) implantation. Two hundred and seventy-two patients with obesity were treated using endoscopic intragastric balloon implantation. Upon analysis of the inclusion and exclusion criteria, the study covered a group of 63 patients with morbid obesity. The patients were implanted with the LexBal balloon. Reduction of excess body mass, changes to BMI values and ailments and complications divided into mild and severe were assessed. Before intragastric balloon treatment, the average body mass index (BMI) value was 58.3 ±10.5 kg/m 2 , whereas after 6 months of treatment it decreased to 49.5 ±8.7 kg/m 2 . The patients with postoperative BMI equal to or greater than 50.0 kg/m 2 reported nausea (69.7%), vomiting (51.5%), flatulence (45.5%), upper abdominal pain (36.4%) and general discomfort (424%) more frequently. Dehydration (9.1%) was also more frequent in this group, whereas frequency of occurrence of such ailments and complications as heartburn (23.3%) and oesophageal candidiasis (10.0%) was higher in the patients with postoperative BMI below 50.0 kg/m 2 . Endoscopic intragastric balloon implantation is an effective and safe method of excess body mass reduction in patients with morbid obesity before a planned bariatric surgical procedure. Pre-operative excess body mass and BMI value and post-operative excess weight loss in patients with morbid obesity have no impact on frequency of occurrence of ailments and complications in IGB treatment.

Correlation of performance with endoscopic and radiographic assessment of epiglottic hypoplasia in racehorses with epiglottic entrapment corrected by use of contact neodymium:yttrium aluminum garnet laser

International Nuclear Information System (INIS)

Tulleners, E.P.

1991-01-01

Epiglottic entrapment in 35 Thoroughbred and 44 Standardbred horses was corrected transendoscopically by use of a neodymium:yttrium aluminum garnet laser. Before surgery, the entrapped epiglottis was classified as hypoplastic or normal in each horse on the basis of endoscopic appearance alone. Using a digitizer, thyroepiglottic length was determined from lateral-view laryngeal radiographs. For 78 racehorses, earnings (less than $5,000 or greater than $5,000) were compared before and after surgery. Earnings category and racing performance after surgery were tested for association with endoscopically determined epiglottic hypoplasia and radiographically determined thyroepiglottic length. Endoscopy and radiography were useful methods of evaluating the epiglottis in horses with epiglottic entrapment. Mean (+/- SD) thyroepiglottic length for both breeds of horses with epiglottic entrapment was significantly (P = 0.0001) smaller (Thoroughbreds, 7.28 +/- 0.67 cm; Standardbreds, 7.21 +/- 0.62 cm), compared with thyroepiglottic length measured from control groups composed of clinically normal Thoroughbred (8.56 +/- 0.29 cm) and Standardbred (8.74 +/- 0.38 cm) racehorses. Both breeds of horses with epiglottic entrapment that had endoscopically apparent hypoplastic epiglottis had significantly (P less than 0.0001) smaller thyroepiglottic length (Thoroughbreds, 6.64 +/- 0.60 cm; Standardbred, 6.93 +/- 0.72 cm) than did horses with epiglottic entrapment that had endoscopically normal epiglottis (Throughbreds, 7.57 +/- 0.47 cm, Standardbreds, 7.36 +/- 0.50 cm). Significant difference was not detected in endoscopic appearance of the epiglottis among age, gender, or breed distributions

Role of endoscopic ultrasonography in treatment and prognostic evaluation of esophageal and gastric varices

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LI Shuang

2016-12-01

Full Text Available Through a comprehensive evaluation of collateral circulation establishment in portal hypertension, endoscopic ultrasonography (EUS not only helps to predict and evaluate the risks of first bleeding from esophageal and gastric varices and recurrence and rebleeding after treatment, but also guides and participates in the treatment of varices. This article introduces the unique advantages of EUS in the treatment and prognostic evaluation of esophageal and gastric varices and provides an important reference for individualized treatment of patients with liver cirrhosis complicated by esophageal and gastric varices. EUS also helps to improve treatment safety and response rate. EUS for the systematic treatment of portal hypertension has become a hot research topic in recent years.

Endoscopic management is the preferred treatment modality for a Grade III vesicoureteric reflux with breakthrough infections in a young girl

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S S Joshi

2008-01-01

Full Text Available Endoscopic injection treatment for VUR appears to have less success rate than open surgical treatment, even in Gr 3 VUR. Economics of use of deflux injection and its success rate do not suit Indian milieu. To achieve high success rate of Atlanta group in endoscopic injection treatmnent , requires a longer learning curve and yet it has not achieved success rate of 96-98% achieved by open surgical techniques. Recent addition of modified extravesical reimplantation technique has reduced significantly the post operative pain and patient can be discharged within 2 days from the hospital.

Children acceptance of laser dental treatment

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Lazea, Andreea; Todea, Carmen

2016-03-01

Objectives: To evaluate the dental anxiety level and the degree of acceptance of laser assisted pedodontic treatments from the children part. Also, we want to underline the advantages of laser use in pediatric dentistry, to make this technology widely used in treating dental problems of our children patients. Methods: Thirty pediatric dental patients presented in the Department of Pedodontics, University of Medicine and Pharmacy "Victor Babeş", Timişoara were evaluated using the Wong-Baker pain rating scale, wich was administered postoperatory to all patients, to assess their level of laser therapy acceptance. Results: Wong-Baker faces pain rating scale (WBFPS) has good validity and high specificity; generally it's easy for children to use, easy to compare and has good feasibility. Laser treatment has been accepted and tolerated by pediatric patients for its ability to reduce or eliminate pain. Around 70% of the total sample showed an excellent acceptance of laser dental treatment. Conclusions: Laser technology is useful and effective in many clinical situations encountered in pediatric dentistry and a good level of pacient acceptance is reported during all laser procedures on hard and soft tissues.

Surgical and endoscopic treatment of pain in chronic pancreatitis: a multidisciplinary update.

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Issa, Y; van Santvoort, H C; van Goor, H; Cahen, D L; Bruno, M J; Boermeester, M A

2013-01-01

Chronic pancreatitis is an inflammatory disease of the pancreas with abdominal pain as the most prominent symptom. Adequate treatment of patients with chronic pancreatitis remains a major challenge, mainly because of the lack of evidence-based treatment protocols. The primary goal of treatment is to achieve long-term pain relief, control of the complications associated with the disease, and to restore the quality of life. Currently, a conservative step-up approach is often used for the treatment of pain; progression to severe and intractable pain is considered necessary before invasive treatment is considered. Recent studies, however, suggest that surgical intervention should not be considered only as last-resort treatment, since it can mitigate disease progression, achieve excellent pain control, and preserve pancreatic function. In this review, we present a state-of-the art overview of endoscopic and surgical treatment options for patients with painful chronic pancreatitis, and elaborate on the timing of surgery. Copyright © 2013 S. Karger AG, Basel.

Systems workplace for endoscopic surgery.

Science.gov (United States)

Irion, K M; Novak, P

2000-01-01

With the advent of minimally invasive surgery (MIS) a decade ago, the requirements for operating rooms (OR) and their equipment have been increased. Compared with conventional open surgery, the new endoscopic techniques require additional tools. Television systems, for video-assisted image acquisition and visualisation, including cameras, monitors and light systems, as well as insufflators, pumps, high-frequency units, lasers and motorised therapy units, are nowadays usually made available on carts during endoscopic surgery. In conjunction with a set of endoscopic instruments, these high-tech units allow new operating techniques to be performed. The benefit for patients has become clear in recent years; however, the technical complexity of OR has also increased considerably. To minimise this problem for the OR personnel, the MIS concept 'OR1' (Operating Room 1) was developed and implemented. OR1 is a fully functional and integrated multi-speciality surgical suite for MIS. The centrepieces of the OR1 are the Storz Communication Bus (SCB) and the advanced image and data archiving system (Aida) from Karl Storz, Tuttlingen, Germany. Both components allow monitoring, access and networking of the MIS equipment and other OR facilities, as well as the acquisition, storage and display of image, patient and equipment data during the endoscopic procedure. A central user interface allows efficient, simplified operation and online clinical images. Due to the system integration, the handling of complex equipment is considerably simplified, logistical procedures in the OR are improved, procedure times are shorter and, particularly noteworthy, operative risk can be reduced through simplified device operation.

Endoscopic placement of double-J ureteric stents in children as a treatment for primary obstructive megaureter

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Carroll Daniel

2010-01-01

Full Text Available Aim: To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution. Materials and Methods: A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. Results: Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions. In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions. Conclusions: Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.

Submucosal tunnel endoscopy: Peroral endoscopic myotomy and peroral endoscopic tumor resection

Science.gov (United States)

Eleftheriadis, Nikolas; Inoue, Haruhiro; Ikeda, Haruo; Onimaru, Manabu; Maselli, Roberta; Santi, Grace

2016-01-01

Peroral endoscopic myotomy (POEM) is an innovative, minimally invasive, endoscopic treatment for esophageal achalasia and other esophageal motility disorders, emerged from the natural orifice transluminal endoscopic surgery procedures, and since the first human case performed by Inoue in 2008, showed exciting results in international level, with more than 4000 cases globally up to now. POEM showed superior characteristics than the standard 100-year-old surgical or laparoscopic Heller myotomy (LHM), not only for all types of esophageal achalasia [classical (I), vigorous (II), spastic (III), Chicago Classification], but also for advanced sigmoid type achalasia (S1 and S2), failed LHM, or other esophageal motility disorders (diffuse esophageal spasm, nutcracker esophagus or Jackhammer esophagus). POEM starts with a mucosal incision, followed by submucosal tunnel creation crossing the esophagogastric junction (EGJ) and myotomy. Finally the mucosal entry is closed with endoscopic clip placement. POEM permitted relatively free choice of myotomy length and localization. Although it is technically demanding procedure, POEM can be performed safely and achieves very good control of dysphagia and chest pain. Gastroesophageal reflux is the most common troublesome side effect, and is well controllable with proton pump inhibitors. Furthermore, POEM opened the era of submucosal tunnel endoscopy, with many other applications. Based on the same principles with POEM, in combination with new technological developments, such as endoscopic suturing, peroral endoscopic tumor resection (POET), is safely and effectively applied for challenging submucosal esophageal, EGJ and gastric cardia tumors (submucosal tumors), emerged from muscularis propria. POET showed up to know promising results, however, it is restricted to specialized centers. The present article reviews the recent data of POEM and POET and discussed controversial issues that need further study and future perspectives. PMID

Progress in the clinical treatment of chronic dacryocystitis

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Xiang-Lei Chen

2018-04-01

Full Text Available Chronic dacryocystitis is often seen in middle-aged and old women, especially in menopause. The opening of the obstruction of the nasolacrimal duct is the key to the treatment of chronic dacryocystitis. At present, surgical treatment is the main type of operation. The commonly used methods include the transnasal canthus skin dacryocystorhinostomy and the endoscopic dacryocystorhinostomy. With the development of technology, the application of laser technology and new lacrimal duct silicon rubber tube makes the clinical treatment of chronic dacryocystitis more perfect. Lacrimal endoscope technology can obtain more intuitive image of lacrimal duct data, to determine the nature, location and degree of obstruction of lacrimal passage and treatment plan is particularly important, is a major breakthrough in the field of diagnosis and treatment of lacrimal duct obstruction, diagnosis and treatment method is currently the most advanced in the field.

Laser treatment of cutaneous angiokeratomas: A systematic review.

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Nguyen, Jannett; Chapman, Lance W; Korta, Dorota Z; Zachary, Christopher B

2017-11-01

Angiokeratomas can present therapeutic challenges, especially in cases of extensive lesions, where traditional surgical methods carry high risks of scarring and hemorrhage. Argon, pulsed dye (PDL), neodymium-doped yttrium aluminum garnet (Nd:YAG), copper vapor, potassium titanyl phosphate, carbon dioxide, and erbium-doped yttrium aluminum garnet (Er:YAG) lasers have emerged as alternative options. To review the use and efficacy of lasers in treating angiokeratomas. A PubMed search identified randomized clinical trials, cohort studies, case series, and case reports involving laser treatment of cutaneous angiokeratomas. Twenty-five studies were included. Quality ratings were assigned using the Oxford Centre for Evidence-Based Medicine scheme. Several laser modalities are effective in treating multiple variants of angiokeratomas. Vascular lasers like PDL, Nd:YAG, and argon are the most studied and of these, PDL offers the safest side effect profile. Nd:YAG may be more effective for hyperkeratotic angiokeratomas. Combination treatment with multiple laser modalities has also demonstrated some success. Lasers are a promising treatment option for angiokeratomas, but current use is limited by the lack of treatment guidelines. There are limited high quality studies comparing laser treatments to each other and to non-laser options. Additional studies are needed to establish guidelines and to optimize laser parameters. © 2017 Wiley Periodicals, Inc.

Nasal encephalocele: endoscopic excision with anesthetic consideration.

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Abdel-Aziz, Mosaad; El-Bosraty, Hussam; Qotb, Mohamed; El-Hamamsy, Mostafa; El-Sonbaty, Mohamed; Abdel-Badie, Hazem; Zynabdeen, Mustapha

2010-08-01

Nasal encephalocele may presents as a nasal mass, its treatment is surgical and it should be done early in life. When removal is indicated, there are multiple surgical approaches; including lateral rhinotomy, a transnasal approach and a coronal flap approach. However, the treatment of a basal intranasal encephalocele using transnasal endoscopic approach could obviates the possible morbidity associated with other approaches. The aim of this study was to evaluate the efficacy of endoscopic removal of intranasal encephalocele, also to document the role of anesthetist in the operative and postoperative periods. Nine cases with nasal encephalocele were included in this study; CT and/or MRI were used in their examination. The lesions were removed via transnasal endoscopic approach. Preoperative evaluation, intervention and postoperative follow-up were presented with discussion of anesthesia used for those children. The lesions of all patients were removed successfully with no recurrence through the follow-up period of at least 21 months. No cases showed morbidity or mortality intra- or post-operatively. Endoscopic excision of intranasal encephalocele is an effective method with high success rate. Anesthetist plays an important role in the operative and postoperative period, even during the endoscopic follow up; sedation of the children is usually needed. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica

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Sergio López-Durán

Full Text Available Endoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique.

Laser treatment of infantile hemangioma: A systematic review.

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Chinnadurai, Sivakumar; Sathe, Nila A; Surawicz, Tanya

2016-03-01

To systematically review studies of laser treatment of infantile hemangioma (IH). We searched multiple databases including MEDLINE® and EMBASE from 1982 to June 2015. Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We identified 29 studies addressing lasers: 4 randomized controlled trials, 8 retrospective cohort studies, and 17 case series. Lasers varied across studies in type, pulse width, or cooling materials. Most comparative studies (n = 9) assessed variations of pulsed dye laser (PDL) and examined heterogeneous endpoints. Most studies reported on treatment of cutaneous lesions. Overall, longer pulse PDL with epidermal cooling was the most commonly used laser for cutaneous lesions; Nd:YAG was the most commonly used intralesionally. Most studies reported a higher success rate with longer pulse PDL compared with observation in managing the size of IH, although the magnitude of effect differed substantially. CO2 laser was used for subglottic IH in a single study, and was noted to have a higher success rate and lower complication rate than both Nd:YAG and observation. Studies comparing laser with β-blockers or in combination with β-blockers reported greater improvements in lesion size in combination arms versus β-blockers alone and greater effects of lasers on mixed superficial and deep IH. Strength of the evidence for outcomes after laser treatments ranged from insufficient to low for effectiveness outcomes. Strength of the evidence was insufficient for the effects of laser compared with β-blockers or in combination with β-blockers as studies evaluated different agents and laser types. Studies assessing outcomes after CO2 and Nd:YAG lasers typically reported some resolution of lesion size, but heterogeneity among studies limits our abilities to draw conclusions. Studies of laser

High-quality endoscope reprocessing decreases endoscope contamination.

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Decristoforo, P; Kaltseis, J; Fritz, A; Edlinger, M; Posch, W; Wilflingseder, D; Lass-Flörl, C; Orth-Höller, D

2018-02-24

Several outbreaks of severe infections due to contamination of gastrointestinal (GI) endoscopes, mainly duodenoscopes, have been described. The rate of microbial endoscope contamination varies dramatically in literature. The aim of this multicentre prospective study was to evaluate the hygiene quality of endoscopes and automated endoscope reprocessors (AERs) in Tyrol/Austria. In 2015 and 2016, a total of 463 GI endoscopes and 105 AERs from 29 endoscopy centres were analysed by a routine (R) and a combined routine and advanced (CRA) sampling procedure and investigated for microbial contamination by culture-based and molecular-based analyses. The contamination rate of GI endoscopes was 1.3%-4.6% according to the national guideline, suggesting that 1.3-4.6 patients out of 100 could have had contacts with hygiene-relevant microorganisms through an endoscopic intervention. Comparison of R and CRA sampling showed 1.8% of R versus 4.6% of CRA failing the acceptance criteria in phase I and 1.3% of R versus 3.0% of CRA samples failing in phase II. The most commonly identified indicator organism was Pseudomonas spp., mainly Pseudomonas oleovorans. None of the tested viruses were detected in 40 samples. While AERs in phase I failed (n = 9, 17.6%) mainly due to technical faults, phase II revealed lapses (n = 6, 11.5%) only on account of microbial contamination of the last rinsing water, mainly with Pseudomonas spp. In the present study the contamination rate of endoscopes was low compared with results from other European countries, possibly due to the high quality of endoscope reprocessing, drying and storage. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

[Endonasal endoscopic surgery in the treatment of spontaneous or post-traumatic cerebrospinal fluid (csf) leaks].

Science.gov (United States)

Nallet, E; Decq, P; Bezzo, A; Le Lievre, G; Peynegre, R; Coste, A

1998-10-01

The incidence and the risk of meningitidis justify treatment in all cases of cerebrospinal fluid rhinorrhea with spontaneous etiology or after traumatic injury. Endonasal surgery with endoscopic instruments provides many advantages compared with transcranial or transfacial approach used by neurosurgeons. We report our experience and our surgical technique in the treatment of CSF leaks in 5 patients. Intrathecal injection of fluoresceine was very useful in all cases for detecting the CSF leak. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enables detection and repair of CSF leaks from the sphenoid cavity. A free graft of inferior turbinal mucosal was used to repair the breache. This rapid low morbidity surgery offered secure closure of rhinorrhea in 4 cases after one procedure and in 1 case after two procedures with an average follow up of 22 months. Cerebrospinal fluid rhinorrhea can be managed in first line therapy with endoscopic intranasal surgical techniques when they are localized in the anterior ethmoid or in the sphenoid cavity.

Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases.

Science.gov (United States)

van Halsema, Emo E; Wong Kee Song, Louis M; Baron, Todd H; Siersema, Peter D; Vleggaar, Frank P; Ginsberg, Gregory G; Shah, Pari M; Fleischer, David E; Ratuapli, Shiva K; Fockens, Paul; Dijkgraaf, Marcel G W; Rando, Giacomo; Repici, Alessandro; van Hooft, Jeanin E

2013-01-01

Temporary placement of self-expandable stents has been increasingly used for the management of benign esophageal diseases. To evaluate the safety of endoscopic removal of esophageal self-expandable stents placed for the treatment of benign esophageal diseases. Multicenter retrospective study. Six tertiary care centers in the United States and Europe. A total of 214 patients with benign esophageal diseases undergoing endoscopic stent removal. Endoscopic stent removal. Endoscopic techniques for stent removal, time to stent removal, and adverse events related to stent removal. A total of 214 patients underwent a total of 329 stent extractions. Stents were mainly placed for refractory strictures (49.2%) and fistulae (49.8%). Of the removed stents, 52% were fully covered self-expandable metal stents (FCSEMSs), 28.6% were partially covered self-expandable metal stents (PCSEMSs), and 19.5% were self-expandable plastic stents. A total of 35 (10.6%) procedure-related adverse events were reported, including 7 (2.1%) major adverse events. Multivariate analysis revealed that use of PCSEMSs (P stent removal. Favorable factors for successful stent removal were FCSEMSs (P ≤ .012) and stent migration (P = .010). No significant associations were found for stent indwelling time (P = .145) and stent embedding (P = .194). Retrospective analysis, only tertiary care centers. With an acceptable major adverse event rate of 2.1%, esophageal stent removal in the setting of benign disease was found to be a safe and feasible procedure. FCSEMSs were more successfully removed than self-expandable plastic stents and PCSEMSs. Adverse events caused by stent removal were not time dependent. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Peroral endoscopic myotomy for achalasia

NARCIS (Netherlands)

Bredenoord, A. J.; Rösch, T.; Fockens, P.

2014-01-01

Treatment of achalasia is complicated by symptom recurrence and a significant risk for severe complications. Endoscopic myotomy was developed in the search for a highly efficacious treatment with lower risks. Since its introduction in 2010, several centers have adopted the technique and published

Expert Statement : Pneumothorax Associated with Endoscopic Valve Therapy for Emphysema - Potential Mechanisms, Treatment Algorithm, and Case Examples

NARCIS (Netherlands)

Valipour, Arschang; Slebos, Dirk-Jan; de Oliveira, Hugo G.; Eberhardt, Ralf; Freitag, Lutz; Criner, Gerard J.; Herth, Felix J. F.

2014-01-01

The use of endoscopically placed unidirectional valves for the treatment of emphysema is increasing. With better patient selection, there is also an increased likelihood of complications associated with the procedure, such as postprocedural pneumothorax. There is, however, little evidence of

Clinical outcomes of endoscope-assisted vitrectomy for treatment of rhegmatogenous retinal detachment

Directory of Open Access Journals (Sweden)

Yokoyama S

2017-11-01

Full Text Available Sho Yokoyama,1 Takashi Kojima,2 Toshio Mori,3 Taisuke Matsuda,1 Hiroyuki Sato,3 Norihiko Yoshida,4 Tatsushi Kaga,1 R Theodore Smith,5 Kazuo Ichikawa6 1Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan; 2Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 3Department of Ophthalmology, Iida Municipal Hospital, Iida, Japan; 4Department of Ophthalmology, Japanese Red Cross Gifu Hospital, Gifu, Japan; 5Department of Ophthalmology, New York University School of Medicine, New York, NY, USA; 6Chukyo Eye Clinic, Nagoya, Japan Summary: We evaluated the clinical outcomes for ophthalmic endoscope-assisted vitrectomy in consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD. The primary success rate was 98.4% (125/127 without performing a posterior drainage retinotomy or using perfluorocarbon liquids (PFCL for subretinal fluid drainage.Purpose: To investigate the clinical outcomes of endoscope-assisted vitrectomy in patients with uncomplicated RRD.Methods: We examined 127 eyes from consecutive patients who underwent repair of RRD by 23- or 25-gauge endoscope-assisted vitrectomy, with a minimum follow-up of 3 months. Eyes with the following criteria were excluded: Giant retinal tears, grade C proliferative vitreoretinopathy, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. All cases underwent subretinal fluid drainage, endolaser photocoagulation and fundus inspection were performed under ophthalmic endoscopic observation. Success rate, visual acuity, surgery time and complications were evaluated.Results: Primary and final success rate was 98.4% (125/127 and 100% (127/127, respectively, Surgery time was 59.6±26.3 minutes. The best-corrected visual acuity significantly improved from 20/100 to 20/20 (P<0.0001. There were 2 cases (1.6% of creation of a peripheral drainage retinotomy and 4

Endoscopic assessment and prediction of prostate urethral disintegration after histotripsy treatment in a canine model.

Science.gov (United States)

Schade, George R; Styn, Nicholas R; Hall, Timothy L; Roberts, William W

2012-02-01

Histotripsy is a nonthermal focused ultrasound technology that uses acoustic cavitation to homogenize tissue. Previous research has demonstrated that the prostatic urethra is more resistant to histotripsy effects than prostate parenchyma, a finding that may complicate the creation of transurethral resection of the prostate-like treatment cavities. The purpose of this study was to characterize the endoscopic appearance of the prostatic urethra during and after histotripsy treatment and to identify features that are predictive of urethral disintegration. Thirty-five histotripsy treatments were delivered in a transverse plane traversing the prostatic urethra in 17 canine subjects (1-3/prostate ≥1 cm apart). Real-time endoscopy was performed in the first four subjects to characterize development of acute urethral treatment effect (UTE). Serial postprocedure endoscopy was performed in all subjects to assess subsequent evolution of UTE. Endoscopy during histotripsy was feasible with observation of intraurethral cavitation, allowing characterization of the real-time progression of UTE from normal to frank urethral disintegration. While acute urethral fragmentation occurred in 3/35 (8.6%) treatments, frank urethral disintegration developed in 24/35 (68.5%) within 14 days of treatment. Treating until the appearance of hemostatic pale gray shaggy urothelium was the best predictor of achieving urethral fragmentation within 14 days of treatment with positive and negative predictive values of 0.91 and 0.89, respectively. Endoscopic assessment of the urethra may be a useful adjunct to prostatic histotripsy to help guide therapy to ensure urethral disintegration, allowing drainage of the homogenized adenoma and effective tissue debulking.

Endoscopic retrograde cholangiopancreatography and endoscopic ...

African Journals Online (AJOL)

An approach to suspected gallstone pancreatitis'based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCp became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on ...

ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE.

Science.gov (United States)

Lopez-Nava, Gontrand; Galvão, M P; Bautista-Castaño, I; Fernandez-Corbelle, J P; Trell, M; Lopez, N

2017-01-01

Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim : To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or 25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up. As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o procedimento endoscópico de gastroplastia sleeve sob anestesia geral com observação do paciente internado durante a noite. Dos 154 pacientes iniciais, 143 estiveram disponíveis para acompanhamento de um mês, 133 durante seis meses, 64 durante 12 meses e 28 completaram a avaliação de 24 meses. O acompanhamento foi realizado por equipe multidisciplinar (nutricionista e psic

Radiation enhancement of laser palliation for malignant dysphagia: a pilot study

Energy Technology Data Exchange (ETDEWEB)

Sargeant, I.R.; Loizou, L.A.; Tobias, J.S.; Blackman, G.; Thorpe, S.; Bown, S.G. (University Coll. Hospital, London (United Kingdom))

1992-12-01

Laser therapy offers rapid relief of dysphagia for patients with cancers of the oesophagus and gastric cardia but repeat treatments are required approximately every five weeks to maintain good swallowing. To try to prolong the treatment interval, 22 elderly patients were given additional external beam radiotherapy. Nine had squamous cell carcinoma and 13 adenocarcinoma: five had documented metastases. Six received 40 Gy and 16, 30 Gy in 10-20 fractions. A check endoscopy was performed three weeks after external beam radiotherapy. Dysphagia was graded from 0-4 (0=normal; 4=dysphagia for liquids). The median dysphagia grade improved from 3 to 1 after laser treatment. This improvement was maintained in the 30 Gy group but there was a noticeable deterioration in three of those who had received the higher radiation dose. A lifelong dysphagia grade of 2 or better was enjoyed by 14 of 16 patients in the 30 Gy group but only two of six in the 40 Gy group. The dysphagia controlled interval was 9 weeks (median) after check endoscopy and subsequent endoscopic procedures were required every 13 weeks to maintain good swallowing. There were no endoscopy related complications. Combined treatment is a promising approach for reducing the frequency of endoscopic treatments. The 30 Gy dose seems more appropriate and may prolong survival. A randomised study to test these conclusions is in progress. (Author).

Radiation enhancement of laser palliation for malignant dysphagia: a pilot study

International Nuclear Information System (INIS)

Sargeant, I.R.; Loizou, L.A.; Tobias, J.S.; Blackman, G.; Thorpe, S.; Bown, S.G.

1992-01-01

Laser therapy offers rapid relief of dysphagia for patients with cancers of the oesophagus and gastric cardia but repeat treatments are required approximately every five weeks to maintain good swallowing. To try to prolong the treatment interval, 22 elderly patients were given additional external beam radiotherapy. Nine had squamous cell carcinoma and 13 adenocarcinoma: five had documented metastases. Six received 40 Gy and 16, 30 Gy in 10-20 fractions. A check endoscopy was performed three weeks after external beam radiotherapy. Dysphagia was graded from 0-4 (0=normal; 4=dysphagia for liquids). The median dysphagia grade improved from 3 to 1 after laser treatment. This improvement was maintained in the 30 Gy group but there was a noticeable deterioration in three of those who had received the higher radiation dose. A lifelong dysphagia grade of 2 or better was enjoyed by 14 of 16 patients in the 30 Gy group but only two of six in the 40 Gy group. The dysphagia controlled interval was 9 weeks (median) after check endoscopy and subsequent endoscopic procedures were required every 13 weeks to maintain good swallowing. There were no endoscopy related complications. Combined treatment is a promising approach for reducing the frequency of endoscopic treatments. The 30 Gy dose seems more appropriate and may prolong survival. A randomised study to test these conclusions is in progress. (Author)

Endoscopic versus open bursectomy of lateral malleolar bursitis.

Science.gov (United States)

Choi, Jae Hyuck; Lee, Kyung Tai; Lee, Young Koo; Kim, Dong Hyun; Kim, Jeong Ryoul; Chung, Woo Chull; Cha, Seung Do

2012-06-01

Compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis. Prospective evaluation of 21 patients (22 ankles) undergoing either open or endoscopic excision of lateral malleolar bursitis. The median age was 64 (38-79) years old. The median postoperative follow-up was 15 (12-18) months. Those patients undergoing endoscopic excision showed a higher satisfaction rate (excellent 9, good 2) than open excision (excellent 4, good 3, fair 1). The wounds also healed earlier in the endoscopic group although the operation time was slightly longer. One patient in the endoscopic group had recurrence of symptoms but complications in the open group included one patient with skin necrosis, one patient with wound dehiscence, and two patients of with superficial peroneal nerve injury. Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favorable results compared to the open resection. Therapeutic studies-Investigating the result of treatment, Level II.

New endoscope shaft for endoscopic transsphenoidal pituitary surgery.

NARCIS (Netherlands)

Lindert, E.J. van; Grotenhuis, J.A.

2005-01-01

OBJECTIVE: To describe a new endoscope shaft developed for suction-aspiration during endoscopic transsphenoidal pituitary surgery. METHODS: A custom-made shaft for a Wolf endoscope (Richard Wolf GmbH, Knittlingen, Germany) was developed with a height of 10 mm and a width of 5 mm, allowing an

Ultrasound-assisted endoscopic partial plantar fascia release.

Science.gov (United States)

Ohuchi, Hiroshi; Ichikawa, Ken; Shinga, Kotaro; Hattori, Soichi; Yamada, Shin; Takahashi, Kazuhisa

2013-01-01

Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure.

[Possibilities of endoscopic surgery in treatment of chronic venous insufficiency of the lower extremities].

Science.gov (United States)

Lazarenko, V A; Okhotnikov, O I; Prokopov, V A; Kopeĭko, I L; Bobrovskaia, E A; Es'kov, V P; Tulupova, L N

2005-01-01

The authors present their experiences with endoscopic dissection of perforating veins in patients with severe forms of chronic venous insufficiency with special reference to the peculiarities of blood supply of the extremity superficial tissue. The generalized morphological description of the perforating arteriovenous structures of the leg is presented as a vascular formation including the arteries and veins put in the general connective-tissue vagina and beginning from the profound or/and muscular veins and arteries. Operations were made on 56 patients aged 25-76 years, 40 of them had postthrombotic disease, 16 - varicose disease. The endoscopic subfascial dissection of the perforating veins was conducted using the standard set of tools for laparoscopic surgery of K. Storz Company. During the surgical procedure the perforating vascular bunch in the subfascial space was isolated, the veins were intersected electrosurgically, the other parts of the vascular bunch were preserved. On the average, the patients were in the hospital for 7+/-2 days. Trophic ulcers healed up during 7-30 days. Long-term results were good in 30%, satisfactory in 64%, unsatisfactory - in 6%. So, the selective endoscopical dissection of perforating veins is thought to be a radical, minimally invasive, anatomically and functionally reasonable method of elimination of the horizontal venous blood regurgitation. This technique resulted in a considerably decreased number of postoperative complications and less time of hospital treatment.

Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation.

Science.gov (United States)

Zoepf, Thomas; Maldonado-Lopez, Evelyn J; Hilgard, Philip; Schlaak, Joerg; Malago, Massimo; Broelsch, Christoph E; Treichel, Ulrich; Gerken, Guido

2005-11-01

Endoscopic treatment of biliary strictures after liver transplantation is a therapeutic challenge. In particular, outcomes of endoscopic therapy of biliary complications in the case of duct-to-duct anastomosis after living related liver transplantation are limited. The aim of this study was to evaluate the feasibility and success of an endoscopic treatment approach to posttransplant biliary strictures (PTBS) after right-sided living donor liver transplantation (RLDLT) with duct-to-duct anastomosis. Ninety patients who received adult-to-adult RLDLT in our center were screened retrospectively with respect to endoscopic treatment of PTBS. Therapy was judged as successful when cholestasis parameters returned to normal and bile duct narrowing was reduced significantly after the completion of therapy. Forty of 90 RLDLT patients received duct-to-duct anastomosis, 12 (30%) showed PTBS. Seven of 12 patients were treated successfully by endoscopy; the remaining 5 patients were treated primarily by surgery. Most patients were treated by balloon dilatation followed by insertion of endoprostheses. A median of 2.5 dilatation sessions were necessary and the median treatment duration was 8 months. One patient developed endoscopy-treatable recurrent stenosis, no surgical intervention was necessary. Mild pancreatitis occurred in 7.9% and cholangitis in 5.3% of the procedures. One minor bleeding episode occurred during sphincterotomy. Bleeding was managed endoscopically. Endoscopic therapy of adult-to-adult right living related liver transplantation with duct-to-duct anastomosis is feasible and frequently is successful. The duct-to-duct anastomosis offers the possibility of endoscopic treatment. Endoscopic treatment of posttransplant biliary strictures is safe, with a low specific complication rate.

LASER TREATMENT OF BENIGN CUTANEOUS VASCULAR LESIONS

Directory of Open Access Journals (Sweden)

Uroš Ahčan

2004-07-01

Full Text Available Background. Congenital and acquired vascular lesions of the skin and subcutis are a common health problem from aesthetic and also from psycho-social point of view. However, recent advances in laser technology have enabled an efficient and safe treatment. This study presents our experience with treatment of cutaneous vascular lesions using modern laser systems. Most common benign cutaneous vascular lesions are described.Patients and methods. In years 2002 and 2003, 109 patients, 4 to 80 (mean 39 years old, Fitzpatrick skin type 1–4, with 210 benign cutaneous vascular lesions were treated using the Dualis VP® laser system (Fotona, Slovenia which incorporates the KTP and Nd:YAG lasers. Vascular lesions in the upper layers of the skin with diameter up to 1 mm were treated with the KTP laser (wavelength 532 nm. For larger vessels in deeper layer we used the Nd:YAG laser (wavelength 1064 nm. Patients graded the pain during treatment on a scale of 1–10. Clinical outcomes were evaluated 1–3 months after the last treatment: according to the percentage of clearance of the lesion compared to the adjacent normal skin and for the presence of adverse effects. According to these criteria each lesion was assigned a score: poor (0–25%, fair (26–50%, good (51–75%, excellent (76–100%.Results. Immediate response after application of a laser beam with proper characteristics was whitish-grey discoloration of treated area. Treatment results after 1–3 months were excellent in 48.1%, good 40.9%, fair in 8.6% and poor in 2.4%. Patients without prior anaesthesia graded pain during treatment from 1 to 8 (mean 4.0 and patients with EMLA® anaesthesia from 1 to 6 (mean 2.6. Side effects were frequent but minimal and transient. Erythema disappeared in several days after treatment while crusting persisted for 14 days. 3 permanent hyperpigmentations, 2 permanent hypopigmentations, 2 hypertrophic scars and 1 beam sized atrophic scar were detected at last follow

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire.

Science.gov (United States)

Senturk, O; Hulagu, S; Celebi, A; Korkmaz, U; Duman, A E; Dindar, G; Bozkurt, N; Yilmaz, H; Ozturkler, M; Can, B; Batman, A

2014-12-01

Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure. Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness. PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure. The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

Laser treatment of medical skin disease in women.

Science.gov (United States)

LaRosa, C; Chiaravalloti, A; Jinna, S; Berger, W; Finch, J

2017-09-01

Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.

Laser tattoo removal with preceding ablative fractional treatment

Science.gov (United States)

Cencič, Boris; Možina, Janez; Jezeršek, Matija

2013-06-01

A combined laser tattoo removal treatment, first the ablative fractional resurfacing (AFR) with an Er:YAG laser and then the q-switched (QSW) Nd:YAG laser treatment, was studied. Experiments show that significantly higher fluences can be used for the same tissue damage levels.

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

Science.gov (United States)

Biočíc, Mihovil; Todoríc, Jakov; Budimir, Dražen; Roíc, Andrea Cvitkovíc; Pogorelíc, Zenon; Juríc, Ivo; Šušnjar, Tomislav

2012-01-01

Background The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection. Methods Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux. Results A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery. Conclusion Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate. PMID:22854114

Laser treatment of radish seed

International Nuclear Information System (INIS)

Kartalov, P.; Nidal, T.

1987-01-01

Trials were conducted in unheated plastic greenhouses in 1985-1986 to test the effect of laser treatment on radish seed. Seed of cv Saxia was irradiated with helio-neon laser of 632.8 Nm wave length at: 2-, 4- and 6-fold irradiation. Results showed that plants of all variants emerged almost simultaneously. The root mass was greatest for plants obtained from 4-fold irradiated seed. Treatment enhanced root production in 1985, and in 1986 4-fold irradiation boosted yield by 15%

Incidence, treatment and outcome of rectal stenosis following transanal endoscopic microsurgery.

Science.gov (United States)

Barker, J A; Hill, J

2011-09-01

As an alternative to more radical abdominal surgery, transanal endoscopic microsurgery (TEM) offers a minimally invasive solution for the excision of certain rectal polyps and early-stage rectal tumours. The patient benefits of TEM as compared to radical abdominal surgery are clear; nevertheless, some drawback is possible. The aim of our study was to determine the risk factors, treatment and outcomes of rectal stenosis following TEM. We analysed a series of 354 consecutive patients who underwent TEM for benign or malignant rectal tumours between 1997 and 2009. We recorded the maximum histological diameter of the lesion, and whether the lesion was circumferential. Rectal stenosis was defined as a rectal narrowing not allowing passage of a 12 mm sigmoidoscope. Histological results with a measured specimen diameter were available in 304 of the 354 cases. There were 11 stenoses in total (3.6%), 7 stenoses due to 9 circumferential lesions (78%) and 4 due to lesions with a maximum diameter ≥ 5 cm (3.2%). Two patients presented as emergencies, and the other 9 patients reported symptoms of increased stool frequency at follow-up. Three of the stenoses were associated with recurrent disease. All stenoses were treated by a combination of endoscopic/radiological balloon dilatation or surgically with Hegar's dilators. A median of two procedures were required to treat stenoses until resolution of symptoms. Rectal stenosis following TEM excision is rare. It is predictable in patients with circumferential lesions but is rare in patients with non-circumferential lesions with a maximum diameter ≥ 5 cm. It is effectively treated with surgical or balloon dilatation. Most patients require repeated treatments.

Clinical research of the micro-invasive treatments for chronic dacryocystitis with the fifth generation lacrimal endoscope

Directory of Open Access Journals (Sweden)

Yong-Zhe Tang

2015-06-01

Full Text Available AIM: To investigate the methods, effect and security of the micro-invasive treatments for chronic dacryocystitis with the fifth generation lacrimal endoscope, and to evaluate its clinical application.METHODS:In this case-control study, 120 patients(120 eyeswith chronic dacryocystitis were collected from April 2013 to July 2014 in our department. The patients were randomly divided into observation group(the fifth generation endoscopic lacrimal microdrill with full intubation group, 62 cases 62 eyesand control group(external dacryocystorhinostomy group, 58 cases 58 eyes. The effective rate and complication were observed and compared between two groups after operation. Statistical package SPSS 13.0 was used for statistical analysis.RESULTS: The effective rate of observation group was 91.9%, and control group was 96.6%, there was no statistically significant difference between the two groups(P>0.05. Hemorrhage occurred in observation group and control group was 35.5% and 79.3%, respectively, additionally palpebral oedema was 19.4% and 55.2%, respectively, there were statistically significant differences between the two groups(PCONCLUSION: The fifth generation lacrimal endoscope is more flexible than traditional one-piece lacrimal endoscope during the operation, it can treat chronic dacryocystitis by directly observing nasolacrimal duct obstruction site and dredge the obstruction under microdrilling with full lacrimal intubation. It was not only good clinical curative effect, but also safer, more efficient than the external dacryocystorhinostomy, visualization and micro-invasive are its special advantage, and worthy for further clinical application.

Endoscope-Assisted Enucleation of Mandibular Odontogenic Keratocyst Tumors.

Science.gov (United States)

Romano, Antonio; Orabona, Giovanni D A; Abbate, Vincenzo; Maglitto, Fabio; Solari, Domenico; Iaconetta, Giorgio; Califano, Luigi

2016-09-01

The keratocyst odontogenic tumor (KCOT) represents a rare and benign but locally aggressive developmental cystic lesion usually affecting the posterior aspect of the mandible bone, the treatment of which has always been raising debate, since Philipsen first described it as a distinct pathological entity in 1956.Recent studies have proposed the use of endoscope-assisted surgical technique, due to the possibility given by the endoscope of improving the effectiveness of the treatment of these lesions thanks to a better visualization of operative field and though a better understanding of the pathology. In this article, we would like to present our experience with the endoscope-assisted treatment of KCOT of the posterior region of the mandible.From April 2000 to April 2012, 32 patients treated for KCOT were enrolled in our retrospective study: patients were divided in 2 groups according to the type of treatment, that is, 18 were treated with traditional enucleation surgery (TES), and 14 patients underwent endoscopic assisted enucleation surgery (EES).Fischer exact test and Kaplan-Meier curves were used to compare the outcomes between the 2 focusing on the recurrence and complication rates. In the TES group, patients we found a higher recurrence rate (39%) and higher postoperative complication rate at 5-year follow-up.Our data suggested, though, that EES seems to be a feasible alternative for the treatment of posterior mandibular KCOT. Further studies and larger series are needed to confirm these results.

Laser treatment of medical skin disease in women

Directory of Open Access Journals (Sweden)

C. LaRosa, MD

2017-09-01

Full Text Available Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS, notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.

Laser welding, cutting and surface treatment

International Nuclear Information System (INIS)

Crafer, R.C.

1984-01-01

Fourteen articles cover a wide range of laser applications in welding, cutting and surface treatment. Future trends are covered as well as specific applications in shipbuilding, the manufacture of heart pacemakers, in the electronics industry, in automobile production and in the aeroengine industry. Safety with industrial lasers and the measurement of laser beam parameters are also included. One article on 'Lasers in the Nuclear Industry' is indexed separately. (U.K.)

Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum.

Science.gov (United States)

Altman, Jason I; Genden, Eric M; Moche, Jason

2005-05-01

Endoscopic diverticulotomy is rapidly becoming the procedure of choice for treatment of Zenker's diverticulum. The endoscopic approach has resulted in significant decreases in patient morbidity, time to resumption of oral intake, and overall cost as compared with open treatment. However, a small but significant patient population is unable to accommodate the rigid laryngoscope and therefore requires open treatment. We present a novel technique, flexible fiberoptic endoscopic-assisted diverticulotomy, for the management of patients who are unable to undergo rigid endoscopy.

Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms.

Science.gov (United States)

Yamamoto, Hironori

2007-09-01

Gastrointestinal neoplasms can be cured by local resection as long as the lesions are in the early stage and have not metastasized. Endoscopic resection is a minimally invasive treatment for early-stage gastrointestinal neoplasms, and endoscopic submucosal dissection (ESD) is one type of endoscopic resection that has been developed in the past 10 years. For ESD to be a reliable, curative treatment for gastrointestinal neoplasms, it is necessary for the endoscopist to detect the lesion early, make a precise pretreatment diagnosis, ensure that the patient has the correct indication for endoscopic resection, and have the skill to perform ESD. For early lesion detection, endoscopists should pay attention to subtle changes in the surface structure, the color of the mucosa and the visibility of underlying submucosal vessels. Chromoendoscopy and magnifying endoscopy are useful for determining the margin of the lesions for pretreatment diagnosis, and endoscopic ultrasonography and magnifying endoscopy are useful for determining the depth of invasion. For ESD to be successful, local injection of sodium hyaluronate helps maintain mucosal elevation during dissection. Selecting the appropriate knife, using transparent hoods wisely, employing a good strategy that uses gravity, and having good control of bleeding are all needed to make ESD reliable.

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

Directory of Open Access Journals (Sweden)

Wei-Chen Lin

Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each

[Research on the laser atomization treatment machine].

Science.gov (United States)

Jiang, Bei-sheng; Tian, Rong-zhe; Zhang, Liang

2005-07-01

This text has introduces a new-type laser treatment device. It utilizes the ultrasound atomized gas passage as its optics and makes the laser beams together with the atomized medicine to be transmitted to the patient's respiratory track and lungs for treatment.

Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.

Science.gov (United States)

Cahen, Djuna L; Gouma, Dirk J; Nio, Yung; Rauws, Erik A J; Boermeester, Marja A; Busch, Olivier R; Stoker, Jaap; Laméris, Johan S; Dijkgraaf, Marcel G W; Huibregtse, Kees; Bruno, Marco J

2007-02-15

For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct. All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study. We randomly assigned patients to undergo endoscopic transampullary drainage of the pancreatic duct or operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function. Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores (25 vs. 51, Psurgical drainage (P=0.007). Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group (a median of eight vs. three, PSurgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis. (Current Controlled Trials number, ISRCTN04572410 [controlled-trials.com].). Copyright 2007 Massachusetts Medical Society.

TU-AB-202-12: A Novel Method to Map Endoscopic Video to CT for Treatment Planning and Toxicity Analysis in Radiation Therapy

International Nuclear Information System (INIS)

Ingram, W; Yang, J; Beadle, B; Wendt, R; Rao, A; Court, L

2016-01-01

Purpose: Endoscopic examinations are routine procedures for head-and-neck cancer patients. Our goal is to develop a method to map the recorded video to CT, providing valuable information for radiotherapy treatment planning and toxicity analysis. Methods: We map video frames to CT via virtual endoscopic images rendered at the real endoscope’s CT-space coordinates. We developed two complementary methods to find these coordinates by maximizing real-to-virtual image similarity:(1)Endoscope Tracking: moves the virtual endoscope frame-by-frame until the desired frame is reached. Utilizes prior knowledge of endoscope coordinates, but sensitive to local optima. (2)Location Search: moves the virtual endoscope along possible paths through the volume to find the desired frame. More robust, but more computationally expensive. We tested these methods on clay phantoms with embedded markers for point mapping and protruding bolus material for contour mapping, and we assessed them qualitatively on three patient exams. For mapped points we calculated 3D-distance errors, and for mapped contours we calculated mean absolute distances (MAD) from CT contours. Results: In phantoms, Endoscope Tracking had average point error=0.66±0.50cm and average bolus MAD=0.74±0.37cm for the first 80% of each video. After that the virtual endoscope got lost, increasing these values to 4.73±1.69cm and 4.06±0.30cm. Location Search had point error=0.49±0.44cm and MAD=0.53±0.28cm. Point errors were larger where the endoscope viewed the surface at shallow angles<10 degrees (1.38±0.62cm and 1.22±0.69cm for Endoscope Tracking and Location Search, respectively). In patients, Endoscope Tracking did not make it past the nasal cavity. However, Location Search found coordinates near the correct location for 70% of test frames. Its performance was best near the epiglottis and in the nasal cavity. Conclusion: Location Search is a robust and accurate technique to map endoscopic video to CT. Endoscope

Endoscopic removal of a dislocated tomour prothesis from the stomach

International Nuclear Information System (INIS)

Rueckauer, K.; Dinkel, E.

1985-01-01

Endoscopic pertubation of oesophagogustric neoplasms is an established method of palliative treatment. The dislocated plastic prosthesis may be removed with difficulties from the stomach endoscopically. A simple technique for endoscopic removal of the prosthesis is described. The tube can be precisely centred within the oesophageal lumen by use of an intestinal decompression tube and additional guidance by the endoscopic retraction forceps. Thus gross damge of the exophytic tumor tissue with bleeding or perforation sequelae can be avoided. Injury to the patient does not exceed that caused by an ordinary gastroscopy. (orig.) [de

Confocal laser endomicroscopy and ultrasound endoscopy during the same endoscopic session for diagnosis and staging of gastric neoplastic lesions.

Science.gov (United States)

Gheorghe, C; Iacob, R; Dumbrava, Mona; Becheanu, G; Ionescu, M

2009-01-01

Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsurface in vivo histological assessment during ongoing endoscopy and targeted biopsies. Ultrasound endoscopy (EUS) is a useful tool in staging upper GI malignant lesions. We describe for the first time the use of both techniques during the same endoscopic session, in a pilot study, in order to increase the diagnostic yield of histological assessment and provide the staging of the gastric neoplastic lesions thus decreasing the time to therapeutic decision. CLE has been performed with the Pentax EG-3870CIK confocal endomicroscope after a 5 ml intravenous 10% fluorescein injection; EUS has been performed subsequently, during the same endoscopic Propofol sedation session, using a standard radial EUS-scope. Eleven patients have been investigated, 4 females, 7 males, mean age 59.7 +/- 12.3 years. The indication of CLE/EUS exploration was the presence of a gastric polypoid lesion in 37% of cases, atypical gastric ulcer in 27% of patients, gastric lymphoma 18%, suspicion of gastric cancer recurrence after resection 9% and infiltrating type gastric cancer 9%. Histological assessment after targeted biopsy has established the diagnosis of gastric adenocarcinoma in 55% of cases, gastric lymphoma in 18% of cases, gastric adenoma, gastric GIST and gastric foveolar hyperplasia in 9% of cases respectively. CLE has allowed targeted biopsies in 81.8% of cases. In 2 patients - one case with suspected recurrent gastric cancer after surgery and one case of gastric lymphoma, CLE has indicated normal gastric mucosa. The EUS evaluation has shown TO lesion in two cases, T1 in 3 cases, T2 in 3 cases, T3 in one case. The EUS evaluation showed in one gastric lymphoma patient a lesion interesting the mucosa and submucosa with regional adenopathy and a submucosal lesion with regional adenopathy in the other gastric lymphoma case. The therapeutic decision was surgery in 73% of cases, chemotherapy and

Endoscopic management of acute peptic ulcer bleeding.

Science.gov (United States)

Lu, Yidan; Chen, Yen-I; Barkun, Alan

2014-12-01

This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video).

Science.gov (United States)

Barakat, Monique T; Girotra, Mohit; Huang, Robert J; Banerjee, Subhas

2018-02-06

Outbreaks of transmission of infection related to endoscopy despite reported adherence to reprocessing guidelines warrant scrutiny of all potential contributing factors. Recent reports from ambulatory surgery centers indicated widespread significant occult damage within endoscope working channels, raising concerns regarding the potential detrimental impact of this damage on the adequacy of endoscope reprocessing. We inspected working channels of all 68 endoscopes at our academic institution using a novel flexible inspection endoscope. Inspections were recorded and videos reviewed by 3 investigators to evaluate and rate channel damage and/or debris. Working channel rinsates were obtained from all endoscopes, and adenosine triphosphate (ATP) bioluminescence was measured. Overall endoscope working channel damage was rated as minimal and/or mild and was consistent with expected wear and tear (median 1.59 on our 5-point scale). Our predominant findings included superficial scratches (98.5%) and scratches with adherent peel (76.5%). No channel perforations, stains, or burns were detected. The extent of damage was not predicted by endoscope age. Minor punctate debris was common, and a few small drops of fluid were noted in 42.6% of endoscopes after reprocessing and drying. The presence of residual fluid predicted higher ATP bioluminescence values. The presence of visualized working channel damage or debris was not associated with elevated ATP bioluminescence values. The flexible inspection endoscope enables high-resolution imaging of endoscope working channels and offers endoscopy units an additional modality for endoscope surveillance, potentially complementing bacterial cultures and ATP values. Our study, conducted in a busy academic endoscopy unit, indicated predominately mild damage to endoscope working channels, which did not correlate with elevated ATP values. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights

Endoscopic Submucosal Dissection: Indications and Application in Western Endoscopy Practice.

Science.gov (United States)

Bourke, Michael J; Neuhaus, Horst; Bergman, Jacques J

2018-05-01

Endoscopic submucosal dissection was developed in Japan, early in this century, to provide a minimally invasive yet curative treatment for the large numbers of patients with early gastric cancer identified by the national screening program. Previously, the majority of these patients were treated surgically at substantial cost and with significant risk of short- and long-term morbidity. En-bloc excision of these early cancers, most with a limited risk of nodal metastasis, allowed complete staging of the tumor, stratification of the subsequent therapeutic approach, and potential cure. This transformative innovation changed the nature of endoscopic treatment for superficial mucosal neoplasia and, ultimately, for the first time allowed endoscopists to assert that the early cancer had been definitively cured. Subsequently, Western endoscopists have increasingly embraced the therapeutic possibilities offered by endoscopic submucosal dissection, but with some justifiable scientific caution. Here we provide an evidence-based critical appraisal of the role of endoscopic submucosal dissection in advanced endoscopic tissue resection. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

The development of laser surgery and medicine in China

Science.gov (United States)

Chen, Mingzhe

2005-07-01

The first Chinese ruby laser was created in 1961 and it was adopted for the retina coagulation experiment in 1965. Since 1970's, lasers had been widely applied clinically including the diseases suitable to physical therapy or acupuncture. The Chinese HpD was first produced in 1981 and first case of PDT was treated using Chinese HpD and Chinese lasers in the same year. Its success brought attention establishing a research group supported by the government in 1982. A nationwide systemic research project on PDT was then carried out. The step taken for PDT also accelerated the development of various fields of laser medicine and surgery. Laser treatments had been commonly adopted in the clinics and hospitals for the diseases of the superficial lesions and the lesions can be reached by the endoscopes non-invasively in 1980's. Since 1990's, the interventional laser therapies adopted mainly were percutaneous laser angioplasty, laser treatments through laparoscope, thoracoscope, arthroscope, neuro-endoscope etc. Ultrasound guided percutaneous laser heat coagulation for small hepatic cancer revealed good results and ultrasound guided percutaneous PDT for advanced large liver cancer revealed unexpected results after five years follow-up. At present: There are more long-term follow-up patients in the clinical trial; more advanced commercial available lasers and new techniques are adopted. Since the popularization of scanning electron microscope, laser scanning confocal microscope, laser induced auto-fluorescence system, high sensitivity fluorescence microscopic imaging system etc. in the laboratories, the basic studies can be more advanced and some times, the sub-cellular level can be reached; ultra-structure histo-morphology and gene studies are involved. In dermatology, Q-switched Alexandrite laser and other Q-switched lasers are used mainly for the treatment of skin pigmentation and vascular diseases; pulsed dye laser, ultra-pulsed CO2 laser are used in resurfacing, facial

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications

Directory of Open Access Journals (Sweden)

Hyun Woo Lee

2017-09-01

Full Text Available Biliary complications are the most common post-liver transplant (LT complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

Treatment of subtotal medial rectus myectomy complicating functional endoscopic sinus surgery.

Science.gov (United States)

Trotter, W L; Kaw, P; Meyer, D R; Simon, J W

2000-08-01

During the past 2 decades, the introduction of functional endoscopic sinus surgery (FESS) has dramatically improved the treatment of sinus disorders. However, a variety of orbital complications have been reported, including optic nerve damage, hemorrhage, infection, compromise of the lacrimal drainage apparatus, and strabismus. At least 10 cases have reported damage to the medial rectus muscle. (1-8) Treatment options for such patients have been limited, especially because most are adults at risk for anterior segment ischemia after transposition of vertical rectus muscles. We describe 2 patients whose medial rectus myectomies were repaired by using nonabsorbable "hang-back" sutures in combination with a botulinum toxin (Botox) injection of the antagonist lateral rectus muscle. Good primary position alignment was achieved in both patients, and one patient was able to regain binocular function. We recommend this surgical approach, especially in patients at increased risk for anterior segment ischemia.

Endoscopic laser thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia: a pilot study on long-term outcome on voice quality.

Science.gov (United States)

Tsuji, Domingos Hiroshi; Takahashi, Marystella Tomoe; Imamura, Rui; Hachiya, Adriana; Sennes, Luiz Ubirajara

2012-09-01

Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. Prospective study. Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). A significant improvement in VHI was observed after surgery, as compared with baseline values (P=0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Radiological findings after endoscopic incision of ureterocele

International Nuclear Information System (INIS)

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; Cheon, Jung Eun; Seok, Eul Hye; Cha, Joo Hee; Choi, Guk Myung

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

Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new?

Science.gov (United States)

Ferreira, Rosa; Loureiro, Rui; Nunes, Nuno; Santos, António Alberto; Maio, Rui; Cravo, Marília; Duarte, Maria Antónia

2016-01-01

Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. PMID:26962404

Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: Multicenter study of the gatekeeper reflux repair system

NARCIS (Netherlands)

Fockens, P.; Bruno, M. J.; Gabbrielli, A.; Odegaard, S.; Hatlebakk, J.; Allescher, H. D.; Rösch, T.; Rhodes, M.; Bastid, C.; Rey, J.; Boyer, J.; Muehldorffer, S.; van den Hombergh, U.; Costamagna, G.

2004-01-01

Background and Study Aims: The safety and effectiveness of the Gatekeeper Reflux Repair System (Medtronic Europe, Tolochenaz, Switzerland) in the treatment of gastroesophageal reflux disease (GERD) was evaluated. This new, reversible treatment modality involves the endoscopic introduction of

Carbon dioxide laser versus erbium:YAG laser in treatment of epidermal verrucous nevus: a comparative randomized clinical study.

Science.gov (United States)

Osman, Mai Abdel Raouf; Kassab, Ahmed Nazmi

2017-08-01

A verrucous epidermal nevus (VEN) is a skin disorder that has been treated using different treatment modalities with varying results. Ablative lasers such as carbon dioxide laser (CO 2 ) and erbium:yttrium-aluminum-garnet (Er:YAG) laser have been considered as the gold standard for the treatment of epidermal nevi. To evaluate and compare the efficacy, postoperative wound healing and side effects of pulsed CO 2 laser and Er:YAG laser for the treatment of verrucous epidermal nevi. Twenty patients with localized VEN were randomly divided into two groups. Group 1 was administered CO 2 laser and group 2 underwent Er:YAG laser treatment. A blinded physician evaluated the photographs and dermoscopic photomicrographs for the efficacy and possible side effects. All patients received one treatment session and were followed up over a 6-month period. Both lasers induced noticeable clinical improvement, but there were no significant differences between two lasers in treatment response, patient satisfaction, duration of erythema and side effects. The average time to re-epithelialization was 13.5 days with CO 2 and 7.9 days with Er:YAG laser (plaser group and no lesional recurrence was detected in CO 2 laser group since treatment. Apart from re-epithelialization, both lasers showed equivalent outcomes with respect to treatment response, patient satisfaction, side effects and complications.

Significance of endoscopic screening and endoscopic resection for esophageal cancer in patients with hypopharyngeal cancer

International Nuclear Information System (INIS)

Morimoto, Masahiro; Nishiyama, Kinji; Nakamura, Satoaki

2010-01-01

The efficacy of endoscopic screening for esophageal cancer in patients with hypopharyngeal cancer remains controversial and its impact on prognosis has not been adequately discussed. We studied the use of endoscopic screening to detect esophageal cancer in hypopharyngeal cancer patients by analyzing the incidence, stage and prognosis. We included 64 patients with hypopharyngeal cancer who received radical radiotherapy at our institute. Chromoendoscopic esophageal examinations with Lugol dye solution were routinely performed at and after treatment for hypopharyngeal cancer. Twenty-eight esophageal cancers were detected in 28 (41%) patients (18 synchronous and 10 metachronous cancers). Of the 28 cancers, 23 were stage 0 or I cancer and 15 of these were treated with endoscopic resection. Local control was achieved in all of these 23 stage 0 or I cancers. The 5-year overall survival rates with esophageal cancer were 83% in stage 0, 47% in stage I and 0% in stage IIA-IVB. This study showed a strikingly high incidence of esophageal cancer in hypopharyngeal cancer patients. We suppose that the combination of early detection by chromoendoscopic examination and endoscopic resection for associated esophageal cancer in hypopharyngeal cancer patients improve prognosis and maintain quality of life. (author)

Temporary endoscopic metallic stent for idiopathic esophageal achalasia.

Science.gov (United States)

Coppola, Franco; Gaia, Silvia; Rolle, Emanuela; Recchia, Serafino

2014-02-01

Idiopathic achalasia is a motor disorder of the esophagus of unknown etiology caused by loss of motor neurons determining an altered motility. It may determine severe symptoms such as progressive dysphagia, regurgitations, and pulmonary aspirations. Many therapeutic options may be offered to patients with achalasia, from surgery to endoscopic treatments such as pneumatic dilation, botulinum injection, peroral endoscopic myotomy, or endoscopic stenting. Recently, temporary placement of a stent was proposed by Cheng as therapy for achalasia disorders, whereas no Western authors have dealt with it up to date. The present study reports our preliminary experience in 7 patients with achalasia treated with a temporary stent. Partially covered self-expanding metallic stents (Micro-Tech, Nanjin, China) 80 mm long and 30 mm wide were placed under fluoroscopic control and removed after 6 days. Clinical follow-up was scheduled to check endoscopic success, symptoms release, and complications. The placement and the removal of the stents were obtained in all patients without complications. Mean clinical follow-up was 19 months. Five out of 7 patients referred total symptoms release and 2 experienced significant improvement of dysphagia. The procedure was not time consuming and was safe; no mild or severe complications were registered. In conclusion, our results may suggest a possible safe and effective endoscopic alternative treatment in patients with achalasia; however, further larger studies are necessary to confirm these promising, but very preliminary, data.

Endoscopic Management of Peri-Pancreatic Fluid Collections.

Science.gov (United States)

Yip, Hon Chi; Teoh, Anthony Yuen Bun

2017-09-15

In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.

Treatment of oral soft tissues benign tumors using laser

Science.gov (United States)

Crisan, Bogdan; Baciut, Mihaela; Crisan, Liana; Bran, Simion; Rotar, Horatiu; Dinu, Cristian; Moldovan, Iuliu; Baciut, Grigore

2014-01-01

The present study aimed to assess the efficacy and indications of surgical laser therapy in the treatment of oral soft tissues benign tumors compared to classic surgery. A controlled clinical study was conducted in a group of 93 patients presenting various forms of oral soft tissues benign tumors. These patients were examined pre-and postoperatively and the oral benign tumors were measured linearly and photographed. The surgery of laser-assisted biopsy excision of oral benign tumors was carried out using a diode laser device of 980 nm. In patients who received surgical laser treatment, therapeutic doses of laser to biostimulate the operated area were administered on the first day after the surgery. The interventions of conventional excision of oral soft tissues benign tumors consisted in removing them using scalpel. In patients who have received therapeutic doses of laser for biostimulation of the operated area, a faster healing of wound surfaces and tumor bed was observed during the first days after surgery. Two weeks after the surgical treatment, good healing without scarring or discomfort in the area of excision was documented. Surgical treatment of oral soft tissues benign tumors with laser assisted postoperative therapy confirms the benefits of this surgical procedure. A faster healing process of the excision area due to laser biostimulation of low intensity has been observed in patients with surgical laser assisted treatment in the postoperative period.

Surgical stress response: does endoscopic surgery confer an advantage?

DEFF Research Database (Denmark)

Kehlet, H

1999-01-01

of postoperative pulmonary function and less hypoxemia with endoscopic operation. The slight modification of surgical stress responses by endoscopic surgery is in contrast to the common, though not universal, demonstration of less pain, shorter hospital stay, and less morbidity after endoscopic surgery...... operations where differences are more likely to be found. The clinical consequences of these findings in relation to all over surgical outcome remain to be defined, but effective pain treatment, stress reduction by other techniques, and provision of an active rehabilitation program with early mobilization...

Per-oral endoscopic myotomy (POEM: a new endoscopic treatment for achalasia

Directory of Open Access Journals (Sweden)

Pablo Miranda-García

Full Text Available Background/aims: Per-oral endoscopic myotomy (POEM is a new minimally invasive technique to treat achalasia. Methods: We performed a review of the literature of POEM with a special focus on technical details and the results obtained with this technique in patients with achalasia and other esophageal motility disorders. Results: Thousands of POEM procedures have been performed worldwide since its introduction in 2008. The procedure is based on the creation of a mucosal entry point in the proximal esophagus to reach the cardia through a submucosal tunnel and then perform a myotomy of the muscular layers of the cardia, esophagogastric junction and distal esophagus, as performed in a Heller myotomy. The clinical remission rate ranges from 82 to 100%. Although no randomized studies exist and available data are from single-center studies, no differences have been found between laparoscopic Heller myotomy (LHM and POEM in terms of perioperative outcomes, short-term outcomes (12 months and long-term outcomes (up to three years. Procedure time and length of hospital stay were lower for POEM. Post-POEM reflux is a concern, and controversial data have been reported compared to LHM. The technique is safe, with no reported deaths related to the procedure and an adverse event rate comparable to surgery. Potential complications include bleeding, perforation, aspiration and insufflation-related adverse events. Thus, this is a complex technique that needs specific training even in expert hands. The indication for this procedure is widening and other motor hypercontractil esophageal disorders have been treated by POEM with promising results. POEM can be performed in complicated situations such as in pediatric patients, sigmoid achalasia or after failure of previous treatments. Conclusions: POEM is an effective treatment for achalasia and is a promising tool for other motor esophageal disorders. It is a safe procedure but, due to its technical difficulty and

Per-oral endoscopic myotomy (POEM): a new endoscopic treatment for achalasia.

Science.gov (United States)

Miranda García, Pablo; Casals Seoane, Fernando; Gonzalez, Jean-Michel; Barthet, Marc; Santander Vaquero, Cecilio

2017-10-01

Per-oral endoscopic myotomy (POEM) is a new minimally invasive technique to treat achalasia. We performed a review of the literature of POEM with a special focus on technical details and the results obtained with this technique in patients with achalasia and other esophageal motility disorders. Thousands of POEM procedures have been performed worldwide since its introduction in 2008. The procedure is based on the creation of a mucosal entry point in the proximal esophagus to reach the cardia through a submucosal tunnel and then perform a myotomy of the muscular layers of the cardia, esophagogastric junction and distal esophagus, as performed in a Heller myotomy. The clinical remission rate ranges from 82 to 100%. Although no randomized studies exist and available data are from single-center studies, no differences have been found between laparoscopic Heller myotomy (LHM) and POEM in terms of perioperative outcomes, short-term outcomes (12 months) and long-term outcomes (up to three years). Procedure time and length of hospital stay were lower for POEM. Post-POEM reflux is a concern, and controversial data have been reported compared to LHM. The technique is safe, with no reported deaths related to the procedure and an adverse event rate comparable to surgery. Potential complications include bleeding, perforation, aspiration and insufflation-related adverse events. Thus, this is a complex technique that needs specific training even in expert hands. The indication for this procedure is widening and other motor hypercontractil esophageal disorders have been treated by POEM with promising results. POEM can be performed in complicated situations such as in pediatric patients, sigmoid achalasia or after failure of previous treatments. POEM is an effective treatment for achalasia and is a promising tool for other motor esophageal disorders. It is a safe procedure but, due to its technical difficulty and possible associated complications, the procedure should be performed

Endoscopic and Photodynamic Therapy of Cholangiocarcinoma.

Science.gov (United States)

Meier, Benjamin; Caca, Karel

2016-12-01

Most patients with cholangiocarcinoma (CCA) have unresectable disease. Endoscopic bile duct drainage is one of the major objectives of palliation of obstructive jaundice. Stent implantation using endoscopic retrograde cholangiography is considered to be the standard technique. Unilateral versus bilateral stenting is associated with different advantages and disadvantages; however, a standard approach is still not defined. As there are various kinds of stents, there is an ongoing discussion on which stent to use in which situation. Palliation of obstructive jaundice can be augmented through the use of photodynamic therapy (PDT). Studies have shown a prolonged survival for the combinations of PDT and different stent applications as well as combinations of PDT and additional systemic chemotherapy. More well-designed studies are needed to better evaluate and standardize endoscopic treatment of unresectable CCA.

Semiconductor lasers in rheumatological treatment

Science.gov (United States)

Pascu, Mihail-Lucian; Suteanu, S.; Ignat, P.; Pruna, Simion; Chitu, A.

1995-03-01

A computer controlled equipment, containing 6 lasers (HeNe and 5 diode lasers--DL) conceived to be used in rheumatological treatment is reported. DL emit at 895 nm and for typical applications, their expanded spots are superposed within the irradiation plane, on the HeNE defocused spot used to define the surface to be irradiated. DL emit 100 nsec pulses between 0.5 KHz and 1.5 KHz repetition rate and 0.5 mW average power (measured at 1 KHz). 150 patients with rheumathologic diseases were treated: lumbar spondylosis (75), gonarthrosis (30), cervical spondylosis (21), coxarthrosis (15), Heberden and Bouchard (9). The treatment consisted of: group I, 50 patients--laser therapy, 10 min/day, 10 days; group II, 50 patients--classical antirheumatic treatment; group III, 50 patients--mixed treatment. Assessment of sympathetic skin activity made using reactometry measurements, shows that latency time was longer before irradiation, 1867 +/- 289) msec then after, (1234 +/- 321) msec. Pain rating indexes decreasing for all three groups of patients were measured. Better results for more superficial diseases were obtained and best results were observed after irradiation with 1 KHz - 1.5 KHz repetition rate IR pulses. Better results were obtained when spot irradiation in a few points combined with zone irradiations was used.

Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery.

Science.gov (United States)

Li, Youzhong; Wu, Weijing; Xiao, Zian; Peng, Anquan

2011-03-01

Orbital apex syndrome (OAS) is a complex disease caused by a variety of pathological factors, and trauma is one of the main factors/causes. Clinical data of 17 cases of traumatic OAS treated by nasal endoscopic surgery in our department from January 2002 to April 2009 were gathered and reviewed. Among them, the six patients presented with OAS after injury to the lateral wall of orbital apex. Seven other patients exhibited OAS after injury to the medial wall of orbital apex, two displayed OAS after zygomatic trauma, while OAS manifested in the other two patients with craniocerebral trauma 3 days after they had decompressive craniotomy--of them, one was blind in both eyes. In the 17 cases, 6 patients were without light sensation, 1 was blind in both eyes; the sight-chart index of eight patients was 0.1, that of three other patients was 0.1-0.2. Fifteen patients displayed eyeball movement disturbance (disorder) and cornea sensory disturbance (disorder), two were with the eyeball abducent disturbance. After the nasal endoscopic surgeries for OAS performed on the 17, the sight of the most patients was restored in varying degrees. The sight of nine patients was between 0.2 and 0.3, that of two patients was between 0.1 and 0.2, that of the other two patients was 0.1, and that of four patients remained unchanged. The eyeball movement and the cornea esthesia in 15 patients recovered from the surgeries, one patient recovered with good eyeball adducent movement and the cornea esthesia but with eyeball abducent disturbance, the other patient did not make a recovery from the eyeball immobility, cornea anesthesia and ptosis. A follow-up lasting 2 months to 2 years suggested that the 16 patients had stable recovery from the surgeries. Satisfactory results could be achieved in the treatment of traumatic OAS by nasal endoscopic surgery. From objective assessment of the therapeutic effects of traumatic OAS, it can be concluded that if a patient is diagnosed with fractures of the

The application of percutaneous endoscopic colostomy to the management of obstructed defecation.

Science.gov (United States)

Heriot, A G; Tilney, H S; Simson, J N L

2002-05-01

We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.

ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

Directory of Open Access Journals (Sweden)

Daniela Benedeto-Stojanov

2015-06-01

Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

Endoscopic treatment of grades IV and V vesicoureteral reflux with two bulking substances: Dextranomer hyaluronic acid copolymer versus polyacrylate polyalcohol copolymer in children.

Science.gov (United States)

Kocaoglu, Canan

2016-10-01

We aimed at evaluating the efficacy and complications of two bulking substances: dextranomer/hyaluronic acid copolymer(Dx/Ha;Dexell®) versus polyacrylate polyalcohol copolymer(PPC;Vantris®) in subureteric injection treatment of children with high grades (grades IV-V) vesicoureteral reflux(VUR). Data of patients undergoing endoscopic treatment of high grade VUR (January 2009-August 2015) were retrospectively investigated. Patients with high grade VUR caused by posterior urethral valve, duplex system, paraureteral diverticula and neurogenic bladder were excluded. Classical subureteric injection method (STING) was used. Seventy-three children (45 girls and 28 boys) who had 88 refluxing renal units (RRUs) with grades IV-V VUR (n=64/n=24) underwent endoscopic treatment using Dx/Ha (n=63 RRUs) and PPC (n=25 RRUs). Mean age of patients in Dx/Ha and PPC groups were 6 (3) and 6 (3.75) year (p=0.81), and volumes of these substances given were 1.3 (1) and 1 (0.5) mL (p=0.003), respectively. Overall, for the first endoscopic injection, success rate of grades IV-V VUR per RRU was 53.9% with Dx/Ha, compared to 80% in PPC-injected group, (p=0.024). Late ureterovesical junction obstruction developed only in one patient in PPC-injected group. No ureteral obstruction was observed in Dx/Ha-injected group. Endoscopic injection of PPC resulted in significantly higher success rate, compared to Dx/Ha in subureteric injection treatment of children with high grade VUR. However, the development of late ureterovesical junction obstruction should also be taken into account in PPC injection. Copyright © 2016 Elsevier Inc. All rights reserved.

Laser removal of water repellent treatments on limestone

Energy Technology Data Exchange (ETDEWEB)

Gomez-Heras, Miguel; Alvarez de Buergo, Monica; Rebollar, Esther; Oujja, Mohamed; Castillejo, Marta; Fort, Rafael

2003-12-15

Protective and water repellent treatments are applied on stone materials used on buildings or sculptures of artistic value to reduce water intrusion without limiting the natural permeability to water vapour of the material. The effect of the wavelength associated with the laser removal of two water repellent treatments applied on limestone, Paraloid B-72, a copolymer of methyl acrylate and ethyl methacrylate, and Tegosivin HL-100, a modified polysiloxane resin, was investigated by using the four harmonics of a Q-switched Nd:YAG laser (1064, 532, 355 and 266 nm). The modifications induced on the surface of limestone samples by laser irradiation were studied using colorimetry, roughness measurements and scanning electron microscopy (SEM). The removal of the treatments was found to be dependent on the laser irradiation conditions and on the characteristics of the coatings. The fundamental laser radiation was effective in removing both treatments, but thermal alteration processes were induced on the constituent calcite crystals. The best results were obtained by irradiation in the near UV at 355 nm.

Laser treatment of plasma sprayed HA coatings

NARCIS (Netherlands)

Khor, KA; Vreeling, A; Dong, ZL; Cheang, P

1999-01-01

Laser treatment was conducted on plasma sprayed hydroxyapatite (HA) coatings using a Nd-YAG pulse laser. Various laser parameters were investigated. The results showed that the HA surface melted when an energy level of greater than or equal to 2 J and a spot size of 2 mm was employed during

Usefulness of combined percutaneous-endoscopic rendezvous techniques after failed therapeutic endoscopic retrograde cholangiography in the era of endoscopic ultrasound guided rendezvous.

Science.gov (United States)

Yang, Min Jae; Kim, Jin Hong; Hwang, Jae Chul; Yoo, Byung Moo; Kim, Soon Sun; Lim, Sun Gyo; Won, Je Hwan

2017-12-01

The rendezvous approach is a salvage technique after failure of endoscopic retrograde cholangiography (ERC). In certain circumstances, percutaneous-endoscopic rendezvous (PE-RV) is preferred, and endoscopic ultrasound-guided rendezvous (EUS-RV) is difficult to perform. We aimed to evaluate PE-RV outcomes, describe the PE-RV techniques, and identify potential indications for PE-RV over EUS-RV.Retrospective analysis was conducted of a prospectively designed ERC database between January 2005 and December 2016 at a tertiary referral center including cases where PE-RV was used as a salvage procedure after ERC failure.During the study period, PE-RV was performed in 42 cases after failed therapeutic ERC; 15 had a surgically altered enteric anatomy. The technical success rate of PE-RV was 92.9% (39/42), with a therapeutic success rate of 88.1% (37/42). Potential indications for PE-RV over EUS-RV were identified in 23 cases, and either PE-RV or EUS-RV could have effectively been used in 19 cases. Endoscopic bile duct access was successfully achieved with PE-RV in 39 cases with accessible biliary orifice using one of PE-RV cannulation techniques (classic, n = 11; parallel, n = 19; and adjunctive maneuvers, n = 9).PE-RV uses a unique technology and has clinical indications that distinguish it from EUS-RV. Therefore, PE-RV can still be considered a useful salvage technique for the treatment of biliary obstruction after ERC failure.

Laser Doppler flowmetry evaluation of gingival recovery response after laser treatment

Science.gov (United States)

Todea, Carmen; Cânjǎu, Silvana; Dodenciu, Dorin; Miron, Mariana I.; Tudor, Anca; Bǎlǎbuc, Cosmin

2013-06-01

This study was performed in order to evaluate in vivo the applicability of Laser Doppler Flowmetry (LDF) in recording the gingival blood flow and to assess the changes of gingival blood flow following gingival reshaping performed with Er:YAG and 980 nm diode lasers. The LDF evaluation was performed on 20 anterior teeth, which underwent reshaping of gingiva, corresponding to 5 female patients (4 anterior teeth/patient), aged between 20 and 35. One part of the mouth was treated with Er:YAG laser (LP, VLP modes, 140 - 250 mJ, 10 - 20 Hz, using cylindrical sapphire tips) and other part with 980 nm diode laser (CW, 4 W, contact mode and saline solution cooling). The gingival blood flow was monitored using a MoorLab laser Doppler equipment (Moor Instruments Ltd., Axminster, UK) with a straight optical probe, MP3b, 10 mm. The data were processed using statistical analysis software SPSS v16.0.1. The investigation showed an evident decrease in perfusion for both areas in comparison with the baseline values 24 hours after treatment. The microvascular blood flow increased significantly after 7 days in both areas but mostly in diode area (pdiode area remained at a high level after 14 days. Both lasers proved efficiency in the surgical treatment of gingival tissue. Moreover, Laser Doppler Flowmetry is adequate for recording changes in gingival blood flow following periodontal surgery.

Endoscopic therapy in early adenocarcinomas (Barrett's cancer) of the esophagus.

Science.gov (United States)

Knabe, Mate; May, Andrea; Ell, Christian

2015-07-01

The incidence of early esophageal adenocarcinoma has been increasing significantly in recent decades. Prognosis depends greatly on the choice of treatment. Early cancers can be treated by endoscopic resection, whereas advanced carcinomas have to be sent for surgery. Esophageal resection is associated with high perioperative mortality (1-5%) even in specialized centers. Early diagnosis enables curative endoscopic treatment option. Patients with gastrointestinal symptoms and a familial risk for esophageal cancer should undergo upper gastrointestinal endoscopy. High-definition endoscopes have been developed with technical add-on that helps endoscopists to find fine irregularities in the esophageal mucosa, but interpreting the findings remains challenging. In this review we discussed novel and old diagnostic procedures and their values, as well as our own recommendations and those of the authors discussed for the diagnosis and treatment of early Barrett's carcinoma. Endoscopic resection is the therapy of choice in early esophageal adenocarcinoma. It is mandatory to perform a subsequent ablation of all residual Barrett's mucosa to avoid metachronous lesions. © 2015 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Efficacy of long pulse Nd:YAG laser versus fractional Er:YAG laser in the treatment of hand wrinkles.

Science.gov (United States)

Robati, Reza M; Asadi, Elmira; Shafiee, Anoosh; Namazi, Nastaran; Talebi, Atefeh

2018-04-01

There are different modalities for hand rejuvenation. Fractional Er:YAG laser and long pulse Nd:YAG laser were introduced for treating hand wrinkles. We plan to compare fractional Er:YAG laser and long pulse Nd:YAG laser in a randomized controlled double-blind design with multiple sessions and larger sample size in comparison with previous studies. Thirty-three participants with hand wrinkles entered this study. They were randomly allocated to undergo three monthly laser treatments on each hand, one with a fractional Er:YAG laser and the other with a long pulse Nd:YAG laser. The evaluations included assessment of clinical improvement determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of hands using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, potential side effects and patients' satisfaction have been documented at baseline, 1 month after each treatment, and 3 months after the final treatment session. Clinical evaluation revealed both modalities significantly reduce hand wrinkles (p value lasers. Mean CRRT values also decreased significantly after the laser treatment compared to those of the baseline in both laser groups. There was no serious persistent side effect after both laser treatments. Both fractional Er:YAG and long pulse Nd:YAG lasers show substantial clinical improvement of hand skin wrinkles with no serious side effects. However, combination treatment by these lasers along with the other modalities such as fat transfer could lead to better outcomes in hand rejuvenation. IRCT2016032020468N4.

Controversy about Management of Hydrocephalus - Shunt vs. Endoscopic Third Ventriculostomy.

Science.gov (United States)

Kumar, Vikas; Bodeliwala, Shaam; Singh, Daljit

2017-08-01

The best management of hydrocephalus is still controversial in the twenty-first century. Shunt treatment for hydrocephalus is the most common procedure performed in neurosurgical practice and is associated with the highest complications rate. But during the last 2 decades, the treatment of hydrocephalus has improved with better shunt devices available today, increased facilities for investigations and newer approaches like endoscopic third ventriculostomy. The recent advances in development of better endoscopes have provided the patient and treating doctor with an option for an alternative surgery for treatment of hydrocephalus.

Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis.

Science.gov (United States)

Akarsu, Cevher; Unsal, Mustafa Gokhan; Dural, Ahmet Cem; Kones, Osman; Kocatas, Ali; Karabulut, Mehmet; Kankaya, Burak; Ates, Mustafa; Alis, Halil

2015-04-01

Endoscopic balloon dilatation (EBD) is currently accepted as an effective, safe, and first-line treatment of postoperative benign gastrointestinal anastomosis stenosis (BGAS); however, a limited number of publications on the subject exist in the literature. The aim of the study was to retrospectively evaluate the efficiency of endoscopic dilatation in patients with postoperative intestinal anastomotic stenoses at a single surgical center. Patients with postoperative BGAS treated by EBD at our institution from February 2008 to 2012 were included. The dilatations were all performed using through-the-scope balloons. The balloon was introduced into the stricture using a guidewire under radiologic guidance. Each dilatation session consisted of 2 to 3 two-minute multistep inflations of the balloon until adequate dilatation was achieved. Of the 48 patients included in the study, 44 patients (91.7%) fully recovered and 4 (8.3%) did not respond to treatment. The mean follow-up period was 24 months (range, 3 to 57 mo). Four patients who did not respond to the procedure were treated surgically. Two patients (4.1%) with intestinal perforation during EBD were treated conservatively with a stent. EBD has a low rate of complications and a high success rate, is well tolerated, and avoids further surgical procedures for BGAS. Therefore, EBD should be the first choice of treatment for postoperative anastomotic stenoses.

Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: where do we stand with current literature?

Science.gov (United States)

Naspro, Richard; Lerner, Lori B; Rossini, Roberta; Manica, Michele; Woo, Henry H; Calopedos, Ross J; Cracco, Cecilia M; Scoffone, Cesare M; Herrmann, Thomas R; de la Rosette, Jean J; Cornu, Jean-Nicolas; DA Pozzo, Luigi F

2018-04-01

The number of patients on chronic anticoagulant or antiplatelet therapy requiring endoscopic urological surgery is increasing worldwide. Therefore, there is a strong demand to standardize the perioperative treatment of this cohort of patients, both from a surgical and cardiological point of view, balancing the risks of bleeding versus thrombosis, and the important possible clinical and medical legal repercussions therein. Although literature is scarce and the quality of evidence quite low, in line with other surgical specialties, guidelines and recommendations for the management of urological patients have begun to emerge. The aim of this review is to analyze current available literature and evidence on the most common endoscopic procedures performed in this high-risk group of patients, focusing on the perioperative management. In particular, to analyze the most frequently performed endoscopic procedures for the treatment of benign prostate enlargement (transurethral resection of the prostate, Thulium, Holmium and greenlight laser prostatectomy), bladder cancer (transurethral resection of the bladder), upper urinary tract urothelial cancer, and nephrolithiasis. Despite the lack of randomized studies, regardless of individual patient considerations, studies would support continuation of acetylsalicylic acid, which is recommended by cardiologists, in patients with intermediate/high risk of coronary thrombosis. In contrast, multiple studies found that bridging with light weight molecular weight heparin can potentially lead to more bleeding than continuation of the anticoagulant(s) and antiplatelet therapy, and caution with bridging is advised. All urologists should familiarize themselves with emerging guidelines and recommendations, and always be prepared to discuss specific cases or scenarios in a dedicated multidisciplinary team.

High power visible diode laser for the treatment of eye diseases by laser coagulation

Science.gov (United States)

Heinrich, Arne; Hagen, Clemens; Harlander, Maximilian; Nussbaumer, Bernhard

2015-03-01

We present a high power visible diode laser enabling a low-cost treatment of eye diseases by laser coagulation, including the two leading causes of blindness worldwide (diabetic retinopathy, age-related macular degeneration) as well as retinopathy of prematurely born children, intraocular tumors and retinal detachment. Laser coagulation requires the exposure of the eye to visible laser light and relies on the high absorption of the retina. The need for treatment is constantly increasing, due to the demographic trend, the increasing average life expectancy and medical care demand in developing countries. The World Health Organization reacts to this demand with global programs like the VISION 2020 "The right to sight" and the following Universal Eye Health within their Global Action Plan (2014-2019). One major point is to motivate companies and research institutes to make eye treatment cheaper and easily accessible. Therefore it becomes capital providing the ophthalmology market with cost competitive, simple and reliable technologies. Our laser is based on the direct second harmonic generation of the light emitted from a tapered laser diode and has already shown reliable optical performance. All components are produced in wafer scale processes and the resulting strong economy of scale results in a price competitive laser. In a broader perspective the technology behind our laser has a huge potential in non-medical applications like welding, cutting, marking and finally laser-illuminated projection.

Laser: A powerful tool for treatment of pyogenic granuloma

Directory of Open Access Journals (Sweden)

Shalu Rai

2011-01-01

Full Text Available Lasers have opened a new door for the treatment of various disorders. Treatment of soft tissue intraoral mucosal growth by laser has profound effect on the patient acceptability taking the functional and aesthetic factor into consideration. The patient is able to get the outdoor treatment without the phobia of local anaesthetic and is out of the clinic in few minutes in contrast to the traditional method of surgical excision. Very few cases have been reported in literature regarding treatment of mucosal growth by soft tissue lasers. We present a case of recurrent pyogenic granuloma in a patient treated with an alternative approach, that is, diode laser, without the use of anaesthesia, sutures, anti-inflammatory drugs, or analgesics. The diagnosis of this lesion is equally important for correct treatment planning.

Laparoscopy-assisted micropercutaneous choledocholithotripsy with holmium laser in a cholecystectomized patient: an initial report.

Science.gov (United States)

Gökçen, Kaan; Atabey, Mustafa; Gökçen, Pınar; Gökçe, Gökhan

2017-12-01

We present a novel minimally invasive technique, laparoscopy-assisted micropercutaneous choledocholithotripsy, for choledocholithiasis that cannot be treated with other endoscopic techniques. This technique includes standard laparoscopic exploration of the common bile duct, combined with an all-seeing needle and holmium laser lithotripsy. As is known, an all-seeing needle is used in micropercutaneous nephrolithotomy for middle-sized renal stones. In this technique, an all-seeing needle was inserted into the dilatated common bile duct under laparoscopic vision and then a lithotripsy procedure was performed with a holmium laser behind the biliary stent. A cholecystectomized female patient with a 21-mm stone in the common bile duct who previously underwent an unsuccessful endoscopic retrograde cholangiopancreatography procedure was operated on in our service with laparoscopy-assisted micropercutaneous choledocholithotomy without a T-tube. This novel procedure was completed uneventfully and the patient was discharged without any complications. In the future, this procedure will hopefully be a treatment modality in choledocholithiasis that cannot be treated by other minimally invasive techniques.

Endoscopic Injection of Dextranomer/Hyaluronic Acid as First-Line Treatment in 851 Consecutive Children with High-Grade Vesicoureteral Reflux: Efficacy and Long-Term Results.

Science.gov (United States)

Friedmacher, Florian; Colhoun, Eric; Puri, Prem

2018-03-15

Endoscopic injection of dextranomer/hyaluronic is widely acknowledged as first-line treatment of lower grade vesicoureteral reflux. Our objective was to demonstrate its long-term efficacy and safety in eradicating high-grade reflux. Eight-hundred-fifty-one children (518 girls, 333 boys), median age 2.3 years (2 months-13.7 years), underwent endoscopic correction of high-grade vesicoureteral reflux using dextranomer/hyaluronic acid. Reflux was unilateral in 415 cases and bilateral in 436, comprising 1,287 refluxing units: grade IV in 1,153 (89.6%) and grade V in 134 (10.4%). 99m technetium-dimercaptosuccinic acid imaging identified renal scarring in 317 (37.3%) patients. Follow-up ultrasound and voiding cystourethrogram were performed 3 months post intervention and renal ultrasound annually thereafter. Median follow-up was 8.5 years (6 months-16 years). Overall resolution rate after the first endoscopic injection was 895/1,287 (69.5%): 70.4% in grade IV and 61.9% in grade V, respectively. Reflux resolved after a second injection in 259 (20.1%) and after a third in 133 (10.4%). Persistent reflux after initial treatment was significantly more common in infants reflux resolution, 43 (5.1%) children developed febrile urinary tract infections: 24 (55.8%) in the first, 15 (34.9%) in the second and 4 (9.3%) after ≥3 years. Of these, 6 had reflux recurrence and 8 demonstrated neocontralateral grade III reflux, which was successfully treated with single endoscopic injection of dextranomer/hyaluronic acid. Endoscopic injection of dextranomer/hyaluronic acid is an efficient and safe long-term treatment for grade IV and V vesicoureteral reflux, which can be easily repeated in cases of failure with a high subsequent resolution rate. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Devices and Endoscopic Bariatric Therapies for Obesity.

Science.gov (United States)

Saunders, Katherine H; Igel, Leon I; Saumoy, Monica; Sharaiha, Reem Z; Aronne, Louis J

2018-04-17

In this review, we describe the FDA-approved and investigational devices and endoscopic bariatric therapies for the treatment of obesity. We focus on literature published in the past few years and present mechanisms of action as well as efficacy and safety data. Devices and endoscopic procedures are emerging options to fill the significant treatment gap in the management of obesity. Not only are these devices and procedures minimally invasive and reversible, but they are potentially more effective than antiobesity medications, often safer for poor surgical candidates and possibly less expensive than bariatric surgery. As many patients require a variety of management strategies (medications, devices, procedures, and/or surgery) in addition to lifestyle modifications to achieve clinically significant weight loss, the future of obesity treatment involves a multidisciplinary approach. Combinations of advanced treatment strategies can lead to additive or synergistic weight loss. This is an area that requires further investigation.

Therapeutic aspects of endoscopic ultrasound

Science.gov (United States)

Woodward, Timothy A.

1999-06-01

Endoscopic ultrasound (EUS) is a technology that had been used primarily as a passive imaging modality. Recent advances have enabled us to move beyond the use of EUS solely as a staging tool to an interventional device. Current studies suggest that interventional applications of EUS will allow for minimally invasive assessment and therapies in a cost-effective manner. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has been demonstrated to be a technically feasible, relatively safe method of obtaining cytologic specimens. The clinical utility of EUS- FNA appears to be greatest in the diagnosis and staging of pancreatic cancer and in the nodal staging of gastrointestinal and pulmonary malignancies. In addition, EUS-FNA has demonstrated utility in the sampling pleural and ascitic fluid not generally appreciated or assessable to standard interventions. Interventional applications of EUS include EUS-guided pseudocyst drainage, EUS-guided injection of botulinum toxin in the treatment of achalasia, and EUS- guided celiac plexus neurolysis in the treatment of pancreatic cancer pain. Finally, EUS-guided fine-needle installation is being evaluated, in conjunction with recent bimolecular treatment modalities, as a delivery system in the treatment of certain gastrointestinal tumors.

Palliative treatment of patients with malignant structures of esophagus

Science.gov (United States)

Zavodnov, Victor Y.; Kuzin, M. I.; Kharnas, Sergey S.; Linkov, Kirill G.; Loschenov, Victor B.; Stratonnikov, Alexander A.; Posypanova, Anna M.

1996-01-01

Photodynamic therapy with the use of laser endoscopic spectrum analyzer (LESA-5), spectral- analyzing video-imaging system, Kr laser and various types of catheters for different localizations and different geometry of tumor, and phthalocyanine aluminum photosensitizers in patients with malignant strictures of esophagus is discussed. Photodynamic therapy was carried out to four patients: with esophageal cancer (3 patients) and gastric cancer with infiltration of lower esophagus (1 patient). All patients suffered from severe dysphagia. Photosensitizer was used in a dose 1-1.5 mg/kg of weight. Usually we used 3-4 seances of laser treatment 10-30 minutes long. The accumulation of photosensitizer was controlled by LESA-5. Laser induced fluorescent image was monitored by the video-imaging system in order to control laser treatment. There were no side-effects. The results show high efficiency of photodynamic therapy. There was marked reduction of dysphagia symptoms in all cases. It seems that photodynamic therapy is a good alternative to palliative surgical treatment of patients with malignant strictures of esophagus.

Optimal management of Barrett's esophagus: pharmacologic, endoscopic, and surgical interventions

Directory of Open Access Journals (Sweden)

Konda VJA

2011-11-01

Full Text Available Vani JA Konda1, Kunal Dalal21Section of Gastroenterology, Department of Medicine, 2Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USAAbstract: Esophageal adenocarcinoma and its precursor, Barrett's esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett's esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett's segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett's esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett's epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett's esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett's esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.Keywords: Barrett's esophagus, high

Laser treatment of Port-wine stains

OpenAIRE

Boffa, Michael J.

2001-01-01

A state-of-the-art pulsed dye laser machine to treat port-wine stains and other vascular lesions has been available in the Malta Health Service since 1999. This article reviews the pathophysiology and clinical features of port- wine stains and describes the principles of laser treatment for this condition.

Laser treatment of medical skin disease in women

OpenAIRE

C. LaRosa, MD; A. Chiaravalloti, MD; S. Jinna, MD; W. Berger, BS; J. Finch, MD

2017-01-01

Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the...

Endoscopic Treatment of Biliary Stenosis in Patients with Alveolar Echinococcosis--Report of 7 Consecutive Patients with Serial ERC Approach.

Directory of Open Access Journals (Sweden)

Marija Stojkovic

2016-02-01

Full Text Available Biliary vessel pathology due to alveolar echicococcosis (AE results in variable combinations of stenosis, necrosis and inflammation. Modern management strategies for patients with cholestasis are desperately needed. The aim is proof of principle of serial ERC (endoscopic retrograde cholangiography balloon dilation for AE biliary pathology.Retrospective case series of seven consecutive patients with AE-associated biliary pathology and ERC treatment in an interdisciplinary endoscopy unit at a University Hospital which hosts a national echinococcosis treatment center. The AE patient cohort consists of 106 patients with AE of the liver of which 13 presented with cholestasis. 6/13 received bilio-digestive anastomosis and 7/13 patients were treated by ERC and are reported here. Biliary stricture balloon dilation was performed with 18-Fr balloons at the initial and with 24-Fr balloons at subsequent interventions. If indicated 10 Fr plastic stents were placed.Six patients were treated by repeated balloon dilation and stenting, one by stenting only. After an acute phase of 6 months with repeated balloon dilation, three patients showed "sustained clinical success" and four patients "assisted therapeutic success," of which one has not yet reached the six month endpoint. In one patient, sustained success could not be achieved despite repeated insertion of plastic stents and balloon dilation, but with temporary insertion of a fully covered self-expanding metal stent (FCSEMS. There was no loss to follow up. No major complications were observed.Serial endoscopic dilation is a standard tool in the treatment of benign biliary strictures. Serial endoscopic intervention with balloon dilation combined with benzimidazole treatment can re-establish and maintain biliary duct patency in AE associated pathology and probably contributes to avoid or postpone bilio-digestive anastomosis. This approach is in accordance with current ERC guidelines and is minimally disruptive

Endoscopic Treatment of Biliary Stenosis in Patients with Alveolar Echinococcosis--Report of 7 Consecutive Patients with Serial ERC Approach.

Science.gov (United States)

Stojkovic, Marija; Junghanss, Thomas; Veeser, Mira; Weber, Tim F; Sauer, Peter

2016-02-01

Biliary vessel pathology due to alveolar echicococcosis (AE) results in variable combinations of stenosis, necrosis and inflammation. Modern management strategies for patients with cholestasis are desperately needed. The aim is proof of principle of serial ERC (endoscopic retrograde cholangiography) balloon dilation for AE biliary pathology. Retrospective case series of seven consecutive patients with AE-associated biliary pathology and ERC treatment in an interdisciplinary endoscopy unit at a University Hospital which hosts a national echinococcosis treatment center. The AE patient cohort consists of 106 patients with AE of the liver of which 13 presented with cholestasis. 6/13 received bilio-digestive anastomosis and 7/13 patients were treated by ERC and are reported here. Biliary stricture balloon dilation was performed with 18-Fr balloons at the initial and with 24-Fr balloons at subsequent interventions. If indicated 10 Fr plastic stents were placed. Six patients were treated by repeated balloon dilation and stenting, one by stenting only. After an acute phase of 6 months with repeated balloon dilation, three patients showed "sustained clinical success" and four patients "assisted therapeutic success," of which one has not yet reached the six month endpoint. In one patient, sustained success could not be achieved despite repeated insertion of plastic stents and balloon dilation, but with temporary insertion of a fully covered self-expanding metal stent (FCSEMS). There was no loss to follow up. No major complications were observed. Serial endoscopic dilation is a standard tool in the treatment of benign biliary strictures. Serial endoscopic intervention with balloon dilation combined with benzimidazole treatment can re-establish and maintain biliary duct patency in AE associated pathology and probably contributes to avoid or postpone bilio-digestive anastomosis. This approach is in accordance with current ERC guidelines and is minimally disruptive for patients.

Endoscopic stent suture fixation for prevention of esophageal stent migration during prolonged dilatation for achalasia treatment.

Science.gov (United States)

Rieder, E; Asari, R; Paireder, M; Lenglinger, J; Schoppmann, S F

2017-04-01

The aim of this study is to compare endoscopic stent suture fixation with endoscopic clip attachment or the use of partially covered stents (PCS) regarding their capability to prevent stent migration during prolonged dilatation in achalasia. Large-diameter self-expanding metal stents (30 mm × 80 mm) were placed across the gastroesophageal junction in 11 patients with achalasia. Stent removal was scheduled after 4 to 7 days. To prevent stent dislocation, endoscopic clip attachment, endoscopic stent suture fixation, or PCS were used. The Eckardt score was evaluated before and 6 months after prolonged dilatation. After endoscopic stent suture fixation, no (0/4) sutured stent migrated. When endoscopic clips were used, 80% (4/5) clipped stents migrated (p = 0.02). Of two PCS (n = 2), one migrated and one became embedded leading to difficult stent removal. Technical adverse events were not seen in endoscopic stent suture fixation but were significantly correlated with the use of clips or PCS (r = 0.828, p = 0.02). Overall, 72% of patients were in remission regarding their achalasia symptoms 6 months after prolonged dilatation. Endoscopic suture fixation of esophageal stents but not clip attachment appears to be the best method of preventing early migration of esophageal stents placed at difficult locations such as at the naive gastroesophageal junction. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Medium-level laser in chronic tinnitus treatment.

Science.gov (United States)

Dejakum, K; Piegger, J; Plewka, C; Gunkel, A; Thumfart, W; Kudaibergenova, S; Goebel, G; Kral, F; Freysinger, W

2013-01-01

The purpose of this study was to evaluate the effect of medium-level laser therapy in chronic tinnitus treatment. In a prospective double-blind placebo-controlled trial, either active laser (450 mW, 830 nm combined Ga-Al-As diode laser) or placebo irradiation was applied through the external acoustic meatus of the affected ear towards the cochlea. Fourty-eight patients with chronic tinnitus were studied. The main outcome was measured using the Goebel tinnitus questionnaire, visual analogue scales measuring the perceived loudness of tinnitus, the annoyance associated with tinnitus, and the degree of attention paid to tinnitus as well as psycho-acoustical matches of tinnitus pitch and loudness. The results did show only very moderate temporary improvement of tinnitus. Moreover, no statistically relevant differences between laser and placebo group could be found. We conclude that medium-level laser therapy cannot be regarded as an effective treatment of chronic tinnitus in our therapy regime considering the limited number of patients included in our study.

The Efficacy of Endoscopic Palliation of Obstructive Jaundice in Hepatocellular Carcinoma

Science.gov (United States)

Park, Semi; Park, Jeong Youp; Chung, Moon Jae; Chung, Jae Bock; Park, Seung Woo; Han, Kwang-Hyub; Song, Si Young

2014-01-01

Purpose Obstructive jaundice in patients with hepatocellular carcinoma (HCC) is uncommon (0.5-13%). Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined. The aim of this study was to evaluate the clinical characteristics of obstructive jaundice caused by HCC and predictive factors for successful endoscopic intervention. Materials and Methods From 1999 to 2009, 54 patients with HCC who underwent endoscopic intervention to relieve obstructive jaundice were included. We defined endoscopic intervention as a clinical success when the obstructive jaundice was relieved within 4 weeks. Results Clinical success was achieved in 23 patients (42.6%). Patients in the clinical success group showed better Child-Pugh liver function (C-P grade A or B/C; 17/6 vs. 8/20), lower total bilirubin levels (8.1±5.3 mg/dL vs. 23.1±10.4 mg/dL) prior to the treatment, and no history of alcohol consumption. The only factor predictive of clinical success by multivariate analysis was low total bilirubin level at the time of endoscopic intervention, regardless of history of alcohol consumption [odds ratio 1.223 (95% confidence interval, 1.071-1.396), p=0.003]. The cut-off value of pre-endoscopic treatment total bilirubin level was 12.8 mg/dL for predicting the clinical prognosis. Median survival after endoscopic intervention in the clinical success group was notably longer than that in the clinical failure group (5.6 months vs. 1.5 months, p≤0.001). Conclusion Before endoscopic intervention, liver function, especially total bilirubin level, should be checked to achieve the best clinical outcome. Endoscopic intervention can be helpful to relieve jaundice in well selected patients with HCC. PMID:25048484

Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography

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Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Arena, Monica; Iabichino, Giuseppe; Consolo, Pierluigi; Opocher, Enrico; Luigiano, Carmelo

2016-01-01

Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents. PMID:26862364

Low-power holmium:YAG laser urethrotomy for treatment of urethral strictures: functional outcome and quality of life.

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Kamp, Stefan; Knoll, Thomas; Osman, Mahmoud M; Köhrmann, Kai Uwe; Michel, Maurice S; Alken, Peter

2006-01-01

To evaluate the efficacy of endourethrotomy with the holmium:YAG laser as a minimally invasive treatment for urethral stricture. Between January 2002 and January 2004, 32 male patients with symptomatic urethral strictures (8 bulbar, 9 penile, 9 combined) were treated with Ho:YAG-laser urethrotomy in our department. The stricture was iatrogenic in 60% (N = 18), inflammatory in 16.6% (N = 5), traumatic in 13.3% (N = 4), and idiopathic in 7% (N = 3). The stricture was incised under vision at the 12 o'clock location or the site of maximum scar tissue or narrowing in asymmetric strictures. Laser energy was set on 1200 to 1400 mJ with a frequency of 10 to 13 Hz. Postoperatively, drainage of the bladder was performed for 4 days using a 18F silicone catheter. Triamcinolone was instilled intraurethrally after removal of the catheter in all patients. Patients were followed up by mailed questionnaire, including International Prostate Symptom Score and quality of life. Retrograde endoscopic Ho:YAG laser urethrotomy could be performed in all 32 patients. Most patients (22; 68.7%) did not need any reintervention. Ten patients developed recurrent strictures that were treated by another laser urethrotomy in 4 patients (12.5%), while 6 patients (18.7%) needed open urethroplasty with buccal mucosa. Including 2 patients treated with repeat laser urethrotomy, 24 patients (75%) were considered successful after a mean follow-up of 27 months (range 13-38 months). No intraoperative complications were encountered, although in 5% of patients, a urinary-tract infection was diagnosed postoperatively. No gross hematuria occurred. The Ho:YAG laser urethrotomy is a safe and effective minimally invasive therapeutic modality for urethral stricture with results comparable to those of conventional urethrotomy. Further data from long-time follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty. Nevertheless, the Ho:YAG laser urethrotomy might at

Minimally invasive endoscopic treatment of necrotizing pancreatitis: A case report with images and review of the literature

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Cassia Lemos Moura

Full Text Available Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.

Emerging indications of endoscopic radiofrequency ablation

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Becq, Aymeric; Camus, Marine; Rahmi, Gabriel; de Parades, Vincent; Marteau, Philippe

2015-01-01

Introduction Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. Results Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency. In the setting of chronic hemorrhagic radiation proctopathy, a prospective monocenter study and a retrospective multicenter study (total 56 patients) suggest that RFA is an efficient treatment. A retrospective comparative study (64 patients) suggests that RFA improves stents patency in malignant biliary strictures. Conclusions Endoscopic RFA is an upcoming treatment modality in early esophageal squamous intra-epithelial neoplasia, as well as in gastric, rectal, and biliary diseases. PMID:26279839

Two randomized controlled studies comparing the nutritional benefits of branched-chain amino acid (BCAA) granules and a BCAA-enriched nutrient mixture for patients with esophageal varices after endoscopic treatment

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Sakai, Yoshiyuki; Iwata, Yoshinori; Enomoto, Hirayuki; Saito, Masaki; Yoh, Kazunori; Ishii, Akio; Takashima, Tomoyuki; Aizawa, Nobuhiro; Ikeda, Naoto; Tanaka, Hironori; Iijima, Hiroko; Nishiguchi, Shuhei

2014-01-01

Background The usefulness of branched-chain amino acid (BCAA) granules and BCAA-enriched nutrient mixtures for patients with liver cirrhosis is often reported. However, no randomized controlled studies have investigated the usefulness of these supplements in the nutritional intervention of cirrhotic patients receiving endoscopic treatment for esophageal varices. Methods Patients without BCAA before endoscopic treatment were divided into study 1, and those who received BCAA were divided into s...

Endoscopic-assisted osteotomies for the treatment of craniosynostosis.

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Hinojosa, J; Esparza, J; Muñoz, M J

2007-12-01

The development of multidisciplinar units for Craniofacial Surgery has led to better postoperative results and a considerable decrease in morbidity in the treatment of complex craniofacial patients. Standard correction of craniosynostosis involves calvarial remodeling, often considerable blood losses that need to be replaced and lengthy hospital stay. The use of minimally invasive techniques for the correction of some of these malformations are widespread and allows the surgeon to minimize the incidence of complications by means of a decreased surgical time, blood salvage, and shortening of postoperative hospitalization in comparison to conventional craniofacial techniques. Simple and milder craniosynostosis are best approached by endoscopy-assisted osteotomies and render the best results. Extended procedures other than simple suturectomies have been described for more severe patients. Different osteotomies resembling standard fronto-orbital have been developed for the correction, and the use of postoperative cranial orthesis may improve the final cosmetic appearance. Thus, endoscopic-assisted procedures differ from the simple strategy of single suture resection that rendered insufficient results in the past, and different approaches can be tailored to solve these cases in patients in the setting of a case-to-case bases.

Fractionated laser skin resurfacing treatment complications: a review.

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Metelitsa, Andrei I; Alster, Tina S

2010-03-01

Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. A literature review was based on a MEDLINE search (1998-2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters.

FUNCTIONAL RESULTS OF ENDOSCOPIC EXTRAPERITONEAL RADICAL INTRAFASCIAL PROSTATECTOMY

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D. V. Perlin

2014-01-01

Full Text Available Introduction. Endoscopic radical prostatectomy is a highly effective treatment for localized prostate cancer. Intrafascial prostate dissection ensures early recovery of urine continence function and erectile function. This article sums up our own experience of performing intrafascial endoscopic prostatectomy.Materials and methods. 25 patients have undergone this procedure. 12 months after surgery 88.2 % of the patients were fully continent, 11.7 % had symptoms of minimal stress urinary incontinence. We encountered no cases of positive surgical margins and one case of bio-chemical recurrence of the disease.Conclusion. Oncologically, intrafascial endoscopic radical prostatectomy is as effective as other modifications of radical prostatectomy and has the benefits of early recovery of urine continence function and erectile function. 

Holmium:YAG Laser Ablation for the Management of Lower Urinary Tract Foreign Bodies Following Incontinence Surgery: A Case Series and Systematic Review.

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Chan, Garson; Mamut, Adiel; Martin, Paul; Welk, Blayne

2016-11-01

The objective of this study was to determine the outcomes associated with the endoscopic removal of foreign bodies (such as mesh or permanent suture) in the lower urinary tract after female stress incontinence surgery with the Holmium:YAG (Ho:YAG) laser, and to systematically review the literature on this topic. A retrospective chart review of 18 consecutive women found to have mesh or suture exposure was performed. All patients underwent Ho:YAG laser ablation. A systematic review was performed to identify literature addressing the endoscopic management of mesh/suture exposure after stress incontinence surgery. Between November 2011 and February 2016, 18 women underwent Ho:YAG laser ablation of exposed mesh or suture. Presenting symptoms included lower urinary tract symptoms, pelvic pain, incontinence, or recurrent urinary tract infections. Thirteen women had a previous synthetic midurethral sling and five had a prior retropubic suspension. The median age was 58 years (interquartile range [IQR] 50-60) and median follow-up was 2 years (IQR 1-2). Four patients (22%) had residual mesh after the first procedure, requiring a repeat endoscopic procedure. Only one patient had a small amount of asymptomatic residual mesh on cystoscopy after the final procedure. Only minor postoperative complications were observed. Eight patients had stress incontinence and four underwent operative treatment for this. In our systematic review, we identified 16 case series, which described a total of 158 patients. Women most commonly presented with voiding symptoms or incontinence. Based on the synthesis of these data, repeat procedures were necessary in 16% and vesicovaginal fistula occurred in 2%. Recurrent/persistent stress incontinence was present in 20%, and of these patients, 3/4 underwent a new stress incontinence procedure. Both our case series and the systematic review of the literature demonstrated that endoscopic treatment of lower urinary tract foreign bodies after stress

Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice

DEFF Research Database (Denmark)

Andersen, J R; Sørensen, S M; Kruse, A

1989-01-01

In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic cholangi......In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic...... in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass....

Endoscopic management of benign biliary strictures: Possibility or exercise in futility?

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Pierre H Deprez

2012-01-01

Full Text Available Benign biliary strictures for which endoscopic treatment is proposed are mostly related to liver transplantation or chronic pancreatitis (one third of cases each and, less frequently, to other causes (e. g., cholecystectomy, sphincterotomy. The question of futility of exercise may therefore be of importance before embarking in these techniques. Endoscopic treatment of iatrogenic (post-operative benign strictures may be considered as the gold standard since 90% of success is achieved with multiple stent placement. In strictures due to chronic pancreatitis, success rates are lower and surgery may be an appropriate alternative, although it may not be futile to propose an endoscopic try, especially when strictures are related to acute pancreatitis, pseudocyst obstruction or any reversible pancreatic cause of obstruction. In sclerosing cholangitis, endoscopic management is also focused on detection of malignancy. It should therefore not be considered as a futile exercise, but indications and aims of endotherapy should be discussed in a multidisciplinary team involving gastroenterologists, radiologists, and surgical specialists.

Endoscopic case

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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.

rhEGF-containing thermosensitive and mucoadhesive polymeric sol-gel for endoscopic treatment of gastric ulcer and bleeding.

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Maeng, Jin Hee; So, Jung Won; Kim, Jungju; Kim, In Ae; Jung, Ji Hoon; Min, Kyunghyun; Lee, Don Haeng; Yang, Su-Geun

2014-03-01

Gastrointestinal endoscopy is a standard diagnostic tool for gastrointestinal ulcers and cancer. In this study, we have developed recombinant human epidermal growth factor-containing ulcer-coating polymeric sol-gel for endoscopic application. Chitosan and pluronic F127 were employed for their thermoresponsive and bioadhesive properties. At temperatures below 21, polymeric sol-gel remains liquid during endoscopic application and transforms to gel at body temperature after application on ulcers. In an in vitro cellular wounding assay, recombinant human epidermal growth factor sol-gel significantly enhanced the cell migration and decreased the wounding area (68%) compared to nontreated, recombinant human epidermal growth factor solution, and sol-gel without recombinant human epidermal growth factor (42, 49, and 32 % decreased at day 1). The in vivo ulcer-healing study was performed in an acetic acid-induced gastric ulcer rat model and proved that our recombinant human epidermal growth factor endoscopic sol-gel facilitated the ulcer-healing process more efficiently than the other treatments. Ulcer sizes in the recombinant human epidermal growth factor sol-gel group were decreased 2.9- and 2.1-fold compared with those in the nontreated group on days 1 and 3 after ulceration, respectively. The mucosal thickness in the recombinant human epidermal growth factor sol-gel group was significantly increased compared to that in the nontreated group (3.2- and 6.9-fold on days 1 and 3 after ulceration, respectively). In a gastric retention study, recombinant human epidermal growth factor sol-gel stayed on the gastric mucosa more than 2 h after application. The present study suggests that recombinant human epidermal growth factor sol-gel is a prospective candidate for treating gastric ulcers via endoscopic application.

Laser Treatment of Professional Tattoos With a 1064/532-nm Dual-Wavelength Picosecond Laser.

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Kauvar, Arielle N B; Keaney, Terrence C; Alster, Tina

2017-12-01

Picosecond-domain laser pulses improve the photomechanical disruption of tattoos. This study evaluates the efficacy and safety of a novel, dual-wavelength, 1,064/532-nm, picosecond-domain laser for tattoo clearance. This was a prospective, self-controlled, clinical study of 34 subjects with 39 tattoos treated at 2 sites with an interval of 4.8 ± 1.6 weeks and up to 10 treatments (mean, 7.5). Blinded evaluation and investigator assessment of serial digital images was performed to evaluate treatment efficacy in the 36 tattoos that received at least 3 treatments. Investigators also assessed efficacy before each treatment visit up to 10 treatments. Safety and tolerability was evaluated for all 39 tattoos that underwent at least 1 treatment. Blinded evaluation demonstrated that lightening of tattoos was achieved in all subjects, with 86% (31 of 36 tattoos) showing at least a 50% clearance after 3 treatments. Adverse events were few and transient in nature. Patient satisfaction and treatment tolerability were high. Treatment of single-colored and multicolored tattoos with this novel 1,064/532-nm picosecond laser is highly safe and effective.

Diode laser: In treatment of recurrent verrucous leukoplakia

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Debanti Giri

2016-01-01

Full Text Available Laser first came into light in 1960 and had been used extensively in various fields of medicine. Laser has been experimented in the various dental field, and its utility is being recognized and established well in the dentistry. Lasers are widely used for a number of procedures such as cavity preparation, scaling, and root planning, surgical procedures like excision of soft tissue growths, etc., Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used diode laser for surgical management of a proliferative verrucous leukoplakia (PVL, because of its many advantages over conventional methods. It presents very specific characteristics, mainly a more aggressive biological behavior than other forms of leukoplakia expressed by: A tendency toward multifocality (field cancerization; a high prospect of recurrence; and a high rate of malignant transformation, which can range between 40% and 100% in a follow-up period of 4.4–11.6 years. In this case, we evaluated the advantages of diode laser for the treatment of verrucous leukoplakia, where the results that we obtained were excellent. The patient had come for evaluation till the time of complete healing.

Modified endoscopic medial maxillectomy for zygomatic implant salvage.

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Schwartz, Joseph S; Tajudeen, Bobby A; Adappa, Nithin D; Palmer, James N

2016-01-01

Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy. We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation. The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test. We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant.

Robot-assisted endoscope guidance versus manual endoscope guidance in functional endonasal sinus surgery (FESS).

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Eichhorn, Klaus Wolfgang; Westphal, Ralf; Rilk, Markus; Last, Carsten; Bootz, Friedrich; Wahl, Friedrich; Jakob, Mark; Send, Thorsten

2017-10-01

Having one hand occupied with the endoscope is the major disadvantage for the surgeon when it comes to functional endoscopic sinus surgery (FESS). Only the other hand is free to use the surgical instruments. Tiredness or frequent instrument changes can thus lead to shaky endoscopic images. We collected the pose data (position and orientation) of the rigid 0° endoscope and all the instruments used in 16 FESS procedures with manual endoscope guidance as well as robot-assisted endoscope guidance. In combination with the DICOM CT data, we tracked the endoscope poses and workspaces using self-developed tracking markers. All surgeries were performed once with the robot and once with the surgeon holding the endoscope. Looking at the durations required, we observed a decrease in the operating time because one surgeon doing all the procedures and so a learning curve occurred what we expected. The visual inspection of the specimens showed no damages to any of the structures outside the paranasal sinuses. Robot-assisted endoscope guidance in sinus surgery is possible. Further CT data, however, are desirable for the surgical analysis of a tracker-based navigation within the anatomic borders. Our marker-based tracking of the endoscope as well as the instruments makes an automated endoscope guidance feasible. On the subjective side, we see that RASS brings a relief for the surgeon.

Fractional CO2 laser is as effective as Q-switched ruby laser for the initial treatment of a traumatic tattoo.

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Seitz, Anna-Theresa; Grunewald, Sonja; Wagner, Justinus A; Simon, Jan C; Paasch, Uwe

2014-12-01

Q-switched laser treatments are considered the standard method for removing both regular and traumatic tattoos. Recently, the removal of tattoo ink using ablative fractional lasers has been reported. Ablative fractional CO2 laser and q-switched ruby laser treatments were used in a split-face mode to compare the safety and efficacy of the two types of laser in removing a traumatic tattoo caused by the explosion of a firework. A male patient suffering from a traumatic tattoo due to explosive deposits in his entire face was subjected to therapy. A series of eleven treatments were performed. The right side of the face was always treated using an ablative fractional CO2 laser, whereas the left side was treated only using a q-switched ruby laser. After a series of eleven treatments, the patient demonstrated a significant lightening on both sides of his traumatic tattoo, with no clinical difference. After the first six treatments, the patient displayed greater lightening on the right side of his face, whereas after another five treatments, the left side of the patient's face appeared lighter. No side effects were reported. In the initial stage of removing the traumatic tattoo, the ablative fractional laser treatment appeared to be as effective as the standard ruby laser therapy. However, from the 6th treatment onward, the ruby laser therapy was more effective. Although ablative fractional CO2 lasers have the potential to remove traumatic tattoos, they remain a second-line treatment option.

[Laser biostimulation in the treatment of pleurisy].

Science.gov (United States)

Milojević, Momir; Kuruc, Vesna

2003-01-01

Low-intensity lasers have been utilized in medicine in two ways: for local stimulation and for stimulation of acupuncture points. Literature data reveal that this method has been indiscriminately applied in psychiatry, rheumatology, gynecology, dermatology, otorhinolaryngology, in diverse acute and chronic pains, inflammations, vascular disorders, angina pectoris, bronchial asthma. Most commonly reported clinical effects are analgesia, spasmolytic and anti-inflammatory effects, as well as faster wound and bone healing. This prospective study analyses effects of laser biostimulation on patients with pleurisy. The analysis included 25 patients treated at the Institute of Lung Diseases in Sremska Kamenica during 2000, 2001 and 2002. Apart from conservative treatment, these patients were treated with laser biostimulation of acupuncture points and local region for ten days. During treatment, changes of present clinical signs, general symptoms, radiological findings, as well as changes of some relevant biochemical parameters were recorded. Results were compared with the control group which included the same number of patients, who differed from the examined group only by not being exposed to laser biostimulation. The examined group of patients with pleuritis presented with quicker resorption of pleural effusion, less pleural adhesions, more significant decrease of clinical symptoms, especially pain, as well as more significant increase of cortisol and immunoglobulin A and decrease of circulating immune complexes (CIC), leukocytes and sedimentation rate than the control group. Mechanisms of laser biostimulation in treatment of pleurisy were described in detail and the obtained results were correlated to those reported by other authors. 1. Patients with pleurisy undergoing laser stimulation presented with faster resorption of effusion and remission of the subjective symptoms, as well as significant decrease of biochemical acute inflammation parameters in the peripheral

Medium-Level Laser in Chronic Tinnitus Treatment

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K. Dejakum

2013-01-01

Full Text Available The purpose of this study was to evaluate the effect of medium-level laser therapy in chronic tinnitus treatment. In a prospective double-blind placebo-controlled trial, either active laser (450 mW, 830 nm combined Ga-Al-As diode laser or placebo irradiation was applied through the external acoustic meatus of the affected ear towards the cochlea. Fourty-eight patients with chronic tinnitus were studied. The main outcome was measured using the Goebel tinnitus questionnaire, visual analogue scales measuring the perceived loudness of tinnitus, the annoyance associated with tinnitus, and the degree of attention paid to tinnitus as well as psycho-acoustical matches of tinnitus pitch and loudness. The results did show only very moderate temporary improvement of tinnitus. Moreover, no statistically relevant differences between laser and placebo group could be found. We conclude that medium-level laser therapy cannot be regarded as an effective treatment of chronic tinnitus in our therapy regime considering the limited number of patients included in our study.

Results Of Endoscopic Transnasal Resection Of Sinonasal Inverted Papiloma

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Baradaranfar M. H

2003-08-01

Full Text Available Inverted papilloma is an uncommon benign neoplasm originating from lateral nasal wall. It commonly invades paranasal sinuses and sometimes invasion to orbit and intracranial structures are seen. There are many surgical methods for its treatment, one of them is endoscopic transnasal approach."nMaterials and Methods: Between 1997 and 2001, 11 patients with this tumor were operated in Amiralam hospital in Tehran and Shahid Rahnemun in Yazd. Nine patients were operated by endoscopic transnasal route and two patients by combined Caldwell-luc and endoscopic transnasal routes."nResults: Tumors were on the right side in 3 patients, on the left side in 7 patients, and bilateral in one patient. There were no intracranial or orbital extensions. No pathologic report of malignancy was made. Surgical technique included complete tumor resection, anterior and posterior ethomidectomies, sphenoidectomy, frontal recess tumor resection and wide maxillary antrostomy, in cases in whom tumor was attached to lamina papyracea, the lamina was removed without any manipulation to orbital periosteum. Mean follow-up time was 29.8 months. There was no recurrence in 82% of cases. Tumor recurred in 18% of cases. No complications were seen."nConclusion: Although the standard treatment for this tumor is medial maxillectomy but endoscopic resection is an effective method in surgery of this tumor. It seems that if tumor does not extend to areas unreachable by endoscopic surgery, due to lower morbidity and excellent visualization of tumor, this method is preferable.

Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos).

Science.gov (United States)

Raczynski, Susanne; Teich, Niels; Borte, Gudrun; Wittenburg, Henning; Mössner, Joachim; Caca, Karel

2006-09-01

Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%. Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis. Case report. University hospital. Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy. Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients. Small number of patients. The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.

Update on the use of diode laser in the management of benign prostate obstruction in 2014.

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Lusuardi, Lukas; Mitterberger, Michael; Hruby, Stephan; Kunit, Thomas; Kloss, Birgit; Engelhardt, Paul F; Sieberer, Manuela; Janetschek, Günter

2015-04-01

To determine the status quo in respect of various diode lasers and present the techniques in use, their results and complications. We assess how these compare with transurethral resection of the prostate and other types of laser in randomized controlled trials (RCTs). When adequate RCTs were not available, case studies and reports were evaluated. Laser for the treatment of benign prostatic hyperplasia (BPH) has aroused the interest and curiosity of urologists as well as patients. The patient associates the term laser with a successful and modern procedure. The journey that started with coagulative necrosis of prostatic adenoma based on neodymium: yttrium-aluminum-garnet (Nd:YAG) laser has culminated in endoscopic "enucleation" with holmium laser. Diode laser is being used in urology for about 10 years now. Various techniques have been employed to relieve bladder outlet obstruction due to BPH. The diode laser scenario is marked by a diversity of surgical techniques and wavelengths. We summarize the current published literature in respect of functional results and complications. More randomized controlled studies are needed to determine the position and the ideal technique of diode laser treatment for BPH.

Mirizzi Syndrome with Endoscopic Ultrasound Image

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K. Rayapudi

2013-05-01

Full Text Available 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 failed to cannulate the CBD. At the University Center, type 1 Mirizzi syndrome was noted on endoscopic ultrasound with narrowing of the CBD with extrinsic compression from cystic duct stone. During repeat ERCP, the CBD could be cannulated over the pancreatic duct wire. A mid CBD narrowing, distal CBD stones, proximal CBD and extrahepatic duct dilation were noted, and biliary sphincterotomy was performed. A small stone in the distal CBD was removed with an extraction balloon. The cystic duct stone was moved with the biliary balloon into the CBD, mechanical basket lithotripsy was performed and stone fragments were delivered out with an extraction balloon. The patient was seen 7 weeks later in the clinic. Skin and scleral icterus had cleared up and he is scheduled for an elective cholecystectomy. Mirizzi syndrome refers to biliary obstruction resulting from impacted stone in the cystic duct or neck of the gallbladder and commonly presents with obstructive jaundice. Type 1 does not have cholecystocholedochal fistulas, but they present in types 2, 3 and 4. Surgery is the mainstay of therapy. Endoscopic treatment is effective and can also be used as a temporizing measure or definitive treatment in poor surgical risk candidates.

Endoscopic Treatment of Biliary Stenosis in Patients with Alveolar Echinococcosis – Report of 7 Consecutive Patients with Serial ERC Approach

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Stojkovic, Marija; Junghanss, Thomas; Veeser, Mira; Weber, Tim F.; Sauer, Peter

2016-01-01

Background and Aims Biliary vessel pathology due to alveolar echicococcosis (AE) results in variable combinations of stenosis, necrosis and inflammation. Modern management strategies for patients with cholestasis are desperately needed. The aim is proof of principle of serial ERC (endoscopic retrograde cholangiography) balloon dilation for AE biliary pathology. Methods Retrospective case series of seven consecutive patients with AE-associated biliary pathology and ERC treatment in an interdisciplinary endoscopy unit at a University Hospital which hosts a national echinococcosis treatment center. The AE patient cohort consists of 106 patients with AE of the liver of which 13 presented with cholestasis. 6/13 received bilio-digestive anastomosis and 7/13 patients were treated by ERC and are reported here. Biliary stricture balloon dilation was performed with 18-Fr balloons at the initial and with 24-Fr balloons at subsequent interventions. If indicated 10 Fr plastic stents were placed. Results Six patients were treated by repeated balloon dilation and stenting, one by stenting only. After an acute phase of 6 months with repeated balloon dilation, three patients showed “sustained clinical success” and four patients “assisted therapeutic success,” of which one has not yet reached the six month endpoint. In one patient, sustained success could not be achieved despite repeated insertion of plastic stents and balloon dilation, but with temporary insertion of a fully covered self-expanding metal stent (FCSEMS). There was no loss to follow up. No major complications were observed. Conclusions Serial endoscopic dilation is a standard tool in the treatment of benign biliary strictures. Serial endoscopic intervention with balloon dilation combined with benzimidazole treatment can re-establish and maintain biliary duct patency in AE associated pathology and probably contributes to avoid or postpone bilio-digestive anastomosis. This approach is in accordance with current

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study).

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van den Broek, Frank J C; de Graaf, Eelco J R; Dijkgraaf, Marcel G W; Reitsma, Johannes B; 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

2009-03-13

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 expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications.The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma > or = 3 cm, located between 1-15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2) number of days not spent in hospital from initial treatment until 2 years afterwards; 3) major and minor morbidity; 4) disease specific and general quality of life; 5) anorectal function; 6) health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR of 3.3% and considering an upper-limit of 10

ENDOSCOPIC DIAGNOSIS AND THERAPY IN GASTRO-ESOPAGEAL VARICEAL BLEEDING

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Sanyal, Arun J.

2016-01-01

Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding and second line definitive therapies introduced quickly if endoscopic and pharmacologic treatment fails. PMID:26142034

Percutaneous endoscopic colostomy: a useful technique when surgery is not an option

OpenAIRE

Tun, Gloria; Bullas, Dominic; Bannaga, Ayman; Said, Elmuhtady M.

2016-01-01

Percutaneous endoscopic colostomy (PEC) is a minimally invasive endoscopic procedure that offers an alternative treatment for high-risk patients with sigmoid volvulus or intestinal pseudo-obstruction who have tried conventional treatment options without success or those who are unfit for surgery. The procedure acts as an irrigation or decompressing channel and provides colonic ?fixation? to the anterior abdominal wall. The risk of complications highlights the importance of informed consent fo...

Proximal design for a multimodality endoscope with multiphoton microscopy, optical coherence microscopy and visual modalities

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Kiekens, Kelli C.; Talarico, Olivia; Barton, Jennifer K.

2018-02-01

A multimodality endoscope system has been designed for early detection of ovarian cancer. Multiple illumination and detection systems must be integrated in a compact, stable, transportable configuration to meet the requirements of a clinical setting. The proximal configuration presented here supports visible light navigation with a large field of view and low resolution, high resolution multiphoton microscopy (MPM), and high resolution optical coherence microscopy (OCM). All modalities are integrated into a single optical system in the endoscope. The system requires two light sources: a green laser for visible light navigation and a compact fiber based femtosecond laser for MPM and OCM. Using an inline wavelength division multiplexer, the two sources are combined into a single mode fiber. To accomplish OCM, a fiber coupler is used to separate the femtosecond laser into a reference arm and signal arm. The reflected reference arm and the signal from the sample are interfered and wavelength separated by a reflection grating and detected using a linear array. The MPM signal is collimated and goes through a series of filters to separate the 2nd and 3rd harmonics as well as twophoton excitation florescence (2PEF) and 3PEF. Each signal is independently detected on a photo multiplier tube and amplified. The visible light is collected by multiple high numerical aperture fibers at the endoscope tip which are bundled into one SMA adapter at the proximal end and connected to a photodetector. This integrated system design is compact, efficient and meets both optical and mechanical requirements for clinical applications.

Office-based endoscopic botulinum toxin injection in laryngeal movement disorders.

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Kaderbay, A; Righini, C A; Castellanos, P F; Atallah, I

2018-06-01

Botulinum toxin injection is widely used for the treatment of laryngeal movement disorders. Electromyography-guided percutaneous injection is the technique most commonly used to perform intralaryngeal botulinum toxin injection. We describe an endoscopic approach for intralaryngeal botulinum toxin injection under local anaesthesia without using electromyography. A flexible video-endoscope with an operating channel is used. After local anaesthesia of the larynx by instillation of lidocaine, a flexible needle is inserted into the operating channel in order to inject the desired dose of botulinum toxin into the vocal and/or vestibular folds. Endoscopic botulinum toxin injection under local anaesthesia is a reliable technique for the treatment of laryngeal movement disorders. It can be performed by any laryngologist without the need for electromyography. It is easy to perform for the operator and comfortable for the patient. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Surgical Reimplantation for the Correction of Vesicoureteral Reflux following Failed Endoscopic Injection

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Boris Chertin

2011-01-01

Full Text Available Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004–2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II–IV following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.

Chronic airway obstruction in children. Most common causes, diagnosis and Surgical and Endoscopic Treatment

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Ana Isabel NAVAZO-EGUÍA

2018-03-01

Full Text Available Introduction: Obstructive airway pathology in children may be congenital or acquired. Fortunately, it is a rare condition, but in most cases, it implies a diagnostic and therapeutic challenge. Endoscopic techniques have experienced in the last years a breakthrough in the treatment of these lesions, but open surgery still plays an important role. Objective: Our objective was to review the most frequent causes of obstruction of the central airway in the child, their diagnostic and current treatment status. Conclusions: Obstructive airway pathology in children requires immediate stabilization, detailed assessment, meticulous planning and individualized treatment. Management of patients with airway obstruction requires a close cooperation between specialists organized in multidisciplinary teams, whose main objective is the diagnosis and timely resolution of the various congenital malformations and acquired lesions that affect the larynx, trachea and bronchi. In many cases the decision of the treatment of choice is not easy. Selection of the most suitable treatment depends on the patient’s clinical situation and the anatomic type of stenosis. The surgeon must master all available techniques, to solve each specific situation.

Endoscopic palliation in gastric cancer

International Nuclear Information System (INIS)

Valdivieso, Eduardo

2010-01-01

The integral search for improved living conditions for those patients with gastric cancer who have not received curative surgical treatment continues to challenge the knowledge, dexterity and ethical foundations of medical teams. The justification for palliative treatment must be based on a thorough consideration of the available options and the particular situation in each case. This article reviews endoscopic therapy with auto expandable prosthetics for palliative treatment of gastric cancer, as well as the scientific evidence that supports its use and the factors that determine its indication.

Endoscopic anatomy of the orbital floor and maxillary sinus.

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Moore, Corey C; Bromwich, Matthew; Roth, Kathy; Matic, Damir B

2008-01-01

Endoscopic repair of orbital blow-out fractures could become a predictable and efficient treatment alternative to traditional methods. However, maxillary sinus endoscopy provides a complex and disorienting view of the orbital floor. To be a useful and consistent technique for providing access to the orbital floor, specific knowledge of maxillary endoscopic anatomy is required. The purpose of the study was to provide an anatomic description of the orbital floor via the endoscopic approach. Objectives include defining consistent landmarks for use in endoscopic repair of orbital floor fractures. Using 0- and 30-degree rigid endoscopes, 6 fresh cadavers (12 maxillary sinuses) were examined via a standard Caldwell-Luc approach. Computed tomographic scans, plastic molds, and digital images were used to compare observable averages within bony anatomy. Potential bony landmarks were correlated with soft-tissue anatomy in fresh specimens. The maxillary ostium, orbital floor, and lateral ethmoid air cells were visualized, and their structures were described. Observations were made in relation to the anatomy of the orbital floor and maxillary sinus, including fracture pattern and force transmission pathways. An "orbitomaxillary" sinus bony thickening was identified and described for the first time. This study provides the basis for further refinement of surgical technique and opens the door for future clinical trials using endoscopic repair.

The minimally invasive endoscopic management of septated chronic subdural hematomas: surgical technique.

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Berhouma, M; Jacquesson, T; Jouanneau, E

2014-12-01

Fibrin membranes and compartmentalization within the subdural space are a frequent cause of failure in the treatment of chronic subdural hematomas (CSH). This specific subtype of CSH classically requires craniotomy, which carries significant morbidity and mortality rates, particularly in elderly patients. In this work, we describe a minimally invasive endoscopic alternative. Under local scalp anesthesia, a rigid endoscope is inserted through a parietal burr hole in the subdural space to collapse fibrin septa and cut the internal membrane. It also allows cauterization of active bleedings and the placement of a drain under direct visualization. The endoscopic treatment of septated CSH represents a minimally invasive alternative to craniotomy especially for the internal membranectomy.

The Durability of Endoscopic Therapy for Treatment of Barrett's Metaplasia, Dysplasia, and Mucosal Cancer After Nissen Fundoplication.

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Johnson, Corey S; Louie, Brian E; Wille, Aaron; Dunst, Christy M; Worrell, Stephanie G; DeMeester, Steven R; Reynolds, Jessica; Dixon, Joe; Lipham, John C; Lada, Michal; Peters, Jeffrey H; Watson, Thomas J; Farivar, Alexander S; Aye, Ralph W

2015-05-01

Radiofrequency ablation (RFA) ± endoscopic resection (EMR) is an established treatment strategy for neoplastic Barrett's and intramucosal cancer. Most patients are managed with proton pump inhibitors. The incidence of recurrent Barrett's metaplasia, dysplasia, or cancer after complete eradication is up to 43 % using this strategy. We hypothesize the addition of fundoplication should result in a lower recurrence rates after complete eradication. Multi-institutional retrospective review of patients undergoing endotherapy followed by Nissen fundoplication A total of 49 patients underwent RFA ± EMR followed by Nissen fundoplication. Complete remission of intestinal metaplasia (CR-IM) was achieved in 26 (53 %) patients, complete remission of dysplasia (CR-D) in 16 (33 %) patients, and 7 (14 %) had persistent neoplastic Barrett's. After fundoplication, 18/26 (70 %) remained in CR-IM. An additional 10/16 CR-D achieved CR-IM and 4/7 with persistent dysplasia achieved CR-IM. One patient progressed to LGD while no patient developed HGD or cancer. Endoscopic therapy for Barrett's dysplasia and/or intramucosal cancer followed by fundoplication results in similar durability of CR-IM to patients being managed with PPIs alone after endoscopic therapy. However, fundoplication may be superior in preventing further progression of disease and the development of cancer. Fundoplication is an important strategy to achieve and maintain CR-IM, and facilitate eradication of persistent dysplasia.

Transforaminal Percutaneous Endoscopic Discectomy and Foraminoplasty after Lumbar Spinal Fusion Surgery.

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Wu, Jian-Jun; Chen, Hui-Zhen; Zheng, Changkun

2017-07-01

The most common causes of pain following lumbar spinal fusions are residual herniation, or foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. The original surgeon may advise his patient that nothing more can be done in his opinion that the nerve was visually decompressed by the original surgery. Post-operative imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of failed lumbar spinal fusions by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain. The authors, having limited their practice to endoscopic surgery over the last 10 years, report on their experience gained during that period to relieve pain by transforaminal percutaneous endoscopic revision of lumbar spinal fusions. To assess the effectiveness of transforaminal percutaneous endoscopic discectomy and foraminoplasty in patients with pain after lumbar spinal fusion. Retrospective study. Inpatient surgery center. Sixteen consecutive patients with pain after lumbar spinal fusions presenting with back and leg pain that had supporting imaging diagnosis of foraminal stenosis and/or residual/recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal fusions treatment for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen in the case of foraminal stenosis, or to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow-up time was 30.3 months, minimum 12 months. Outcome data at each visit

Endoscopic Decompression and Marsupialization of A Duodenal Duplication Cyst

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Eliza I-Lin Sin

2018-06-01

Full Text Available Introduction: Duodenal duplication cysts are rare congenital foregut anomalies, accounting for 2%–12% of all gastrointestinal tract duplications. Surgical excision entails risk of injury to the pancreaticobiliary structures due to proximity or communication with the cyst. We present a case of duodenal duplication cyst in a 3 year-old boy who successfully underwent endoscopic decompression. Case report: AT is a young boy who first presented at 15 months of age with abdominal pain. There was one subsequent episode of pancreatitis. Ultrasonography showed the typical double wall sign of a duplication cyst and magnetic resonance cholangio-pancreatography showed a large 5 cm cyst postero-medial to the second part of the duodenum, communicating with the pancreaticobiliary system and causing dilatation of the proximal duodenum. He subsequently underwent successful endoscopic ultrasound guided decompression at 3 years of age under general anesthesia, and had an uneventful postoperative recovery. Conclusion: Endoscopic ultrasound guided assessment and treatment of gastrointestinal duplication cysts is increasingly reported in adults. To the best of our knowledge, only one case of endoscopic treatment of duodenal duplication cyst, in an older child, has been reported thus far in the paediatric literature. In this paper, we review the current literature and discuss the therapeutic options of this rare condition.

Poly(vinyl pyrrolidone)-Chitosan implant for endoscopic treatment of vesicoureteral reflux

International Nuclear Information System (INIS)

Relleve, Lorna S.; Abad, Lucille V.; Aranilla, Charito T.; Dela Rosa, A.M.; Bolong, David T.; Bisnar, Carlo C.

2008-01-01

Radiation-crosslinked poly(vinyl pyrrolidone) (PVP)-Chitosan was prepared as a potential injectable implant for endoscopic treatment of vesicoureteral reflux (VUR). The physical and histological properties of PVP-Chitosan implant in comparison with the commercial dextranomer/hyaluronic acid copolymer (Deflux) have been evaluated in vivo by subcutaneous and abdominal injection in rats over a period of 6 months. The PVP-Chitosan implant was easily injected through 26-gauge needle. Monthly gross examination of the implanted sites showed no significant decrease in volume of implant and no local inflammatory reaction. Histological findings indicated no evidence of migration to the distant organs after 6 months of implantation. Results of this study indicated that PVP-Chitosan implant has properties of a good tissue augmenting substance such as stability, biocompatibility and non-migration but long-term studies are needed to evaluate its therapeutic efficiency. (author)

Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

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Ignacio Couto-Worner

2013-09-01

Full Text Available Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection.

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Machida, H; Tominaga, K; Minamino, H; Sugimori, S; Okazaki, H; Yamagami, H; Tanigawa, T; Watanabe, K; Watanabe, T; Fujiwara, Y; Arakawa, T

2012-06-01

This prospective study aimed to evaluate the feasibility and safety of locoregional mitomycin C (MMC) injection to treat refractory esophageal strictures after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Patients with dysphagia and strictures that were refractory to repeated endoscopic balloon dilation (EBD) were eligible. After EBD, MMC was injected into the dilated site. Between June 2009 and August 2010, five patients were recruited. The treatment was performed once in two patients and twice in three patients with recurrent dysphagia or restenosis. In all patients, passing a standard endoscope through the site was easy and the dysphagia grade improved (grade 3→1 in 3 patients, grade 4→2 in 2 patients). No serious complications were noted. During the observation period of 4.8 months, neither recurrent dysphagia nor re-stricture appeared in any of the patients. The combination of locoregional MMC injections and EBD is feasible and safe for the treatment of esophageal strictures after ESD.Recently, endoscopic submucosal dissection (ESD) has been developed and accepted as a new endoscopic treatment for gastrointestinal tumors. ESD is a promising treatment for superficial esophageal carcinoma (SEC), and it has a reliable en bloc resection rate. However, the application of ESD for widespread lesions is challenging because of the high risk of the development of severe strictures, which lead to a low quality of life after ESD. Although endoscopic balloon dilation (EBD) is effective for benign strictures, it needs to be performed frequently until the dysphagia disappears 1. Mitomycin C (MMC), which is a chemotherapeutic agent derived from some Streptomyces species 2, reduces scar formation when topically applied to a surgical lesion. MMC has been applied to treat strictures in a variety of anatomical locations, including a variety of organs 3. The aim of this study was to prospectively evaluate both the feasibility and the safety of

Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas.

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Esquenazi, Yoshua; Essayed, Walid I; Singh, Harminder; Mauer, Elizabeth; Ahmed, Mudassir; Christos, Paul J; Schwartz, Theodore H

2017-05-01

Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches. A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications. Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P < 0.001) macroadenomas (P < 0.001) with higher rates of cavernous sinus invasion (P = 0.012). The pooled rate of gross total tumor resection was 53.5% for the endoscopic group and 46.6% for the microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group. This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option. Copyright © 2017 Elsevier Inc. All rights reserved.

Laser Surface Treatment of Sintered Alumina

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Hagemann, R.; Noelke, C.; Kaierle, S.; Wesling, V.

Sintered alumina ceramics are used as refractory materials for industrial aluminum furnaces. In this environment the ceramic surface is in permanent contact with molten aluminum resulting in deposition of oxidic material on its surface. Consequently, a lower volume capacity as well as thermal efficiency of the furnaces follows. To reduce oxidic adherence of the ceramic material, two laser-based surface treatment processes were investigated: a powder- based single-step laser cladding and a laser surface remelting. Main objective is to achieve an improved surface quality of the ceramic material considering the industrial requirements as a high process speed.

Investigations into localized re-treatment of the retina with a 3-nanosecond laser.

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Chidlow, Glyn; Plunkett, Malcolm; Casson, Robert J; Wood, John P M

2016-08-01

Subvisual retinal lasers necessarily cause clinically invisible lesions, hence, they could intentionally or inadvertently be targeted at precisely the same or an overlapping location during repeat laser treatment. Herein, we investigated the structural integrity and cellular responses of localized re-treatment using a nanosecond laser (2RT) currently in trials for early age-related macular degeneration. Rats were randomly assigned to one of five groups: sham, subvisual 2RT, subvisual 2RT re-treatment, visual effect 2RT, visual effect 2RT re-treatment. Re-treatment groups were lasered on days 0 and 21; single laser groups were only lasered on day 21. All rats were euthanized at day 28 and eyes were then dissected and processed for immunohistochemistry. For re-treatment, the laser was targeted at precisely the same locations on both delivery occasions. Analytical endpoints included monitoring of retinal vascular integrity overlying lesions, investigation into any potential choroidal neovascularization, assessment of the RPE, quantification of collateral injury to photoreceptors or other neuronal classes, and delineation of glial reactivity. Repeat laser administration to rats caused ostensibly identical retinal-RPE-choroid responses to those obtained in age-matched rats that received only a single application. Specifically, 7 days after treatment, RPE cells were re-populating lesion sites. No obvious consistent differences were evident between the single and repeat laser groups. Moreover, repeat laser caused no (measurable) additive injury to photoreceptors or other retinal neuronal classes from single laser treatment. In re-lasered animals, there was no increase in microglial activity overlying and adjacent to lesion sites relative to single lasered rats. Finally, there was no evidence of choroidal neovascularization after repeat laser treatment. The overall results provide a measure of confidence that re-treatment of patients with 2RT should not provide any

Percutaneous endoscopic colostomy: a useful technique when surgery is not an option.

Science.gov (United States)

Tun, Gloria; Bullas, Dominic; Bannaga, Ayman; Said, Elmuhtady M

2016-01-01

Percutaneous endoscopic colostomy (PEC) is a minimally invasive endoscopic procedure that offers an alternative treatment for high-risk patients with sigmoid volvulus or intestinal pseudo-obstruction who have tried conventional treatment options without success or those who are unfit for surgery. The procedure acts as an irrigation or decompressing channel and provides colonic 'fixation' to the anterior abdominal wall. The risk of complications highlights the importance of informed consent for patients and relatives.

Management of odontogenic cysts by endonasal endoscopic techniques: A systematic review and case series.

Science.gov (United States)

Marino, Michael J; Luong, Amber; Yao, William C; Citardi, Martin J

2018-01-01

Odontogenic cysts and tumors of the maxilla may be amendable to management by endonasal endoscopic techniques, which may reduce the morbidity associated with open procedures and avoid difficult reconstruction. To perform a systematic review that evaluates the feasibility and outcomes of endoscopic techniques in the management of different odontogenic cysts. A case series of our experience with these minimally invasive techniques was assembled for insight into the technical aspects of these procedures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to identify English-language studies that reported the use of endoscopic techniques in the management of odontogenic cysts. Several medical literature data bases were searched for all occurrences in the title or abstract of the terms "odontogenic" and "endoscopic" between January 1, 1950, and October 1, 2016. Publications were evaluated for the technique used, histopathology, complications, recurrences, and the follow-up period. A case series of patients who presented to a tertiary rhinology clinic and who underwent treatment of odontogenic cysts by an endoscopic technique was included. A systematic review identified 16 case reports or series that described the use of endoscopic techniques for the treatment of odontogenic cysts, including 45 total patients. Histopathologies encountered were radicular (n = 16) and dentigerous cysts (n = 10), and keratocystic odontogenic tumor (n = 12). There were no reported recurrences or major complications for a mean follow-up of 29 months. A case series of patients in our institution identified seven patients without recurrence for a mean follow-up of 10 months. Endonasal endoscopic treatment of various odontogenic cysts are described in the literature and are associated with effective treatment of these lesions for an average follow-up period of >2 years. These techniques have the potential to reduce morbidity associated with the resection of these

Laser treatment of a neodymium magnet and analysis of surface characteristics

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Yilbas, B. S.; Ali, H.; Rizwan, M.; Kassas, M.

2016-08-01

Laser treatment of neodymium magnet (Nd2Fe14B) surface is carried out under the high pressure nitrogen assisting gas. A thin carbon film containing 12% WC carbide particles with 400 nm sizes are formed at the surface prior to the laser treatment process. Morphological and metallurgical changes in the laser treated layer are examined using the analytical tools. The corrosion resistance of the laser treated surface is analyzed incorporating the potentiodynamic tests carried out in 0.05 M NaCl+0.1 M H2SO4 solution. The friction coefficient of the laser treated surface is measured using the micro-scratch tester. The wetting characteristics of the treated surface are assessed incorporating the sessile water drop measurements. It is found that a dense layer consisting of fine size grains and WC particles is formed in the surface region of the laser treated layer. Corrosion resistance of the surface improves significantly after the laser treatment process. Friction coefficient of laser treated surface is lower than that of the as received surface. Laser treatment results in superhydrophobic characteristics at the substrate surface. The formation of hematite and grain size variation in the treated layer slightly lowers the magnetic strength of the laser treated workpiece.

POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia.

Science.gov (United States)

Miller, Heidi J; Neupane, Ruel; Fayezizadeh, Mojtaba; Majumder, Arnab; Marks, Jeffrey M

2017-04-01

Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015. Cost of LM was set to 1, and other procedures are presented as percentage change. Cost-effectiveness was calculated based on cost, number of interventions required for optimal results for dilations and injections and efficacy reported in the current literature. Incremental cost-effectiveness ratio was calculated by a cost-utility analysis using quality-adjusted life year gained, defined as a symptom-free year in a patient with achalasia. Average number of interventions required was 2.3 dilations or two injections for efficacies of 80 and 61 %, respectively. POEM cost 1.058 times the cost of LM, and PD and BI cost 0.559 and 0.448 times the cost of LM. Annual cost per cure over a period of 4 years for POEM, and LM were consistently equivalent, trending the same as PD although this has a lower initial cost. The cost per cure of BI remains stable over 3 years and then doubles. The cost-effectiveness of POEM and LM is equivalent. Myotomy, either surgical or endoscopic, is more cost-effective than BI due to high failure rates of the economical intervention. When treatment is being considered BI should be utilized in patients with less than 2-year life expectancy. Pneumatic dilations are cost-effective and are an acceptable approach to treatment of achalasia, although myotomy has a lower relapse rate and is cost-effective compared to PD after 2 years.

Laser therapy in the periodontitis treatment

International Nuclear Information System (INIS)

Pinto Nancassa, Raul; Quintana Gonzalez, Julio; Rodriguez de Bernardo, Carlos; Hernandez Cruz, Hector; Hernandez Alvarez, Victor

2009-01-01

We performed a controlled clinical trial to evaluate the efficacy of low-power laser surgery combined with parodontal in the treatment of periodontitis in patients undergoing surgical treatment for this condition in the municipality of Moron North Clinic from February to July 2006. The world of work consisted of all patients diagnosed with periodontitis in this period of time were operated on at the Clinic of North County Moron (N = 86), leaving the sample for 80 patients. In patients where surgery was applied parodontal combined with low power laser radiation pain appeared in only a small number of cases 48 hours and none required the use of analgesics. For seven days the largest percentage of individuals submitted a total healing of soft tissue. No side effects to treatment. Patients treated with surgery parodontal, in whole required the use of analgesics in the first 24 hours and even at 72 hours after surgery in some patients, the seven days the number of patients with partial healing of the soft tissues was although the prevailing high total healing. There was no bone gain, the patients were stable, resulting in only stop. Statistically significant differences were found between groups suggesting that allowing the treatment of low-power laser in the surgery of periodontitis as well as being easy to apply proved to be effective. (Author)

Endoscopic Pubic Symphysectomy for Athletic Osteitis Pubis.

Science.gov (United States)

Matsuda, Dean K; Sehgal, Bantoo; Matsuda, Nicole A

2015-06-01

Osteitis pubis is a common form of athletic pubalgia associated with femoroacetabular impingement. Endoscopic pubic symphysectomy was developed as a less invasive option than open surgical curettage for recalcitrant osteitis pubis. This technical note demonstrates the use of the anterior and suprapubic portals in the supine lithotomy position for endoscopic burr resection of pubic symphyseal fibrocartilage and hyaline endplates. Key steps include use of the suprapubic portal for burr resection of the posteroinferior symphysis and preservation of the posterior and arcuate ligaments. Endoscopic pubic symphysectomy is a minimally invasive bone-conserving surgery that retains stability and may be useful in the treatment of recalcitrant osteitis pubis or osteoarthritis. It nicely complements arthroscopic surgery for femoroacetabular impingement and may find broader application in this group of co-affected athletes.

Endoscopic endonasal repair of spontaneous sphenoid sinus lateral wall meningocele presenting with cerebrospinal fluid leak

Directory of Open Access Journals (Sweden)

Ali Erdem Yildirim

2014-01-01

Full Text Available Spontaneous sphenoid sinus lateral wall meningoceles are rare lesions with an unknown etiology. Endoscopic endonasal technique is a considerable route in the treatment of this condition. The aim of this paper is to report the etiology, surgical technique, and outcome in a patient repaired via endoscopic endonasal approach. A 51-year-old male patient applied with rhinorrhea started three months ago after an upper respiratory infection. There were no history of trauma or sinus operation. Biochemical analysis of the fluid was positive for beta-2-transferrin. This asypthomatic patient had undergone for repairment of lateral sphenoid sinus meningocele with endoscopic endonasal transsphenoidal approach. After endoscopic endonasal meningocele closure procedure no complications occured and a quick recovery was observed. Endoscopic endonasal approach is an effective and safe treatment modality of spontaneous lateral sphenoid sinus meningoceles and efficient in anterior skull base reconstruction.

Estimating the best laser parameters for skin cancer treatment using finite element models

International Nuclear Information System (INIS)

El-Berry, A.A.; El-Berry, A.A.; Solouma, N.H.; Hassan, F.; Ahmed, A.S.

2010-01-01

Skin cancer is an intimidating disease which necessitates the presence of a non-invasive treatment. Laser-induced thermo therapy is one of the recent noninvasive modalities of superficial lesion treatment. Although of its promising effect, this method still needs more effort to be quantized. Many studies are being conducted for this purpose. Modeling and simulating the process of skin lesion treatment by laser can lead to the best quantization of the treatment protocol. In this paper, we provide finite element models for the treatment of skin cancer using laser thermal effect. A comparison between the effects of using different laser parameters of diode laser (800nm) and Nd: Yag laser (1064 nm) revealed that Nd: Yag laser can be used effectively foe skin cancer treatment specially with high intensities of about 106 w/m 2 .

A widespread allergic reaction to black tattoo ink caused by laser treatment.

Science.gov (United States)

Bernstein, Eric F

2015-02-01

This is the first reported case of a local and widespread reaction in a 39 year old woman, to black tattoo ink, induced by Q-switched laser treatment. A 39 year old woman was treated with the Q-switched Nd:YAG laser for removal of a decorative tattoo of her lower back. Subsequent to laser treatment, a severe, widespread allergic reaction developed within and surrounding the treated tattoo. Tattoo reactions subsequent to laser treatment should be considered in addition to reactions to topical antibiotics or wound dressings, following laser treatment of tattoos. © 2015 Wiley Periodicals, Inc.

Endoscopic electrocautery dilation of benign anastomotic colonic strictures: a single-center experience.

Science.gov (United States)

Bravi, Ivana; Ravizza, Davide; Fiori, Giancarla; Tamayo, Darina; Trovato, Cristina; De Roberto, Giuseppe; Genco, Chiara; Crosta, Cristiano

2016-01-01

Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures. Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up. The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation. Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.

Combination treatment with excimer laser and narrowband UVB light in vitiligo patients.

Science.gov (United States)

Shin, Sungsik; Hann, Seung-Kyung; Oh, Sang Ho

2016-01-01

For the treatment of vitiligo, narrowband UVB (NBUVB) light is considered the most effective for nonsegmental vitiligo, while excimer laser treatment is commonly used for localized vitiligo. However, treatment areas may potentially be missed with excimer laser treatment. We aimed to evaluate the effect of combinational treatment with NBUVB light and excimer laser on vitiligo. All patients were first treated with NBUVB; excimer laser was then applied in conjunction with NBUVB phototherapy due to a slow response or no further improvement with continuous NBUVB treatment alone. To minimize adverse effects, a fixed dose of NBUVB was administered, and the dose of excimer laser was increased based on patient response. Among 80 patients, 54 patients showed responses after combination with excimer laser; however, 26 patients (32.5%) showed no remarkable change after combination therapy. Of the 26 patients who showed no further response, 12 patients (46.1%) presented with vitiligo on the acral areas, which are known to the least responsive sites. Our study suggests that combined treatment of NBUVB and excimer laser in vitiligo may enhance the treatment response without remarkable side effects, therefore might also increase the compliance of the patients to the treatment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Treatment of tattoos with a 755-nm Q-switched alexandrite laser and novel 1064 nm and 532 nm Nd:YAG laser handpieces pumped by the alexandrite treatment beam.

Science.gov (United States)

Bernstein, Eric F; Bhawalkar, Jay; Clifford, Joan; Hsia, James

2010-11-01

Multi-colored and even black tattoos often require more than one wavelength to remove the target pigment. The authors report here a novel alexandrite laser with two Nd:YAG laser handpieces pumped by the alexandrite treatment beam enabling the delivery of three wavelengths from a single device. To describe and evaluate the effectiveness of a novel Q-switched laser-pumped laser for treating tattoos. Twenty tattoos in 14 subjects were treated at four-week intervals using a combination of available wavelengths (532, 755 and 1064 nm) as determined by the treating physician. Digital cross-polarized photographs were taken before treatment and two months following the fourth and final treatment. Photographs were evaluated by three physician observers blinded as to the treatment condition and rated for clearance by the following scale: 1 = > 95 percent, 2 = 76-95 percent, 3 = 51-75 percent, 4 = 26-50 percent and 5 = 0-25 percent clearance. The average clearance score was 3.1, in the 51-75 percent range, two months following four treatments. No scarring, hyper- or hypopigmentation was noted on post-treatment photographs or by the treating physician. The alexandrite and alexandrite-pumped 532 nm and 1064 nm Q-switched lasers are effective for removing decorative tattoos, and represents the first commercial laser with laser-pumped, laser handpieces.

Improving superficial target delineation in radiation therapy with endoscopic tracking and registration

Energy Technology Data Exchange (ETDEWEB)

Weersink, R. A.; Qiu, J.; Hope, A. J.; Daly, M. J.; Cho, B. C. J.; DaCosta, R. S.; Sharpe, M. B.; Breen, S. L.; Chan, H.; Jaffray, D. A. [Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9 (Canada)

2011-12-15

Purpose: Target delineation within volumetric imaging is a critical step in the planning process of intensity modulated radiation therapy. In endoluminal cancers, endoscopy often reveals superficial areas of visible disease beyond what is seen on volumetric imaging. Quantitatively relating these findings to the volumetric imaging is prone to human error during the recall and contouring of the target. We have developed a method to improve target delineation in the radiation therapy planning process by quantitatively registering endoscopic findings contours traced on endoscopic images to volumetric imaging. Methods: Using electromagnetic sensors embedded in an endoscope, 2D endoscopic images were registered to computed tomography (CT) volumetric images by tracking the position and orientation of the endoscope relative to a CT image set. Regions-of-interest (ROI) in the 2D endoscopic view were delineated. A mesh created within the boundary of the ROI was projected onto the 3D image data, registering the ROI with the volumetric image. This 3D ROI was exported to clinical radiation treatment planning software. The precision and accuracy of the procedure was tested on two solid phantoms with superficial markings visible on both endoscopy and CT images. The first phantom was T-shaped tube with X-marks etched on the interior. The second phantom was an anatomically correct skull phantom with a phantom superficial lesion placed on the pharyngeal surface. Markings were contoured on the endoscope images and compared with contours delineated in the treatment planning system based on the CT images. Clinical feasibility was tested on three patients with early stage glottic cancer. Image-based rendering using manually identified landmarks was used to improve the registration. Results: Using the T-shaped phantom with X-markings, the 2D to 3D registration accuracy was 1.5-3.5 mm, depending on the endoscope position relative to the markings. Intraobserver standard variation was 0

Usefulness of abdominal ultrasonography in the analysis of endoscopic activity in patients with Crohn's disease: changes following treatment with immunomodulators and/or anti-TNF antibodies.

Science.gov (United States)

Moreno, Nadia; Ripollés, Tomás; Paredes, José María; Ortiz, Inmaculada; Martínez, María Jesús; López, Antonio; Delgado, Fructuoso; Moreno-Osset, Eduardo

2014-09-01

The objective of this study was to analyze the accuracy of abdominal ultrasonography (AUS) in the assessment of mucosal healing in patients with Crohn's disease (CD) receiving immunomodulators and/or biological treatment, with ileocolonoscopy as the reference standard. Thirty patients were included in a prospective longitudinal study. All patients underwent ileocolonoscopy and AUS before and after a minimum of one year of treatment. The Crohn's Disease Endoscopic Inflammatory Index of Severity (CDEIS) was used for endoscopic assessment whereas AUS was analyzed by means of bowel wall thickness, color Doppler grade and percentage of increase of parietal enhancement after contrast injection. In the segmental analysis, endoscopic healing was found in 71.2% of the segments and AUS findings were normalized in 62.8%, with a significant correlation between the two techniques (κ=0.76, pimmunomodulators and/or biological drugs in Crohn's disease. AUS is a highly accurate technique for evaluating the healing of the intestinal mucosa. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Wavefront-Guided and Wavefront-Optimised Laser Treatments

Directory of Open Access Journals (Sweden)

Canan Aslı Utine

2012-12-01

Full Text Available Optical aberrations of the eye are the errors of the optical system that limit the resolution, contrast and amount of detail in the image formed on the retina. Wavefront technology allows us to measure these optical aberrations, calculate mathematically, and transfer this information into excimer laser system to perform customized treatment on the cornea. Two treatment algorithms developed to create low aberration-corneal profile are wavefront-optimised (WF-O and wavefront-guided (WF-G treatments. WF-O treatment, aims not to increase the existing spherical aberration while treatment is based on manifest refractive error as in conventional laser treatments. By increasing the number of laser spots applied peripherally in order to optimize the corneal asphericity, the preoperative central:peripheral keratometry ratio is preserved and optic zone shrinkage is prevented. On the other hand, WF-G treatment is based on aberrometry measurements and aims to correct the existing high-order aberrations in the eye. Thus, retinal image with high spatial details can be achieved. However, presence of postoperative defocus can abolish the successful results obtained with WF-G treatment. Clinical randomized controlled trials showed that in patients with preoperative RMS value of <0.3 μm, higher order aberration outcomes are similar after WF-G and WF-O treatments, but WF-G treatment yields better results when it is ≥0.4 μm. In normal eyes, very limited visual advantage can be achieved with WF-G treatment and preservation of asphericity value with WF-O treatment carries greater importance. On the other hand, in case of high astigmatism or higher order aberrations other than spherical aberration, decreasing aberrations with WF-G treatment becomes more important. In this study, we aimed to make a comparative analysis of characteristics and outcomes of the two treatment algorithms. (Turk J Ophthalmol 2012; 42: 474-8

Bile fistula after penetrating hepatic trauma with expectant management in the "era" of endoscopic treatment: clinical report

OpenAIRE

Armenta-Duran, Eduardo; Enríquez-Domínguez, Lenin; Díaz-Rosales, Juan de Dios; Duarte-Erives, Ever

2013-01-01

Objective: to report a clinical case of bile fistula after penetrating hepatic trauma given its low incidence, which was expectant managed by not having endoscopic retrograde cholangiopancreatography. Clinical case: we present a 28 years-old man, with biliary fistula resulting after a penetrating hepatic trauma. Discussion: bile leakage is a major complication after liver surgery and a rare one in complication of major hepatic trauma. Conventional treatment has consisted of surgical intervent...

Endoscopic treatment of cerebrospinal fluid leaks with the use of lower turbinate grafts: a retrospective review of 125 cases.

Science.gov (United States)

Cassano, Michele; Felippu, Alexandre

2009-12-01

Endoscopic transnasal approaches to the skull base have revolutionized the treatment of cerebrospinal fluid (CSF) fistulae, making repair less invasive and more effective compared with craniotomy or extracranial techniques. This study evaluated, retrospectively, the results of endoscopic repair of dural defects with the use of mucoperiostal grafts taken from the lower turbinate. Between January 1997 and January 2007, 125 cases of anterior skull base CSF fistulae were treated endoscopically at the Instituto Felippu de Otorrinolaringologia, Sao Paolo, Brazil, and at the Department of Otolaryngology of the University Hospital "Ospedali Riuniti", Foggia, Italy. Fistula closure was achieved by overlay apposition of a lower turbinate mucoperiostal graft fixated with fibrin glue and Surgicell. The etiology of the fistula was accidental trauma in 41 cases, iatrogenic trauma in 29, skull base tumour in 12, and spontaneous in 43. The site of the defect was the sphenoid sinus in 43 patients, the cribriform plate in 42, the anterior ethmoid roof in 21, the posterior ethmoid roof in 17, and the posterior wall of the frontal sinus in 2. The success rate at first attempt was 94.4%; the 7 cases of postoperative recurrent CSF leakage involved patients presenting with spontaneous fistula and elevated intracranial pressure; 5 of these had a body-mass index > 30 and 3 suffered from diabetes mellitus. In our hands, the success rate of endoscopic fistula repair was high, even in defects larger than 2 cm. Success rates may be further improved with accurate diagnosis of elevated intracranial pressure, a contributing factor to failure of spontaneous fistula repair.

Induction heat treatment of laser welds

DEFF Research Database (Denmark)

Bagger, Claus; Olsen, Flemming Ove; Sørensen, Joakim Ilsing

2003-01-01

of an induction coil. A number of systematic laboratory tests were then performed in order to study the effects of the coil on bead-on-plate laser welded samples. In these tests, important parameters such as coil current and distance between coil and sample were varied. Temperature measurements were made...... the laser beam as close as possible. After welding, the samples were quality assessed according to ISO 13.919-1 and tested for hardness. The metallurgical phases are analysed and briefly described. A comparison between purely laser welded samples and induction heat-treated laser welded samples is made......In this paper, a new approach based on induction heat-treatment of flat laser welded sheets is presented. With this new concept, the ductility of high strength steels GA260 with a thickness of 1.8 mm and CMn with a thickness of 2.13 mm is believed to be improved by prolonging the cooling time from...

Comparison of pulsed dye laser versus combined pulsed dye laser and Nd:YAG laser in the treatment of inflammatory acne vulgaris.

Science.gov (United States)

Salah El Din, Manal Mohamed; Samy, Nevien Ahmed; Salem, Amira Eid

2017-06-01

Both pulsed dye laser and combined 585/1064-nm (sequential dual-wavelength PDL and Nd:YAG) laser improves inflammatory skin disorders including acne vulgaris. To compare the efficacy of 585-nm pulsed dye laser versus sequential dual-wavelength PDL and Nd:YAG in treatment of acne vulgaris. Thirty patients with acne vulgaris were treated by PDL alone on half of the face while contra lateral half was treated by combined 585/1064 nm laser. The study showed that inflammatory acne lesions count was significantly reduced by 82.5% (p 0.0001) on PDL sides and by 83.5% (p 0.00001) on combined 585/1064-nm side after 8 weeks, while reduction of non-inflammatory acne lesions was observed at 8 weeks by 58.4% and 71.5% respectively. However, difference between the two modalities was not statistically significant. PDL and combined PDL/Nd:YAG laser treatment were found to be an effective, safe and well-tolerated treatment option for inflammatory and non-inflammatory acne vulgaris.

Medium-Level Laser in Chronic Tinnitus Treatment

OpenAIRE

Dejakum, K.; Piegger, J.; Plewka, C.; Gunkel, A.; Thumfart, W.; Kudaibergenova, S.; Goebel, G.; Kral, F.; Freysinger, W.

2013-01-01

The purpose of this study was to evaluate the effect of medium-level laser therapy in chronic tinnitus treatment. In a prospective double-blind placebo-controlled trial, either active laser (450 mW, 830 nm combined Ga-Al-As diode laser) or placebo irradiation was applied through the external acoustic meatus of the affected ear towards the cochlea. Fourty-eight patients with chronic tinnitus were studied. The main outcome was measured using the Goebel tinnitus questionnaire, visual analogue sc...

[Prognostic factors for laser treatment in retinopathy of prematurity].

Science.gov (United States)

Talu, Simona; Cormos, Diana; Zaharia, Gabriela; Stefanut, Claudia; Popa, Monica; Lucaci, Daiana Ioana

2011-01-01

The paper aims to determine the anatomical results of the eyes treated by laser photocoagulation for "threshold" retinopathy of prematurity (ROP) and to identify the potential risk factors for the unfavorable outcomes. A retrospective study including all the consecutive ROPs that were treated by laser photocoagulation between January the 1st 2006 and September the 1st 2009 has been conducted. The followed criteria has been the anatomical result after the laser treatment. The outcomes have been correlated with: the gestational ages, the birth weights, the moment of treatment (postnatal and post-conceptional ages), the sex of the premature infants, the stage and zone of ROR. RESULTS The total number of prematurely newborns that met the screening criteria for ROP in the above-mentioned period has been 474. Of these, 350 (74%) presented no ROP and the remaining 124 (26%) developed various stages of the disease. Within the ROP group, 54 patients required laser therapy (44% of the retinopathies, representing 11% of all the prematures). The anatomical outcome has been favorable in 84% of the treated eyes, the remaining 16% presenting the progression of ROP The results of the treatment depended on the type of ROP, being significantly better in the classic disease as in the agressive posterior disease (APD) (p < 0.05). The gender also influenced the outcome: the results were better in girls as compared with boys (p < 0.05). The precocity of the laser treatment (evaluated by the postnatal and postconceptional age) has positively influenced the ROP evolution (p < 0.05). Laser photocoagulation has proved its efficacy in the treatment of ROP on our cases. The factors that have negatively influenced the postlaser outcome were: the aggressive posterior disease, the delayed moment of the laser therapy and the male gender.

Pulsed photothermal depth profiling of tattoos undergoing laser removal treatment

Science.gov (United States)

Milanic, Matija; Majaron, Boris

2012-02-01

Pulsed photothermal radiometry (PPTR) allows noninvasive determination of temperature depth profiles induced by pulsed laser irradiation of strongly scattering biological tissues and organs, including human skin. In present study, we evaluate the potential of this technique for investigational characterization and possibly quantitative evaluation of laser tattoo removal. The study involved 5 healthy volunteers (3 males, 2 females), age 20-30 years, undergoing tattoo removal treatment using a Q-switched Nd:YAG laser. There were four measurement and treatment sessions in total, separated by 2-3 months. Prior to each treatment, PPTR measurements were performed on several tattoo sites and one nearby healthy site in each patient, using a 5 ms Nd:YAG laser at low radiant exposure values and a dedicated radiometric setup. The laser-induced temperature profiles were then reconstructed by applying a custom numerical code. In addition, each tatoo site was documented with a digital camera and measured with a custom colorimetric system (in tristimulus color space), providing an objective evaluation of the therapeutic efficacy to be correlated with our PPTR results. The results show that the laser-induced temperature profile in untreated tattoos is invariably located at a subsurface depth of 300 μm. In tattoo sites that responded well to laser therapy, a significant drop of the temperature peak was observed in the profiles obtained from PPTR record. In several sites that appeared less responsive, as evidenced by colorimetric data, a progressive shift of the temperature profile deeper into the dermis was observed over the course of consecutive laser treatments, indicating that the laser tattoo removal was efficient.

Pulsed dye laser treatment of rosacea using a novel 15 mm diameter treatment beam.

Science.gov (United States)

Bernstein, Eric F; Schomacker, Kevin; Paranjape, Amit; Jones, Christopher J

2018-04-10

The pulsed-dye laser has been used to treat facial redness and rosacea for decades. Recent advances in dye laser technology enable 50% higher output energies supporting 50% larger treatment areas, and beam-diameters up to 15 mm with clinically-relevant fluences. In this study, we investigate this novel pulsed-dye laser using a 15 mm diameter beam for treatment of rosacea. Twenty subjects with erythemato-telangiectatic rosacea were enrolled in the study. A total of 4 monthly treatments were administered, first treating linear vessels with a 3 × 10 mm elliptical beam, then diffuse redness with a 15-mm diameter circular beam. Blinded assessment of digital, cross-polarized photographs taken 2 months following the last treatment was performed using an 11-point clearance scale. Nineteen subjects completed the study. Blinded reviewers correctly identified baseline photos in 55 out of the total of 57 images (96.5%). The blinded reviewers scored 17 of the 19 subjects with an improvement greater than 40%, and 11 of the 19 subjects greater than 50%. The average improvement was 53.9%. Side effects were limited to mild edema, mild to moderate erythema, and mild to moderate bruising. This study demonstrates that a newly designed pulsed-dye laser having a novel 15-mm diameter treatment beam improves the appearance of rosacea with a favorable safety profile. Lasers Surg. Med. 9999:1-5, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Endobronchial Valves for Endoscopic Lung Volume Reduction : Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction

NARCIS (Netherlands)

Slebos, Dirk-Jan; Shah, Pallav L.; Herth, Felix J. F.; Valipour, Arschang

Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in

The learning curve, interobserver, and intraobserver agreement of endoscopic confocal laser endomicroscopy in the assessment of mucosal barrier defects.

Science.gov (United States)

Chang, Jeff; Ip, Matthew; Yang, Michael; Wong, Brendon; Power, Theresa; Lin, Lisa; Xuan, Wei; Phan, Tri Giang; Leong, Rupert W

2016-04-01

Confocal laser endomicroscopy can dynamically assess intestinal mucosal barrier defects and increased intestinal permeability (IP). These are functional features that do not have corresponding appearance on histopathology. As such, previous pathology training may not be beneficial in learning these dynamic features. This study aims to evaluate the diagnostic accuracy, learning curve, inter- and intraobserver agreement for identifying features of increased IP in experienced and inexperienced analysts and pathologists. A total of 180 endoscopic confocal laser endomicroscopy (Pentax EC-3870FK; Pentax, Tokyo, Japan) images of the terminal ileum, subdivided into 6 sets of 30 were evaluated by 6 experienced analysts, 13 inexperienced analysts, and 2 pathologists, after a 30-minute teaching session. Cell-junction enhancement, fluorescein leak, and cell dropout were used to represent increased IP and were either present or absent in each image. For each image, the diagnostic accuracy, confidence, and quality were assessed. Diagnostic accuracy was significantly higher for experienced analysts compared with inexperienced analysts from the first set (96.7% vs 83.1%, P 0.86 for experienced observers. Features representative of increased IP can be rapidly learned with high inter- and intraobserver agreement. Confidence and image quality were significant predictors of accurate interpretation. Previous pathology training did not have an effect on learning. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Endoscopic sleeve gastroplasty: the learning curve.

Science.gov (United States)

Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

2017-09-01

 Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

Science.gov (United States)

Thulasidas, Ponnaiah; Vaidyanathan, Venkatraman

2014-01-01

Introduction Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist. Objectives To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients. Methods A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations. Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences. Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis. PMID:25992084

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

Directory of Open Access Journals (Sweden)

Thulasidas, Ponnaiah

2014-02-01

Full Text Available Introduction Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist. Objectives To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients. Methods A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations. Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences. Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis.

Posterior Endoscopic Excision of Os Trigonum in Professional National Ballet Dancers.

Science.gov (United States)

Ballal, Moez S; Roche, Andy; Brodrick, Anna; Williams, R Lloyd; Calder, James D F

2016-01-01

Previous studies have compared the outcomes after open and endoscopic excision of an os trigonum in patients of mixed professions. No studies have compared the differences in outcomes between the 2 procedures in elite ballet dancers. From October 2005 to February 2010, 35 professional ballet dancers underwent excision of a symptomatic os trigonum of the ankle after a failed period of nonoperative treatment. Of the 35 patients, 13 (37.1%) underwent endoscopic excision and 22 (62.9%) open excision. We compared the outcomes, complications, and time to return to dancing. The open excision group experienced a significantly greater incidence of flexor hallucis longus tendon decompression compared with the endoscopic group. The endoscopic release group returned to full dance earlier at a mean of 9.8 (range 6.5 to 16.1) weeks and those undergoing open excision returned to full dance at a mean of 14.9 (range 9 to 20) weeks (p = .001). No major complications developed in either group, such as deep infection or nerve or vessel injury. We have concluded that both techniques are safe and effective in the treatment of symptomatic os trigonum in professional ballet dancers. Endoscopic excision of the os trigonum offers a more rapid return to full dance compared with open excision. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Institute of Scientific and Technical Information of China (English)

Kazuto Kishimoto; Akira Hokama; Tetsuo Hirata; Yasushi Ihama; Manabu Nakamoto; Nagisa Kinjo; Fukunori Kinjo; Jiro Fujita

2008-01-01

AIM: To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (5. stercoralis) hyperinfection.METHODS: Over a period of 23 years (1984-2006), we investigated 25 patients with 5. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively.RESULTS: Twenty-four (96%) of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 ± 2.47 vs 2.71 ± 1.38, P ＜ 0.05).CONCLUSION: Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that 5. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

Endoscopic placement of double-J ureteric stents in children as a treatment for primary hydronephrosis.

Science.gov (United States)

Pogorelić, Zenon; Brković, Tomislava; Budimir, Dražen; Todorić, Jakov; Košuljandić, Đurđica; Jerončić, Ana; Biočić, Mihovil; Saraga, Marijan

2017-06-01

The aim of this study was to determine the efficacy and potential complications of double-J ureteric stents in the treatment of primary hydronephrosis in pediatric patients. A retrospective case-records review of 133 patients (45 girls and 88 boys) treated because of primary hydronephrosis with double-J ureteric stents, in Department of Pediatric Surgery, Split University Hospital, between December 1997 and December 2014, was performed. Success of treatment, results of follow up investigations and complications were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. In all, 133 endoscopic double-J ureteric stents insertions were performed. Of the total number of patients, left-sided hydronephrosis was found in 82 patients, right-sided in 38, and bilateral in 13 patients. The median age of children was 2 years (range 0-17 years). Mean hospital stay was 2 days (range 1-10 days). In primary hydronephrosis, double-J ureteric stenting alone was effective with resolution of hydronephrosis in 73% of cases (97/133 insertions). Regarding the age of the patients the highest success of 83.5% was achieved in age group 0-4 years. Success in groups 5-9 years; 10-14 years and 15-17 years were 47%; 33.5% and 0%, respectively. Several complications have been recorded: symptomatic infections, migration in the renal pelvis and bladder, progression of hydronephrosis, spontaneously prolapse of prosthesis, bleeding and perforation of the renal pelvis. A significant, decreasing trend in success rates by age of participants was observed (p hydronephrosis. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of primary hydronephrosis especially in children till 4 years of age, with success rate of 83.5% and without the need for conventional surgery. In a case of failure we are time-consuming to definitive surgery.

Endoscopic submucosal dissection

DEFF Research Database (Denmark)

Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry

2015-01-01

evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may...... RECOMMENDATIONS: 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when...

A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation.

Science.gov (United States)

Simşek Kaya, Göksel; Yapici Yavuz, Günay; Sümbüllü, Muhammed A; Dayi, Ertunç

2012-03-01

This study compared the use of diode and Er:YAG lasers in treating gingival melanin pigmentation (GMP) in terms of gingival depigmentation, local anesthesia requirements, postoperative pain/discomfort, depigmentation effectiveness, and total treatment duration. Twenty patients (13 female, 7 male) referred with GMP were enrolled in the study. Patients were randomly divided into 2 groups. Group 1 was treated with a gallium aluminum arsenide diode laser with a continuous wavelength of 808 nm, and group 2 was treated with an Er:YAG laser with a continuous wavelength of 2,940 nm. Gingival depigmentation was performed by applying the laser at 1 W. Treatment was administered on a weekly basis until a normal pink gingival color was observable in clinical examination and photographs. In addition, patients were asked to evaluate the procedure by using a self-administered questionnaire. Procedures were carried out without the need for any topical or local anesthetic, and no unpleasant events occurred during the actual procedure or the healing period. The total length of treatment was significantly shorter with the diode laser (group 1) than with the Er:YAG laser (group 2; P Diode and Er:YAG lasers administered at 1 W both result in satisfactory depigmentation of GMP. Copyright © 2012 Elsevier Inc. All rights reserved.

Treatment of alopecia areata with the 308-nm xenon chloride excimer laser: case report of two successful treatments with the excimer laser.

Science.gov (United States)

Gundogan, Cuneyt; Greve, Bärbel; Raulin, Christian

2004-01-01

Alopecia areata is a common disease of unknown etiology; it causes significant cosmetic and psycho-social distress for most of the people it affects. We report on an innovative form of treatment in two patients with typical alopecia areata on the capillitium. We successfully treated two patients whose alopecia areata had worsened progressively for 3 and 14 weeks. The treatment involved the use of a 308 nm xenon chloride excimer laser (dosage 300-2,300 mJ/cm(2) per session). After 11 and 12 sessions within a 9-week and 11-week period, the entire affected focus showed homogenous and thick regrowth. No relapse was observed during the follow-up period of 5 and 18 months. The use of the excimer laser is an effective, elegant, and safe means of treatment and has good tolerability. Analogous to topical treatment of alopecia areata, the immunosuppressive mechanism of the excimer laser can be interpreted as an induction of T-cell apoptosis. This new means of treatment has yet to be discussed in medical literature. Further studies with greater numbers are needed to assess its potential more precisely and evaluate the excimer laser in treating alopecia areata. Copyright 2004 Wiley-Liss, Inc.

Novel strategy for prevention of esophageal stricture after endoscopic surgery.

Science.gov (United States)

Mizutani, Taro; Tadauchi, Akimitsu; Arinobe, Manabu; Narita, Yuji; Kato, Ryuji; Niwa, Yasumasa; Ohmiya, Naoki; Itoh, Akihiro; Hirooka, Yoshiki; Honda, Hiroyuki; Ueda, Minoru; Goto, Hidemi

2010-01-01

Recently, novel endoscopic surgery, including endoscopic submucosal dissection (ESD), was developed to resect a large superficial gastrointestinal cancer. However, circumferential endoscopic surgery in the esophagus can lead to esophageal stricture that affects the patient's quality of life. This major complication is caused by scar formation, and develops during the two weeks after endoscopic surgery. We hypothesized that local administration of a controlled release anti-scarring agent can prevent esophageal stricture after endoscopic surgery. The aims of this study were to develop an endoscopically injectable anti-scarring drug delivery system, and to verify the efficacy of our strategy to prevent esophageal stricture. We focused on 5-Fluorouracil (5-FU) as an anti-scarring agent, which has already been shown to be effective not only for treatment of cancers, but also for treatment of hypertrophic skin scars. 5-FU was encapsulated by liposome, and then mixed with injectable 2% atelocollagen (5FLC: 5FU-liposome-collagen) to achieve sustained release. An in vitro 5-FU releasing test from 5FLC was performed using high-performance liquid chromatography (HPLC). Inhibition of cell proliferation was investigated using normal human dermal fibroblast cells (NHDF) with 5FLC. In addition, a canine esophageal mucosal resection was carried out, and 5FLC was endoscopically injected into the ulcer immediately after the operation, and compared with a similar specimen injected with saline as a control. 5-FU was gradually released from 5FLC for more than 2 weeks in vitro. The solution of 5-FU released from 5FLC inhibited NHDF proliferation more effectively than 5-FU alone. In the canine model, no findings of stricture were observed in the 5FLC-treated dog at 4 weeks after the operation and no vomiting occurred. In contrast, marked esophageal strictures were observed with repeated vomiting in the control group. Submucosal fibrosis was markedly reduced histologically in the 5FLC

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study

Directory of Open Access Journals (Sweden)

Geldof Han

2009-03-01

Full Text Available Abstract 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 expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications. The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Methods/design Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma ≥ 3 cm, located between 1–15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2 number of days not spent in hospital from initial treatment until 2 years afterwards; 3 major and minor morbidity; 4 disease specific and general quality of life; 5 anorectal function; 6 health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR

Endoscopic techniques for diagnosis and correction of complications after retroperitoneal pancreas transplantation

Directory of Open Access Journals (Sweden)

A. V. Pinchuk

2016-01-01

Full Text Available Relevance. Timely diagnosis and treatment of postoperative complications after pancreas transplantation is an actual problem of modern clinical transplantation. Purpose. The assessment of the endoscopy potential for the diagnosis and correction of postoperative complications after pancreas transplantation. Materials and methods. Since October 2011, simultaneous retroperitoneal pancreas-kidney transplantation has been performed in 27 patients. In 8 cases, the use of endoscopic techniques allowed a timely identification and treatment of the complications occurred. Conclusions. Endoscopic techniques proved to be highly efficient in the diagnosis and treatment of surgical complications and immunological impairments after retroperitoneal pancreas transplantation. 

Fractional CO2 laser treatment for vaginal laxity: A preclinical study.

Science.gov (United States)

Kwon, Tae-Rin; Kim, Jong Hwan; Seok, Joon; Kim, Jae Min; Bak, Dong-Ho; Choi, Mi-Ji; Mun, Seok Kyun; Kim, Chan Woong; Ahn, Seungwon; Kim, Beom Joon

2018-05-07

Various studies have investigated treatment for vaginal laxity with microablative fractional carbon dioxide CO 2 laser in humans; however, this treatment has not yet been studied in an animal model. Herein, we evaluate the therapeutic effects of fractional CO 2 laser for tissue remodeling of vaginal mucosa using a porcine model, with the aim of improving vaginal laxity. The fractional CO 2 laser enables minimally invasive and non-incisional procedures. By precisely controlling the laser energy pulses, energy is sent to the vaginal canal and the introitus area to induce thermal denaturation and contraction of collagen. We examined the effects of fractional CO 2 laser on a porcine model via clinical observation and ultrasound measurement. Also, thermal lesions were histologically examined via hematoxylin-eosin staining, Masson's trichrome staining, and Elastica van Gieson staining and immunohistochemistry. The three treatment groups, which were determined according to the amount of laser-energy applied (60, 90, and 120 mJ), showed slight thermal denaturation in the vaginal mucosa, but no abnormal reactions, such as excessive hemorrhaging, vesicles, or erythema, were observed. Histologically, we also confirmed that the denatured lamina propria induced by fractional CO 2 laser was dose-dependently increased after laser treatment. The treatment groups also showed an increase in collagen and elastic fibers due to neocollagenesis and angiogenesis, and the vaginal walls became firmer and tighter because of increased capillary and vessel formation. Also, use of the fractional CO 2 laser increased HSP (heat shock protein) 70 and collagen type I synthesis. Our results show that microablative fractional CO 2 laser can produce remodeling of the vaginal connective tissue without causing damage to surrounding tissue, and the process of mucosa remodeling while under wound dressings enables collagen to increase and the vaginal wall to become thick and tightened. Lasers Surg. Med

Treatments of the oral leukoplakia by laser

Science.gov (United States)

Capocci, M.; Mohsen, M.; Lo Giudice, R.; Del Vecchio, A.; Gaimari, G.; Tribolati, L.; Palaia, G.; Romeo, U.

2016-03-01

Oral leukoplakia is catalogued under the group of "potentially malignant disorders". In daily practice, the World Health Organization definition "white patch or plaque that cannot be characterized clinically or histologically as any other disease" is completed by including the observation that it cannot be removed by simple scraping, thereby distinguishing it from pseudo-membranous candidiasis. The aim of this study is to find a definitive treatment of oral leukoplakia, because of its recurrence and its potentiality to the malignant transformation. There are currently different approaches to oral leukoplakia: scalpel surgery, systemic therapy (carotenoids, vitamins, etc.), electro-cauterization, cryotherapy and the use of the laser. In every lesion, biopsy and histological analysis has been performed to identify the stage and classification of the oral leukoplakia. Laser can be used for the complete excision of the lesion (which is more effective, but also more invasive), for the photodynamic therapy (non-invasive procedure, which requires several applications) or for the vaporization of the lesion (very precise treatment and relatively easy to perform). Laser treatments have shown better healing, less soft tissues retraction and less post-operative pain, comparing with traditional surgery. The use of systemic therapies and smoking habit interruption (where present) has been also useful to reduce the lesions before the clinical treatments. The treatment has always to be supported by histological analysis to identify the risk and consequently planning the clinical approach.

endoscope-i: an innovation in mobile endoscopic technology transforming the delivery of patient care in otolaryngology.

Science.gov (United States)

Mistry, N; Coulson, C; George, A

2017-11-01

Digital and mobile device technology in healthcare is a growing market. The introduction of the endoscope-i, the world's first endoscopic mobile imaging system, allows the acquisition of high definition images of the ear, nose and throat (ENT). The system combines the e-i Pro camera app with a bespoke engineered endoscope-i adaptor which fits securely onto the iPhone or iPod touch. Endoscopic examination forms a salient aspect of the ENT work-up. The endoscope-i therefore provides a mobile and compact alternative to the existing bulky endoscopic systems currently in use which often restrict the clinician to the clinic setting. Areas covered: This article gives a detailed overview of the endoscope-i system together with its applications. A review and comparison of alternative devices on the market offering smartphone adapted endoscopic viewing systems is also presented. Expert commentary: The endoscope-i fulfils unmet needs by providing a compact, highly portable, simple to use endoscopic viewing system which is cost-effective and which makes use of smartphone technology most clinicians have in their pocket. The system allows real-time feedback to the patient and has the potential to transform the way that healthcare is delivered in ENT as well as having applications further afield.

Establishment of a biophysical model to optimize endoscopic targeting of magnetic nanoparticles for cancer treatment.

Science.gov (United States)

Roeth, Anjali A; Slabu, Ioana; Baumann, Martin; Alizai, Patrick H; Schmeding, Maximilian; Guentherodt, Gernot; Schmitz-Rode, Thomas; Neumann, Ulf P

2017-01-01

Superparamagnetic iron oxide nanoparticles (SPION) may be used for local tumor treatment by coupling them to a drug and accumulating them locally with magnetic field traps, that is, a combination of permanent magnets and coils. Thereafter, an alternating magnetic field generates heat which may be used to release the thermosensitively bound drug and for hyperthermia. Until today, only superficial tumors can be treated with this method. Our aim was to transfer this method into an endoscopic setting to also reach the majority of tumors located inside the body. To find the ideal endoscopic magnetic field trap, which accumulates the most SPION, we first developed a biophysical model considering anatomical as well as physical conditions. Entities of choice were esophageal and prostate cancer. The magnetic susceptibilities of different porcine and rat tissues were measured with a superconducting quantum interference device. All tissues showed diamagnetic behavior. The evaluation of clinical data (computed tomography scan, endosonography, surgical reports, pathological evaluation) of patients gave insight into the topographical relationship between the tumor and its surroundings. Both were used to establish the biophysical model of the tumors and their surroundings, closely mirroring the clinical situation, in which we could virtually design, place and evaluate different electromagnetic coil configurations to find optimized magnetic field traps for each tumor entity. By simulation, we could show that the efficiency of the magnetic field traps can be enhanced by 38-fold for prostate and 8-fold for esophageal cancer. Therefore, our approach of endoscopic targeting is an improvement of the magnetic drug-targeting setups for SPION tumor therapy as it holds the possibility of reaching tumors inside the body in a minimal-invasive way. Future animal experiments must prove these findings in vivo.

Fully endoscopic resection of juvenile nasopharyngeal angiofibroma - own experience and clinical outcomes.

Science.gov (United States)

Kopeć, Tomasz; Borucki, Łukasz; Szyfter, Witold

2014-07-01

The treatment of choice in juvenile nasopharyngeal angiofibroma (JNA) is surgery - nowadays endoscopic techniques. The aim of the study was to present the results of endoscopic treatment in patients diagnosed with juvenile angiofibroma. In this retrospective case series, 10 patients with a diagnosis of JNA treated at the Department of Otolaryngology of the Medical University in Poznań from 2006 to June 2013 were included. The age of patients were between 11 and 19 years old (14.6 on average). In 9 out of 10 patients the treatment was preceded by embolization. The surgery used the endoscopic approach through one nostril and the four-handed technique. Total resection was possible in all cases. Blood loss ranged from 100 to 250 ml. Post-operative hospitalization lasted from 3 to 5 days (3.3 days on average). Recurrence was reported in one patient. The observation lasted from six months to seven years (3.55 on average). Endoscopic resection of juvenile angiofibroma is safe for the patient. Moreover, if the evaluation of the tumour size and staging is correct, the ability of total removal of the tumour is very high. It is also connected with small blood loss, short hospital stay and good cosmetic effects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Acute asthma attacks introduced by anesthesia before nasal endoscopic surgery].

Science.gov (United States)

Lü, Xiaofei; Han, Demin; Zhou, Bing; Ding, Bin

2004-05-01

In order to pay our attention to the perioperative treatment before nasal endoscopic surgery. Three patients with asthma accompanied chronic sinusitis were analyzed systemically, who had undergone acute attacks of asthma introduced by anesthesia. Anesthetic drugs and instruments can lead to acute attacks of asthma, because sinusitis with asthma means allergic airway inflammation, broncho-hyperreactivity and lower compensatory pulmonary function. Then all of the 3 cases had missed the preoperative treatment. Anesthetic drugs and instruments can lead to acute attacks of asthma. The perioperative treatment before nasal endoscopic surgery is very important for the prevention of the occurrences of this severe complication. Except emergency, the operation should be can celled for avoiding the acute attack of asthma introduced by anesthesia.

Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study.

Science.gov (United States)

Weber, Andreas; Schneider, Jochen; Neu, Bruno; Meining, Alexander; Born, Peter; von Delius, Stefan; Bajbouj, Monther; Schmid, Roland M; Algül, Hana; Prinz, Christian

2013-02-07

This study analyzed clinical long-term outcomes after endoscopic therapy, including the incidence and treatment of relapse. This study included 19 consecutive patients (12 male, 7 female, median age 54 years) with obstructive chronic pancreatitis who were admitted to the 2(nd) Medical Department of the Technical University of Munich. All patients presented severe chronic pancreatitis (stage III°) according to the Cambridge classification. The majority of the patients suffered intermittent pain attacks. 6 of 19 patients had strictures of the pancreatic duct; 13 of 19 patients had strictures and stones. The first endoscopic retrograde pancreatography (ERP) included an endoscopic sphincterotomy, dilatation of the pancreatic duct, and stent placement. The first control ERP was performed 4 wk after the initial intervention, and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological conditions. Clinical follow-up was performed annually to document the course of pain and the management of relapse. The course of pain was assessed by a pain scale from 0 to 10. The date and choice of the therapeutic procedure were documented in case of relapse. Initial endoscopic intervention was successfully completed in 17 of 19 patients. All 17 patients reported partial or complete pain relief after endoscopic intervention. Endoscopic therapy failed in 2 patients. Both patients were excluded from further analysis. One failed patient underwent surgery, and the other patient was treated conservatively with pain medication. Seventeen of 19 patients were followed after the successful completion of endoscopic stent therapy. Three of 17 patients were lost to follow-up. One patient was not available for interviews after the 1(st) year of follow-up. Two patients died during the 3(rd) year of follow-up. In both patients chronic pancreatitis was excluded as the cause of death. One patient died of myocardial infarction, and one patient succumbed to

The feasibility of endoscopy-CT image registration in the head and neck without prospective endoscope tracking.

Directory of Open Access Journals (Sweden)

W Scott Ingram

Full Text Available Endoscopic examinations are frequently-used procedures for patients with head and neck cancer undergoing radiotherapy, but radiation treatment plans are created on computed tomography (CT scans. Image registration between endoscopic video and CT could be used to improve treatment planning and analysis of radiation-related normal tissue toxicity. The purpose of this study was to explore the feasibility of endoscopy-CT image registration without prospective physical tracking of the endoscope during the examination.A novel registration technique called Location Search was developed. This technique uses physical constraints on the endoscope's view direction to search for the virtual endoscope coordinates that maximize the similarity between the endoscopic video frame and the virtual endoscopic image. Its performance was tested on phantom and patient images and compared to an established registration technique, Frame-To-Frame Tracking.In phantoms, Location Search had average registration errors of 0.55 ± 0.60 cm for point measurements and 0.29 ± 0.15 cm for object surface measurements. Frame-To-Frame Tracking achieved similar results on some frames, but it failed on others due to the virtual endoscope becoming lost. This weakness was more pronounced in patients, where Frame-To-Frame tracking could not make it through the nasal cavity. On successful patient video frames, Location Search was able to find endoscope positions with an average distance of 0.98 ± 0.53 cm away from the ground truth positions. However, it failed on many frames due to false similarity matches caused by anatomical structural differences between the endoscopic video and the virtual endoscopic images.Endoscopy-CT image registration without prospective physical tracking of the endoscope is possible, but more development is required to achieve an accuracy suitable for clinical translation.

Test results of the experimental laser device for potato tubers radiation treatment

International Nuclear Information System (INIS)

Anufrik, S.S.; Korzun, O.S.

2007-01-01

Results of 3 year investigation of the influence of the presowing low intensity laser radiation treatment of potato (Solanum tuberosum L.) tubers with the help of laser device with various spectral composition and exposition on plant growth, development and productivity and potato tubers quality and starch content in the conditions of the Republic of Belarus were presented. Presowing tubers treatment of potato cultivars Sante, Yavar and Arkhideya was realized by He-Ne, Ar-, Cu (in course of 3 and 5 minutes) and CO2 (in course of 5 seconds) lasers. Research results have shown that presowing treatment with CO2 laser promoted the higher (on 1,7-6,6%) potato germination capacity in comparison with the control variant without radiation treatment. Height of potato plants of Sante variety after radiation treatment fell behind the control ones. Haulm quantity per one plant and yield quality did not depend on radiation treatment Treatment with CO2 laser exercised the stimulatory action on productivity of Sante variety without changing the starch content in tubers. Tuber weight increased up to 0,4 kg (0,2 kg in the control variant). Similar effect for Arkhideya and Yavar varieties was obtained after Cu-laser treatment in course of 5 minutes. Radiation treatment with He-Ne laser caused the increased starch accumulation (on 0,4-0,6% in comparison with the control variant) in potato tubers of all studied varieties

Upper gastrointestinal endoscopic findings and prevalence of ...

African Journals Online (AJOL)

Upper gastrointestinal endoscopic findings and prevalence of Helicobacter pylori infection among adult patients with dyspepsia in northern Tanzania. ... Endoscopy (EGD) for initial work up. Study on antimicrobial susceptibility pattern of H. pylori is recommended to guide choices for evidence based treatment option.

Endoscopic management of bile leaks after laparoscopic ...

African Journals Online (AJOL)

2013-11-04

Nov 4, 2013 ... operative treatment is necessary, repair by a surgeon with expertise in biliary ... vascular injuries or other endoscopic findings requiring surgical or radiological intervention. Of 84 patients ..... necrosis and unrecognised distal CD injury. ... placement of multiple simultaneous stents, an alternative option.

Single center experience with endoscopic subureteral dextranomer/hyaluronic acid injection as first line treatment in 1,551 children with intermediate and high grade vesicoureteral reflux.

Science.gov (United States)

Puri, Prem; Kutasy, Balazs; Colhoun, Eric; Hunziker, Manuela

2012-10-01

In recent years the endoscopic injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis and the surgical management of vesicoureteral reflux. We determined the safety and effectiveness of the endoscopic injection of dextranomer/hyaluronic acid as first line treatment for high grade vesicoureteral reflux. Between 2001 and 2010, 1,551 children (496 male, 1,055 female, median age 1.6 years) underwent endoscopic correction of intermediate and high grade vesicoureteral reflux using dextranomer/hyaluronic acid soon after the diagnosis of vesicoureteral reflux on initial voiding cystourethrogram. Vesicoureteral reflux was unilateral in 761 children and bilateral in 790. Renal scarring was detected in 369 (26.7%) of the 1,384 patients who underwent dimercapto-succinic acid imaging. Reflux grade in the 2,341 ureters was II in 98 (4.2%), III in 1,340 (57.3%), IV in 818 (34.9%) and V in 85 (3.6%). Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure, and renal ultrasound was performed annually thereafter. Patients were followed for 3 months to 10 years (median 5.6 years). Vesicoureteral reflux resolved after the first, second and third endoscopic injection of dextranomer/hyaluronic acid in 2,039 (87.1%), 264 (11.3%) and 38 (1.6%) ureters, respectively. Febrile urinary tract infections developed during followup in 69 (4.6%) patients. None of the patients in the series needed reimplantation of ureters or experienced any significant complications. Our results confirm the safety and efficacy of the endoscopic injection of dextranomer/hyaluronic acid in the eradication of high grade vesicoureteral reflux. We recommend this 15-minute outpatient procedure as the first line of treatment for high grade vesicoureteral reflux. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Foot-controlled robotic-enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study.

Science.gov (United States)

Chan, Jason Y K; Leung, Iris; Navarro-Alarcon, David; Lin, Weiyang; Li, Peng; Lee, Dennis L Y; Liu, Yun-hui; Tong, Michael C F

2016-03-01

To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. Cadaveric study. Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. NA. Laryngoscope, 126:566-569, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Endoscopic management of posterior epistaxis.

Science.gov (United States)

Paul, J; Kanotra, Sohit Paul; Kanotra, Sonika

2011-04-01

The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26-50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of the bleeding vessel. Of these, in four cases unsuspected diagnosis was made. Of the remaining 19, in three patients, the bleeding point could not be localized accurately and these patients were managed by anteroposterior packing. The rest of the 16 patients were managed by endoscopic cauterization. In four patients, there was recurrence of bleeding within 24 h. In one of these, cauterization controlled the bleeding while in the rest nasal packing had to be resorted to. Thus, of the 23 patients of posterior epistaxis subjected to nasal endoscopy, we could avoid nasal packing in 17 (74%). To conclude, endoscopic nasal cauterization is recommended as the first line to treatment in all cases of posterior epistaxis. This will not only prevent the uncomfortable and potentially dangerous nasal packing but also help in finding the underlying pathology.