Management of Esophageal Perforations after Therapeutic Upper Gastrointestinal Endoscopy

Esophageal perforation is one of the most dreaded complications in therapeutic gastrointestinal endoscopy. We assessed the frequency of esophageal perforation after endoscopic procedures in a highly specialized endoscopy unit and compared clinical outcomes in patients undergoing either surgical or conservative management.From January 1985 to June 1996, 1011 instrumental endoscopic procedures (dilatation and bougienage) were performed in our department. The computerized complication database was searched to identify all patients with esophageal perforation during this same period, and their records were reviewed.Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedur…

Pancreatic Endoscopic Sphincterotomy in Patients with Chronic Pancreatitis: A Single-Center Experience in 171 Consecutive Patients

Background and Study Aims: In recent years, interest in endoscopic therapy techniques for pancreatic diseases has been constantly increasing. The aim of the present study was to assess the technical success, technique, and complications of endoscopic pancreatic sphincterotomy (EPS) in patients with chronic pancreatitis. Patients and Methods: A total of 171 patients with chronic pancreatitis and abdominal complaints were identified in whom at least one attempt at EPS was carried out. During the procedure, sphincterotomy was carried out using a guide-wire sphincterotome or a needle-knife papillotome. Patients were followed up after EPS for at least 24 h, including clinical symptoms and labora…

Lasso Technique for Retrieval of a Dislocated and Impacted Esophageal Stent

Endoluminal therapy of GERD with a new endoscopic suturing device

Background Endoscopic, endoluminal therapy might be an alternative treatment option in light of the costs of proton pump inhibitor therapy and possible complications after laparoscopic surgery. The aim of the current study was to assess the efficacy and the safety of a new endoluminal suture device (ESD) in pig models and humans. Secondly, 3 and 6 months' follow-ups were performed, and possible complications and their management were evaluated. Methods In the preclinical phase of the study, suturing procedures were practiced and evaluated in 8 pig models (Erlanger Endo Trainer). In the clinical phase, 20 patients with mild esophagitis, small or no hiatal hernia, and signs of abnormal acid e…

Long-term follow-up of patients with iron deficiency anemia after a close endoscopic examination of the upper and lower gastrointestinal tract.

Background In patients with Iron Deficiency Anemia (IDA) occult gastrointestinal bleeding is generally investigated by bidirectional endoscopy. The aim of our study was to examine the long-term follow-up of patients with IDA where the sources of bleeding couldn't be detected despite close endoscopic and radiologic examination of the GI tract. Methods Based on the endoscopic data base we examined consecutive patients who were referred for gastrointestinal endoscopy due to IDA with a negative endoscopic (upper GI endoscopy and colonoscopy) evaluation. Further diagnostic work up (repeated endoscopy of the upper and lower GI tract by an experienced investigator, small bowel enteroclysis, push e…

Fragmentation of bile duct stones: a prospective systematic in vitro evaluation of argon plasma coagulation, cryotechnology, and water-jet technology

Background and study aim Choledocholithiasis is a common disease in the West. Lithotripsy by mechanical methods using baskets and by laser or electrohydraulic methods varies in effectiveness. With argon plasma coagulation (APC), high temperatures are used for devitalization and fragmentation; cryogenic techniques use the selective controlled application of freeze-thaw cycles to devitalize pathological tissue; and the dissecting water jet exploits the high pressure action of a thin laminar jet. We aimed to assess the feasibility and effectiveness of APC, cryotechnology, and the dissecting water jet as options for the fragmentation of bile duct stones. Methods In an in vitro feasibility study…

Helicobacter pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis: a prospective single-center trial.

Background and study aims Eradication of Helicobacter pylori infection can reduce the rebleeding rate of peptic ulcer bleeding in the long term. There are few data on the influence of H. pylori on the rebleeding rate in the acute phase of bleeding however. We therefore prospectively investigated the influence of H. pylori infection on the early rebleeding rate in patients who had undergone successful endoscopic hemostasis treatment for peptic ulcer bleeding. Patients and methods Between January 1996 and November 2000 all patients with peptic ulcer bleeding were evaluated consecutively. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease tes…

Endometriose des Colon transversum

HISTORY A 65-year-old woman with no complaints came to our hospital for a colonoscopy because of a family history of a colorectal carcinoma. Because of postmenopausal complaints she had been undergoing estrogen therapy for the past five years. INVESTIGATIONS Colonoscopy revealed a 2 x 2 cm polyp like structure with central tissue proliferation in the transverse colon. Neither chromoendoscopy with indigocarmine nor multiple biopsies indicated an adenomatous glandular proliferation. Miniendosonography revealed the image of a tumour located in the muscularis propria. DIAGNOSIS AND CLINICAL COURSE: As a malign process could not definitely be excluded, a colon segment resection was carried out b…

A negative rapid urease test is unreliable for exclusion of Helicobacter pylori infection during acute phase of ulcer bleeding

Abstract Background. The reliability of the rapid urease test has not been proven in patients with peptic ulcer bleeding. Some studies show bad diagnostic results with the rapid urease test for gastrointestinal bleeding. Aims. To evaluate the efficacy of the rapid urease test in patients with bleeding gastric or duodenal ulcers. Patients and methods. A total of 96 patients with acute peptic ulcer bleeding without proton pump inhibitor or antibiotic therapy within the last 14 days before bleeding were included into the study. During index endoscopy, specimens for histological and rapid urease test were obtained from the antrum and corpus mucosa of the stomach. Patients were also investigated…

Successful treatment of gallstone ileus (Bouveret's syndrome) by using extracorporal shock wave lithotripsy and argon plasma coagulation.

Successful treatment of pancreatobiliary fistula by endoscopic stenting

An unusual pancreatobiliary fistula occurred as a complication of chronic pancreatitis. Endoscopic papillotomy was performed and a plastic endoprosthesis was inserted into the main pancreatic duct. The pancreatic stenting led to the closure of the fistula and no additional surgical treatment was necessary.

Inkarzeration eines Pankreassteinfragmentes im distalen Pankreasgang nach Therapie durch extrakorporale Stoßwellenlithotripsie (ESWL)

A partial or total absence of stones in pancreaticolithiasis therapy can be reached by using ESWL. We report on a patient who happened to get an incarceration of a fragment in the distal pancreatic duct after having been treated by ESWL without a previous sphincterotomy to the ductus Wirsungianus. This emphasizes the recommendation to carry out a papillotomy of the pancreatic main duct before applying ESWL to pancreatic stones.

Magnetic resonance cholangiopancreatography

With the introduction of endoscopic retrograde cholangio-pancreatography in the early 1970s, gastroenterologists have a lot of diagnostic options in the biliopancreatic system to their disposal. Meanwhile, magnetic resonance cholangiopancreatography (MRCP) has become a competitive replacement for diagnostic ERCP with the advantage of avoiding complications related to endoscopic techniques. Mounting evidence suggests that both MRCP and MRI (magnetic resonance imaging) have a profound influence of diagnostic algorithms in a variety of hepatobiliary and pancreatic diseases.

Diagnostik eines hochmalignen B-Zell-Lymphoms des Dünndarms mit der Kapselendoskopie

Wireless capsule endoscopy is a new diagnostic procedure to detect diseases of the small bowel, in particular in patients with obscure gastrointestinal bleeding. We report on a 76-year-old patient who presented at our hospital with signs of gastrointestinal bleeding and hypochromic anaemia. Bidirectional endoscopy, push enteroscopy, angiography as well as small bowel barium enema rendered no pathologic findings. Wireless capsule endoscopy demonstrated a polypous space in the cantral area of the small bowel. Subsequent intraoperative endoscopy revealed a subtotal stenosing tumour of the upper jejunum which was resected. Based on the histology a high-grade B-Cell lymphoma was diagnosed. The p…

Magnetic Resonance Imaging in Gastroenterology: Time to Say Good-bye to All That Endoscopy?

Magnetic resonance imaging (MRI) has been described as the most important development in medical diagnosis since the discovery of the roentgen ray more than 100 years ago. The effectiveness of MRI has been extended to make it applicable in a wide variety of gastrointestinal disorders. The attention of gastroenterologists is currently focusing on pancreaticobiliary and bowel diseases. Magnetic resonance cholangiopancreatography (MRCP) has become a competitive alternative to diagnostic endoscopic retrograde cholangiopancreatography in a variety of hepatobiliary and pancreatic diseases. Magnetic resonance enteroscopy has the potential to become the preferable method for evaluating the entire s…

Transvalvular enteroscopy using a mother-baby endoscope system: a new approach to the distal ileum.

In the past decade various endoscopes have been developed to examine the small bowel, with two principal procedures established: sonde-type enteroscopy and push-type enteroscopy. The main indication is gastrointestinal bleeding of obscure origin. Push-type enteroscopy has proved itselfto be useful for the investigation ofdiseases of the small intestine. 1 The mean instrumental insertion length published by different working groups varied between 50 and 90 cm past the ligament of Trei tzfl 2 The small bowel examination area is limited to the jejunum. The alternative method is sonde-type enteroscopy that allows an insertion length of 140 (30 to 200) cm. 3, 4 Disadvantages of this type of ente…

Feasibility and Diagnostic Impact of Fluorescence-Based Diagnostic Laparoscopy in Hepatocellular Carcinoma: A Case Report

Fluorescence-based diagnostic techniques are an evolving field in the staging of hepatologic and gastroenterologic malignancies. The method aims at improved accuracy in the detection of locoregional and distant metastases. In hepatocellular carcinoma, detection of metastases is of utmost importance, because advanced tumors preclude curative surgical therapy. We present here our first experience of fluorescence-based diagnostic laparoscopy in a patient with hepatocellular carcinoma. We performed diagnostic laparoscopy in a 76-year-old woman who presented with a tumor of the liver and increased serum levels of alpha-fetoprotein. For photosensitization, 5-aminolevulinic acid (20 mg/kg bodyweig…

Does Cytokeratin7/20 immunoreactivity help to distinguish Barrett's esophagus from gastric intestinal metaplasia? Results of a prospective study of 75 patients

Barrett's esophagus is a recognized risk factor for the development of esophageal dysplasia and carcinoma. Unfortunately, gastric incomplete intestinal metaplasia arising in Short Segment Barrett's esophagus can be indistinguishable histologically on hematoxylin/eosin stains. Distinct patterns of CK 7 and CK 20 immunohistochemical expression have been demonstrated to be both highly sensitive and specific for Barrett's esophagus, but have not been found in gastric metaplasia. The aim of our study was to test whether immunostaining with CK 7/20 helps to distinguish between Barrett's epithelium and gastric incomplete metaplasia. Cases of long segment Barrett's esophagus, short segment Barrett'…

Incomplete Conventional Colonoscopy: Magnetic Resonance Colonography in the Evaluation of the Proximal Colon

Background and Study Aims: The purpose of this study was to evaluate dark-lumen magnetic resonance (MR) colonography prospectively in patients with incomplete conventional colonoscopy. Patients and Methods: Thirty-two patients with incomplete conventional colonoscopy underwent same-day dark-lumen MR colonography on the basis of a standard protocol. The depiction of colorectal diseases was assessed in the following colon segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The reasons for incomplete colonoscopy included high-grade stenosis in 26 patients (four with occlusive cancer, 12 with fibrotic stenosis based on recurrent sigmoid diverticuliti…

ERCP and MRCP in the Differentiation of Pancreatic Tumors

The introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the early 1970s provided gastroenterologists with a number of diagnostic as well as therapeutic possibilities for examining biliopancreatic systems. In the meantime, magnetic resonance cholangiopancreatography presents a non-invasive alternative to diagnostic ECRP providing the advantage of a lower rate of possible complications. This article addresses the two methods presently available for differentiating pancreatic tumors. The objective of this article is to describe the advantages and disadvantages as well as the possibilities inherent in both methods.

Therapie des komplizierten Ulkus

Minilaparoscopy versus conventional laparoscopy in the diagnosis of hepatic diseases

Minilaparoscopy (ML) is being used increasingly in the diagnosis of liver disease. This is a prospective study of the accuracy and safety of ML compared with conventional laparoscopy (CL) in the diagnostic workup of liver disease.One hundred four patients with suspected liver disease were randomized either to undergo CL (n = 50) or ML (n = 54). CL was performed with a standard Storz laparoscope (Ø 11 mm, Storz GmbH, Tuttlingen, Germany) according to accepted guidelines. For ML a 1.9-mm small-diameter optical telescope was used (Richard Wolf GmbH, Knittlingen, Germany). In all cases, an attempt was made to obtain a liver biopsy specimen.Laparoscopy could successfully be performed in 100 of 1…

Endoscopic stenting for postoperative biliary strictures due to hepatic hydatid disease: effectiveness and long-term outcome.

Background Postoperative strictures due to hepatic hydatid disease caused by Echinococcus surgery is considered to be a rare cause of benign bile duct strictures, especially in the Western world. Goals The aim of this retrospective study is to demonstrate possible characteristics of the strictures as well as the effectiveness of long-term endoscopic stenting. Study Between 1994 and 2001, we treated 10 of these cases in our clinic. All patients had surgery for hepatic Echinococcus disease one or more times. These types of benign biliary strictures, secondary to surgery of hepatic hydatid disease, were multiple and located in the proximal common bile duct. Endoscopic stent therapy was carried…

Arthralgia as an early extraintestinal symptom of Whipple's disease. Report of five cases.

Five patients with Whipple's disease all suffered from arthralgia for a long time (15 years in one case) before developing gastrointestinal or other symptoms. In all patients, arthralgia was seronegative, and there was no evidence of joint destruction. Arthralgias were symmetric and migrating. Whipple's disease is part of the differential diagnosis of enteropathic arthralgia. Thereby, the polymerase chain reaction can be a helpful tool to prove Whipple's disease in difficult differential diagnosis.

Laser fragmentation of pancreatic duct stones using a rhodamine laser with an automatic stone-tissue detection system. Basic in-vitro studies

OBJECTIVES The aim of our study was to examine the suitability of a rhodamine 6G laser with an integrated stone-tissue detection system (STDS) for fragmenting pancreatic stones. METHODS A total of 64 pancreatic duct stones were measured for weight, diameter, main chemical components and in some cases for their computerized tomography density. Recognition of all stones was checked with the standard STDS or a prototype version. Number of fragmentation pulses, total fragmentation energies and correlation with the individual stone parameters were determined. The quality of the tissue-detection mode was evaluated in postmortem pancreata. RESULTS The standard STDS detected only 45% of the pancrea…

Der hyperplastische Polyp des Magens - eine Präkanzerose?

In general, hyperplastic polyps of the stomach are regarded as benign lesions. Still there is the chance to find carcinomas within them as documented in this case report. This finding can be interpreted as an incidental appearance. At the moment there are no standardized guidelines regarding diagnostics and therapy of gastric hyperplastic polyps. Referring to a short review of the literature endoscopic snare polypectomy seems to be a reasonable therapeutic option of hyperplastic polyps with a size of 0.5-1 cm. Although it is possible to determine the histology by forceps biopsy, it is possible to be misled by missing areas of focal carcinomas. Complications after polypectomy are rare and of…

Wireless Capsule Endoscopy in a Patient with Obscure Occult Bleeding

A case of obscure/occult bleeding in a 39-year old man with a 7-year history of chronic fatigue and iron-deficiency anemia is presented here. Esophagogastroduodenoscopy, push enteroscopy, ileocolonoscopies, and a magnetic resonance imaging small-bowel follow-through did not reveal any abnormalities. Multiple inflammatory lesions with fibrin-covered ulcers and petechial bleeding in the area of the lower jejunum and ileum were diagnosed only with capsule endoscopy. One ulcer located near the ileocecal valve was then biopsied during a repeat ileocolonoscopy, and the histology showed signs of Crohn's enteritis. The further treatment approach was changed, with medical treatment being initiated a…

In vitro evaluation of forces exerted by a new computer-assisted colonoscope (the NeoGuide Endoscopy System).

Background: The NeoGuide Endoscopy System (NES) utilizes a fully articulated, computer-controlled insertion tube that allows proximal segments of the colonoscope to follow the path taken by the tip as it is manually advanced through the colon. The system was designed to eliminate looping and scope displacement during colonoscopy. Material and methods: Using in vitro testing, an inanimate flexible model of the colon incorporating four force transducers located at the key flexure points was employed to measure the axial forces on the colon wall during colonoscopy. In the second part of the study, 10 gastroenterologists performed colonoscopies, using a training latex-based simulator, with the …

Capsule Endoscopy versus Push Enteroscopy in Patients with Occult Gastrointestinal Bleeding

Background Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. In this study we prospectively examined the diagnostic precision of capsule endoscopy compared with push enteroscopy in patients with occult gastrointestinal bleeding. Methods Between July 2001 and October 2002 we examined 48 patients with suspected disorders of the small intestine using capsule endoscopy. 33 patients with obscure bleeding (19 men, 14 women, mean age 58 +/- 23 years) were prospectively examined using capsule endoscopy and push enteroscopy. Results On average, the patients had been suffering from chronic gastrointestinal bleeding for 30 +/- 36 (1-12…

Colorectal Polyps: Detection with Dark-Lumen MR Colonography versus Conventional Colonoscopy

To prospectively compare dark-lumen magnetic resonance (MR) colonography with conventional colonoscopy in the detection of colorectal polyps.Local ethical committee approval and informed consent were obtained. One hundred consecutive patients (56 men, 44 women; mean age +/- standard deviation, 67.7 years +/- 14.7; range, 25-82 years) who were referred for conventional colonoscopy from January 2003 to January 2004 underwent MR colonography and conventional colonoscopy after standard precolonoscopic bowel cleansing. Colonoscopy was performed immediately after MR colonography. For MR colonography, the colon was filled with approximately 2000 mL of tap water. Imaging was performed with a 1.5-T …

Endoscopic laser palliation for rectal cancer-- therapeutic outcome and complications in eighty-three consecutive patients.

OBJECTIVE The treatment of advanced rectal cancer is still a challenge. We analysed the short-term success, treatment-related complications and the long-term outcome after laser palliation for rectal cancer. METHODS Over a ten-years period eighty-three consecutive patients (median age 81 (46-94) yrs; 43 female) were treated mainly for obstructive symptoms or tumour bleeding. Laser palliation was performed using a Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser. RESULTS The immediate overall-success rate was 96.4 % (80 of 83 patients) and only one female received a diverting colostomy because of an inaccessible high-grade rectal stenosis, initially. During follow-up, eight additional patie…

Diagnosis of Liver Cirrhosis

Background/goals Liver cirrhosis, the final stage of chronic liver disease, is characterized by an unfavorable prognosis and an increased risk of hepatocellular carcinoma and also requires an appropriate management. Laparoscopy, the gold standard in the diagnosis of cirrhosis, is hampered by its invasiveness. Therefore, a noninvasive method for diagnosing liver cirrhosis would be of great benefit. Study A consecutive series of 100 patients, sent to our gastroenterological unit for diagnostic laparoscopy, underwent a standardized ultrasonographic examination prior to laparoscopy. Results Conventional ultrasonographic examination revealed a sensitivity of 55% and a specificity of 86% in the d…

Bacteremia after diagnostic conventional laparoscopy and minilaparoscopy: a prospective study in 100 patients.

Background/Goals: Diagnostic laparoscopy under sedoanalgesia is a valuable tool in the work-up of liver diseases and is helpful as a staging procedure. The rate of bacteremia caused by this procedure is unknown, in particular when performed as minilaparoscopy. Study: A 100 consecutive patients having undergone diagnostic laparoscopy carried out either conventionally (group I, n = 50) or as minilaparoscopy (group II, n - 50) were prospectively enrolled in this study. Blood cultures were drawn before and within 5 minutes after the procedure. Risk factors for bacteremia were evaluated. Results: Bacterial growth occurred in 4 blood cultures drawn immediately after laparoscopy. No patient develo…

Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding.

Background Esophageal intramural pseudodiverticulosis (EIP) is a rare condition manifested by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent dilated excretory ducts of esophageal mucous glands. Study Five patients with EIP were evaluated with regard to symptoms and concomitant diseases, as well as endoscopic, radiologic, and manometric findings. Results Primary clinical symptoms reported by the five patients (three men and two women; age range, 59–72 years) were increasing dysphagia (n = 3), upper gastrointestinal bleeding (n = 1), and no symptoms (n = 1). Concomitant diseases were chronic alcoholism (n = 3), diabetes mellitus (n = 1), and reflux esophagit…

Impact of Gallbladder Status on the Outcome in Patients with Retained Bile Duct Stones Treated with Extracorporeal Shockwave Lithotripsy

BACKGROUND AND STUDY AIMS The use of endoscopic therapy in combination with lithotripsy techniques has become increasingly common in patients with complicated common bile duct stones. In many units, although this is controversial, cholecystectomy is then performed, because of possible subsequent cholecystitis and recurrence of choledocholithiasis. The aim of this study was to investigate whether gallbladder status influences the long-term outcome in patients after extracorporeal shockwave lithotripsy (ESWL) of common bile duct stones. PATIENTS AND METHODS Recruited for the study were 120 patients with an average age of 68 years (range 28 - 86). They were selected from 137 consecutive patien…

Hemosuccus pancreaticus--a rare cause of gastrointestinal bleeding: diagnosis and interventional radiological therapy.

Hemorrhage from the pancreatic duct, i.e. hemosuccus pancreaticus (HP), is a rare cause of gastrointestinal bleeding. Pancreatic hemosuccus is usually due to the rupture of an aneurysm of a visceral artery, most likely the splenic artery, in chronic pancreatitis. Other causes of HP are rare. We present a case of HP in a female patient with no history but with positive findings of chronic calcifying pancreatitis upon ultrasonographic investigation, computed tomography scan, and endoscopic retrograde cholangiopancreatography. With detectable fresh blood in the descending duodenum, angiography of the celiac artery revealed an aneurysm of the splenic artery as the suspected cause of intermitten…

Enteroscopic Cyanoacrylate Sclerotherapy of Jejunal and Gallbladder Varices in a Patient with Portal Hypertension

Bleeding from varices outside the gastroesophageal region is a rare, but regularly reported complication of portal hypertension. The treatment differs from the management of esophageal and gastric varices. We present here a report on the diagnosis and treatment of bleeding jejunal and gallbladder varices in a man with portal hypertension caused by chronic calcifying pancreatitis. The patient was suffering from recurrent, frequent, and massive gastrointestinal bleeding from varices at the anastomotic area of a cholecystojejunostomy. For diagnostic purposes, we carried out percutaneous Duplex ultrasonography and push enteroscopy with the Doppler technique. The treatment of varices in this are…

A prospective evaluation of magnetic resonance cholangiopancreatography in patients with suspected bile duct obstruction.

Background—The value of magnetic resonance cholangiopancreatography (MRCP) is under debate.Aims—To assess the diagnostic accuracy of MRCP and endoscopic retrograde cholangiopancreatography (ERCP) and to determine whether MRCP may help to prevent unnecessary interventional procedures.Methods—Eighty six patients with suspected common bile duct obstruction who presented between January and December 1996 were enrolled. Twenty six were excluded due to anatomical reasons or because MRCP or ERCP could not be performed successfully. Results of MRCP were interpreted by two radiologists and a gastroenterologist unaware of clinical diagnosis. Final diagnosis was determined by ERCP and histopathologica…

Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy

BACKGROUNDThere have been conflicting reports as to whether pancreatic ductal drainage achieved by endoscopy and lithotripsy improves the clinical outcome of patients with chronic pancreatitis.AIMSTo determine the clinical outcome in patients with chronic pancreatitis who received extracorporeal shock wave lithotripsy (ESWL), and were followed up for two to eight years.METHODSEighty patients with severe chronic pancreatitis and endoscopically unretrievable obstructive stones underwent ESWL with a piezoelectric lithotripter between 1989 and 1996. Clinical status, relief of symptoms, further endoscopic or surgical interventions, and mortality were defined.RESULTSForty three (54%) patients wer…

Value of magnetic-resonance cholangio-pancreatography (MRCP) after unsuccessful endoscopic-retrograde cholangio-pancreatography (ERCP).

Background and Study Aims: The present study tries to evaluate the success rate of MRCP when two attempts by experts to perform ERCP in a center failed. Patients and Methods: From March 1996 to December 1996 thirteen patients fulfilled the inclusion criteria. The MR cholangiopancreatograms were acquired using commercially available software in a clinical MR scanner (Magnetom Expert 1T-Scanner, Siemens, Erlangen, Germany). MRCP utilized heavily T2-weighted turbo-spin echo sequences with fat supression (HASTE). Maximum intensity projection (MIP) of the pancreatic duct and biliary tree was then carried out. Additionally, T1-weighted sequences were obtained using the breath-hold technique. Resu…

Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up.

Abstract Aims. To compare the efficacy and the complication rate between endoscopic snare resection of adenomas of Vater's papilla and endoscopic palliation. Methods. In a retrospective, non randomized manner, we compared long-term results of our endoscopic strategies in 36 patients with histologically confirmed adenoma of Vater's papilla submitted either to local endoscopic snare resection (n=18) or to simple endoscopic palliation (n=18), respectively. Results. Between 1985 and 1998 results were reviewed. Median age was 76.5 (range 42–89) years in the palliation, and 64.0(23–89) years in the endoscopic snare resection group. Median duration of follow-up was 33 (6–135) and 75.0 (27–123) mon…

Schwannoma of the common bile duct: a rare cause of obstructive jaundice.

The endoscopic diagnosis of bile duct lesions has improved over recent years through the introduction of cholangioscopy and intraductal ultrasound. Combining this with biopsies examined using routinely administered immunohistochemical markers, the diagnosis of tumors of the extrahepatic bile duct can be improved substantially. We report a rare case of a schwannoma of the bile duct causing obstructive jaundice.

Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones. A prospective randomized trial.

Today, nearly 90% of common bile duct stones are extracted endoscopically. Problems are encountered if there are large stones or a duct stenosis. Extracorporeal piezoelectric lithotripsy (EPL) as well as intracorporeal electrohydraulic lithotripsy (EHL) serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed. A total of 35 patients with common bile duct stones in whom conventional endoscopic treatment had failed were selected on the condition that stone visualization through ultrasound was possible and that the papilla was within easy reach of the endoscope. Patients fulfilling the inclusion criteria were randomly treated either by EPL…

Buprenorphine or procaine for pain relief in acute pancreatitis. A prospective randomized study.

To assess the analgesic efficacy and side effects of buprenorphine and procaine in patients with acute pancreatitis.Forty patients (average age, 50 years; 23 male) with acute pancreatitis or an acute bout of a chronic pancreatitis were prospectively randomized to receive buprenorphine or procaine for pain relief. Both analgesics were administered as constant intravenous (i.v.) infusions and additional analgesics were given on demand. Pain scores were assessed on a visual analogue scale. Close clinical control and laboratory checks were performed during the three-day study period.Patients receiving buprenorphine were significantly less likely to demand additional analgesics (1 versus 14 pati…

Mucinous cystadenomas and intraductal papillary mucinous tumors of the pancreas in magnetic resonance cholangiopancreatography.

Background and Study Aims: In mucin-producing tumors of the pancreas, diagnosis using endoscopic retrograde cholangiopancreatography (ERCP) is limited to cystic formations that communicate with the main pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) is a new, sophisticated method which is currently under evaluation. The authors describe the usefulness of MRCP in diagnosis of mucin-producing tumors. Patients and Methods: Six patients with mucin-producing tumors were investigated using MRCP and ERCP. Imaging was compared with surgery and histopathological examinations. Results: Three patients were found to have mucinous cystadenomas (MC), two patients had intraductal papi…

Prospective, randomized, single-center trial comparing 3 different 10F plastic stents in malignant mid and distal bile duct strictures.

Abstract Background: The aim of this study was to determine whether patency rates differ with respect to the material, design, and surface texture of 3 different plastic stents. Methods: A total of 120 patients (median age 70.5 years; interquartile range 62-78 years) with malignant mid or distal bile duct strictures, seen between March 1996 and May 1999, were prospectively randomized to receive a 10F polyurethane stent, a Teflon Tannenbaum stent, or a hydrophilic hydromer-coated polyurethane stent. The primary study outcome measure was the interval between stent insertion and the first episode of clogging (or the presence of jaundice at death without stent exchange). All 3 types of stent we…

High frequency of colorectal adenoma in patients with duodenal adenoma but without familial adenomatous polyposis

Abstract Background Duodenal adenomas are extremely common in patients with familial adenomatous polyposis. However, it is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis are at greater risk for colorectal neoplasia and, therefore, should routinely undergo surveillance colonoscopy. The aim of this study was to determine whether there is a correlation between non-papillary duodenal adenoma without familial adenomatous polyposis and colorectal adenoma. Methods Twenty-five patients with non-papillary duodenal adenomas without familial adenomatous polyposis, seen from January 1990 to April 2003, were retrospectively evaluated. Results Non-papillary duode…